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3. Cat & Dog > nutrition for the sick patient > Flashcards

nutrition for the sick patient Flashcards

1
Q

How do we detect malnutrition?

A
  • MEDICAL & DIET HISTORY:
    – Physiological status: reproduction, age, activity
    – Persistent GI signs: nausea, vomiting, diarrhea
    – Disease history: Concurrent diseases may:
    > Worsen without nutrition support
    > Inhibit food intake for long time
    – Diet history: homemade, limited ingredient, therapeutic, etc.
  • PHYSICAL EXAM:
    – Significant weight loss
    – Evidence of muscle wasting
    – Depletion of subcutaneous fat
    – Poor hair coat, discolouration
  • Lab work
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2
Q

wiehgt loss or BCS indicative of malnutrition

A

Weight loss > 10% in 1 wk
BCS < 3/9
MCS < mild muscle loss

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3
Q

Who should receive nutritional support?

A
  • Patients already with malnutrition
  • Patients at risk of malnutrition
  • Inappetant
    > Not eating for 48 h
    > Food intake < RER for > 3 d
  • Concurrent disease
  • GI dysfunction
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4
Q

food deprivation - what is used for endogenous fuel

A
  1. Glycogen
  2. Fat tissue
  3. Muscle protein
    > Fuel to meet metabolic needs
    > Maintain blood glucose
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5
Q

cachexia:
- mechanism
- appetite
- effect of feeding
- metabolism
- thyroid
- body energy stores

A
  • mechanism: chronic illness
  • appetite: decreased
  • effect of feeding: does not change appetite, may maintain body weight but lean losses continue
  • metabolism: no change to increased
  • thyroid: no change to increased
  • body energy stores: use fat or muscle for energy, but seems to be a preference for muscle breakdown
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6
Q

cachexia is driven by

A

catecholamines, glucocorticoids, glucagon, inflammatory mediators

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7
Q

complications of protein malnutrition

A
  • Ileus & Bacterial translocation > Sepsis
  • Immunity ↓ - infection risk ↑
  • Tissue synthesis & repair ↓
  • Drug metabolism > risk for activity and overdose
    > Hepatic biotransformation ↓
    > Binding & transport ↓
    > Renal blood flow ↓ - Elimination↓
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8
Q
  • Not always appropriate to feed a therapeutic diet in hospital because
A

learned food aversion

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9
Q

Every day without adequate nutrition impacts recovery how?

A

3-5 days extra for recovery

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10
Q

when should we make sure a sick patient is eating?

A

ASAP
GOAL - Within 24-48 h of hospitalization
- Hemodynamically stable

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11
Q

what to feed the hospitalized patient?
KNFs

A

PROTEIN
* Protein requirement ↑ (2-3 x > healthy)
Dog ~3g/kg BW0.75

FAT
- efficient energy source

CARBOHYDRATE
* Less efficient as energy source
* Adverse effects: DIARRHEA, HYPERGLYCEMIA

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12
Q

why do hospitalized animals need more protein? cautions?

A
  • Protein breakdown ↑
  • protein synthesis ↑
  • GOAL
  • Protein synthesis ↑
  • Spare endogenous muscle protein
  • Essential AA and amino groups acute phase proteins / immune response
  • caution if:
  • liver or renal dz
    > if less than RER high protein can be ok
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13
Q

caution feeding more fat to hospitalized patient if

A

Pancreatitis
Hyperlipidemia
Diarrhea
Vomiting
> If less than RER, Moderate/high fat diet can be OK!

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14
Q

purpose of fat in hospital diet

A
  • Much more efficient (> 2x calories/volume)
  • Calorically dense > smaller volume
  • Shift glucose to fat metabolism
    > Metabolic complications ↓
    > CO2 production ↓
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15
Q

adverse effects of carbohydrate in hostpital diet

A

Malabsorption > DIARRHEA
- Dehydration
- Acid/base & mineral balance
- Contamination of wounds
- Colonic fermentation ↓
- Butyrate production ↓
()
Altered glucose control > HYPERGLYCEMIA
- Osmotic shifts: Refeeding syndrome
- Glucosuria
- Altered immune function
- Predispose to infection
- Oxidative stress / damage
- Respiratory work ↑ (CO2)

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16
Q

how much protein, fat, carbs do we want in a recovery diet

A

PROTEIN:
Dog ~3g/kg BW0.75
Cat ~5g/kg BW0.75

Dog 5 – 12 g/100 kcal
Cat 7.5 – 12 g/100 kcal

FAT
2g/kg BW0.75
5 – 7.5 g/100 kcal

CARBOHYDRATE
2 – 4 g/100 kcal

17
Q

can we feed cat food to dog, or dog food to cat for recovery?

A

No problem feeding cat food to dog – short term
- NOT vice versa!!!

18
Q

can we feed human products to animals for hospital recovery? why

A

Human products, not complete & balanced for dogs/cats
Not high enough in protein & fat, too much carbohydrates

19
Q

can we feed GI diets to animals for recvoery? why?

A

Usually not high enough in protein & fat, too much carbohydrates

20
Q

can we feed baby food or home cooked stuff for recovery?

A
  • Not complete & balanced
  • other risks eg. toxic ingrediets, risk of contaminatin
21
Q

ENERGY REQUIREMENT – In hospital

A

RER = 70 kcal x BW0.75

  • Unless underweight
  • Increase gradually
  • Multiple small meals / day
22
Q

why is enteral feeding the best?

A
  • Less expensive
  • More physiological
  • Stimulate systemic & GI immune systems
  • Maintain gut mucosal barrier
  • Risk for bacterial translocation ↓
  • Metabolic complications ↓
    ()
    > ORAL FEEDING
    > TUBE FEEDING
23
Q

Encourage eating how?

A
  • Palatability ↑
    > Wet food (dog)
    > Fat ↑ & protein ↑
    > Sweet (dog) / salt
  • Freshness, aroma
    > Warm the food > body temp.
    > Leave food in cage for MAX 15 min
  • Texture (cat)
    > Diet history!!
    > Try dry food as well
  • Variety – cafeteria-style
    > Record each item
    > Watch for food aversion
  • Multiple small meals!!
  • Environment – Minimize stressors
  • Gentle coaching – Verbally encouraging / hand feeding
  • Food on lips, paws, in mouth – gently!!
  • Owner – NOT if basing live/death “on eat or not eat”
24
Q

are appetite stimulants reccomended? why?

A

IN GENERAL: NOT recommended
- Unpredictable / unreliable / intermittent
- Short-term effect
- Delaying true nutritional support

25
Q

how fast does mirtazapine work?

A
  • Should see a response in 1-2 hours
26
Q

Capromorelin - what is it how does it work? danger maybe?

A
  • Ghrelin receptor agonist
  • Appetite stimulant
  • Safety and efficacy not known after 4 consecutive days
27
Q

force feeding - is it useful? risks?

A
  • Imagine this in human medicine ?!?!
  • It is an inappropriate form of nutritional support
  • Its use should be DISCOURAGED
  • RISKS/CONCERNS:
  • Poorly accepted
  • Food aversion
  • Oral and/or pharyngeal trauma
  • Food aspiration
28
Q

how long would we place nasoesophageal or nasogastric tube, vs esophagotomy, gastrotomy, jejunostomy tube?

A

nasoesophageal or nasogastric tube
- Typically <5 days

esophagotomy, gastrotomy
- Long term (weeks to months)

jejunostomy
- while hospitalized only

29
Q

OROGASTRIC TUBE FEEDING - how it works? concerns? when acceptable?

A
  • Tube passed down the mouth into the stomach
  • Placed at each feeding
    ()
  • RISKS/CONCERNS:
  • Poorly accepted
  • Food aversion
  • Food aspiration
    ()
    Acceptable in 2 circumstances :
  • Birds
  • Neonatal puppies & kittens
30
Q

Complications of enteral feeding

A
  • Gastrointestinal
    ~ volume intolerance
    Distension
    Nausea & vomiting
    Diarrhea
  • Metabolic
    Refeeding syndrome
    Hyperglycemia
    Hyperlipemia
    Azotemia
  • Mechanical
    Tube occlusion
    Tube displacement
    Sinusitis
  • Infectious
    Aspiration pneumonia
31
Q

Parenteral nutrition issues? indications?

A
  • Nutrition delivered intravenously
  • More Expensive!
  • Needs more technical expertise!
  • More complications!
    > Catheter placement & management
    > Metabolic complications > Probably because of overfeeding
    ()
  • Indications:
  • Abnormal gut function
  • Inability to gain enteral access (ie. coagulopathy)
  • Inability to consume adequate amounts of energy
32
Q

Refeeding Syndrome
- what is it?

A

Metabolic derangements
- ↓ Potassium / ↓ Magnesium / ↓ Phosphorus
* Neuromuscular dysfunction
* Cardiac dysfunction
* RBC & WBC dysfunction
- Altered glucose metabolism; hyperglycemia

33
Q

how to prevent refeeding synrome

A
  • Not exceed RER
  • GRADUAL introduction of food
  • Correct electrolyte abnormalities PRIOR to feeding
  • Monitor electrolytes: K, P, Mg
34
Q

fundamentals for hospital nutrition

A
  • Each patient deserves a feeding plan
  • Diet history on every patient
  • Write food orders like drug orders
  • If the gut works use it
  • Proceed only as the patient tolerance allows
  • Avoid food aversions

3. Cat & Dog (33 decks)

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