Patients placed on continuous drip TF often cannot tolerate large volumes of hypertonic formulas with greater than 500 mOsm/L. Therefore, hypertonic formulas may need to be diluted at first to 1/2 to 1/3 strength*.

Formulas should be administered slowly at first, about 50 ml per hour, then increased by 25 ml per hour every 8-12 hours as tolerated until the required volume of formula is met. A typical final rate is 100-125 ml /hr.

*Dilution of enteral formulas is less and less common. Generally, starting the feeding at a slow rate is sufficient for the patient to adapt to a hypertonic formula.