Nutritional Supplement - Enteral Nutrition

1. Polymeric - Standard
   1. Isotonic, lactose-free, nutritionally complete formulas
   2. Indicated for normal gastrointestinal tract
   3. Adult: 1-1.2 kcal/ml
      1. Boost, Ensure, Isocal, Jevity 1.2, Nutren 1.0, Osmolite
   4. Child: 1 kcal/ml or 30 kcal/oz
      1. Boost kid essentials, Pediasure, Nutren Junior
2. Polymeric - High Calorie
   1. Concentrated formulas with significantly higher calories per ml (typically by increasing fat concentration)
   2. Indicated for fluid restriction (CHF, SIADH) or high calorie requirement (e.g. trauma)
   3. Adult: 2 kcal/ml
      1. Deliver 2.0, Novasource 2.0, Nutren 2.0, Twocal HN
   4. Child: 1.5 kcal/ml or 45 kcal/oz
      1. Boost kid essentials 1.5, Resource Just for Kids 1.5
3. Polymeric - High Protein
   1. Indicated for hypercatabolic state or high protein requirement (e.g. Wound Healing)
   2. Adult: 1-1.5 kcal/ml with protein comprising 18-25% of total calories
      1. Boost high protein, Ensure plus HN, Isocal HN, Isosource HN, Osolite 1.2 CAL, Replete, Sustacal HC
4. Polymeric - With fiber
   1. Isotonic, typically soy-based fiber of both soluble and insoluble types with 4-22 grams fiber per Liter
   2. Indicated for prevention of Diarrhea in the short-term, and Constipation in the long-term
   3. Adult: Ensure with fiber, Fibersource HN, Jevity, Ultracal
   4. Child: Nutren Junior with fiber, Pediasure with fiber
5. Oligomeric
   1. Elemental formula, proteins with short peptides and free amino acids, higher osmolarity and lactose-free; 1-1.5 kcals/ml
   2. Indicated for malabsorption syndromes and pancreatic insufficiency
   3. Disadvantages: Expensive, may worsen Diarrhea
   4. Adults: Criticare HN, Peptamen, Perative, Subdue, Tolarex, Vital HN, Vivonex TEN, Vivonex Plus
   5. Child: Peptamen Junior, Vivonex Pediatric
6. Diabetic Formulation
   1. Lower carbohydrate, higher monounsaturated fat, and higher fiber; 1 kcal/ml
   2. Preparations: Choice DM, Diabetisource, Glucerna, Glytrol
7. Immunomodulating Formulation
   1. Higher protein, with increased arginine, glutamine, Omega-3 Fatty Acids and other components thought to improve immune response
   2. Indicated in ICU patients with major trauma, burns, or the critically ill on Mechanical Ventilation
   3. Deliver 1-1.5 kcal/ml
   4. Preparations: Alitraq, Crucial, Impact
8. Modular Formulation
   1. Indicated for a specific nutrient deficiency or as a component in a multi-formulation plan
   2. Protein formulations: Beneprotein instant protein powder, Promod
   3. Carbohydrate formulations: Moducal, Polycose
   4. Fat formulations: MCT Oil, Microlipid
   5. Fiber formulations: Benefiber
9. Pulmonary Formulation
   1. Low carbohydrate, high fat, no fiber formulations with 1.5 kcal/ml
      1. Some contain Omega-3 Fatty Acids and antioxidants which may be considered in Acute Lung Injury or ARDS
   2. Indicated for COPD, Mechanical Ventilation weaning (formulated to reduce carbon dioxide production)
   3. Preparations: Nutren, Nutrivent, Oxepa, Pulmocare
10. Renal Formulation
    1. Formulations with reduced potassium, phosphorus and Magnesium; available in low and high protein formulations
    2. High protein formulation (for renal replacement therapy): Magnacal Renal, Nepro
    3. Low protein formulation (if not ion Dialysis): Novasource Renal, Renalcal, Suplena