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%.
Special Requirements
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.
PMX Instructions
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
- adding extra water
- increasing the time taken to administer the formula
- reducing the dose per serving
- increasing the frequency of servings.
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.
Mix Alpha PMX with fresh or frozen fruits, vegetables, or juices in a blender and be healthy. Alpha PMX is an all-propose meal replacement
formula. Packaged as a dry powder in 1000 gram jars. PMX is mixed with with vegetable
oil to make a complete meal. Before you order, we want you to be well educated about PMX ingredients, nutrient
values and uses. Alpha PMX is gluten free and does not contain cows milk, Soya,
or egg ingredients.
Alpha PMX is suitable for vegetarians.
A summary of PMX information is available in the Adobe PDF eBook
format for free download
Download Book of Alpha PMX
New Formula Orders If you are ordering Alpha PMX for the first time, we
limit formula orders to one jar. You need to evaluate the formula and learn how
to use it properly before you order more. We also want you to read our books and
become well-informed. If you believe you have allergy or intolerance to vitamins,
minerals, oils, or sugars please review our ingredient lists carefully before you
order.
Order Alpha PMX
Alpha Nutrition products and services are ordered at Alpha Online. We ship
through the Post Office to all destinations in Canada and the USA.
Prices are quoted in Canadian dollars.
US $ cost
is less depending on the dollar exchange
rate.
Alpha Nutrition ® is a registered trademark and a division of Environmed
Research Inc., Sechelt, British Columbia, Canada. In business since 1984. Online
since 1995.
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