Caregiver’s Guide to the
Ketogenic Diet
and KetoCal
®
KetoCal
®
Table of Contents
Section 1:
General Information about the Ketogenic Diet............................2
Section 2:
What is KetoCal®?.......................................................................................5
Section 3:
How Is KetoCal Helpful in the Ketogenic Diet?............................6
Section 4:
Cooking with KetoCal...............................................................................7
Section 5:
KetoCal Nutrition Information.............................................................8
Section 6:
Directions for Preparation, Use and Storage..............................11
Section 7:
Ordering and Reimbursement Information ................................12
Section 8:
Important Contacts and Provider Notes......................................14
Please note that this guide is intended for caregivers in the United States only.
The information included may not be accurate for caregivers outside of the US.
KetoCal should be used under medical supervision.
C A R E G I V E R ’ S G U I D E TO T H E K E TO G E N I C D I E T A N D K E TO C A L ®
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Section 1: General Information about
the Ketogenic Diet
Ketogenic Diet – 4:1 Ratio
Ketogenic Diet – 3:1 Ratio
Percentage of Calories
Percentage of Calories
10%
Protein
+ Carb
Typical American Diet*
Percentage of Calories
13%
Protein
+ Carb
35%
Fat
What is the ketogenic diet?
The ketogenic diet is a special high-fat, low-carbohydrate diet
that is used for the dietary management of seizures in children
with intractable epilepsy, as well as for certain metabolic
disorders, including GLUT1 Deficiency Syndrome and Pyruvate
Dehydrogenase Deficiency. The ketogenic diet is strictly controlled
and precisely calculated. It should only be used under close medical
and nutritional supervision1.
How effective* is the ketogenic diet?
Research shows that just over half of children on the ketogenic
diet will have 50% or more improvement in seizures2. About 1/3
of children will have over 90% improvement in seizures and about
10-15% will become seizure-free. In addition to seizure control, the
ketogenic diet has been reported to help improve sleep quality3,
behavior4, and quality of life5.
What is the ketogenic ratio?
The ketogenic ratio describes the amount of fat in the diet compared
to the amount of protein plus carbohydrate in the diet. The
healthcare provider determines which ratio is most appropriate for
the needs of each patient. The traditional ketogenic diet is usually a
4:1 ratio, however, adolescents and children under the age of 2 are
sometimes started on a 3:1 ratio to allow for more protein in the
diet1. A 4:1 ketogenic diet provides 4 grams of fat for every 1 gram
of carbohydrate plus protein while 3:1 ketogenic diet provides 3
grams of fat for every 1 gram of carbohydrate plus protein. Another
1 Kossoff EH, Freeman J, Turner Z, Rubenstein J. Ketogenic Diets: Treatments for Epilepsy and Other Disorders;
Fifth Edition. Demos Health Publishing, NY, NY, 2011.
2 Freeman JM, et al. The efficacy of the ketogenic diet-1998: a prospective evaluation of intervention in 150
children. Pediatrics. 1998 Dec;102(6):1358-63.
3 Hallböök T, et al. Ketogenic diet improves sleep quality in children with therapy-resistant epilepsy. Epilepsia.
2007 Jan;48(1):59-65
4 Hallböök T, et al. The effects of the ketogenic diet on behavior and cognition. Epilepsy Res. 2012
Jul;100(3):304-9.
5 Kayyali HR, et al. Ketogenic diet efficacy in the treatment of intractable epileptic spasms. Pediatr Neurol. 2014
Mar;50(3):224-7.
90% Fat
87% Fat
50%
Carbohydrate
15%
Protein
* Adapted from: Freedman MR, King J, Kennedy E. Popular diets: a scientific review. Obes Res 2001; 9(suppl
1):3S,11S,12S.
way to look at this ratio is by the percentage of calories provided
by each energy source. Fat provides more calories per gram than
carbohydrates and protein, so a 4:1 ketogenic diet provides 90% of
calories from fat and a 3:1 ketogenic diet provides 87% of calories
from fat.
How does the ketogenic diet work?
With a typical diet, the body uses mostly glucose (carbohydrate) for
energy. The ketogenic diet limits the number of carbohydrates in the
diet while increasing the intake of fat so that the body uses fat for
energy instead.
For some patients with epilepsy, this change in the body’s energy
metabolism helps manage seizures. It is still not known exactly why
this change in the source of energy can reduce seizures in some
patients. When the body burns fat for energy, it produces ketone
bodies or “ketones”, which build up in the blood. One theory is that the
ketones contribute to improved seizure control, however, its possible
that there are other factors not yet known.6
For patients with GLUT1 Deficiency Syndrome or Pyruvate
Dehydrogenase Deficiency, it is better understood how the diet
works. With these conditions, the body is unable to properly
metabolize carbohydrates, so the ketones produced by the
ketogenic diet provide an alternative source of energy.
6 Kossoff EH, Freeman J, Turner Z, Rubenstein J. Ketogenic Diets: Treatments for Epilepsy and Other Disorders;
Fifth Edition. Demos Health Publishing, NY, NY, 2011.
* Efficacy is different for each individual. Consult with your healthcare professional to determine efficacy for your child.
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How long do individuals typically stay on the diet?
The ketogenic diet is usually maintained for at least 2 years if it is
effective7*. After this time, the healthcare provider may recommend
weaning off the diet. Many children are able to come off the diet
without worsening of seizures.
For patients with Glut1 Deficiency Syndrome and Pyruvate
Dehydrogenase Deficiency, the ketogenic diet is often used for a
much longer period and sometimes for life8.
Which type of seizures can the ketogenic diet help
manage?
The ketogenic diet can help manage different kinds of seizures
and forms of epilepsy. Research suggests that the ketogenic diet
may be particularly beneficial for patients with myoclonic-astatic
epilepsy (aka Doose syndrome), Rett syndrome, Glut1 Deficiency
Syndrome, tuberous sclerosis complex, Dravet syndrome and
children on a formula-only ketogenic diet, taken orally or through a
feeding tube9.
Are there any adverse effects of the
ketogenic diet?
There may be side effects associated with a ketogenic diet, which
is why it should only be used under medical supervision. The most
commonly reported side effects are gastrointestinal disturbances
such as constipation, nausea, vomiting, or diarrhea10. Consult
with your child’s healthcare provider to learn more about
potential side effects and how to manage them.
7 Martinez CC, Pyzik PL, Kossoff EH. Discontinuing the ketogenic diet in seizure-free children: recurrence and
risk factors. Epilepsia. 2007 Jan;48(1):187-90.
8 Veggiotti P & De Giorgis V. Dietary Treatments and New Therapeutic Perspective in GLUT1 Deficiency
Syndrome. Curr Treat Options Neurol. 2014 May;16(5):291.
9 Kossoff EH, Zupec-Kania BA, Amark PE, et al. Optimal clinical management of children receiving the ketogenic
diet: recommendations of the international ketogenic diet study group. Epilepsia. 2009;50(2):304-317.
10 Kang HC, Chung DE, Kim DW, Kim HD. Early- and late-onset complications of the ketogenic diet for
intractable epilepsy. Epilepsia. 2004 Sep;45(9):1116-23.
Section 2: What is KetoCal ?
®
What is KetoCal?
KetoCal is a family of nutritionally-complete, ketogenic medical
foods for children age 1 and up with intractable epilepsy, Glut1
Deficiency Syndrome, or Pyruvate Dehydrogenase Deficiency who
are following a ketogenic or modified Atkins™ diet.
KetoCal comes in both a 3:1 and a 4:1 ratio, depending on the
ketogenic ratio that is recommended by the healthcare provider. It is
available in vanilla or unflavored, and as a ready-to-feed liquid or an
easy-to-prepare powder.
KetoCal can be taken as a drink, used as an on-the-go substitute for
a meal and even used as the sole source of nutrition.* It can
also be used in cooking and baking to create more palatable
ketogenic recipes. KetoCal is appropriate for oral consumption or
tube-feeding. KetoCal should only be used under the direction and
supervision of a health care professional.
*KetoCal products should be used for individuals over 1 year of age. KetoCal may be
suitable as a sole source or supplemental nutrition depending on the age and caloric
needs of the individual.
Product Features
Benefits to You
4:1 or 3:1 ratio of fat to
carbohydrates and protein
Ketogenically balanced,
whether one sip or an entire
serving is consumed
2 flavors to choose from
Flavor and recipe options for
even the pickiest eaters
Nutrient dense for children with
low-energy needs
Helps meet nutritional needs
with low volume
Convenient ready-to-feed liquid
or easy-to-prepare powder
Choose the form that best fits
your lifestyle!
* Efficacy is different for each individual. Consult with your healthcare professional to determine efficacy for your child.
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Section 3: How is KetoCal Helpful in
the Ketogenic Diet?
KetoCal’s ease of preparation and convenience help make the
ketogenic diet more manageable for caregivers. Below are just a few
of the ways that KetoCal can be helpful.
Nutritional Reassurance
Section 4: Cooking with KetoCal
Cooking with KetoCal adds variety and texture to create more
palatable and nutritious ketogenic recipes. Visit MyKetoPlanner.com
to find a wide variety of ketogenic recipes, including pizzas, pancakes,
muffins, smoothies, soups, and more. By registering on MyKetoPlanner
and connecting your account to your healthcare provider, you are able
to adjust and personalize these recipes to meet your child’s diet needs.
KetoCal provides complete nutrition and can help fill in the
nutritional gaps of the ketogenic diet.11 Parents can rest assured
knowing that their child is getting the right ketogenic ratio and the
right nutrition from KetoCal.
Help for Picky Eaters at Mealtime
We don’t have to tell you that meal-time can be challenging.
KetoCal’s smooth, sweet taste and kid-friendly drink box were
designed to be accepted by even the pickiest of eaters. Because it is
ketogenically balanced and nutritionally complete, KetoCal makes
mealtime a little less stressful for mom and dad too.
Solution for Sick Days
KetoCal can be helpful for sick days when your child is not hungry
for a solid meal. Because KetoCal has a consistent ketogenic ratio,
you don’t have to worry that the ratio is off if they don’t finish it.
Travel Convenience
KetoCal is easily transported as a ready-to-drink liquid or an
easy-to-prepare powder. It’s great for vacations and outings when
you don’t have access to a kitchen.
Peace-Of-Mind For Meals Without Mom Or Dad
KetoCal is an easy meal substitute to provide at times when the
usual “ketogenic chef” is unavailable. KetoCal works great for
daycare, school days, babysitters and play dates!
Quick Solution for Unexpected Situations
Working late, stuck in traffic, or forgot to pack the lunch box? Keep
some KetoCal on hand for unexpected situations.
11 Zupec-Kania B, Zupanc ML. Long-term management of the ketogenic diet: seizure monitoring, nutrition, and
supplementation. Epilepsia. 2008;49 Suppl 8:23-6. 6
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Section 5: Nutrition Information
The following nutrition information refers to the US versions of
KetoCal products only.
KetoCal® 4:1 Powder
Nutrients
Per 100 g Per 100 kcal Minerals, Trace Elements Per 100 g Per 100 mL
Energy, kcal (kJ)
705 (2950)100 (411) Calcium, mg
700
99.3
Protein, g
14.4
2.0
Phosphorus, mg
420
59.6
Carbohydrate, g
8.2
1.2
Magnesium, mg
96.3
13.7
Fiber, g
5.3
0.75
Iron, mg
7.0
0.99
Soluble, g
3.2
0.45
Zinc, mg
3.6
0.51
Insoluble, g
2.1
0.30
Manganese, mg
0.83
0.12
Fat, g
69.2
9.8
Copper, mg
0.50
0.071
Saturated, g
26.7
3.8
Iodine, mg
0.0862 0.0122
Monounsaturated, g
22.8
3.2
Molybdenum, mg
0.0287 0.0041
Polyunsaturated, g
19.7
2.8
Chromium, mg
0.0148 0.0021
Arachidonic Acid, mg
120
17.0
Selenium, mg
0.027
0.0038
Docosahexaenoic Acid, mg110
15.6
Sodium, mg
481
68.2
Vitamins
Potassium, mg
771
109
Vitamin A, IU (mcg)
1232 (370) 175 (52.5) Chloride, mg
726
103
Vitamin D, IU (mcg)
420 (10.5) 59.6 (1.5) L-Carnitine, mg
45.0
6.4
Vitamin E, IU (mg α TE)
15.9 (10.7) 2.3 (1.5) Taurine, mg
33.04.7
Vitamin K, mg
0.031
0.0044
Thiamin, mg
0.89
0.13
Riboflavin, mg
0.70
0.10
0.70
0.10
Vitamin B6, mg
0.0013 0.00018
Vitamin B12, mg
Niacin, mg
4.9
0.70
Folic Acid, mg
0.116
0.0165
Pantothenic acid, mg
2.9
0.41
Biotin, mg
0.0191 0.0027
Vitamin C, mg
40.0
5.7
* Standard Dilution = 1 kcal/mL
Choline, mg
320
45.5
Fiber is not included in calculating the
Inositol, mg
19.1
2.7
ketogenic ratio
Ingredients:
Refined Vegetable Oils (Palm, Soy, High Oleic Sunflower), Casein (Milk), Soy Lecithin, Whey
(Milk), Microcrystalline Cellulose, Chicory Root Inulin, Calcium Carbonate, Corn Syrup Solids,
Fructooligosaccharide (FOS), Silicon Dioxide, Gum Arabic, Tripotassium Citrate, Potassium
Chloride, Sodium Chloride, Calcium Phosphate Tribasic, High Amylose Corn Starch, Artificial
Flavor (Vanilla), L-Arginine, L-Cystine, Choline Bitartrate, M. Alpina Oil*, C. Cohnii Oil**, Soy Fiber,
L-Tryptophan, Magnesium Oxide, Sodium Caseinate (Milk), Sodium Ascorbate, L-Phenylalanine,
Maltodextrin, L-Ascorbic Acid, L-Valine, L-Tyrosine, L-Carnitine, Taurine, Ferrous Sulfate, Monoand Diglycerides, DL-alpha Tocopheryl Acetate, Sucralose§,M-Inositol, L-Histidine, Zinc Sulfate,
Niacinamide, Calcium D-Pantothenate, Manganese Sulfate, Cupric Sulfate, Thiamine Chloride
Hydrochloride, Pyridoxine Hydrochloride, Riboflavin, Vitamin A Acetate, Ascorbyl Palmitate,
Mixed Tocopherols, Folic Acid, Potassium Iodide, Sodium Molybdate, Chromium Chloride, Sodium
Selenite, Phylloquinone, D-Biotin, Cholecalciferol, Cyanocobalamin.
Contains: Milk, Soy
* A source of Arachidonic Acid (ARA)
** A source of Docosahexaenoic Acid (DHA)
§ Contains sucralose 14.2 mg/100 mL
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KetoCal® 4:1 Liquid - Unflavored and
Vanilla
Nutrition Information:
Per
Per Tetra Pak
Nutrients
100 mL
(237 mL)
Calories
150356
Protein, g
3.09
7.32
Carbohydrate, g
1.73
4.10
Fiber, g 1.12
2.65
Soluble, g
0.56
1.33
Insoluble, g
0.56
1.33
Fat, g
14.8
35.1
Saturates, g 2.2
5.2
Monounsaturates, g
8.3
19.7
Polyunsaturates, g
3.7
8.8
Linoleic Acid, mg 3228
7650
a-Linolenic Acid, mg 313
741
DHA, mg
55
131
ARA, mg
55
131
Vitamins
Vitamin A, IU (mcg R.E.) 2
64 (79.2) 626 (188)
Vitamin D, IU (mcg)
92.0 (2.3) 220 (5.5)
Vitamin E, IU (mg a T.E.) 2.3 (1.5)
5.5 (3.6)
Vitamin K, mcg
5.6
13.3
Thiamine, mg
0.19
0.45
Riboflavin, mg
0.15
0.36
0.15
0.36
Vitamin B6, mg
0.17
0.40
Vitamin B12, mcg
Niacin, mg
1.5
3.6
Folic Acid, mcg
28.7
68.0
Pantothenic Acid, mg
0.62
1.5
Biotin, mcg
4.1
9.7
Vitamin C, mg
9.3
22.0
Choline, mg
51.5
122
Inositol, mg
4.1
9.7
Per Per Tetra Pak
Minerals, Trace Elements100 mL (237 mL)
Calcium, mg
88.4
210
Phosphorus, mg
88.4
210
Magnesium, mg
22.7
53.8
Iron, mg
1.5
3.6
Zinc, mg
1.2
2.8
Manganese, mg
0.18
0.43
Copper, mcg
120
284
Iodine, mcg
18.5
43.8
Molybdenum, mcg
6.2
14.7
Chromium, mcg
3.2
7.6
Selenium, mcg
7.1
16.8
Sodium, mg
103
244
Potassium, mg
165
391
Chloride, mg
155
367
L-Carnitine, mg
8.3
19.7
Taurine, mg
6.3
14.9
Fiber is not included in calculating the
ketogenic ratio.
Ingredients:
Water, Refined Vegetable Oil (High Oleic Sunflower, Soy, Palm), Sodium Caseinate (Milk), Whey
Protein Concentrate (Milk), Soy Fiber, Corn Starch, Inulin, CAEM (an Emulsifier), Dipotassium
Phosphate, Gum Arabic, Calcium Chloride, M. Alpina Oil*, Magnesium Acetate, Potassium
Chloride, C. Cohnii Oil**, Microcrystalline Cellulose, Fructooligosaccharide , L-Ascorbic Acid,
Calcium Phosphate Monobasic, Mono and Diglycerides, Trisodium Citrate, Sodium Hydroxide,
Choline Chloride, L-Cystine, Calcium Phosphate Dibasic, Propylene Glycol Alginate, Ferrous
Lactate, L-Carnitine, Taurine, M-Inositol, L-Tryptophan, Zinc Sulfate, DL-Alpha Tocopheryl
Acetate, Soy Lecithin, Niacinamide, Calcium D-Pantothenate, Manganese Sulfate, Ascorbyl
Palmitate, Cupric Sulfate, Thiamine Chloride Hydrochloride, Pyridoxine Hydrochloride,
Riboflavin, Vitamin A Acetate, Mixed Tocopherols, DL-Alpha Tocopherol, Folic Acid, Potassium
Iodide, Chromium Chloride, Sodium Selenite, Sodium Molybdate, Phylloquinone, D-Biotin,
Vitamin D3, Cyanocobalamin.
Unflavored version also contains: Sugar.
Vanilla flavored version also contains: Artificial Flavor, Sugar, Artificial Sweetener: Sucralose,
Sodium Hydroxide, Choline Chloride.
*A Source of Arachidonic Acid (ARA)
**A Source of Docosahexaenoic Acid (DHA)
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Section 6: Directions for Preparation,
Usage & Storage
KetoCal® 3:1 Powder
Directions for Preparation:
Nutrition Information:
Nutrients
Per 100 g
Per 100 kcal*
Calories
699100
Protein, g 15.3
2.2
Carbohydrate, g 7.2
1.0
Fat, g 67.7
9.7
Saturated, g
25.5
3.6
Monounsaturated, g 22.3
3.2
Polyunsaturated, g
16.6
2.4
DHA, mg 116
16.6
AHA, mg 116
16.6
Vitamins
Vitamin A, IU (mcg RE) 1748 (525)
250 (75.1)
Vitamin D, IU (mcg)
508 (12.7)
72.7 (1.8)
Vitamin E, IU (mg a TE) 11.8 (7.9)
1.7 (1.1)
Vitamin K, mcg
55.9
8.0
Thiamin, mg
0.89
0.13
Riboflavin, mg
0.70
0.10
0.70
0.10
Vitamin B6, mg
1.4
0.20
Vitamin B12, mcg
Niacin, mg
4.9
0.70
Folic Acid, mcg
140
20.0
Pantothenic Acid, mg
2.8
0.40
Biotin, mcg
13.9
2.0
Vitamin C, mg
84.0
12.0
Choline, mg
180
25.8
Inositol, mg
153
21.9
Minerals
Per 100 g
Calcium, mg
760
Phosphorus, mg
510
Magnesium, mg
95.0
Iron, mg
10.9
Zinc, mg
7.4
Manganese, mcg
570
Copper, mcg
760
Iodine, mcg
124
Molybdenum, mcg
31.3
Chromium, mcg
26.2
Selenium, mcg
18.9
Sodium, mg (mEq)
287 (12.5)
Potassium, mg (mEq) 900 (23.1)
Chloride, mg (mEq)
440 (12.6)
L-Carnitine, mg
48.0
Taurine, mg
48.0
Per 100 kcal*
109
73.0
13.6
1.6
1.1
81.5
109
17.7
4.5
3.7
2.7
41.0 (1.8)
129 (3.3)
62.9 (1.8)
4.6
4.6
Mixing Guide:
*Standard Dilution = 30 kcal/fl oz
Ingredients:
Refined Vegetable Oils (Palm, Soy, Sunflower), Milk Protein (Casein, Whey), Lactose (Milk),
Tricalcium Phosphate, Tripotassium Citrate, Corn Syrup Solids, Potassium Chloride, Calcium
Phosphate Dibasic, Magnesium Acetate, Choline Bitartrate, L-Cystine, M. Alpina Oil*, C. Cohnii
Oil**, L-Tryptophan, M-Inositol, Ferrous Sulfate, Sodium Caseinate (Milk), Sodium Chloride,
Sodium Ascorbate, L-Ascorbic Acid, L-Carnitine, Taurine, Mono and Diglycerides, Zinc Sulfate,
DL-alpha Tocopheryl Acetate, Niacinamide, Soy Lecithin, Calcium D-Pantothenate, Cupric
Sulfate, Manganese Sulfate, Thiamine Chloride Hydrochloride, Pyridoxine Hydrochloride,
Riboflavin, Vitamin A Acetate, Potassium Iodide, Folic Acid, Ascorbyl Palmitate, Mixed
Tocopherols, Chromium Chloride, Sodium Molybdate, Phylloquinone, Sodium Selenite,
D-Biotin, Vitamin D3, Cyanocobalamin.
10
For oral and tube feeding:
KetoCal 3:1 and 4:1 Powders
1. Measure the required amount of warm water into a container that seals
with a screw top lid. To completely dissolve the powder, the water must
be warmed to a temperature of 113-122°F (45-50°C).
2. Add the prescribed amount of KetoCal to the water.
3. Cover and shake until the powder has dissolved.
4. Once prepared, the formula should be stored in a refrigerator and kept
no longer than 24 hours.
Directions for Use:
• For oral feeding, best served chilled and consumed immediately.
• Tube feeding hang time: Nutricia recommends formula can be safely
kept at room temperature for up to 4 hours, at which time unused
formula should be discarded.
• It is recommended that the tube is flushed with lukewarm water
(approximately 98°F or 37°C) between each feed.
• Do not boil or microwave formula.
• Do not freeze. Recommended storage between 39°F-77°F (4°C-25°C).
• Once powdered formula is prepared or liquid formula is open, use
immediately or refrigerate promptly at 39°F/4°C or less and use within
24 hours.
KetoCal 4:1 Powder
KetoCal 3:1 Powder
Dilution to be determined by medical prescription:
Dilution to be determined by medical prescription:
Dilution
Powder Water Final Volume Osmolality
20 kcal/fl oz 9.5 g
91 mL
100 mL 110 mOsm/kg
24 kcal/fl oz 11.4 g 88 mL
100 mL 130 mOsm/kg
30 kcal/fl oz 14.2 g 86 mL
100 mL 170 mOsm/kg
45 kcal/fl oz 21.3 g 79 mL
100 mL 260 mOsm/kg
A gram scale is necessary for proper preparation of formula.
Dilution
Powder Water Final Volume Osmolality
20 kcal/fl oz 9.5 g
90 mL
100 mL 100 mOsm/kg
24 kcal/fl oz 11.4 g 89 mL
100 mL 120 mOsm/kg
30 kcal/fl oz 14.3 g 86 mL
100 mL 150 mOsm/kg
45 kcal/fl oz 21.4 g 79 mL
100 mL 240 mOsm/kg
A gram scale is necessary for proper preparation of formula.
Storage:
Store unopened product in a cool, dry place and away from sunlight.
*A Source of Arachidonic Acid (ARA)
KetoCal 3:1 and 4:1 Powders:
**A Source of Docosahexaenoic Acid (DHA)
Once can has been opened, replace container lid and store in a cool, dry
place (not in a refrigerator). Use within one month.
C A R E G I V E R ’ S G U I D E TO T H E K E TO G E N I C D I E T A N D K E TO C A L ®
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Section 7: Ordering and
Reimbursement/Coverage
Information
Ordering and Sample Requests:
KetoCal® can be ordered directly from Nutricia by calling
1-800-365-7354, opt 1. In order to purchase or receive samples of
KetoCal, the patient’s healthcare provider must complete a Sample
Authorization Request and Consent Form and fax it to Nutricia at
1-301-795-2292.
KetoCal can also be purchased through pharmacies, medical supply
companies and home care companies.
Packaging Information and Product Codes:
Reimbursement & Coverage:
KetoCal 4:1 Liquid Vanilla
KetoCal may be covered by insurance, Medicaid, or WIC, especially
when used as a sole or main source of nutrition. KetoCal may also be
covered through the National School Lunch Program.
Product Code
Reimbursement Code
Packaging
HCPCS Code
80180 – Vanilla
49735-0187-96
27 x 237 mL (8 fl oz)
B4154
Nutricia Product Coverage Navigator
KetoCal 4:1 Liquid Unflavored
Product Code
Reimbursement Code
Packaging
HCPCS Code
80183 – Unflavored
49735-0130-54
27 x 237 mL (8 fl oz)
B4154
KetoCal 4:1 Powder
Product Code
Reimbursement Code
Packaging
HCPCS Code
101777
49735-0166-70
6 x 300 g (11 oz)
B4154
KetoCal 3:1 Powder
Product Code
Reimbursement Code
Packaging
HCPCS Code
16672
49735-0166-72
6 x 300 g (11 oz)
B4154
The Nutricia Product Coverage Navigator
NAVIGATOR
program is a free, easy-to-use, valuable tool for
families and healthcare professionals. Our dedicated specialists will
help your patients execute the complicated and labor-intensive work.
Whether your patients are
seeking coverage through:
• Private insurance,
• A self-funded plan,
• Medicaid, or
• The National School
Lunch Program
They can access Nutricia
Product Coverage Navigator
and their services.
Assistance may include help with:
• Obtaining prior authorization for
Nutricia products
• Answering questions regarding claims
submissions
• Obtaining letters of medical necessity
from providers when needed
• Correcting billing errors
• Appealing a denied claim
• And much more!
To contact the Nutricia Product Coverage Navigator program, call
1-800-365-7354 extension 1200 or email NutriciaNavigator@nutricia.
com. Learn more online at www.nutricia-na.com/NutriciaNavigator.
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C A R E G I V E R ’ S G U I D E TO T H E K E TO G E N I C D I E T A N D K E TO C A L ®
13
Section 8: Important Contacts and
Provider Notes
Healthcare Provider Notes:
KetoCal® Nutrition Services Helpline:
(To be determined by the healthcare provider)
1-800-365-7354, Option 2
Phone number: ...............................................................................................................
[email protected]
E-mail address:................................................................................................................
Mixing Instructions for _________________________________________
(patient name)
Mix _____________________ (amount of powder or liquid) of
________________________________ (specific product name) with
__________ (volume) of water. This amount should be given
__________ times per day.
Important:
Dietitian: Name: .................................................................................................................................
Phone number: ...............................................................................................................
• When preparing KetoCal Powder (3:1 or 4:1), the temperature
of the water should be between 113-122°F (45-50°C) to mix
properly. A kitchen thermometer can be used to measure the
temperature of the water.
• A gram scale should be used to ensure accurate measurement
of KetoCal.
E-mail address: ...............................................................................................................
Neurologist:
Name: .................................................................................................................................
Phone number: ...............................................................................................................
E-mail address: ...............................................................................................................
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C A R E G I V E R ’ S G U I D E TO T H E K E TO G E N I C D I E T A N D K E TO C A L ®
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“
“Adding KetoCal to Nathan’s
diet has been wonderful just
because he loves the taste. The
texture is amazing. The first
time I made him the pancakes,
the house smelled amazing and
he loved it. I’ve never seen this
kid happier in his life. He was so
happy eating his pancakes.”
– Nathan’s mom
KetoCal® Pancakes
(4:1 Recipe*)
KetoCal® LQ Blueberry
Smoothies (4:1 Recipe*)
Directions:
Ingredients:
26 g KetoCal 4:1 powder
8 g Butter
7 g Cream, 36%
4 g Olive oil
28 g Egg (raw, mixed well)
4 ml Water
1. Melt the butter.
2. Stir in the eggs, cream, oil and
optional carb-free sweetener.
3. Mix the KetoCal 4:1 powder and
water, and then add into the mixture.
4. Spray a small frying pan with oil and
warm to a medium heat.
5. Cook until golden brown, then flip
and cook other side.
6. Optional: Serve with butter and/or
carb-free pancake syrup.
Carbohydrate
Calories
Fat
Protein
Ratio
1.11
341
34.01
7.47
4:1
Ingredients:
Directions:
200 g KetoCal 4:1 LQ
Unflavored or Vanilla
1. Place the KetoCal LQ, blueberries,
oil, about 4 ice cubes, and optional
carb-free sweetener into a blender.
2. Blend until smooth.
30 g Blueberries, frozen
unsweetened
12 g Canola oil
Carbohydrate
Calories
Fat
Protein
Ratio
4.05
418
41.81
6.31
4:1
Find these recipes and more on MyKetoPlanner.com.
*Always check with your healthcare professional to ensure that a recipe is appropriate.
Recipes are also available in a 3:1 ratio and as Modified Atkins Diet (MAD) recipes.
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*Always check with your healthcare professional to ensure that a recipe is appropriate.
Recipes are also available in a 3:1 ratio and as Modified Atkins Diet (MAD) recipes.
C A R E G I V E R ’ S G U I D E TO T H E K E TO G E N I C D I E T A N D K E TO C A L ®
17
Caregiver’s Guide to the
Ketogenic Diet
and KetoCal
®
TO PLACE AN ORDER, CALL 1-800-365-7354
www.myketocal.com
My KETO
PLANNER
TM
www.myketoplanner.com
www.ketoconnect.com
www.facebook.com/KetoCal
www.youtube.com/user/KetoCalUS
twitter.com/KetoCalUS
www.pinterest.com/KetoCalUS
KetoCal is a registered trademark owned by SHS International Ltd. Nutricia is a registered trademark of N.V. Nutricia.
Nutricia leads the development of advanced medical nutrition. Nutricia products and
services transform the daily lives of millions of infants, children, adults and seniors.
© 2016 Nutricia North America.
ZKCG 08/16
9497350-70134