Incorrectly prepared formula contributing to severe hypovolemic hypernatremia in enteral tube-fed children: A report of two cases.

CASE PRESENTATIONS: We describe two cases of children who were significantly impacted by incorrectly prepared, hyperosmolar formula delivered via enteral tubes. The first case is of a 5-month-old post-pancreatectomy patient with complex needs who received hyperosmolar formula while in a pediatric intensive care unit (PICU), whereas the second is of a 1-year-old with spinal muscular atrophy who received hyperosmolar formula at home - resulting in a PICU admission.

DISCUSSION: Hypovolemic hypernatremia is an important but poorly understood complication that can occur if overly concentrated formula is fed to children. Risk is almost certainly greater in enteral-tube fed patients because of their medical fragility but also because tube-feeding delivers formula directly and potentially very rapidly to the gastrointestinal system.

CONCLUSIONS

Formula for medically fragile, enteral tube-fed children should be prepared with utmost care - particularly when family caregivers are responsible for home feeding. In these cases, additional education and feeding support should be considered - including provision of pre-mixed formula. The clinical biochemistry laboratory can verify formula osmolality for these high-risk patients.