Fatty infiltration of the liver in 4 children treated with the medium chain triglyceride (MCT) diet is reported from the Depts of Paediatrics and Radiology, Leeds General Infirmary, Belmont Grove, Leeds, England. This was not associated with hepatic dysfunction and resolved after discontinuing the diet. The patient's ages ranged from 4 to 12 years. The seizures were astatic myoclonic in pattern and resistant to medications, including sodium valproate, clobazam, or carbamazepine. The duration of the diet was 2 to 3 years at time of diagnosis by ultrasound scan and, in one case, by liver biopsy. Triglyceride and cholesterol levels were normal in 2 and liver function tests normal in 3 patients tested. Seizure control was improved during treatment with the MCT diet. 
COMMENT. The mechanism of the fatty liver infiltration was undetermined. The standard ketogenic diet is not always associated with a significant increase in serum lipids but it is accompanied by a fall in blood pH, standard bicarbonate, and blood sugar . The accumulation of excess hydrogen ion within the liver cell is cited as one possible mechanism of fatty change in the liver. The concomitant therapy with anticonvulsant drugs, particularly valproate, might also be contributory.