KetoCal 4:1 Powder is a Food for Special Medical Purposes for use in the dietary management of drug resistant epilepsy or other conditions for which the ketogenic diet is indicated, providing complete nutritional support or supplementary feeding from 1-10 years of age and may be used for supplementary feeding over the age of 10 years. Must be used under medical supervision. Only to be prescribed on the advice of a secondary care physician with experience of a ketogenic diet. KetoCal 4:1 Powder is suitable as the sole source of nutrition for children aged 1-10 years, or for supplementary feeding over the age of 10 years. For enteral use only. Monitor for hypoglycaemia, renal stones, hyperlipidaemia and adequate growth.

The recommended feed dilution is 14.2% w/v (i.e. 14.2g KetoCal 4:1 Powder plus 86ml water to give a final volume of 100ml)*. For sip and tube feeding:

1. Measure the required amount of warm water into a container that seals with a screw top lid. KetoCal 4:1 Powder must be made up with hot water (45-50°C or 113-122°F) to fully dissolve.
2. Measure the temperature using a thermometer or mix freshly boiled water and cold tap water in a 1:1 ratio to achieve this temperature. Add the prescribed amount of KetoCal 4:1 Powder to the water.
3. Whisk or shake vigorously until the powder is completely dissolved. Remove the lid carefully.
4. Chill in a refrigerator if desired and use within 24 hours of preparation. Stir before use.
5. On standing, some settling of KetoCal 4:1 Powder may occur which is a normal feature of the product. This settling should not block an enteral tube, however it is recommended that the tube is flushed with water between each feed.
6. If given orally, best served chilled.
7. To ensure that this high fat feed is tolerated when first introducing a ketogenic diet, a less concentrated feed or lower feed volume may need to be provided initially.
   *A more concentrated dilution may be medically prescribed based on individual requirements.

Unflavoured: Refined vegetable oils (palm oil, soy oil, sunflower oil), milk protein (casein, whey), soy lecithin, dietary fibres (cellulose, inulin, oligofructose, arabic gum, resistant starch, soy polysaccharides), calcium carbonate, dried glucose syrup, anti-caking agent (E551), calcium phosphate tri basic, tri potassium citrate, potassium chloride, sodium chloride, magnesium acetate, L-arginine, L-cystine, choline bitartrate, high arachidonic acid single cell vegetable oil, high docosahexaenoic acid oil from crypthecodinium cohnii, L-tryptophan, maltodextrin, sodium caseinate (from cow's milk), sodium ascorbate, L-phenylalanine, L-ascorbic acid, L-valine, L-tyrosine, L-carnitine, taurine, ferrous sulphate, emulsifier (E471), DL- ɑ tocopheryl acetate, inositol,L-histidine, zinc sulphate, nicotinamide, calcium D-pantothenate, manganese sulphate, copper sulphate, thiamin hydrochloride, pyridoxine hydrochloride, riboflavin, vitamin A acetate, antioxidants (E304, E306), folic acid, potassium iodide, sodium molybdate, chromium chloride, sodium selenite, vitamin K1, D-biotin, vitamin D3, cyanocobalamin. For Vanilla flavour, please see individual packaging. Allergy Advice: For allergens, see ingredients in bold.