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 Formulary Chapter 9: Nutrition and blood - Full Section
Notes:

 Principles of using Oral Nutritional Supplements (ONS)

 

FIRST LINE Option

ONS Option

Food First

[Dietary measures (food fortification, increased frequency, nutritious snacks and drinks - using everyday ordinary foods)]

 Please note:- hygiene considerations/infection control

Except where patient has special dietary

requirements/ restrictions

·         Supplements should be given in-between meals and snacks NOT INSTEAD OF MEALS.

 

·         Most supplements contain milk – in diagnosed /milk intolerance – refer to dietitian

 

 

 

Homemade milkshake

 

Exceptions:-

·         Lactose intolerance

·         Milk allergy or intolerance

·         CKD 4 and 5

·         Tube feed patients (not licensed)

·         Cannot be prepared (dexterity issues, lack of carer support, hygiene considerations/infection control)

·         Liver/hepatobiliary and pancreatic disease/conditions.

 

 

Preferred option: Powdered Feeds

Alternative option, where powdered feed is unsuitable:

Ready-made/ready to drink feeds (e.g. bottled)

Make up with whole (full fat) milk

Exceptions:

·         Lactose intolerance

·          Milk allergy or intolerance

·         CKD 4 and 5

·         Tube feed patients (not licensed)

·         Cannot be prepared (dexterity issues, lack of carer support, hygiene considerations/infection control)

Note – can be made in a smaller volume, on the advice of a dietitian, for volume intolerance.

·         Unable to tolerate large amounts of lactose

·         Cannot be prepared (dexterity issues, lack of carer support, hygiene considerations/infection control - while in acute setting)

Dietary advice sheets and guidance available from local nutrition and dietetic services.

Please note- Not all patients will be able to meet their specific nutritional requirements with food first measures alone and supplements are required for some conditions e.g. very high protein requirement in liver transplantation, sarcopenia. The supplements will be recommended by the specialist dietitian.

Review criteria

·         All patients on ONS should be monitored and for adult patients an appropriate nutritional screening tools should be used (e.g. MUST, Birmingham learning disability screening tool).

·         Review the MUST score at least every 3 months or as advised by specialist dietitian

·         Patients on active dietitian case load will be monitored upto the point of discharge.

·         If no dietetic input, other healthcare professionals should monitor ONS for its effectiveness.

·         Please contact your local dietetic service for advice, guidance or referral criteria.

 

 

 

 

Numbers in brackets indicate counts of (Formulary items, Non Formulary items)
09.01 Anaemias and some other blood disorders (1,0)
09.01.01 Iron-deficiency anaemias (0,0)
09.01.01.01 Oral iron (6,2)
Iron and folic acid (1,2)
Compound iron preparations (0,2)
09.01.01.02 Parenteral iron (3,1)
09.01.02 Drugs used in megaloblastic anaemias (2,1)
09.01.03 Drugs used in hypoplastic, haemolytic, and renal anaemias (1,2)
Erythropoietin (3,2)
Iron overload (3,0)
09.01.04 Drugs used in autoimmune thrombocytopenic purpura (3,0)
09.01.05 G6PD deficiency (0,0)
09.01.06 Drugs used in neutropenia (3,0)
09.01.07 Drugs used to mobilise stem cells (0,0)
09.02 Fluids and electrolytes (0,0)
09.02.01 Oral preparations for fluid and electrolyte imbalance (0,0)
09.02.01.01 Oral potassium (3,1)
Potassium removal (1,0)
09.02.01.02 Oral sodium and water (1,1)
Oral rehydration therapy (ORT) (1,0)
09.02.01.03 Oral bicarbonate (1,1)
09.02.02 Parenteral preparations for fluid and electrolyte imbalance (0,0)
09.02.02.01 Electrolytes and water (0,0)
Intravenous sodium (0,0)
Intravenous glucose (0,0)
Intravenous potassium (0,0)
Bicarbonate and lactate (0,0)
Water (1,0)
09.02.02.02 Plasma and plasma substitutes (0,0)
Plasma substitutes (1,8)
09.03 Intravenous nutrition (0,0)
Supplementary preparations (0,0)
09.04 Oral nutrition (116,92)
Nutritional supplements for metabolic diseases (1,0)
Glutaric aciduria (type 1) (5,2)
Glycogen storage disease (2,0)
Homocystinuria or hypermethioninaemia (8,4)
Hyperlysinaemia (0,2)
Isovaleric acidaemia (1,0)
Maple syrup urine disease (11,0)
Methylmalonic or propionic acidaemia (2,3)
Other inborn errors of metabolism (10,5)
Phenylketonuria (24,11)
Tyrosinaemia (10,4)
ALD (2,0)
Other powder feeds (1,0)
Rarely Used (0,5)
09.04.01 Foods for special diets (11,1)
09.04.02 Enteral nutrition (41,1)
09.05 Minerals (0,0)
09.05.01 Calcium and magnesium (0,0)
09.05.01.01 Calcium supplements (3,0)
09.05.01.02 Hypercalcaemia and hypercalciuria (2,1)
09.05.01.03 Magnesium (4,2)
09.05.02 Phosphorus (0,0)
09.05.02.01 Phosphate supplements (3,0)
09.05.02.02 Phosphate-binding agents (6,1)
09.05.03 Fluoride (3,0)
09.05.04 Zinc (1,0)
09.05.05 Selenium (1,0)
09.06 Vitamins (0,0)
09.06.01 Vitamin A (3,3)
09.06.02 Vitamin B group (5,0)
Oral vitamin B complex preparations (1,3)
Other compounds (0,0)
09.06.03 Vitamin C (1,0)
09.06.04 Vitamin D (6,4)
09.06.05 Vitamin E (1,1)
09.06.06 Vitamin K (4,0)
09.06.07 Multivitamin preparations (4,6)
Vitamin and mineral supplements and adjuncts to synthetic diets (6,1)
09.07 Bitters and tonics (0,4)
09.08 Metabolic disorders (0,0)
09.08.01 Drugs used in metabolic disorders (1,3)
Wilsons disease (2,1)
Carnitine deficiency (0,1)
Fabry's disease (0,2)
Gaucher's disease (1,2)
Mucopolysaccharidosis I (0,1)
Pompe disease (0,1)
Nephropathic cystinosis (1,0)
Urea cycle disorders (0,4)
09.08.02 Acute porphyrias (0,1)
Drugs unsafe for use in acute porphyrias (0,0)
09.09 Feed thickeners and pre-thickened drinks (5,0)
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