CCM: Nutrition 124-127

Question 1

What are the levels of the muscle condition scoring system? What animal is this system validated in?

Answer 1

Four levels
1 - normal muscle mass 4 - severe muscle loss
assessed mainly by palpating the paralumbar muscles

Question 2

List 5 indications for nutritional support/intervention in the ICU

Answer 2

• anorexia for 3+ days
• hyporexia for 10+ days
• 10% BW loss
• low BCS
• moderate to severe muscle atrophy

Question 3

What is the terminology for muscle loss from age versus disease?

Answer 3

cachexia - disease induced
sarcopenia - age-related

Question 4

List the 3 groups of antioxidants and examples for each

Answer 4

• proteins - e.g., albumin, haptoglobin, ceruloplasmin
• enzymes - e.g., superoxide dismutase, glutathione peroxidase, catalase
• non-enzymatic/small molecules - e.g., vitamin C, vitamin E, glutathione, selenium, lycopene, beta-carotene

Question 5

What are the 3 main functions of arginine

Answer 5

• precursor of nitric oxide
• cell growth and proliferation (polyamine synthesis)
• wound healing (proline synthesis)

Question 6

Describe how critically ill versus healthy but fasting animals differ in their source of products for gluconeogenesis

Answer 6

illness –> protein breakdown and AA used for gluconeogenesis predominates
fasting but healthy –> lipid and glycogen stores prioritized for breakdown

Question 7

What is the current recommendation for the length of anorexia in days, on when to start nutritional intervention (i.e., feeding tube)

Answer 7

5 days

Question 8

When should enteral nutrition be supplemented with parenteral nutrition

Answer 8

if < 50% intake achieved by voluntary intake

Question 9

What should be addressed before nutritional support is implemented?

Answer 9

hydration status
cardiovascular instability
electrolyte disorders
acid-base disorders

Question 10

What is the recommendation for protein intake for dogs versus cats when initiating enteral nutrition in the hospital?

Answer 10

dogs 5-6 g/100 calories
cats 6-8g/100 calories

Question 11

List the typical duration of, advantages of, and disadvantages of a NG or NE tube

Answer 11

less than 5 days
advantages: cheap and easy to place, minimally invasive, no anesthesia required
disadvantages: liquid diet only, no gruel, dislodgement possible, obstruction common

Question 12

List the typical duration of, advantages of, and disadvantages of an E-tube

Answer 12

weeks to months
advantages: cheap and easy to place, gruel diet can be fed
disadvantages: needs GA, invasive, tube site infection or inflammation, obstruction possible

Question 13

List the typical duration of, advantages of, and disadvantages of a G-tube

Answer 13

weeks to months
advantages: gruel diet can be fed
disadvantages: dislodgement may lead to peritonitis, GA needed, special equipment for PEG

Question 14

List the typical duration of, advantages of, and disadvantages of a J-tube

Answer 14

weeks
advantages: bypasses most of the upper GI
disadvantages: dislodgement may lead to peritonitis, GA needed, laparotomy needed, can only feed a complete liquid diet

Question 15

what is the maximum volume of food that can be fed per feeding

Answer 15

10 mL/kg

Question 16

What is major concern if giving parenteral nutrition with a too high osmolarity?

Answer 16

thrombophlebitis

Question 17

What is the caloric density and osmolarity of 8.5% amino acids?

Answer 17

0.34 kcal/mL, 880 mOsm/L

Question 18

What is the recommendation for protein feeding amounts for parenteral nutrition?

Answer 18

4-6 g/100kcal (dog)
6-8 g/100kcal (cat)

Question 19

What is the caloric density and osmolarity of 50% dextrose

Answer 19

1.7 kcal/mL
2500 mOsm/L

Question 20

How much of the calorie intake should be provided by dextrose in parenteral nutrition?

Answer 20

half of the non-protein calories

Question 21

What is the caloric density and osmolarity of a 20% lipid emulsion?

Answer 21

2 kcal/mL
260 mOsm/L

Question 22

What is the typically recommended daily dose of lipids in parenteral nutrition? Why is this amount limited?

Answer 22

maximum of 2 g/kg/day
concern for side effects such as thrombophlebitis, hyperlipidemia/triglyceridemia, exaggerated inflammatory response, lipid embolization, microbial contamination

Question 23

What size filter should be used for parenteral nutrition administration?

Answer 23

1.2 micrometer