nutrition

Question 1

what are 3 major things to consider when looking at nutrition in disease management?

Answer 1

1) differentiate between actual diet effects from companies claims
2) dont exacerbate one condition with the treatment of another
3) if no ideal diet consists then prioritise

Question 2

when may a home made diet be considered?

Answer 2

as a last resort

Question 3

what is the 8 step systematic approach to figuring out a diet?

Answer 3

1) list working diagnoses
2) determine which are amenable to dietary intervention
3) prioritise conditions
4) list nutrients of interest for each disease
5) list other nutritional consideratiosn (e.g. compliance)
6) determine if any conflicts between nutrients
7) prioritise factors
8) determine a diet that can satisfy most factors

Question 4

what would you limit sodium?

Answer 4

heart disease

Question 5

what should sodium be restricted to?

Answer 5

less than 100 mg/100kcal

Question 6

why may sodium normally be added to food?

Answer 6

to increase palatability

Question 7

why may protein be restricted?

Answer 7

kidney failure
liver failure
allergy
protein-losing nephropathy

Question 8

what should protein be restricted to?

Answer 8

Dog - under 5g/100kcal

Cat - under 7g/100kcal

Question 9

what needs to be added to a low protein diet?

Answer 9

high fat to make up calories

Question 10

when may phosphorus be restricted?

Answer 10

advanced kidney disease - puts greater strain on kidney and associated with worse prognosis

Question 11

when should phosphorus never be restricted?

Answer 11

in growing animals

Question 12

what should phosphorus be restricted to?

Answer 12

dog - under 140mg/100kcal

cat - under 150 mg/100kcal

Question 13

why would fat be restricted?

Answer 13

weight loss
pancreatitis
GI malabsorption

Question 14

what is done in low fat diets?

Answer 14

extra fibre added to dilute calories

Question 15

what should fat be restricted to?

Answer 15

dog and cat - under 5g/100kcal

Question 16

why would a high fibre diet be needed?

Answer 16

GI disease (esp large bowel)

Question 17

how much fibre would be needed in a high fibre diet?

Answer 17

dog and cat - over 2g/100kcal

Question 18

to lose weight what calories would you restrict to?

Answer 18

dog - under 300kcal/can or cup
cat - under 300 kcal/cup
cat - under 150 kcal/can

Question 19

what are 2 things often targeted with diet to do with urolithiasis?

Answer 19

• diuresis for any urolith by increasing water intake

- changing urine pH to dissolve exsisting and preventative

Question 20

how can struvite uroliths be managed by diet?

Answer 20

• diuresis
• calculolytic diets for about 1 month - make urine acidic to dissolve stones and reduce urine levels of urea,phosphorous and magnesium by being moderate in protein and highly digestible fibre

Question 21

what is seen on an ECG with hyperkalaemia?

Answer 21

tented T waves
lack of p waves
widening complexes
bradycardia

Question 22

how can diet help resolve calcium oxalate dihydrate uroliths?

Answer 22

these uroliths only form when the urine is supersaturated with these crystalloids so the diet controls excessive calcium and oxalate intake
-diuresis

Question 23

what should not be dietary restricted in an animal with calcium oxalate uroliths?

Answer 23

-phosphorus as it can increase urinary calcium extcretion which contributes to the urolith formation

Question 24

what is the dietary management of urate uroliths?

Answer 24

increase urine pH
lower urine concentrations of uric acid, ammonium and/or hydrogen ions
severe protein restriction to decrease purine
diuresis

Question 25

what is the diet strategy for managing dogs with cystine uroliths?

Answer 25

• reducing cystine in urine by protein restriction
• increase solubility of cystine by alkalixing the diet
• Thiol-containing drugs as they react with cystine forming a more soluble complex
• diuresis

Question 26

What is the diet for renal disease?

Answer 26

low protein
low po4
restricted Na and K
decrease need for urine acid secretion
omega 3 FA
high fibre
calorie dense

Question 27

why is protein restricted with renal disease?

Answer 27

minimise nitrogenous waste so relieves kidney workload

and reduces signs of uraemia

Question 28

Do you still restrict protein with protein losing nephropathy?

Answer 28

yes as will reduce loss

-need good balance

Question 29

what is the consequence of too low protein?

Answer 29

malnutrition
compromise renal function
muscle catabolism – azotaemia

Question 30

why is phosphorus restricted in renal diets?

Answer 30

can improve prognosis

help prevent secondary renal hyperPTH

Question 31

why is sodium often restricted in renal diets but why be careful with it?

Answer 31

• link with high bp causing renal disease in people

- in chronic PU they may be wasted so be needed

Question 32

How is the acid/base status modified in renal diets?

Answer 32

want to decrease need for urinary acid secretion

Question 33

what is the pH status of chronic kidney disease patients?

Answer 33

acidotic

Question 34

what are the signs of acidosis?

Answer 34

anorexia
naursea
vom
lethargy
weakness
muscle wasting
wt loss

Question 35

why is the caloric content of renal diets important?

Answer 35

most are often inappetant so higher caloric density will improve their nutrition

Question 36

Why are renal diets substituted with omega 3 FA?

Answer 36

omega 3’s in the cell memebranes compared to omega 6’s mean less inflammatory leukotrienes and eicosanoids made

• this reduced infl may slow renal disease progression

Question 37

why is high fibre important in renal disease?

Answer 37

fermented in colon and reduces pH which can trap ammonia so its excreted in the faeces instead of renally