Alpha PMX is gluten free and does not contain cows milk, Soya, or egg ingredients. Alpha PMX is suitable for vegetarians.
Alpha PMX for Tube Feeding
Alpha PMX is an elemental nutrient formula that supplies most nutrients except fat. PMX has been used successfully for tube feeding, sometimes long term, but addition nutrients and expert management are required. The formula is hypoallergenic, easily digested and absorbed. The nutrient values of Alpha PMX are listed on the label per 100 grams of formula. Alpha formulas are designed to supply vitamins above recommended daily allowances and mineral levels at RDA (except for lower sodium and potassium) with an intake of 300 grams per day.
300 grams of the formula supplies approx. 1100 calories of energy, a minimum daily intake to supply all nutrients. A 1000 gram bottle contains 19 * 50 gram servings. A one kilogram bottle can supply about 1100 calories per day for 3.3 days. Fat should be added in the form of vegetable and fish oil to increase caloric intake by up to 30%.
There are many concerns when tube feeding with formulas replaces eating food. While Alpha ENF and PMX are suitable for tube feeding and may solve problems created by other enteral formulas, nutrient intake must be customized to suit the specific needs of each patient. Expert medical supervision is required. We recommend that a nutrient intake analysis is done at intervals and compared with RDIs. In addition, regular blood tests are recommended to assess nutrient absorption and metabolic status. This testing should include blood counts, vitamin B12, electrolytes, kidney and liver function tests including prothrombin measurement (usually by measuring the INR) Supplemental fats, Vitamins K1 and B12 are often required. Other "accessory" nutrients that are available in food but are absent in the formulas may also be desirable in the long term. All the advice regarding supplementing a regular diet may be relevant when relying on Alpha formulas long term. The optional accessory nutrients that we find most attractive are CoEnzyme Q10 and Vitamin K2. See the companion book, Nutrition Notes for a detailed evaluation of nutrient intake recommendations and accessory nutrients.
Various enteral feeding tubes are available, classified by site of insertion and location of the distal tip of the feeding tube. A tube into the stomach is best because the stomach tolerates more variations and concentrations of ingredients including hypertonic solutions. The stomach also provides valuable digestive functions and regulates small bowel activity. Vitamin B12 absorption requires the stomach, the presence of hydrochloric acid, and intrinsic factor. An empty stomach will atrophy and will become infected with microbes that cannot survive in a normally active stomach. Feeding tubes placed in the small bowel are more problematic and should be avoided unless there is no alternative. Jejunal infusion often causes abdominal cramping and diarrhea. Tubes move, irritate the bowel wall, cause bleeding and promote infection.
Small-bore enteral feeding tubes are preferred but are more prone to clogging. Williams cites predisposing factors such as thick formulas with intact proteins, insufficient flushing, and incorrect medication administration, She recommends that tubes are flushed with 30 mL of water every four hours When feeding are intermittent tubes should be irrigated with 30 mL of water after each feeding. When medications are administered, tubes should be flushed with 15–30 mL of water before and after drug delivery. When several medications are being given at the same time, each one should be administered separately. The feeding tube should be flushed with at least 5-10 mL of water between medications.
Start with 50-gram servings every two hours or 6 times a day and increase until caloric needs are met.50 gm is about 1/2 cup of formula. Mix in 1.5 to 2.0 cups of warm water (about 90 degrees F is best.) Blend for 1 minute and administer. For the first few days it is best to add extra water to formula and administer slowly (take 10-20 minutes to add the complete serving). This gradual introduction allows the digestive tract to adjust to the input of pure nutrients.
Adding vegetable and fish oils to the formula
Add vegetable oil at the rate of one to two tablespoons per 100 grams of the formula. The addition of fat is required to supply essential fatty acids and to increase caloric intake. A combination of extra virgin olive oil and Canola oil in equal proportions is recommended. Also add omega 3 fish oil (salmon or blend of fish oils) to provide DHA daily intake of at least 500 mg. Fat intake can be increased to about 30% of daily caloric intake. Estimate vegetable oil requirement as 9 calories per gram of oil.
For example start with 100 grams of PMX (360 calories) and add 15 Grams of oil (140 calories) to supply a total of 500 calories. The recommended average daily intake for physically active adults who want to maintain current body weight is 1000 to 1500 calories. You would use 2 or 3 of the 500-calorie batches to supply daily nutrition. With added oil, the energy intake profile should be in the range of: Carbohydrate 59% Fat 30 % Amino Acids 11%.
Fat will not stay in suspension when the formula is mixed in water; add oil after the formula has been mixed with warm water in the blender and then blend another 30-40 seconds at high speed. Administer promptly. If you mix the formula and let it sit, the oil will separate and a small amount of the less soluble nutrients will settle- a quick remix in the blender may be required.
Cocktail Mixer Method.
If you do not have a blender the next best mixing method is to place the formula, warm water and oil in a closed container and shake until thoroughly mixed. Most problems with tube feeding can be solved by
Night feedings A feeding schedule that extends from 8 AM to 10 PM, for example, may work well. Sometimes, however, feedings are required overnight. An overnight fast of 8-10 hours may be well tolerated, but for many reasons blood sugar levels may drop during sleep. In normal circumstances hunger and thirst wakes a person who then eat and drinks according to body signals. If you are depending on tube feeding you may need to prepare one or two 50-gram servings and leave at the bedside in a shakeable container. Shake briefly to remix and administer.
If the formula is too concentrated (not enough water) the symptoms may be bowel cramps and possibly distension; dark yellow urine, dry mouth, dehydration. If the dose is too high bowel cramps may occur or mental fogginess, sedation or confusion might occur if high doses of amino acids reach the brain suddenly. This is uncomfortable but not harmful. If the interval between servings is too long, hypoglycemia might occur. The symptoms are hunger, anxiety, tremor, and confusion.