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APPET{DIXcr Parental Formulas
c-7
ENTERALFORMULAS
The large number of enteral formulas available allows health
care professionals to neet a variety of their patients, medicai
needs, but also complicates the process of selecting an appropriate formula. The first step in narrowing the choice offor_
mulas is to determine the patient's ability to digest and absorb
nutrients. Table I-1 on pp, ]-2 through J-3 lists examples of
standard formulas for patients who can adequately digest and
absorb rrutrients, and Table l-2 onp.]-4 provides examples of
hydrolyzed formulas for patients with limit€d ability to digest
or absorb nutrients. Products promoted to the generat pubtic
and intended primarily as oral supplements, such as C"rnr_
tion Instant Breakfasto (Nestl...),
. Mead Iohnson Nutritionals:a
Kindercalo TF
Boost@ (Mead |ohnson),
. Nestl€ Nutrition:b
and Ensure (Ross), are not included as examples. Each
for_
mula is listed only once, although a formula may h"ve
more
than^one use. A high-protein formula, for example,
may also
be a fiber-conraining formula. Thbles
|-3 through I_5 on p. f-5
list modular formulas.
The information listed in this appendix reflects the
liter_
ature provided by manufacturers and does not
.Novartis Medical Nutrition:c
Casec@
Glytrolo
Advera@
Choice DM@ TF
Alitraqo
Nutren@ 2.0
Nutren@ Fiber
Nutren@ Junior
NutriHepo
Compleat@ Pediatric
Glucerna@
Cornplp
Criticare HNo
IevitYo
Optimentalo
Impact@
Osmolite@
NutriRenal@
NutriVent@
Impact@ 1.5
hnpact@ Glutamine
PediaSure@
Isocal@
Peptamen@
Perative@
Isocal@
HN
Peptamen IuniortD
Isocal@
HN PIus
Oxepa@
Polycose Liquido
Polycose Powder@
Probalance@
Isosource@ Standard
Repleteo
ProModo
Magnacal@
Promote@
Promote@ with Fiber
Pulmocare@
Renal@
Microlipido
Novasource@
pulmonary
Novasource@ Renal
Protain XLo
Diabetic
Resource@
Ultracal@ HN plus
Vivonex@ Pediatric
Vivonexrd PIus
Vivonexo T.E.N.
" Mead ]ohnson Nutritionals, www.meadjohnson.com, visitert Marcl"g2005.
I'Nestld Nutrition,
rvmv-nestreclinicarnutrition.com, visited tvtarch s,il05'Novartis lr,ledical Nutrition, ryww.novartis.conr, visited March 9, 2005.
Ross Medical
NePro@
Delivero 2.0
MCTOiI@
d
. Ross Medical Nutritionals:d
Crucial@
Nutren@ 1.0
Nutren@ 1.5
suggest
endorsement by the authors. Manufacture.s fr.q,r.rrtlildd
new formulas, discontinue old ones, and change formula
composition. Consult the manufacturers, literature and
websites for updates and additional examples of enteral
formulas. The following products are listed in this appendix:
Nutritionals, trnyw.ross.com, visited March 9,2005.
C-8
AppENDtxc Parenteral and Enteral Formulas
TABLE C2.1
Standard Formulas
lo0K
Volume to
Meet 100%
RDlb(mt)
Produrf
/
Eneryy
Protein 0r
Amino Acids
(kol/mt)
Ca6ohydrah
Fat
(stLl
(e/t)
(s/U
A, l{ d)atrnta-t
0rttrcf
gqt
Osmolalityr
(mOsm/kg)
Notes
lactose-Frce, Standard Fomulas
lsoca16
1890
1.06
34
r35
44
270
20%fatfrom M(T
lsosourceo Standard
1165
1.20
43
170
39
490
50% fatfrom MG
Nutrenol.0
1500
1.00
40
127
38
315
25%fatfromMG
0smoliteo
2000
1.06
3t
151
l5
300
20% fatfrom MCI
lactosc-Free, tiber-(ontainin g tormulas
Jevityo
1321
1.06
44
155
l5
300
14 g fiber/L
Nutreno Fiber
1500
1.00
40
127
38
130
14 g fiber/L
PmBalanceo
1000
1.20
54
156
41
350
10 g fiber/L
Promoteowith Fiber
1000
1.00
63
28
380
14 g fiber/L
20%fatfrom MO
(omplyo
'I38
830
1.50
60
180
61
460
Delivero 2.0
1000
2.00
75
200
101
640
30%fatfromMC
Nutreno 1.5
1000
1.50
60
169
68
430
50%fatfom MCI
Nutreno 2.0
750
2.00
80
196
104
745
75%fatfrom MO
[actoseFree, High-Protein tormulas
lsocalo HN
I 180
1.06
44
124
45
270
Low residue
lsocalo HN Plus
1000
r.20
54
156
40
400
Low residue
Promote@
1000
1.00
63
130
26
340
20%fatfrom MO
1000
1.20
54
156
40
370
30%fatfrom MO
low residue
ultncalo
HN Plus
10 g fiber/L
Formulas: Pediatd< (t to 1 0 yean)
(ompleato Pediauic
Variesd
1.00
130
380
Blenderized formuii
6,8 q fiber/L
KindercaloTF
Varied
1.06
30
13s
44
345
Nutren JunioP
12%fatfrom MO
Variesd
1.00
30
110
50
350
21%fatfrom MO
PediaSureo
Variesd
1.00
l0
110
50
430
Formulas: Glurose lntolerance
--$-'
(hoice DMoTF
1
120
1.06
45
119
51
300
14 g
Glucerna@
1420
1.00
42
96
54
355
14 g
fiber/l
6lytrolo
1400
1.00
45
100
48
180
15 g
fiber/L;
180
1.06
6l
'100
47
100
fiberA
20%fatfrom MCi
Resource@
Diabetic
1
13 g fiberiL
Enriched with
N
arginine, nudeic
acids, and omega-3
lmpacto 1.5
1250
lmpacto Glutamine
1000
'1.50
1.30
84
78
140
150
69
43
fatty acids
550
630
Same as above
Same as above and enriched
with glutamine;10
NOIE:
a
g
fiberlL
MO Medium-chain triglycerides.
Formulas come in ready-to-use (liquid) form unless specified under,,Notes.,,
the product.
'Osmolality may vary depending on the flavorings added to a product.
d
Depends on age ofchild.
(entinued on the following pogi
c2
APPENDTx
TABLE C2.1
Enteral Formulas
c-9
(continued)
Standard Formulas
Volume to
Meet 100%
ProducF
Rotb
(mt)
Energy
(kcal/mL)
Protein or
Amino Acids
Carbohydrate
(sA)
tat
(sA)
0smolalityc
(g/L)
(m0sm/kg)
75
200
'101
s70
Notes
SperiaFUse Formulas: Renal tailure
Ma!nacalo Renal
1000
2.00
20% fatfrom
Mfi;
intended for use
once hemodialysis
has been instituted
NeProo
947
2.00
70
222
96
665
High-calcium,lowphosphorus;
intended for use
once dialysis
has been instituted
Novasource@ Renal
1000
2.00
74
200
100
700
Low in electrolytes;
intended for use
once dialysis has
been instituted
NutriRenalo
750
2.00
70
205
104
50%fatfromMO
650
enrirhed with
vitamins
C
and 86,
olate,zinc,and
selenium; intended
for use onre dialysis
instituted
as been
SpeciaFUse Formulas: Respiratory lnsufficiency
Novasource@ Pulmonary
NutriVent@
933
't000
1.50
75
150
68
6s0
8 g fiber/L
1.50
68
100
94
330
55% kcal from fat,
1.50
63
106
94
493
40% fat from MCI
0xepa
1420
55% kcal from fat,
enriched with
Pulmocare@
antioxidant nufiients
1420
1.50
63
106
93
475
55% kcatfrom fat,
20%fatfromM(I,
enriched with
antioxidant nutrients
Protain XLo
9 g
fiberll,20% fat
from MCI, enriched
with vitamins A and
C
Repleteo
1000
i.00
62
113
14
300
and zinc
Enriched
with
vitamins A and
and zinc;25%
from MO
(
fat
C-l0
AppENDtxc Parenteral and Enteral Formulas
TABLE C2.2
Hydrolyzed Protein tormulas
Product'
Volume to
Meet 100%
RDlb (mL)
Energy
Proteln or
(kcal/
Amino Acids
(arbohydrate
Fat
0smolalltyc
(m0sm/
mL)
(q/r)
(s/t)
(s/L)
ks)
Notes
NutriHepo
Free
amino acids, h:;-
in branched chain
amino acids,low in
aromati( amino a(i,:i
formulas: HIV lnfection or Al05
1184
78% hydrolyzed an:
22% intact protein.
low fat, fiber adde:
enriched with
vitamins E,(,86,8:and folate
Powder form;47
i:
free amino acids,
j.:.
small peptides,
enriched with
glutamine and
arginine
Crucialo
1000
1.s0
94
r35
68
490
Enriched
with
argining glutamin:.
antioxidant
nutrlents, and zin(
Perative@
1500
1.30
67
180
37
460
Enrirhed with
arginine and
beta-carotene
Vivonexo PIus
1800
1.00
45
190
550
Powder form; 1OC:r
free amino acids,
enriched with
glutamine, arginiri
and branched-ch; amino acids
Special-Use Hydrolyzed Formulas: Malabsorption
Criticare HNo
1890
1.06
38
220
650
Mix of free aminc
acids and small
peptides
0ptimentalo
1D)
1.00
139
28
540
(ontains Mff and
arginine; enricheti
with yitamins ( ar:
E
Peptameno
i500
1.00
40
127
39
270
VivonexoT.E.N.
2000
1.00
38
210
3
630
and beta-carote::
70%fatfrom MO
Powder form; 10C::
free amino acids,
enriched with
glutamine
5pecial-Use Hydrolyzed FormulaslPediatric(1 to I0 years)
Peptamen Junioro
Varies'
1.0
30
138
39
164
60%fatfrom
Mft
contains glutamif:
Vivonexo Pediatric
Varies'
0.8
24
130
24
160
Powder form;
1
0i::
free amino acids
using the produrt.
b0smolallty
may vary depending on the flavorings added to a product.
(
Depends on age of child.
APPET{DIX
TABLE C2.3
Protein Modules
Major Protein
Energy
Protein
Source
(kcal/g)
(g/1 00 s)
Casec@
Powder
(alcium caseinate
1.8
90
ProMod@
Powder
Whey protein
4.7
75
TABLE C2.4
(arbohydrate Modules
Polycose Liquido
Polycose Powder@
Major (arhohydrate
Energy
5ource
(kol/mI or9)
Liquid
Hydrolyzed cornstarch
2.0 kcaliml
Powder
Hydrolyzed (ornstarch
3.8 ktal/g
TABLE C2.5
Fat Modules
Energy
Major Fat Source
(kcal/mL)
Protein
(g/100 mt)
MtT oil@
Liquid
Medium-chain triglyceildes
7.7
86
MicroliPido
Liquid
5afflower oil
4.5
5l
c-r
1