Disabled Child Suffers Bone Loss From GI Tube Feeding Regimen

Case Overview

This case involves a female child with cerebral palsy and reflux who required G-tube feeding. She was not gaining enough weight and was not tolerating many types of formulas. When the child was 2-years-old, a GI put her on nutritional toddler formula. The patient seemed to tolerate it well. Several months later, the child developed multiple bone fractures with no trauma, including femur and ulnar shaft fractures. Despite being bedridden, the patient broke 10 bones over the course of a few weeks. Around this same time, the child’s phosphorus levels were dangerously low and she was hospitalized. After months of working with an endocrinologist, it was determined that the nutritional toddler formula caused the child’s hypophosphatemic state. The child was weaned off the formula but was left with severe osteopenia. An expert in pediatric gastroenterology was sought to discuss whether or not the GI should have better monitored the child’s phosphorus levels.

Questions to the Gastroenterology expert and their responses

How frequently do you treat developmentally delayed patients who are G-tube fed?

I have taken care of many severely developmentally delayed patients dependent on gastrostomy tube feedings, including children with spastic quadriplegia and reflux.

What type of regimen do you typically recommend for patients like this?

These children are generally fed a completely nutritious formula or a completely nutritious blenderized diet which can be given through a G-tube. It's hard to generalize a 'typical' regimen for these cases.

What is the standard of care with regards to monitoring phosphorus levels in patients like this?

The standard of care with regards to monitoring phosphorus levels in patients like this is also hard to generalize. I would need to review the medical files more closely.

About the expert

This highly qualified expert has nearly 40 years of experience as a pediatric gastroenterologist. He earned his BS from the University of North Dakota before earning his MD from Stanford University. He then completed both his internship and residency in pediatrics and a fellowship in pediatric gastroenterology at the University of Wisconsin. He is board-certified in pediatrics with a subspecialty in pediatric gastroenterology, has been published over 100 times, and has maintained a research lab for over 30 years with several millions of dollars awarded in grants. He held positions as a full professor at both the University of Wisconsin and Oregon Health & Science University, and he was an attending physician for their respective hospitals. He also served as the director of the pediatric gastroenterology fellowship program at the University of Wisconsin and as the chief of pediatric gastroenterology at Oregon Health & Science University. This expert then moved on to the University of Minnesota, where he was also a full professor and the program director of the pediatric gastroenterology fellowship. He also served as a staff physician for Minnesota Gastroenterology. This expert is a co-founder of the Center for Eosinophilic Esophagitis and Food Allergy and is currently a physician at multiple gastroenterology clinics in Minnesota.

E-026174

Specialties:

Gastroenterology

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.