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Prod ID Product RFO Description Qualifying Conditions Staff Guidance Manufacturer/ Packaging 16 (CI) Ketonex- 1 (14.1 oz. Powder) 96.00 Special Medical Conditions - Metabolic: branched-chain amino acid-free, lactose-free, gluten-free; nutritionally incomplete Must be supplemented with protein and fluid in prescribed amounts to completely meet isoleucine, leucine, valine and water requirements.

1 Tbsp powder = 8 g; preparation and dilution only as directed by a physician

RFO is calculated based on mixing to 20cal/oz

Allergens by Nature: Coconut and Soy 1. Maple Syrup Urine Disease (MSUD) 2. Beta-ketothiolase deficiency Limitations: Can only issue to infants and children.

Requirements: Metabolic formulas must be approved by District Nutrition Director or State WIC Office Abbott 6 cans/case unflavored 82 (CI) Ketonex- 2 (14.1 oz. Powder) 65.00

Special Medical Conditions - Metabolic: Branched-chain amino acid-free, lactose-free, gluten-free, Not intended as a sole source of nutrition; nutritionally incomplete. Must be supplemented with protein and fluid in prescribed amounts to completely meet isoleucine, leucine, valine and water requirements.

1 Tbsp powder = 8 g; Preparation and dilution only as directed by a physician

RFO is calculated based on mixing to 30cal/oz

Allergens by Nature: Coconut and Soy 1. Maple Syrup Urine Disease (MSUD) 2. Beta-ketothiolase deficiency Limitations: Can only issue to children 12 months to 5 years old and women.

Requirements: Metabolic formulas must be approved by District Nutrition Director or State WIC Office Abbott 6 cans/case unflavored 231 (CI) Lipistart (14.1 oz Powder) 80.00 Special Medical Conditions - Metabolic: high MCT, low LCT, nutritionally complete formula. Suitable as sole source of nutrition for infants. Can be used as a supplementary feed from 1 to 10 years of age.

Standard dilution of 20cal/oz is made by adding 1 level scoop (5g) to 1 fl oz water.

Allergens by Nature: Milk 1. Long chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) 2. Very long chain acyl-CoA dehydrogenase deficiency (VLCADD) 3. Other Long-chain fatty acid oxidation 4. Other disorders requiring dietary management using a high MCT, low LCT formula Limitations: Can only issue to infants and children.

Requirements: Metabolic formulas must be approved by District Nutrition Director or State WIC Office Vitaflo 6 cans/case 200 (CI) Liquigen (8.5 fl oz.) 8.50 Modular: 45 cal/10 ml; Emulsion of 50% MCT oil and 50% water; nutritionally incomplete.

Allergens by Nature: Coconut Conditions where MCTs are part of dietary management, such as: 1. Conditions managed by the medical ketogenic diet 2. Long-chain fatty acid oxidation disorders 3. Chylothorax 4. Fat malabsorption 5. Short bowel syndrome

No Limitations: May issue to infants, children, and women.

Liquigen may require dilution for children under 5 years of age. Follow physician's directions.

Requirements: Modular formulas must be approved by District Nutrition Director or State WIC Office Nutricia 12 containers/case