Hypertonic formula resulting from added oral medications
K. C. White and K. L. Harkavy
Necrotizing enterocolitis developed in a premature infant after a
medication in elixir form, calcium glubionate, was added to his feedings.
The osmolalities of this medication and four others--theophylline elixir,
phenobarbital elixir, dexamethasone elixir, and digoxin elixir--were
measured by freezing-point depression and compared with the osmolalities of
the analogous intravenous (IV) preparations. The osmolalities of the IV
preparations were much lower than those of the corresponding oral
preparations, except in the case of digoxin. When clinically appropriate
doses of dexamethasone and phenobarbital elixirs were mixed in volumes of
formula appropriate for a single feeding for a 1,500-g infant, the
osmolalities of the drug-formula mixtures increased at least 300% over
formula alone. This effect was less noticeable with digoxin elixir,
theophylline elixir, and calcium glubionate.
