Thread by @PEMTweets

There is a critical #FormulaShortage in the US. This post reviews why this is happening & highlights what bad things happen if infants don't get formula or breastmilk and receive something else (cow's milk, diluting formula, homemade) #FOAMed #MedTwitter pemcincinnati.com/blog/what-can-…

The shortage is due to bacterial contaminants in Abbott's largest factory in Michigan that was linked to two infant deaths

At least 40% of stores are out of stock of Similac products because of this, and the plan has been closed from February though now with no open date in sight. Couple this with supply chain woes and you have the #FormulaShortage

Recall that generic formulas are nutritionally similar to name brand and are not affected by the shortage - Here is a handy table from @StrBrandFormula

Diluting formula to stretch it out is dangerous & can lead to acute or chronic hyponatremia. Acute hyponatremia presents with seizures. Remember that 1mEq/L of hypertonic saline raises serum Na by 1 MEq/L. Pts with Na<125 who are seizing need hypertonic saline to stop the seizure

Cow's milk given to infants <12mos is deficient in iron and can lead to anemia, also GI hemorrhage, and severe dehydration - the latter is due to the high calcium and casein in cow milk and how the kidney can't handle the solute load and water balance breaks down

Goat milk is deficient in many nutrients - most importantly folate and iron - which can lead to microcytic anemia

Nut and plant milks do not have enough calories or nutrients for children under the age of 12 months

Home made formulas are not recommended. Many of the essential nutrients are not commercially available.

Encourage breastfeeding as much as possible for mothers that can do so - and throw all of your knowledge and lactation support towards parents who need it