128 Pivot ® 1.5 Cal Peptide-Based, High Protein, Therapeutic Nutrition for Metabolic Stress Usage PIVOT 1.5 CAL is peptide-based complete, balanced therapeutic nutrition for short- or long-term tube feeding for metabolically stressed surgical, trauma, burn, or head and neck cancer patients who could benefit from an immune-modulating enteral formula. • For tube feeding. • For sole-source or supplemental nutrition. • Use under medical supervision. Features • Provides very high protein (93.8 g/L, 25% of calories) to support protein synthesis, tissue repair and wound healing. 1,2 • Provides 1.5 Cal/mL—concentrated calories for fluid- restricted patients. • Immune support: • L-Arginine (13 g/L, 3.5% of calories) to support proliferation and function of immune cells. 2 • L-Glutamine (inherent) (7.6 g/L) for GI-tract integrity and energy for immune cells. 3,4 • Omega-3 fatty acids (EPA, 2.6 g/L; DHA, 1.1 g/L) to help modulate inflammation and support immune function. 5,6 • Tolerance: • Advanced blend of hydrolyzed protein, structured lipid, and prebiotics (scFOS) to promote absorption and tolerance. • Hydrolyzed, peptide-based protein system. • MCT/fish oil structured lipid, a well-tolerated 7,8 and absorbed 8 next-generation fat to promote absorption of fatty acids. • 1.8 g of scFOS/8 fl oz (7.5 g/L). scFOS are prebiotic soluble fibers that stimulate the growth of beneficial bacteria in the colon. 9 • Elevated antioxidants vitamins C and E, selenium and beta carotene to help reduce tissue and cell damage due to oxidative stress. 10,11 • 1950 Calories (1300 mL) provide at least 100% of the RDIs for 25 essential vitamins and minerals. • Halal, gluten-free, suitable for lactose intolerance. Precautions • Not for IV use. • Not for people with galactosemia. Availability List No. NDC Format Code — 33.8-fl oz ( 1.0-L) Ready to Hang Prefilled Container; 8/case Unflavored . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62719 . . . . . . . . . . . . 70074-0627-20 — 8.0-fl oz ( 237.0-mL) Recloseable Carton; 24/case Unflavored . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65007 . . . . . . . . . . . 70074-0650-06 1 Demling RH. Eplasty. 2009;9:65-94. 2 Weitzel LR, et al. Curr Opin Anaesthesiol. 2009;22(2):177-183. 3 Rao RK, et al. J Epithel Biol Pharmacol. 2012;5(Suppl 1-M7):47-54. 4 Cruzat V, et al. Nutrients. 2018;10(11):1564-1594. 5 Calder PC. Prostaglandins Leukot Essent Fatty Acids. 2008;79(3-5):101-108. 6 Calder PC. Clin Nutr. 2010;29(1):5-12. 7 Kenler AS, et al. Ann Surg. 1996;223(3):316-333. 8 McKenna MC, et al. J Pediatr Gastroenterol Nutr. 1985;4(1):45-51. 9 Robertfroid, M. et al. British Journal of Nutrition 2010;104:S1-S63. 10 Institute of Medicine (US) Panel on Dietary Antioxidants and Related Compounds. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington (DC): National Academies Press (US);2000. 11 Sies H. Redox Biol. 2015;4:180-183. Pivot 1.5 Cal -Vital Peptide 1.5 Cal 128