oral supplements

March 10th, 2016: In Service

What are Oral Nutritional Supplements? ONS are typically used in addition to the normal diet, when diet alone is insufficient to meet daily nutritional requirements. Oral nutritional supplements provide additional calories, protein, carbohydrates, fats, and vitamins and minerals to the diet.

Why are they used? ONS are used to increase protein and calorie intake. Oral nutrition supplements should be considered for any patients taking inadequate food and fluid to meet their requirements.

What types of patients often receive supplements? Patients who are malnourished- thin, weak, have lost a lot of weight Patients with increased calorie needs

o Difficulty breathing Patients with increased protein needs

o Wounds, Malnutrition Patients with poor appetites

o Oncology (cancer) patients o Patients with conditions causing confusion such as dementia

Patients who have difficulty chewing

Supplements on the Edward Hospital Formulary1

Supplement Name Properties Types of Patients Ensure Original - Standard supplement.

Contains a moderate amount of protein.

- For patients requiring additional protein and calories but who do not have any special considerations

Ensure Plus - Higher protein - Higher calories

- Malnourished, at risk for malnutrition.

- Weight gain- Conditions requiring

increased protein

Ensure Clear - Clear supplement- Contains no fat

- Patients on clear liquid diets

Oral Nutritional Supplements and Tube Feeding Formulas


- Contains less calories and protein than other supplements

- Conditions requiring low fat diets such as pancreatitis

Glucerna Shake - Contains less carbohydrates

- Patients who have diabetes

Nepro - Contains more protein- Contains less of specific

minerals: potassium, phosphorus, sodium

- Patients with end stage kidney disease who are receiving dialysis

Resource Health Shake - Consistency similar to a milkshake

- ONLY supplement that contains lactose

- No specific population- alternative to standard supplement

- Not suitable for those with lactose intolerance

Carnation Instant Breakfast - Standard supplement. Contains a moderate amount of protein.

- No specific population- alternative to standard supplement

Arginaid - Powder supplement: mix with water, juice

- Contains a special amino acid (protein) called Arginine

- For patients with wounds and pressure ulcers

What is Tube Feeding?3


Tube Feeding is other wise known as “Enteral Nutrition.” Tube feeding is nutrition provided through the GI tract via a tube, catheter, or a surgically made hole into the GI tract. It is the preferred method of feeding when patients are unable to eat enough calories on their own. Tube feedings may be administered through the nasal tube that extends into the GI tract, or directly into the stomach or intestines via a surgical hole.

Formula Name Properties Types PatientsJevity 1 Cal - Fiber fortified standard

formulaStandard formula for patients receiving tube feeding who do not have special considerations

Jevity 1.5 Cal - High calorie - Fiber fortified

May be used patients on fluid restrictions or patients with elevated energy needs

Glucerna 1.0 Cal - Reduced carbohydrate- Fiber fortified

Patients with diabetes

Glucerna 1.2 Cal - High calorie - Reduced carbohydrate- Fish Oil fortified- Fiber fortified

May be used for patients with diabetes who are on a fluid restriction or who have elevated energy needs

Nepro - Elevated protein - Lower levels of

phosphorus, sodium, potassium

- Fiber fortified

For patients with end stage kidney disease. This formula is meant especially for those on dialysis- as dialysis depletes the body of protein

Pulmocare/Oxepa - High calorie- Reduced carbohydrates- Does not contain fiber

“low residue”

For patients with COPD, respiratory failure, mechanical ventilation

The importance of distinguishing between Jevity 1 Cal vs Jevity 1.5 Cal, Glucerna 1.0 Cal vs Glucerna 1.2 CalHigher calorie formulas provide more calories in a smaller amount. Patients on fluid restrictions or with elevated calorie needs may need to receive a higher calorie formula. If a patient receives a 1 Cal formula instead of a higher calorie formula the patient may not be able to meet their calorie and protein requirements.


Quiz: Test Your Knowledge!

1. Which of the following are reasons an oral nutritional supplement may be used?a. Malnutritionb. Increased protein needsc. Increased calorie needsd. Decreased ability to chew solid foodse. All of the above

2. What is the difference between Ensure Original and Ensure Plus?a. Ensure Original has more calories than Ensure Plusb. Ensure Original is used for standard patients whereas Ensure Plus is used for

patients with end stage renal diseasec. Ensure Original has more protein than Ensure Plusd. Ensure Plus has more protein and more calories than Ensure Original

3. If a patient is lactose intolerant which supplement are they not able to have?a. Glucernab. Nepro c. Resource Health Shaked. Carnation Instant Breakfast

4. What is the ONLY oral nutritional supplement that can be ordered for patients on a “Clear Liquid Diet?” __________________

5. Name the oral nutritional supplement for those with end stage kidney disease receiving dialysis _____________.

6. Name the tube feeding formula intended for those with diabetes __________________. 7. A patient is in the ICU with respiratory failure. The patient needs to receive nutrition

through a tube feed. What formula would be appropriate for this patient? a. Pulmocareb. Neproc. Jevity 1.5 Cald. Oxepa e. a and d

8. A patient is on a fluid restriction. The patient is going to receive nutrition through a tube feed. The dietitians are trying to give all the required nutrients in the least amount of volume. Which formula will help the dietitians reduce the volume?

a. Jevity 1 Calb. Jevity 1.5 Cal


References1. Oral nutritional supplements (ONS). Available at: http://malnutritionpathway.co.uk/ons 2. Laboratories A. Abbott brands. 2015. Available at:

http://abbottnutrition.com/brands/abbott-brands [Accessed March 8, 2016].3. American College of Gastroenterology. Enteral and Parenteral nutrition. 2016. Available

at: http://patients.gi.org/topics/enteral-and-parenteral-nutrition/

oral supplements

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