Errors in Emergency Feeds in Inherited Metabolic Disorders: a Randomised Controlled Trial of Three Preparation Methods

Hulya Gokmen Ozel^1,*, Anne Daly¹, Paul Davies², Satnam Chahal¹, Anita MacDonald¹

¹ Birmingham Children's Hospital, United Kingdom;
² University of Birmingham, Institute of Child Health, United Kingdom

Correspondence to: Hulya Gokmen Ozel, Nutrition and Dietetics, Hacettepe University, Hacettepe University, Faculty of Heath Sciences, Nurtition and Dietetics Department, D Bloklari, Samanpazari, Ankara, 06100, Turkey; hgokmen{at}hacettepe.edu.tr

Accepted 6 September 2009

Objective: Glucose polymer based emergency feeds (EF), used during illness to prevent metabolic decompensation and encephalopathy in inherited metabolic disorders, should be produced accurately and safely.

Design: In a randomised, prospective, controlled study, the aim was to investigate if when preparing age-appropriate EF, a pre-measured sachet of glucose polymer, compared with scoops and weighing (using digital scales), decreased carer errors.

Subjects: Forty-seven carers (3 male, 44 female) of 52 inherited metabolic disorders patients were recruited. Setting and intervention: The carers made EF using all three techniques (weighing, scoops and pre-measured sachets) under supervision in controlled and home conditions. A 100 ml aliquot of each EF was analysed for carbohydrate concentration.

Results: Under controlled preparation conditions, with 1 litre EF’s, the % median glucose polymer concentration closest to target amounts was 1) pre-measured sachets (105%); 2) weighing (107%); and 3) scoops (118%) (p<0.001). Similarly, under home conditions, the closest method was 1) pre-measured sachets (111%), 2) weighing (112%), and 3) scoops (118%) (p<0.05). Under home preparation conditions, with 200 ml EF’s, the pre-measured sachets were more likely to be within 20% of target weight than weighing (p<0.05) but there was no difference with scoops. Common errors observed were inaccurate water measurements (40% controlled and home conditions), incorrect scoop measurements and difficulty using digital scales.

Conclusions: Overall, using pre-measured sachets was more accurate in EF production. Pre-measured sachets are likely to decrease preparation error and, therefore, reduce the risk of feed intolerance, particularly osmotic diarrhoea, and consequential metabolic decompensation and encephalopathy.

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