Is there a TF Formula Without Milk or Soy?

[SweetOldWorld]

I have a patient who is unable to swallow, and has a G-tube. This patient is allergic to milk, soy and eggs. The dietician says there is no formula which does not contain milk or soy, and is recommending the patient go home on TPN through a central line. I can't believe there is no formula made for people with such allergies! Does anyone know of a suitable formula?

:typing

Thanks for your help!

[NotReady4PrimeTime, RN]

We use Neocate in our older kids and teenagers who have ESRD because it contains no protein. If we can feed it to teenagers, you can feed it to your grown-up. I'm not sure that the cost would necessarily be higher than TPN and lipid over the long term. Home TPN still requires nursing followup and home nutrition clinic visits plus the cost of supplies for PICC maintenance. Enteral nutrition is safest in the home setting.

[core0]

Just a dose of reality though, the infant formulas that are cooked up in labs without all the allergens are SUPER expensive for babies, that would need a fraction of the volume an adult would. Once you get into specialty formulas, TPN and lipids may actually end up being cheaper, even if not the preferred solution. So even if you get the problem solved, you may end up in the world of problems of how to pay for it.

Its a relative cost difference. Even the most expensive formulas are 1/4th the cost of TPN (cost not what the hospital bills). Also there is significant mortality and morbidity associated with TPN that is not present with enteral nutrition. The only time that TPN should be used is in the absence of a functioning gut. Even if it were true that EN was more expensive than TPN it would be inexcusable to use TPN given its side effects, costs and dangers. Payment can be an issue but most of the time you can get these paid for as medical foods if you work at it.

We use Neocate in our older kids and teenagers who have ESRD because it contains no protein. If we can feed it to teenagers, you can feed it to your grown-up. I'm not sure that the cost would necessarily be higher than TPN and lipid over the long term. Home TPN still requires nursing followup and home nutrition clinic visits plus the cost of supplies for PICC maintenance. Enteral nutrition is safest in the home setting.

Umm you should really look at the PI for Neocate. It is specifically not indicated for those over 1 year of age. The mineral and lipid profile is completely wrong for those age groups and will lead to growth deficiencies. Neocate junior is indicated up to age 10 (or neocate 1+). Over that Vivonex is probably the best choice for allergy. I am unsure why you would be using Neocate when there are a ton of renal specific formulas that are better for the patient, cost less and taste better (well the taste is a relative thing). I would suggest a good pediatric dietician to help sort this out.

To the OP the best suggestions I can give is suggest to the patient or the patients POA that a consult with a dietician versed in food allergy may be in the best interest of the patient. Given the side effects associated with TPN its hard to justify it in this case (with the information given).

David Carpenter, PA-C