Below are my thoughts.
1- The idea behind ketogenic diets is relatively simple. If glucose is the primary fuel for cancer, then lower carbohydrate intake and replace carbohydrates with other sources of fuel, such as fats, in order to push the body’s metabolism into ketosis.
2- Preclinical and case report studies indicated that the restricted ketogenic diet can be an effective “metabolic therapy” for managing malignant cancer in children and adults.
3- From the provided macronutrient information your patient typically on balanced ketogenic formula (lipid 75-85 % remaining from Amino acid and dextrose). However, because of elevated liver enzyme I would recommend reducing Lipid dose and change PN to cyclic over 12-14 hours.
4- Drainage must be replaced. Yet, for such cases the fluid replacement and total fluid intake must be discussed with primary physician.
5- Addition of Carnitine should be considered along with a high-fat or ketogenic PN solution. Carnitine is a nonessential amino acid that facilitates the transport of fatty acids from long-chain fats into the mitochondria. It is also essential in certain conditions, such as liver disease, trauma, sepsis, and organ failure, and is advised when the major source of calories are derived from fat.
6- Selenium is an essential trace mineral that is generally included in PN solutions when used longer than 4 weeks.