How precisely must one follow the manufacturer’s directions with regard to the amount of powder and water used in preparing infant formula? If mixed incorrectly, will there be an imbalance in the electrolytes? — Carla Higbee, FNP-C, Long Beach, Calif.

Electrolyte imbalance can occur in infants who are fed formula that has been incorrectly mixed. Moreover, hypernatremia can result from formula mixed too thickly. The resulting concentration of sodium is too much for the kidneys to handle, and it is excreted along with water, leading to dangerous dehydration.

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Mixing the formula with too much water in an effort to save money can lead to failure to thrive and all the problems that entails. To get an infant to gain weight, use less water when mixing formula to increase the calories per ounce, but only up to a certain extent. — Julee B. Waldrop, DNP (174-2)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a question, submit it here.