Ch.6 Metabolism and Nutritional support of the Surgical Patient Flashcards
How long can a healthy adult horse go without food for?
3-4 days
What triggers lipid mobilisation
Alterations in insulin or glucagon levels
and the activity of hormone sensitive lipase.
What is the metabolic response to injury
Increased metabolism
Onset of catabolic processes leading to excessive breakdown of tissue proteins
What increases the resting metabolic rate and lipolysis in horses post injury
1) Interactions of inflammatory cytokines released at the site of injury
2) Circulating hormones in response to stress/injury - hypothalamic-pituitary- adrenal axis
3) and neurotransmitters.
4) Infusion of cytokines stimulates
corticotrophin, cortisol, epinephrine, glucagon
What stimulates the proteolytic pathways
TNF-Alpha activation of nuclear factor kappa (NFk-Beta)
Calculate the DEm for horse under 600kg
DEm(Mcal/day) = 1.4 + (BW X 0.03)
Calculate the DEm for horse over 600kg
DEm(Mcal/day) = 1.82 + (BW X 0.0383) - (BW X 0.000015)
Kcal req for horses
33kcal/kg/day
Energy req of pregnancy mare over last 3 months of gestation
1.1
1.13
1.2 times the DEm
Calculate DEm for 300-900kg mare in first 3 months of lactation
DE (Mcal/day) = DEm + (0.03 x BW x 0.792)
Calculate DEm for 300-900kg mare after 3 months of lactation
DE (Mcal/day) = DEm + (0.02 x BW x 0.792)
Kcal content of mare’s milk
500-600kcal/liter
What % of its body weight does a 1 week old foal consume per day
20-30%
What volume of mares milk does a 1 week old 45kg foal consumer per day
9-13.5 litres of mare’s milk
How many calories does a 1 week old 45kg foal consume via milk per day
4500 - 7800 kcal
What is the resting metabolic rate of a healthy foal
45-50kcal/kg/day
What level of requirement should a sick foal be started on
DEr = 10% of foals body weight of mares milk
When does the largest growth rate occur
First month of life
DEr (resting energy requirement)
DEr (Mcal/day) = (BW x 0.021) + 0.975
(It’s about 70% of the DEm)
CP crude protein req in horse
CP in grams = 40 x DEm (in Mcal/day)
0.5 - 1.5g of protein per kg per day
Which vitamins are synthesised in the horse’s large colon and caecum?
K, all the B vits minus niacin
Which vitamins need to be ingested
Precursor to Vit A - Beta carotene
and Vit E
Which are the fat soluble vitamins
A, K, D and E
How does a lack of enteral feeding affect the gut
Mucosal atrophy, increased gut permeability and enzymatic dysfunction
What does EEN early enteral nutrition refer to
Initiation of enteral feeding within 48 hours after surgery
What is Glutamine an essential amino acid for?
As a fuel for lymphocytes, hepatocytes and mucosal cells of the gut.
Describe how to prepare a slurry diet from pellets
1kg pellets into 4L water, once soaked add 2 more L of water
How to begin feeding a patient with prolonged anorexia
Start with 50% over 24 hours then increase over days if tolerated.
When using PN/TPN/PPN how are carbohydrates most commonly delivered?
With 50% dextrose solutions (2525mOsm/L) that contain 1.7Kcal/ml
Isotonic lipid emulsions come in what % formulations and what do they typically contain
10% or 20%
Safflower
Soybean oil
Egg yolk phospholipids
Glycerin
What % preparations of amino acids are most commonly used
8.5% and 10%
Why can dextrose not be used as long term support
Less calorie dense than lipids
No amino acids for protein production
When would trace element supplementation be required
Sick animals on PN for >7days
What DE and CP requirements are needed for animals receiving PN
DEr
Maintenance cp - 0.5-1.5g protein per kg bw per day
What should the ration of nonprotein calories to nitrogen be in the final solution
100:1
How long can PN fluids be used before disposing of them due to bacteria growth concerns
24 hours
At what rate should PN be started
25-50% of calculated req for first 24 hours
Complications of PN
Hyperglycemia
Hyperammonemia
Hyperlipemia
Elevation of serum urea nitrogen
Thrombophlebitis
Sepsis
Lipid infusions have been associated with allergic rxns
hyperlipemia
alterations in liver function
fat embolism
Rebound hypoglycaemia when rates are altered too rapidly
What extra caution should be used if using lipids in PN
Triglyceride levels and platelets should be checked regularly
Don’t use in horses with preexisting or predisposed to hyperlipemia or underlying liver dysfunction
What daily monitoring should be performed on horses on PN during the acclimation period
- Electrolytes
- Blood urea nitrogen
- TriG
- Ammonia
- Liver function
How often should blood glucose be checked on a horse on PN
Every 4-6 hours
What precautions should be taken when ceasing PN
Over 24 hours
Freq glucose monitoring
Difference btw grade 2 and grade 3 BCS
2 Spinous processes, ribs, tailhead, hooks and pins prominent
3 Pin bones not distinguishable, tail head prominent but individual vertebrae not visually identified, transverse processes cannot be felt
Nutritional content of equine senior
CP 14%
Fat. 4%
Fiber 16%
kcal/kg feed 2695
Nutritional content of strategy
CP 14%
Fat. 6%
Fiber 8%
kcal/kg feed 3300
Nutritional content of purina horse chow
CP 10%
Fat. 2%
Fiber 30%
kcal/kg feed 454
Nutritional content of Vital NH and Osmolite
Cal/L. 1000
Protein 41.7g/dl
Fat 10.8g/dl
Carbohydrate 185 g/L
Osmolite
Cal/L. 1008
Protein 40g/dl
Fat 34g/dl
Carbohydrate 135.6 g/L
Cal/L. 1000
Protein 41.7g/dl
Fat 10.8g/dl
Carbohydrate 185 g/L
