107 HCPCS Code B4160 www.AbbottNutrition.com PediaSure ® 1.5 Cal Ingredients Vanilla Water, Corn Maltodextrin, Blend of Vegetable Oils (High Oleic Safflower, Soy, Medium Chain Triglycerides), Milk Protein Concentrate, Soy Protein Isolate, Less than 0.5% of: Vitamins & Minerals (Potassium Citrate, Potassium Chloride, Magnesium Phosphate, Calcium Phosphate, Ascorbic Acid, Choline Chloride, Calcium Carbonate, Potassium Phosphate, Ferrous Sulfate, dl-Alpha- Tocopheryl Acetate, Zinc Sulfate, Niacinamide, Calcium Pantothenate, Manganese Sulfate, Thiamine Hydrochloride, Pyridoxine Hydrochloride, Riboflavin, Vitamin A Palmitate, Copper Sulfate, Folic Acid, Chromium Chloride, Potassium Iodide, Sodium Molybdate, Sodium Selenate, Biotin, Phylloquinone, Vitamin D3, Vitamin B12), Natural & Artificial Flavors, Cellulose Gel, Soy Lecithin, Tuna Oil*, Monoglycerides, Cellulose Gum, Potassium Hydroxide, Carrageenan, Inositol, Taurine, Sucralose, Salt, L-Carnitine, Lutein * Source of DHA. Contains milk and soy ingredients. Nutrition Information Vanilla 8 fl oz 1 L 1.5 L Protein, g 14 59 89 Total Fat, g 16 67 101 Saturated Fat, g 3.5 15 22 Polyunsaturated Fat, g 5 21 32 Monounsaturated Fat, g 7 30 44 Trans Fat, g 0 0 0 Cholesterol, mg 10 42 63 Total Carbohydrate, g 38 160 240 Dietary Fiber, g <1 1 2 scFOS, g 0 0 0 Total Sugars, g 3 11 17 Added Sugars, g 3 10 15 L-Carnitine, mg 4.0 17 25 Taurine, mg 18 76 114 Water, mL 185 780 1170 Calories 350 1500 2250 Vitamin A, mcg RAE 140 590 884 Vitamin D, mcg 6.0 25 38 Vitamin E, mg 3.0 13 19 Vitamin K, mcg 18 76 114 Vitamin C, mg 23 95 142 Folate, mcg DFE 60 253 380 Folic Acid, mcg 36 152 227 Vit B1 (Thiamin), mg 0.30 1.3 1.9 Vit B2 (Riboflavin), mg 0.33 1.4 2.1 Vitamin B6, mg 0.34 1.4 2.2 Vitamin B12, mcg 0.48 2.0 3.0 Niacin, mg NE 3.2 13 20 Choline, mg 80 338 506 Biotin, mcg 8.0 34 51 Pantothenic Acid, mg 1.3 5.3 7.9 Inositol, mg 20 84 127 Vanilla 8 fl oz 1 L 1.5 L Sodium, mg 90 380 570 Sodium, mEq 3.9 16.5 24.7 Potassium, mg 470 1983 2975 Potassium, mEq 12.1 51 76 Chloride, mg 230 970 1456 Chloride, mEq 6.5 27 41 Calcium, mg 330 1392 2089 Calcium, mEq 16.5 70 104 Phosphorus, mg 250 1055 1582 Magnesium, mg 40 169 253 Magnesium, mEq 3.3 14 21 Iodine, mcg 23 95 142 Manganese, mg 0.46 1.9 2.9 Copper, mg 0.14 0.57 0.85 Zinc, mg 1.7 7 10.4 Iron, mg 2.7 11 17 Selenium, mcg 8.0 34 51 Chromium, mcg 9.0 38 57 Molybdenum, mcg 9.0 38 57 Free Water, % 78.2 78.1 78 Vanilla Caloric Density, Cal/mL 1.5 Protein, % Cal 16 Carbohydrate, % Cal 43 Fat, % Cal 41 Omega-6:Omega-3 3:1 MCT:LCT 10:90 Total Cal:g Nitrogen 158:1 Nonprotein Cal:g Nitrogen 133:1 Osmolality, mOsm/kg H2O 400 Renal Solute Load, mOsm/L 413 Recommended Tube Size for Gravity/Pump Feeding (Fr) 10/10 Technical Data PEDIASURE ® 1.5 CAL