Professional Information
Enteral Nutrition Formulas (Systemic)
1) Blenderized Enteral Nutrition Formulas
2) Disease-specific Enteral Nutrition Formulas §
3) Fiber-containing Enteral Nutrition Formulas
4) Milk-based Enteral Nutrition Formulas
5) Modular Enteral Nutrition Formulas
6) Monomeric (Elemental) Enteral Nutrition Formulas
7) Polymeric Enteral Nutrition Formulas
VA CLASSIFICATION
Primary: TN200
§ Use for product as stated in product information.
Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).
Category:
Nutritional replacement—
Indications
Accepted
Nutritional deficiency (prophylaxis and treatment)—Enteral nutritional formulas are indicated to provide nutritional support for individuals with impaired digestion or specialized nutritional support for individuals with special nutritional needs. Enteral nutrition formulas may be the sole source of nutrition or a partial supplement to the diet. Under most circumstances, enteral feeding is preferred over parenteral feeding. {37} {51}Enteral nutrition may be necessary in certain persons or conditions, such as:
• Acquired immunodeficiency syndrome (AIDS) {50}
• Burns {36}
• Cancer {36}
• Dysphagia {65}
• Gastrointestinal disorders—bowel resection, Crohn's, inflammatory bowel disease, malabsorption, partial gastrointestinal obstruction, stricture, ulcerative colitis {19}
• Hepatic dysfunction {36} {38}
• Pancreatic insufficiency {61}
• Pancreatitis {60}
• Pulmonary dysfunction {36}
• Renal dysfunction {36} {39}
• Sepsis, prolonged {36}
• Surgery, major {36} {37}
• Trauma, major {36}
—For Blenderized Formulas Blenderized enteral nutrition formulas are made from selected, blended, foods. {01} These formulas use milk or beef or a combination of the 2 as the main source of protein, and may contain pectins, some saturated fat, and cholesterol. {01} These formulas are made from a limited range of foods. {01}
—For Disease-specific Formulas Disease-specific enteral nutrition formulas are formulated to meet nutrient requirements for patients with specific medical diseases and can be divided into products containing branched-chain amino acids, high-fat formulas, essential amino acid-as-protein-source formulas, and formulas high in omega fatty acids. {01} Branched-chain amino acids may have beneficial effects on nitrogen balance. {01} High-fat formulas provide calories through fat rather than through carbohydrates, and thus may be beneficial in patients with respiratory problems. {01} Essential amino acid formulas minimize nitrogen waste because they contain only essential amino acids; these formulas may be beneficial to patients with renal dysfunction. {01} {39} Omega-3 fatty acid formulas are believed by some clinicians to modify the immune response and diminish inflammation. {01} While polymeric and blenderized formulas are used for a variety of disease states, disease-specific formulas should only be administered for their claimed use. {19} In general, scientific evidence for efficacy of these products for a specific disease state is weak and requires further study. {54}
—For Fiber-containing Formulas Fiber-containing enteral nutrition formulas may be beneficial in modulating stool consistency. {35} {44} However, fiber-containing formulas may cause gastrointestinal symptoms. {46}
—For Milk-based Formulas Milk-based enteral nutrition formulas contain the same nutrients as polymeric formulas but in a milk-based formula. They should not be used in patients who are lactose intolerant.
—For Modular Formulas Modular enteral nutrition formulas provide carbohydrates, proteins, fats, vitamins, and minerals separately and in varying combinations for addition to foods or other formulas. {01} These are not nutritionally complete.
—For Monomeric (Elemental) Formulas Monomeric (elemental) enteral nutrition formulas contain fats, carbohydrates, and proteins in a more easily absorbed state. {01} The term ``elemental'' is being replaced by ``monomeric'' because these formulas are not truly elemental in nature. {63} These products contain protein in the form of peptides and/or amino acids; fat as medium-chain triglycerides and/or polyunsaturated oils such as safflower, corn, soy, or sunflower; and carbohydrates in the form of intermediate starches such as maltodextrins and glucose oligosaccharides. {01} Monomeric (elemental) enteral formulas may be useful in patients with compromised digestive or absorptive capabilities, but, because of cost, they should be used only in patients who cannot tolerate polymeric enteral formulas. {01}
—For Polymeric Formulas Polymeric enteral nutrition formulas are the most common and are all lactose-free. Some polymeric formulas have a high caloric density and provide more calories per volume for patients on fluid restriction. However, patients receiving high-caloric-density formulas are more prone to dehydration and nitrogen or electrolyte retention problems due to an increased renal solute load. {01}
Unaccepted
There is no documented benefit for use of enteral products in healthy populations. {19}
Pharmacology/Pharmacokinetics
Other actions/effects:
Enteral Nutrition formulas are designed into varying formula types: blenderized, disease-specific, fiber-containing, milk based, modular, monomeric, and polymeric.{01}{35}
Precautions to Consider
Pregnancy/Reproduction
Pregnancy—
Studies have not been done in humans or animals; however, problems would not be expected. {19} {33} {55} {56}
Breast-feeding
Problems in humans would not be expected. {19}
Pediatrics
Appropriate studies performed to date have not demonstrated pediatrics-specific problems that would limit the usefulness of enteral feedings in children. {29} {30} {31} However, children up to one year of age are known to have immature gastrointestinal, hepatic, and renal systems, which may determine the type of enteral formula the infant should receive. {29} {31} Pediatric patients may also have milk sensitivity and metabolic disorders. {19}
Geriatrics
Studies performed to date indicate that the elderly may be more at risk of developing nasogastric tube problems such as aspiration pneumonia, especially with prolonged use of enteral feeding. {20} {21} {22} {23} The elderly are also more likely to remove the nasogastric tube. {21} {22} {23}
Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):
Note: Combinations containing any of the following medications, depending on the amount present, may also interact with enteral nutrition formulas.
Only specific interactions between enteral formulas and other oral medications have been identified in this monograph. However, enteral formulas that are administered continuously may reduce the rate and/or extent of absorption of medications that must be given on an empty stomach. {19} {52}
Ciprofloxacin (concurrent administration of ciprofloxacin and enteral formulas has been found to decrease the absorption of ciprofloxacin; ciprofloxacin administration should be separated from enteral feedings if possible {13})
Phenytoin, oral (enteral formulas have been found to decrease the absorption of phenytoin; the enteral feeding should be held and the nasogastric tube should be flushed 2 hours before and 2 hours after administration of phenytoin; monitoring of phenytoin blood levels is recommended {06} {07} {08} {09} {18})
Sucralfate (concurrent use of sucralfate and enteral nutrition formulas in a nasogastric feeding tube has resulted in bezoar formation due to the protein-binding properties of sucralfate {40} {41})
Warfarin, oral (warfarin resistance has been reported with concurrent administration of enteral feedings, possibly due to the vitamin K found in some products; more frequent monitoring of prothrombin times may be recommended {10} {11} {12} {19})
Laboratory value alterations
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):
With physiology/laboratory test values
Alkaline phosphatase, serum and
Cholesterol, serum and
Glucose, serum and
Phospholipids, serum and
Transaminase, serum and
Triglycerides, serum (concentrations may be increased)
Electrolytes, serum (concentrations may be increased or decreased)
Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).
Except under special circumstances, this enteral nutrition formula should not be used when the following medical problems exist:
» Bowel obstruction, total or{05}
» Ileus preventing nutrient absorption or
» Ischemic bowel or{57}
» Pancreatitis, severe or{62}
» Perforated bowel (some patients may require post-pyloric feeding to achieve enteral nutrition; patients with pancreatitis must be fed beyond the Ligament of Treitz {66} {19})
Risk-benefit should be considered when the following medical problems exist
Note: Administration of enteral formulas in patients with the following medical problems may be accomplished by careful selection of an enteral formula or by changing the manner of administration. {19}
Aspiration pneumonitis, especially in the presence of severe pulmonary disease{05} (condition may be exacerbated by introduction of nasogastric tube, especially in the elderly {20} {22})
Cardiac insufficiency (condition may be exacerbated, especially during initiation of feeding in severely malnourished patients; adjustment of infusion rate may be required {47} {48})
Dehydration (condition may be exacerbated, especially if supplementary fluids are not given; patients should be monitored for signs of dehydration {03} {04})
Diabetes mellitus or
Hyperglycemia (the carbohydrate content of many enteral formulas may require adjustment of antidiabetic therapy or addition of insulin or other antidiabetic medications to the treatment regimen in patients with diabetes mellitus or hyperglycemia {03} {04} {05} {14} {32} {33})
Diarrhea, severe (condition may be exacerbated by enteral feedings; use of formulas with a low osmolality may decrease the risk of diarrhea {49} {03} {04} {05})
Electrolyte abnormalities (electrolyte disturbances may occur with enteral feedings; patient monitoring may be necessary {03} {04} {14} {24})
» Gastric function abnormalities (gastric emptying may be delayed with certain disease processes, which may lead to retention, nausea, and/or vomiting; passing the tube into the duodenum {53} or switching to a formula with a low osmolality {69} may be necessary {03})
Hepatic function impairment (enteral formulas have been reported to alter hepatic function {15} {25})
Hyperlipidemia (the fat content of some enteral formulas may exacerbate the condition)
Lactose intolerance (some enteral formulas contain lactose)
» Malnutrition, severe (severe cardiopulmonary and neurologic complications have been reported when refeeding severely malnourished patients; adjustment of infusion rate may be required {58})
Pancreatic insufficiency with fat malabsorption{03} (condition may be exacerbated; use of an enteral supplement with a low fat content may be necessary)
Phenylketonuria (some enteral formulas contain phenylalanine, which may exacerbate the condition)
Renal function impairment (certain components such as fluid, proteins, {64} electrolytes, vitamins, and minerals may need to be used with caution in patients with compromised renal function {34})
Respiratory difficulty (condition may be exacerbated, especially with high carbohydrate formulas in patients who retain carbon dioxide {64}, or during initiation of feeding in severely malnourished patients; adjustment of infusion rate may be required {47} {48})
» Vomiting, severe{03}{04}{05}
Patient monitoring
The following (listed in order of progression) may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; (» = major clinical significance):
Anthropometric measurements and{49}
Body weight{49} (recommended periodically as a measure of lean body or adipose tissue mass or fluid status {59}; body weight should be determined daily for patients on short-term enteral nutrition therapy and weekly for patients on long-term therapy {19})
Albumin, serum and
Prealbumin, serum and
Transferrin, serum and
Urea nitrogen, 24-hour, urinary (recommended periodically to assess protein status; transferrin should be monitored in patients receiving short-term enteral nutrition therapy and albumin in those receiving long-term enteral nutrition therapy; some clinicians recommend monitoring prealbumin, but this test is expensive and may not be available in some institutions {49} {68})
Energy expenditure{19} (may be necessary, to determine success of short-term enteral nutrition therapy)
Complete blood count and{19}
Electrolytes, serum and{34}
Glucose, serum and{43}
Hepatic function determinations and{03}{26}{32}
Renal function determinations and{03}{27}{32}
Vitamin and mineral status{19} (recommended periodically depending on patient condition; abnormal serum glucose may require an adjustment of insulin dosage in diabetic patients; mineral status determinations may be necessary in patients receiving long-term enteral nutrition therapy; if a patient has an abnormal renal function, there may be a need to restrict fluids, electrolytes, vitamins, and/or trace minerals)
Side/Adverse Effects
Note: Aspiration pneumonitis may occur with enteral tube feedings, and is more common in the elderly. {20} {21} {22} {23} {25}
The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:
Those indicating need for medical attention
Incidence more frequent
Dehydration{03}{25} (decrease in urine volume ; unusual tiredness or weakness)
hyperglycemia (frequent urination or unusual thirst)
hyperkalemia (confusion; irregular heartbeat; numbness or tingling in hands, feet, or lips; shortness of breath or difficulty breathing; unexplained nervousness; unusual tiredness or weakness; weakness or heaviness of legs){03}{14}{16}{24}{25}
hypokalemia (dryness of mouth; increased thirst; irregular heartbeat; mood or mental changes; muscle cramps or pain; weak pulse){03}{14}{16}{25}
hypophosphatemia {03}(convulsions; respiratory distress; unusual tiredness or weakness)
Incidence less frequent
Hyperphosphatemia (muscle cramps; numbness, tingling, pain, or weakness in hands or feet; shortness of breath or troubled breathing){14}
Those indicating need for medical attention only if they continue or are bothersome
Incidence more frequent
Gastrointestinal disturbances, specifically constipation{04}{67}
or diarrhea {02}{03}{04}{16}{17}{25}
nausea and vomiting{03}{04}{16}{25}
Note: Gastrointestinal disturbances may also be a complication of feeding tube use, with or without pneumonitis.
Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Enteral Nutrition Formulas (Systemic).
In providing consultation, consider emphasizing the following selected information (» = major clinical significance):
Before using this enteral nutrition formula
» Conditions affecting use, especially:
Sensitivity to any ingredient in the enteral nutrition formula
Use in children—Use with caution in children up to one year of age because of their decreased ability to metabolize certain components of enteral feeding
Use in the elderly—Elderly more at risk of developing aspiration pneumonitis or of self-extubation
Other medical problems, especially bowel obstruction, gastric function abnormalities, ileus preventing nutrient absorption, ischemic or perforated bowel, severe pancreatitis, severe malnutrition, or severe vomiting
Precautions while using this enteral nutrition formula
Caution about bacterial contamination, particularly with home use
Side/adverse effects
Dehydration, hyperglycemia, hyperkalemia, hypokalemia, hyperphosphatemia, and hypophosphatemia
General Dosing Information
Bacterial contamination of enteral feedings may occur due to improper handling. Enteral formulas for tube-feeding use should not be hung or left for longer than 12 hours at room temperature. {23} {26} {27} {28}
Some products may be given either orally or by feeding tube; other products are designed to be given only by feeding tube.
The complication of aspiration can be reduced by confirming the anatomic position of the feeding tube, elevating the patient's head to 30° while feeding, and limiting the administration rate to 150 mL per hour or less. {42}
Formulas that are dense in consistency are more likely to clog the feeding tube. {19}
Oral Dosage Forms
ENTERAL NUTRITION FORMULAS
Usual adult and adolescent dose
The administration of enteral formula by continuous or intermittent feeding and the dosage are very individualized and are a decision of the prescribing physician. {12}
Usual pediatric dose
The administration of enteral formula by continuous or intermittent feeding and the dosage are very individualized and are a decision of the prescribing physician. {19}
Strength(s) usually available
U.S.—
See Tables 1—7.
Canada—
See Tables 1—7.
Packaging and storage:
The unopened product should be stored below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by the manufacturer.
Preparation of dosage form:
For formulas in the powder form—This product must be reconstituted before administration. Follow carefully the directions for mixing on the product container.
Stability:
For formulas in the ready-to-use form—Formulas should be refrigerated after opening. Any unused portions should be discarded within 24 to 48 hours after opening.
For formulas in the powder form—Any unused solution should be refrigerated and used within 24 to 48 hours after preparation, depending on the manufacturer"s instructions.
Auxiliary labeling:
Shake container well before opening.
Additional information:
Table 1. Blenderized Formulas
Note: Some products may be given either orally or by feeding tube; others are designed to be given by feeding tube only.
| Brand name [availability] |
KCal (kJoules) per mL |
mOsm per kg water |
Protein |
Carbohydrates |
Fat |
Na + mg (mEq) per L |
K + mg (mEq) per L |
Ca ++ mg (mEq) per L |
Mg ++ mg (mEq) per L |
Phos mg per L |
mL to supply 100% RDI for vitamins |
Comments |
||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Grams per 1000 mL |
Source; % KCal |
Nonprotein KCal per gm of Nitrogen |
Grams per 1000 mL |
Source; % KCal |
Grams per 1000 mL |
Source; %KCal |
||||||||||
| Compleat Modified Oral Solution [U.S.] |
1.07 (4.5) |
300 |
43 |
Beef, calcium caseinate; 16 |
131:1 |
140 |
Maltodextrin, vegetables, fruits; 53 |
37 |
Beef, canola oil; 31 |
1000 (43) |
1400 (36) |
670 (33.5) |
270 (22) |
870 |
1500 |
Lactose-free, contains 4.2 grams fiber per 1000 mL |
| Oral solution [Canada] |
1.07 (4.5) |
300 |
43 |
Beef, calcium caseinate; 16 |
131:1 |
140 |
Maltodextrin, vegetables, fruits; 53 |
37 |
Beef, corn oil; 31 |
850 (37) |
1400 (36) |
730 (36) |
270 (22) |
930 |
N/A |
Lactose-free, contains 4.2 grams fiber per 1000 mL |
| Compleat Regular Oral Solution [U.S.] |
1.07 (4.5) |
450 |
43 |
Beef, nonfat milk; 16 |
131:1 |
130 |
Maltodextrin, vegetables, fruits, nonfat milk; 48 |
43 |
Beef, corn oil; 36 |
1300 (57) |
1400 (36) |
670 (33) |
270 (22) |
1200 |
1500 |
Contains lactose, contains 4.2 grams fiber per 1000 mL |
| Vitaneed Oral Solution [U.S.] |
1 (4.2) |
300 |
40 |
Beef, calcium and sodium caseinates; 16 |
134:1 |
128 |
Maltodextrin vegetables, fruits, soy fiber; 48 |
40 |
Corn oil; 36 |
680 (30) |
1250 (32) |
667 (33.4) |
267 (21.4) |
667 |
1500 |
Lactose-free, contains 8 grams fiber per 1000 mL |
Table 2. Disease-specific Formulas
Note: Some products may be given either orally or by feeding tube; others are designed to be given by feeding tube only.
| Brand name [availability] |
KCal (kJoules) per mL |
mOsm per kg water |
Protein |
Carbohydrates |
Fat |
Na + mg (mEq) per L |
K + mg (mEq) per L |
Ca ++ mg (mEq) per L |
Mg + mg (mEq) per L |
Phos mg per L |
mL to supply 100% RDI for vitamins |
Comments |
||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Grams per 1000 mL |
Source; % KCal |
Nonprotein KCal per gm of Nitrogen |
Grams per 1000 mL |
Source; % KCal |
Grams per 1000 mL |
Source; %KCal |
||||||||||
| For Patients with Hepatic Disease * |
||||||||||||||||
| Hepatic-Aid II for Oral Solution [U.S.] |
1.2 (5) |
560 |
44.1 |
Crystalline amino acids; 15 |
148:1 |
168.5 |
Malto- dextrins, sucrose; 57.3 |
36.2 |
Soybean oil, lecithin monodigly- cerides; 27.7 |
Less than 339 (14.7) |
Less than 230.3 (5.9) |
N/A |
N/A |
N/A |
N/A |
Contains phenylalanine, contains tartrazine |
| NutriHep Oral Solution [U.S.] |
1.5 (6.3) |
690 |
40 |
Crystalline L-amino acids, whey protein concentrate; 11 |
209:1 |
290 |
Maltodextrin, modified cornstarch; 77 |
21.2 |
MCT † oil, canola oil, lecithin, corn oil; 12 |
320 (14) |
1320 (34) |
1000 (50) |
400 32 |
1000 |
1000 |
Lactose-free |
| For Immunocompromised Patients or Patients with Metabolic Stress/Trauma * |
||||||||||||||||
| Advera Oral Solution [U.S.] |
1.28 |
680 |
60 |
Soy protein hydrolysate, sodium caseinate; 18.7 |
108:1 |
215.8 |
Maltodextrin, sucrose, soy fiber; 65.5 |
22.8 |
Canola oil, MCT † oil, refined deodorized sardine oil; 15.8 |
1056 (45.9) |
2827 (72.5) |
1083 (54.2) |
338 (27.5) |
1083 |
1184 |
|
| Crucial Oral Solution [U.S.] |
1.5 (6.3) |
490 |
94 |
Enzymati- cally hydrolyzed casein; L-arginine; 25 |
75:1 |
135 |
Maltodextrin, cornstarch; 36 |
68 |
MCT †, fish oil, soy oil; 39 |
1168 (51) |
1872 (48) |
1000 (50) |
400 (32) |
1000 |
1000 |
Lactose-free |
| Immun-Aid for Oral Solution [U.S.] |
1 (4.2) |
580 |
37 |
Amino acids; 15 |
167:1 |
120 |
Maltodextrin; 48 |
22 |
MCT † oil, canola oil; 20 |
800 (35) |
1756 (45) |
600 (30) |
200 (16) |
600 |
2000 |
|
| Impact Oral Solution [U.S./Canada] |
1 (4.2) |
375 |
56 |
Sodium and calcium caseinates; L-arginine; 22 |
71:1 |
130 |
Hydrolyzed cornstarch; 53 |
28 |
Structured lipid, menhaden oil; 25 |
1100 (48) |
1400 (36) |
800 (40) |
270 (22) |
800 (26) |
1500 |
Lactose-free |
| Impact with Fiber Oral Solution [U.S.] |
1 (4.2) |
375 |
56 |
Sodium and calcium caseinates, L-arginine; 22 |
71:1 |
140 |
Hydrolyzed cornstarch, soy fiber, enzymatically modified guar; 53 |
28 |
Structured lipid, menhaden oil; 25 |
1100 (48) |
1400 (36) |
800 (40) |
270 (22) |
800 (26) |
1500 |
Lactose-free, contains 10 grams fiber per 1000 mL |
| Perative Oral Solution [U.S.] |
1.3 (5.4) |
385 |
66.6 |
Partially hydrolyzed sodium caseinate, lactalbumin hydrolysate, L-arginine; 20.5 |
97:1 |
177.2 |
Maltodextrin; 54.5 |
37.4 |
Canola oil, MCT † oil, corn oil; 25 |
1040 (45.2) |
1730 (44.2) |
867 (43.3) |
347 (28.9) |
867 |
1155 |
|
| Protain XL Oral Solution [U.S.] |
1 (4.2) |
340 |
55 |
Sodium and calcium caseinates; 14 |
92:1 |
138 |
Maltodextrin, soy fiber; 51 |
30 |
MCT †, corn oil; 27 |
860 (37.4) |
1500 (38.4) |
800 (40) |
320 (25.6) |
800 |
1250 |
Lactose-free |
| TraumaCal Oral Solution [U.S.] |
1.5 (6.3) |
560 |
82 |
Sodium and calcium caseinates; 22 |
91:1 |
142 |
Corn syrup, sugar; 38 |
68 |
MCT † oil, soy oil; 40 |
1180 (51) |
1390 (36) |
750 (37) |
200 (16.5) |
750 |
2000 |
Lactose-free |
| Traum-Aid HBC for Oral Solution [U.S.] |
1 (4.2) |
640 |
56 |
Crystalline amino acids; 22.4 |
132:1 |
166 |
Maltodextrin; 66.4 |
12.4 |
Soybean oil, MCT † oil, lecithin; 11.2 |
530 (23) |
1173 (30) |
400 |
133 |
400 |
3000 |
|
| For Patients with Fat Malabsorption * |
||||||||||||||||
| Citrotein for Oral Solution [Canada] |
0.67 (2.8) |
41 |
Egg white solids: 25 |
76:1 |
120 |
Maltodextrin sugar; 73 |
1.6 |
Partially hydroge- nated soybean oil; 2 |
670 (29) |
550 (14) |
1100 (56) |
420 (35) |
1100 |
N/A |
Lactose-free, cholesterol-free |
|
| orange |
490 |
|||||||||||||||
| punch |
480 |
|||||||||||||||
| Lipisorb for Oral Solution [U.S.] |
Dilution #1 1 (4.2) |
320 |
35 |
Sodium caseinate; 14 |
157:1 |
116 |
Corn syrup, sucrose; 46 |
48 |
MCT † oil, corn oil; 40 |
740 (32) |
1260 (32) |
710 (36) |
200 (16.5) |
710 |
2000 |
Lactose-free |
| Dilution #2 1.35 (5.6) |
470 |
47 |
Sodium caseinate; 14 |
157:1 |
155 |
Corn syrup, sucrose; 46 |
65 |
MCT † oil, corn oil; 40 |
990 (43) |
1690 (43) |
950 (48) |
270 (22) |
950 |
1480 |
Lactose-free |
|
| Oral Solution [U.S.] |
1.35 (5.6) |
630 |
57 |
Sodium and calcium caseinates; 17 |
125:1 |
161 |
Maltodextrin, sucrose; 48 |
57 |
MCT † oil, soy oil; 35 |
1350 (59) |
1690 (43) |
850 (43) |
340 (28) |
850 |
1180 |
Lactose-free |
| Nutren 2.0 Oral Solution [U.S.] |
2 (8.4) |
720 |
80 |
Calcium and potassium caseinates; 16 |
131:1 |
196 |
Corn syrup solids, maltodextrin, sucrose; 39 |
106 |
MCT † oil, canola oil, corn oil; 45 |
1300 (56.5) |
1920 (49.2) |
1340 (67) |
536 (42.9) |
1340 |
750 |
Lactose-free, vanilla |
| Peptamen Oral Solution [U.S.] |
1 (4.2) |
270 |
40 |
Hydrolyzed whey; 16 |
131:1 |
127 |
Maltodextrin, starch; 51 |
39 |
MCT † oil, sunflower oil; 33 |
500 (22) |
1250 (32) |
800 (40) |
400 (32) |
700 |
1500 |
Lactose-free |
| Peptamen Junior Oral Solution [U.S.] |
1 (4.2) |
260 |
30 |
Enzymati- cally hydrolyzed whey protein; 12 |
183:1 |
137.5 |
Maltodextrin, cornstarch; 55 |
38.5 |
MCT †, soybean oil, canola oil; 33 |
460 (20) |
1320 (34) |
1000 (50) |
200 (16) |
800 |
1000 |
Lactose-free |
| Peptamen VHP Oral Solution [U.S.] |
1 (4.2) |
300 |
62.5 |
Enzymati- cally hydrolyzed whey protein; 25 |
75:1 |
104.5 |
Maltodextrin, cornstarch; 42 |
39 |
MCT †, soybean oil; 33 |
560 (24) |
1500 (38.5) |
800 (40) |
300 (24) |
700 |
1500 |
Lactose-free |
| For Patients with Glucose Intolerance * |
||||||||||||||||
| DiabetiSource Oral Solution [U.S.] |
1 (4.2) |
360 |
50 |
Beef and calcium caseinates; 20 |
100:1 |
90 |
Maltodextrin, fructose; 36 |
49 |
High-oleic sunflower oil, canola oil; beef fat; 44 |
1000 (43) |
1400 (36) |
670 (33) |
270 (22) |
670 |
1500 |
Lactose-free, contains 6.4 grams fiber per 1500 mL |
| Glucerna Oral Solution [U.S./Canada] |
1 (4.2) |
375 |
41.8 |
Sodium and calcium caseinates; 16.7 |
125:1 |
93.7 |
Hydrolyzed cornstarch, soy fiber, fructose; 33.3 |
55.7 |
High-oleic safflower oil, soy oil; 50 |
930 (40.5) |
1560 (40) |
704 (35.2) |
282 (23.5) |
704 |
1422 |
Lactose-free, contains 14.4 grams fiber per 1000 mL |
| Glytrol Oral Solution [U.S.] |
1 (4.2) |
380 |
45 |
Calcium and potassium caseinates; 18 |
114:1 |
100 |
Maltodextrin, modified cornstarch, fructose; 40 |
47.5 |
Canola oil, high-oleic safflower oil, MCT †; 42 |
740 (32) |
1400 (36) |
720 (36) |
286 (23) |
720 |
1400 |
Lactose-free, contains 15 grams fiber per 1000 mL |
| For Patients with Pulmonary Disease * |
||||||||||||||||
| NutriVent Oral Solution [U.S.] |
1.5 (6.3) |
330 |
67.5 |
Calcium and potassium caseinates; 18 |
113:1 |
100 |
Maltodextrin, sugar; 27 |
94 |
MCT † oil, canola oil, corn oil, lecithin; 55 |
1170 (51) |
1872 (48) |
1200 (60) |
480 (38) |
1200 |
1000 |
Lactose-free |
| Pulmocare Oral Solution [U.S./Canada] |
1.5 (6.3) |
475 |
62.6 |
Sodium and calcium caseinates; 16.7 |
125:1 |
105.7 |
Sucrose, maltodextrin; 28.2 |
93.3 |
Canola oil, MCT † oil, corn oil, high-oleic safflower oil; 55.1 |
1310 (57) |
1730 (44.2) |
1056 (52.8) |
423 (35.3) |
1056 |
947 |
Lactose-free |
| Respalor Oral Solution [U.S.] |
1.52 (6.4) |
580 |
76 |
Sodium and calcium caseinates; 20 |
102:1 |
148 |
Corn syrup, sucrose; 39 |
71 |
MCT † oil, canola oil; 41 |
1270 (55) |
1480 (38) |
710 (36) |
280 (23) |
710 |
1420 |
|
| For Patients with Renal Disease * |
||||||||||||||||
| Amin-Aid for Oral Solution [U.S.] |
2 (8.4) |
510 |
19.4 |
Crystalline, amino acids; 4 |
640:1 |
365.6 |
Malto- dextrins, sucrose; 74.8 |
46.2 |
Partially hydroge- nated soybean oil lecithin, mono- and diglycerides |
Less than 339 (14.7) |
Less than 230.3 (5.9) |
N/A |
N/A |
N/A |
N/A |
Contains tartrazine |
| Magnacal Oral Solution [U.S.] |
2 |
590 |
70 |
Sodium and calcium caseinates; 14 |
154:1 |
250 |
Maltodextrin sucrose; 50 |
80 |
Soy oil; 36 |
1000 (43.5) |
1250 (32) |
1000 (50) |
400 (32) |
1000 |
1000 |
|
| Nepro Oral Solution [U.S./Canada] |
2 (8.4) |
635 |
69.9 |
Calcium, magnesium, and sodium caseinates; 14 |
154:1 |
215.2 |
Corn syrup, sucrose; 43 |
95.6 |
High-oleic safflower oil, soy oil; 43 |
829 (36.1) |
1057 (27) |
1373 (68.6) |
211 (17.6) |
686 |
947 |
|
| Suplena Oral Solution [U.S./Canada] |
2 (8.4) |
600 |
30 |
Sodium and calcium caseinates; 6 |
393:1 |
255.2 |
Maltodextrin, sucrose; 51 |
95.6 |
High-oleic safflower oil, soy oil; 43 |
783 (34) |
1116 (28.5) |
1385 (69.2) |
211 (17.6) |
728 |
947 |
|
| Travasorb Renal Diet for Oral Solution [U.S.] |
1.35 (5.6) |
590 |
22.9 |
Amino acids; 6.9 |
339:1 |
270.5 |
Glucose oligo- saccharides, sucrose;81.1 |
17.7 |
MCT † oil, sunflower oil; 12 |
N/A |
N/A |
N/A |
N/A |
N/A |
N/A |
|
† Medium-chain triglyceride
Table 3. Fiber-containing Formulas
Note: Some products may be given either orally or by feeding tube; others are designed to be given by feeding tube only.
| Brand name [availability] |
KCal (kJoules) per mL |
mOsm per kg water |
Protein |
Carbohydrates |
Fat |
Na + mg (mEq) per L |
K + mg (mEq) per L |
Ca mg (mEq) per L |
Mg ++ mg (mEq) per L |
Phos mg per L |
mL to supply 100% RDI for vitamins |
Comments |
||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Grams per 1000 mL |
Source; % KCal |
Nonprotein KCal per gm of Nitrogen |
Grams per 1000 mL |
Source; % KCal |
Grams per 1000 mL |
Source; %KCal |
||||||||||
| Ensure with Fiber Oral Solution [U.S./Canada] |
1.1 (4.6) |
480 |
39.7 |
Sodium and calcium caseinates, soy protein isolate; 14.5 |
148:1 |
162 |
Maltodextrin, sucrose, soy fiber; 55 |
37.2 |
Corn oil; 30.5 |
846 (36.8) |
1693 (43.3) |
719 (35.9) |
288 (24) |
719 |
1391 |
Lactose-free, contains 14.4 grams fiber per 1000 mL |
| Fiberlan Oral Solution [U.S.] |
1.2 (5) |
310 |
50 |
Caseinates; 16.7 |
122:1 |
160 |
Maltodextrin; 53.3 |
40 |
MCT † oil, corn oil; 27.8 |
1012 (44) |
1716 (44) |
800 (40) |
320 (25.6) |
800 |
1250 |
Lactose-free, contains 14 grams fiber per 1000 mL |
| Fibersource Oral Solution [U.S.] |
1.2 (5) |
390 |
43 |
Sodium and calcium caseinates; 14 |
151:1 |
170 |
Hydrolyzed cornstarch, soy fiber; 56 |
41 |
MCT † oil, canola oil; 30 |
1100 (48) |
1800 (46) |
670 (33) |
270 (22) |
670 |
1500 |
Lactose-free, contains 10 grams fiber per 1000 mL |
| Fibersource HN Oral Solution [U.S.] |
1.2 (5) |
390 |
53 |
Sodium and calcium caseinates; 18 |
118:1 |
160 |
Hydrolyzed cornstarch, soy fiber; 52 |
41 |
MCT † oil, canola oil; 30 |
1100 (48) |
1800 (46) |
670 (33) |
270 (22) |
670 |
1500 |
Lactose-free, contains 6.7 grams fiber per 1000 mL |
| Glytrol Oral Solution [U.S.] |
1.0 (4.2) |
380 |
45 |
Calcium and potassium caseinate; 18 |
114:1 |
100 |
Maltodextrin, modified cornstarch, fructose; 40 |
47.5 |
Canola oil, high-oleic safflower oil, MCT †; 42 |
740 (32) |
1400 (36) |
720 (36) |
286 (23) |
720 |
1400 |
Lactose-free, 15 grams fiber/1000 mL |
| Impact with Fiber Oral Solution [U.S.] |
1 (4.2) |
375 |
56 |
Sodium and calcium caseinates, L-arginine; 22 |
71:1 |
140 |
Hydrolyzed cornstarch, soy fiber, enzymatically modified guar; 53 |
28 |
Structural lipid menhaden oil; 25 |
1100 (48) |
1400 (36) |
800 (40) |
270 (22) |
800 (26) |
1500 |
Lactose-free, contains 10 grams fiber per 1000 mL |
| IsoSource VHN Oral Solution [U.S.] |
1 (4.2) |
300 |
62 |
Sodium and calcium caseinates; 25 |
77:1 |
130 |
Hydrolyzed cornstarch, soy fiber and hydrolyzed guar fiber; 50 |
29 |
MCT † oil, canola oil; 25 |
1300 (57) |
1600 (41) |
800 (40) |
320 (25.6) |
800 |
1250 |
Lactose-free, contains 12.5 grams fiber per 1250 mL |
| Jevity Oral Solution [U.S.] |
1.06 (4.4) |
310 |
44.3 |
Sodium and calcium caseinates; 16.7 |
125:1 |
154.4 |
Maltodextrin, soy fiber; 54.3 |
34.7 |
High-oleic safflower oil, canola oil, MCT † oil; 29 |
930 (40.5) |
1570 (40.2) |
909 (45.4) |
304 (25.3) |
758 |
1321 |
Lactose-free, contains 14.4 grams fiber per 1000 mL |
| Oral Solution [Canada] |
1.06 (4.4) |
310 |
44 |
Sodium and calcium caseinates; 16.7 |
125:1 |
152 |
Hydrolyzed cornstarch, soy fiber; 53.3 |
37 |
MCT † oil, corn oil; 30 |
740 (32) |
1240 (32) |
908 (45.4) |
302 (24.2) |
748.8 |
1321 |
Lactose-free, contains 14.4 grams fiber per 1000 mL |
| Kindercal Oral Solution [U.S.] |
1.06 (4.4) |
310 |
34 |
Sodium and calcium caseinates, milk protein concentrate; 13 |
171:1 |
135 |
Maltodextrin, sucrose; 50 |
44 |
MCT † oil, canola oil, corn oil, high-oleic safflower oil; 37 |
370 (16.1) |
1310 (34) |
850 (43) |
210 (17.4) |
850 |
950 |
Lactose-free, contains 6.3 grams fiber per 1000 mL |
| NuBasics with Fiber Oral Solution [U.S.] |
1 (4.2) |
520 |
35 |
Calcium and potassium caseinates; 14 |
153:1 |
132.4 |
Corn syrup solids, sucrose; 53 |
36.8 |
Canola oil, corn oil; 33 |
876 (38) |
1248 (32) |
500 (25) |
200 (16) |
500 |
2000 |
Lactose-free, contains 14 grams fiber per 1000 mL |
| Nutren 1.0 with Fiber Oral Solution [U.S.] |
1 (4.2) |
310 |
40 |
Calcium and potassium caseinates; 16 |
131:1 |
127 |
Maltodextrin, corn syrup solids; 51 |
38 |
MCT † oil, canola oil, corn oil; 33 |
876 (38) |
1250 (32) |
668 (33) |
268 (21.4) |
668 |
1500 |
Contains 14 grams fiber per 1000 mL |
| NutriSource Oral Solution [Canada] |
1.2 (5) |
390 |
43 |
Sodium and calcium caseinates; 14 |
151:1 |
170 |
Maltodextrin, corn syrup solids, soy fiber; 56 |
41 |
MCT † oil, canola oil; 30 |
1100 (48) |
1800 (46) |
670 (33) |
270 (22) |
670 |
N/A |
Lactose-free, contains 10 grams fiber per 1000 mL |
| NutriSource HN Oral Solution [Canada] |
1.2 (5) |
390 |
53 |
Sodium and calcium caseinates; 18 |
118:1 |
160 |
Maltodextrin, corn syrup solids, soy fiber; 52 |
41 |
MCT † oil, canola oi; 30 |
1100 (48) |
1800 (46) |
670 (33) |
270 (22) |
670 |
N/A |
Lactose-free, contains 6.7 grams fiber per 1000 mL |
| Pediasure with Fiber Oral Solution [U.S.] |
1 (4.2) |
<345 |
30 |
Sodium caseinate, whey protein concentrate; 12 |
185:1 |
113.5 |
Hydrolyzed cornstarch, sucrose, soy fiber; 43.9 |
49.7 |
High-oleic safflower oil, soy oil, MCT † oil; 44.1 |
380 (16.5) |
1310 (33.5) |
970 (48.5) |
200 (16.7) |
800 |
1000 |
Trace lactose, contains 5 grams fiber per 1000 mL |
| ProBalance Oral Solution [U.S.] |
1.2 (5) |
350 |
54 |
Calcium and potassium caseinates; 18 |
114:1 |
156 |
Maltodextrin; 52 |
40.6 |
Canola oil, MCT †, corn oil; 30 |
763 (33) |
1560 (40) |
1250 (62.5) |
400 (32) |
1000 |
1000 |
Lactose-free, contains 10 grams fiber per 1000 mL |
| Profiber Oral Solution [U.S.] |
1 (4.2) |
300 |
40 |
Sodium and calcium caseinates; 16 |
134:1 |
147 |
Maltodextrin, soy fiber; 54 |
35 |
Corn oil, MCT † oil; 30 |
800 (34.8) |
1500 (38.4) |
800 (40) |
320 (25.6) |
800 |
1250 |
Lactose-free, contains 12 grams fiber per 1000 mL |
| Promote with Fiber Oral Solution [U.S.] |
1 |
370 |
62.5 |
Sodium and calcium caseinates; 25 |
75:1 |
139.4 |
Hydrolyzed cornstarch, sucrose, oat fiber, soy fiber; 50 |
28.2 |
High-oleic safflower oil, canola oil, MCT † oil; 25 |
1300 (56.6) |
1980 (50.6) |
1200 (60) |
400 (32.6) |
1200 |
1000 |
Lactose-free, contains 14.4 grams fiber per 1000 mL |
| Replete with Fiber Oral Solution [U.S.] |
1 (4.2) |
300 |
62.5 |
Calcium and potassium caseinates; 25 |
75:1 |
113 |
Maltodextrin, corn syrup solids; 45 |
34 |
Canola oil; MCT † oil; 30 |
876 (38) |
1500 (38) |
1000 (50) |
400 (32) |
1000 |
1000 |
Lactose-free, contains 14 grams fiber per 1000 mL |
| Sustacal with Fiber Oral Solution [U.S.] |
1.06 (4.4) |
490 |
46 |
Sodium and calcium caseinates, soy protein isolates; 17 |
120:1 |
139 |
Maltodextrin, sugar; 53 |
35 |
Corn oil; 30 |
720 (31) |
1390 (36) |
850 (43) |
280 (23) |
710 |
1420 |
Lactose-free, contains 10.6 grams fiber per 1000 mL |
| Ultracal Oral Solution [U.S.] |
1.06 (4.4) |
310 |
44 |
Sodium and calcium caseinates; 17 |
128:1 |
123 |
Maltodextrin; 46 |
45 |
MCT † oil, canola oil; 37 |
930 (40) |
1610 (41) |
850 (43) |
340 (28) |
850 |
1180 |
Lactose-free, contains 14.4 grams fiber per 1000 mL |
Table 4. Milk-based Formulas
Note: Some products may be given either orally or by feeding tube; others are designed to be given by feeding tube only.
| Brand name [availability] |
KCal (kJoules) per mL |
mOsm per kg water |
Protein |
Carbohydrates |
Fat |
Na + mg (mEq) per L |
K + mg (mEq) per L |
Ca ++ mg (mEq) per L |
Mg ++ mg (mEq) per L |
Phos mg per L |
mL to supply 100% RDI for vitamins |
Comments |
||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Grams per 1000 mL |
Source; % KCal |
Nonprotein KCal per gm of Nitrogen |
Grams per 1000 mL |
Source; % KCal |
Grams per 1000 mL |
Source; %KCal |
||||||||||
| Carnation Instant Breakfast for Oral Solution [U.S.] |
1 (4.2) |
— |
63.3 |
Nonfat dry milk, fluid milk § |
— |
149.6 |
Lactose, sucrose § |
34.6 |
Milk fat § |
1062.5 (45.8) |
3083.3 (78.8) |
2045.8 (102.3) |
470.8 (37.7) |
1700 |
N/A |
Contains lactose |
| Carnation Instant Breakfast No Sugar Added for Oral Solution [U.S.] |
0.7 (2.9) |
— |
62.5 |
Casein, nonfat dry milk, fluid milk § |
— |
86.3 |
Lactose, § maltodextrin |
20.8 |
Milk fat § |
1041.7 (45.4) |
2822.9 (72.5) |
1716.7 (85.8) |
470.8 (37.7) |
1362.5 |
N/A |
Contains lactose, sugar-free, contains aspartame |
| Great Shake Oral Solution [U.S.] |
1.67 (7.04) |
910 |
50 |
Nonfat milk, skim milk; 12 |
183:1 |
261 |
Corn syrup, high fructose corn syrup, lactose; 62.7 |
50 |
Partially hydroge- nated soybean oil, milk- fat; 27 |
1100 (48.1) |
1940 (49.5) |
1670 (83.5) |
670 (54.7) |
1110 |
900 |
Contains lactose |
| Great Shake Jr. Oral Solution [U.S./Canada] |
1.92 (7.95) |
890 |
66.7 |
Nonfat milk, skim milk; 13.9 |
155:1 |
165 |
Corn syrup, high fructose corn syrup, lactose; 57.4 |
35 |
Partially hydroge- nated soybean oil, milk- fat; 27.4 |
800 (35) |
1500 (38.3) |
1000 (50) |
400 (32) |
1000 |
800 |
Contains lactose |
| Menu Magic Instant Breakfast for Oral Solution [U.S.] |
1.12 (5) |
— |
64 |
Nonfat milk, whole milk, isolated soy protein; 22.1 |
113:1 |
144 |
Sucrose, lactose; 49.9 |
36 |
Milk fat; 28 |
900 (39) |
2960 (75) |
3600 (180) |
320 (25.6) |
1800 |
715 |
Contains lactose |
| Menu Magic Milk Shake Oral Solution [U.S.] |
1 (4.2) |
— |
32 |
Nonfat milk, whole milk; 13.5 |
187.5:1 |
136 |
Lactose, dextrose, maltodextrin; 56.5 |
32 |
Milk fat; 30 |
600 (26.3) |
1600 (41.1) |
1400 (67) |
560 (45.7) |
1200 |
1000 |
Contains lactose |
| Meritene for Oral Solution [U.S.] |
1.06 (4.4) |
690 |
69 |
Nonfat milk, whole milk; 26 |
71:1 |
120 |
Lactose, sugar, hydrolyzed corn starch; 45 |
34 |
Milk fat; 29 |
1100 (48) |
2800 (72) |
2200 (110) |
380 (31) |
1900 |
1040 |
Contains lactose |
| for Oral Solution [Canada] |
1.06 (4.4) |
690 |
72 |
Nonfat milk, whole milk; 26 |
96:1 |
120 |
Corn syrup solids; 45 |
35 |
Partially hydroge- nated soybean oil; 29 |
960 (42) |
3000 (77) |
2300 (110) |
380 (31) |
1900 |
N/A |
Contains lactose |
| 206 Shake Oral Solution [U.S.] |
1.67 (7.04) |
910 |
50 |
Nonfat milk, skim milk; 12 |
183:1 |
261 |
Corn syrup, high fructose corn syrup, lactose; 62.7 |
50 |
Partially hydroge- nated soybean oil, milkfat; 27 |
1100 (48.1) |
1940 (49.5) |
1670 (83.5) |
670 (54.7) |
1110 |
900 |
Contains lactose |
| Sustagen for Oral Solution [U.S./Canada] |
1.86 (7.8) |
1130 |
115 |
Nonfat milk, whole milk, calcium caseinate; 25 |
78:1 |
320 |
Lactose, dextrose, corn syrup solids; 67 |
16.8 |
Milk fat; 8 |
1060 (46) |
3400 (87) |
3400 (170) |
420 (35) |
2500 |
950 |
Contains lactose |
| Tasty Shake Oral Solution [U.S.] |
1.2 (5) |
— |
64 |
Whole milk, nonfat milk, isolated soy protein; 22.1 |
113.3:1 |
144 |
Sucrose, lactose; 49.9 |
36 |
Milk fat; 28 |
900 (39.5) |
2960 (75) |
3600 (180) |
320 (26.7) |
1800 |
715 |
Contains lactose |
Table 5. Modular Formulas
Note: Some products may be given either orally or by feeding tube; others are designed to be given by feeding tube only.
| Brand name [availability] |
KCal (kJoules) per gram |
Protein |
Carbohydrates |
Fat |
Na + mg (mEq) per 100 grams |
K + mg (mEq) per 100 grams |
Ca ++ mg (mEq)< | |||
|---|---|---|---|---|---|---|---|---|---|---|