Nutrition for Underweight Animals Flashcards
What defines a ‘starved’ animal?
- appetite is good
- otherwise healthy / no underlying disease
- attempt made to preserve lean tissue
What defines a ‘critical’ underweight patient?
- hyporexia/anorexia (unable or unwilling to eat)
- unable to preserve lean tissue
What are consequences of hyporexia/anorexia?
- general malnutrition
- weight loss, reduced BCS and MCS
- GI dysfunction (stasis, reduced digestive enzyme secretion)
- ketone production
- insulin resistance
- hepatic lipidosis
What are indications for nutritional support?
- BCS <4/9
- mild/mod /sev muscle loss
- recent unintended weight loss >10% of body weight
- anorexia or hyporexia (esp if >3d)
- lab abnormalities (hypoalbuminemia, anemia, low BUN, lymphopenia, electrolytes abnormalities, etc.)
T/F: when presented with a starved or critically underweight patient, you should begin nutritional support ASAP.
false – correct any dehydration and electrolyte abnormalities FIRST
What are they KEY nutritional factors to provide an underweight patient?
- water
- protein (restrict if kidney dz or HE; enhance if PLE)
- fat (restrict if lymphangiectasia, hyperlipidemia, or pancreatitis)
- prevent GI and metabolic complications
What is refeeding syndrome?
a metabolic complication that can occur when reintroducing food to starved or critically underweight animals.
Carbohydrates are novel to a patient that is anorexic/starved for 1 week or more. Insulin resistance can also develop during starvation/critical illness. And hypophosphatemia and/or hypokalemia can lead to threatening cardiac arrhythmias and resp failure.
When is risk for refeeding syndrome highest?
during the 1st week of refeeding
so its important to regularly check electrolytes, BG, etc.
What do the general guidelines for refeeding look like?
If anorexia for 1 day: RER x 0.5 on day 1, RER x 1 on day 2 and 3
if anorexia for 2-3 days: RER x0.25 on day 1, RER x 0.5 on day 2, and RER x 1 on day 3
if anorexia >3 days: RER x 0.25 for days 1-2, RER x 0.5 for days 2-4, RER x 0.75 for days 3-6, and RER x 1 on days 4-8.
Only increase if there are no metabolic or GI complications
Gradually increase to DER over 1-2 weeks.
How do you estimate an accurate target body weight?
- determine target BCS (5/9)
- subtract current BCS from ideal BCS (ex. 5/9 - 1/9 = need to gain 4 BCS, aka 60% ideal weight)
- current weight / % ideal weight = target body weight
(ex. 40 lb / 0.6 = 66.7 lbs)
Choose the false statement regarding refeeding a starved patient:
A. patient will not have a good appetite and may need an appetite stimulant
B. an energy dense food is likely not needed
C. a therapeutic/rx/vet diet is not needed
A. patient will not have a good appetite and may need an appetite stimulant
these patients have good appetites.
Which of the following statements is true about refeeding critical underweight patients?
A. patient will not have a good appetite and may need assisted feeding
B. an energy dense food is likely not needed
C. a therapeutic/rx/vet diet is not needed
A. patient will not have a good appetite and may need assisted feeding
What would be indications to utilize assisted feeding?
if the underlying cause of the anorexia/hyporexia s not yet resolved or managed.
What are available appetite stimulants?
- Capromorelin (entyce): a ghrelin agonist for dogs
- Cyprohepatadine: a serotonin antagonist for cats
- Remeron (mirtazapine): a serotonin antagonist for dogs and cats
note: you could always add cerenia or ondansetron too to help with nausea.
What might influence your decision to do enteral assisted feeding versus parenteral?
Enteral: if the gut works; need long-term, animal has gag reflex
Parenteral: dysfunctional GI tract (vomiting, ileus, etc.), animal does not have a gag reflex, need short-term
