Objective:To summarize the evaluation and management of early enteral nutrition tolerance in a patient with refractory status epilepticus after ketogenic diet.Methods:Nursing essentials were as follows: Individualized enteral nutrition tolerance assessment was given every 4 hours after ketogenic diet, including nausea, vomiting, abdominal distention, diarrhea, gastric retention and upper gastrointestinal bleeding; when patients suffered from intolerance to ketogenic diet, nasointestinal tube was retained to upper jejunum, ketogenic diet was diluted, dietary fiber and trypsin were increased. Intake of preparations and probiotics could reduce the incidence of diarrhea and gastric retention. Blood sugar and ketone levels were monitored every 4 hours to evaluate the therapeutic effect of ketogenic diet by Engel grading. Early active mobility was carried out to reduce the mechanical ventilation time and improve limb muscle strength.Results:After careful treatment and nursing, ketogenic diet progressed smoothly and gastrointestinal intolerance improved significantly. On the 30th day of admission, Engel was grade I. The patient was stable with no functional epileptic attack. On the 66th day after admission, the patient was successfully taken off line and transferred to the general treatment area. During the period of hospitalization, there was no nursing related complications such as pressure ulcer, and the patient recovered and discharged.Conclusion:Individualized assessment and management of enteral nutrition tolerance can effectively reduce the related complications and improve the prognosis of patients with refractory status epilepticus who take ketogenic diet.