It may take time for the body to adapt to a hypertonic formula; therefore, hypertonic formulas must be introduced slowly or diluted* until adaptation occurs. This is particularly important if the patient has been without feedings (NPO) for a while.

Additionally, patients with low serum albumin concentrations may have a lower than normal body fluid osmolality. These patients are at particular risk for symptoms related to hypertonic formulas.

*For most patients, gradual administration of the formula is sufficient - dilution of the formula is usually not necessary and is now rarely practiced.