Nutrition and IV Fluids

Question 1

For how long is it recommended to exclusively breastfeed?

Answer 1

exclusively for the first six months

Question 2

What are contraindications to breastfeeding?

Answer 2

HIV, infectious tuberculosis
infant has galactosemia (cant convert galactose to glucose)
breastfeeding is RARELY contraindicated

Question 3

What are the benefits of breastfeeding?

Answer 3

nutrition
immunologic protection
growth and development

Question 4

What are alternatives if breastfeeding is not possible?

Answer 4

expressed breastmilk from the mother
-if baby cant latch or any other reason
pasteurized milk donor (from appropriate sources)
-limited to hospitalized infants who will benefit the most
-do not share or use unprocessed milk or unscreened human milk
commercial infant formula

Question 5

In general, what does infant formula provide?

Answer 5

provides all nutrition
-no vitamin supplementation is required

Question 6

What kind of formula is recommended?

Answer 6

cow milk-based
-always try and encourage this

Question 7

Formulas low in which mineral should be avoided?

Answer 7

iron-low formula
-marketed as “easier digestion” but can lead to iron deficiency in some infants

Question 8

Is lactose intolerance common in kids?

Answer 8

extremely rare
-lactose is the main carbohydrate source in breast milk
-most babies don’t need to switch to low-lactose formula

Question 9

What is the consensus regarding the need for formula that contains probiotics?

Answer 9

not likely to be harmful but the evidence is weak and the products are expensive
-not a must have

Question 10

What kind of infants should be referred to a physician before initiating a formula?

Answer 10

infants with medical conditions
-may require a special formula

Question 11

What kind of formula should be discouraged from being used?

Answer 11

homemade formula or other milks (e.g. goat milk)
-wont contain the nutrition needed to grow

Question 12

What is an important consideration to keep in mind regarding the caregiver and infant formula?

Answer 12

ensure the caregiver can properly prepare and administer the formula
-can they measure appropriately? sterilize water? etc.
instructions on formula are usually quite robust, follow them!

Question 13

What should never be done while an infant is feeding?

Answer 13

leaving them alone
-choking hazard

Question 14

Which vitamin should all breastfed infants be supplemented with and why?

Answer 14

all breastfed infants should be supplemented with 400 IU of vitamin D daily up to 1yr of life to prevent rickets

Question 15

When do infants start to need iron supplementation?

Answer 15

most infants have sufficient stores until about 6 months of life, then they need to be supplemented for development
-meat, meat alternatives, iron-fortified cereals

Question 16

What does it mean when food or drugs are delivered by an enteric route of administration?

Answer 16

feeding tubes deliver nutrition and medications directly into the intestines

Question 17

Are pharmacists involved in the decision to initiate tube feeding?

Answer 17

no, decision to initiate is usually by a dietitian and/or medical team
-pharmacist is not generally involved except when medications are also given through the tube

Question 18

What are the different types of feeding tubes?

Answer 18

nasogastric/orogastric
naso-jejunal
gastrostomy/jejunostomy

Question 19

Describe a nasogastric/orogastric feeding tube.

Answer 19

inserted through the nasopharynx or mouth, ending in the stomach
used for short to medium term feeding (days to weeks)

Question 20

Describe a naso-jejunal feeding tube.

Answer 20

inserted through the nasopharynx, ending in the jejunum
require endoscopy or radiology to ensure the tube is in the correct position
short to medium use

Question 21

What are naso-jejunal feeding tubes prone to?

Answer 21

prone to blockage; evidence for using in drug administration is weaker

Question 22

Describe gastrostomy/jejunostomy feeding tubes.

Answer 22

surgical placement into the stomach via the abdominal wall
long-term feeding (months to years)

Question 23

What is the pharmacists role with feeding tubes?

Answer 23

assess for interactions
-drug-formula/food interactions
assess absorption
-most drug are absorbed in GIT, does the tube reach there?
assess for drug-tube compatibility
-can the drug and/or formulation be given via tube?

Question 24

Why does it matter where the feeding tube ends in the GIT when administering drugs?

Answer 24

directly impacts overall exposure to the medication and consequently, effectiveness
-when medications go through a tube, the exit site of the tube is important to understand

Question 25

What are two main problems with drug-tube compatibility?

Answer 25

tube occlusion
drug adhesion

Question 26

What causes tube occlusion?

Answer 26

formula and/or medications

Question 27

What needs to be done if a tube cannot be unblocked?

Answer 27

must be replaced

Question 28

What is drug adhesion to a tube? What is the consequence?

Answer 28

drug interacts with the tube materials and binds
-results in decreased absorption of drug

Question 29

What are some solutions if absorption is an issue with a tube?

Answer 29

alternate route of admin
-suppository, transdermal, IV, small amounts orally?
therapeutic alternatives
-would a different drug be better absorbed?

Question 30

What are some solutions to tube occlusion?

Answer 30

solutions or soluble tablets are the formulation of choice
-crushing a soluble tablet and mixing into a small amount of water is generally preferred
-easier transport and cheaper for patients
families should have instructions on how to flush an occluded tube and when to seek care

Question 31

What are some solutions if drug adhesion to a tube occurs?

Answer 31

alternate routes of therapy or other medications that could be used

Question 32

What is the 4-2-1 Rule?

Answer 32

used to calculate maintenance fluid regimens (IV and enteral) in children
-maintenance fluid: amount of fluid needed to replace normal daily losses
-respiratory, urinary, GIT, skin losses

Question 33

How do you calculate the 4-2-1 Rule?

Answer 33

first 10 kg: 4ml/kg/hr
second 10 kg: 2ml/kg/hr
remaining kg: 1ml/kg/hr

Question 34

What is the pharmacists role with IV fluids?

Answer 34

electrolyte imbalance
-electrolyte dosage, administration safety
IV compatibility
-children usually have limited IV access
-need to understand chemistry and how to use references
TPN compounding