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How British cycling success inspired a new emergency regimen! Justin Ward Paediatric Metabolic Dietitian, Bradford Teaching Hospital Justin has been a clinical Paediatric Metabolic Dietitian for the last 18 months. He has a passion for research, biochemistry, teaching and is aiming to raise the profile of the Metabolic Dietitian. He is currently working on introducing the dietary management of metabolic diseases into higher education academic courses.
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As a relatively new dietitian without much in the way of a professional profile, I suspect many readers will puzzle at the title of this article, stare blankly at my name, look at my photo and ask themselves, “Who is this bloke and what on earth is he writing about?” To make sense of the title we must first understand the recent history of Britain’s cycling performances. Don’t worry if you aren’t a particularly big cycling fan, I’ll keep it brief . . . Prior to 2003, cycling was (sadly) just one in a long list of sports that Great Britain struggled to get to grips with. After years in the doldrums, a man by the name of Sir David Brailsford was appointed as British Cycling’s Performance Director. Fast forward to the present day and we Brits are now the dominant force in world cycling. Achieving any sort of success in British sport instantly catapults the athletes and their managers into the spotlight in an attempt to reveal their secret winning formula. In Sir Brailsford’s case, he believes success was achieved by applying his ‘Marginal Gains’ theory to every aspect of the team’s preparation. “The whole principle came from the idea that if you broke down everything you could think of that goes into riding a bike and then improve it by 1%, you will get a significant increase when you put them all together.” (Dave Brailsford, 2012). This logic struck a chord and had me thinking, “How can I apply this theory to my clinical practice as a Paediatric Metabolic Dietitian?” STANDARD EMERGENCY REGIMENS (SER)
An SER is a drink protocol primarily intended as treatment for a number of inherited errors of metabolism (IEM). The SER drink consists of glucose polymer and water, carefully formulated to achieve a specific glucose concentration dependent upon the age of the child. Its consumption is advised during times of
illness, pyrexia, hypoglycaemia and/ or reduced nutritional intake, with the aim of preventing catabolism and providing sufficient fluid.1 At times of acute metabolic decompensation, patients typically stop their usual diet and consume their SER drink at regular intervals throughout the day and night. Two conditions that require an SER are Medium Chain Acyl CoA Dehydrogenase Deficiency (MCADD) and Ketotic Hypoglycaemia (KH). It is beyond the remit of this article to differentiate the pathological features of these two conditions; nonetheless, their respective dietetic management have similar themes, notably preventing excessive fasting and treating episodes of illness with an SER. Typically, a patient and their family receive their SER protocol during their initial visit to the consultant-led multidisciplinary (MDT) clinic. They receive a two-sided, A4 paper document detailing when an emergency drink is indicated, how to make it, how much of the drink to take and what to do should their child not tolerate it. A protocol to aid dietitians in devising an SER is presented in Table 1 overleaf. It is worth noting that any SER given to parents only details how to make the drink appropriate to the current age of the child. Once a child enters the next age range whereby a renewal is indicated, a dietitian will construct an updated copy of the SER. This specifies www.NHDmag.com April 2018 - Issue 133
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