Nutrition in critical patient Flashcards
Why is nutrition essential in managing a critical patient?
critical illness –> physiological stress & inflammatory responses –> promotes protein catabolism & impairs healing –> poorer outcomes & increased complication rates
How is a patients nutritional state assessed?
Body Condition Score (BCS) – Focuses on fat stores
Muscle Condition Score (MCS) – Evaluates lean mass (more useful in critical illness)
Repeat on daily basis to monitor rate of loss
- can take pictures or measure muscle belly size with tape measure
What does the traffic light system indicate in critical care nutrition?
Green (1-2 days): Monitor food intake, write feeding orders
Yellow (3-4 days): Nutritional support likely needed to prevent tissue breakdown
Red (5 days): Urgent! Place a feeding tube or initiate parenteral nutrition
EARLY INTERVENTION ALWAYS BETTER THAN LATE
Why do hypoalbuminemic patients require immediate nutritional support?
In sepsis or critical illness, liver prioritizes producing pro-inflammatory cytokines over albumin
Low albumin levels → risk of fluid overload, making nutrition crucial regardless of time without food
So always check blood chemistry
What are the definitions of anorexia and hyporexia?
Anorexia: No food intake
Hyporexia: Intake of <75% of RER daily
When should nutritional support start at the latest in critically ill patients?
After 3 days of anorexia
After 7 days of hyporexia
Fill in the table with feeding tubes
remember that it might not be as simple in real life & every case is different
What role do Omega-3 fatty acids play in critical illness?
They have anti-inflammatory properties
May help if started early in sepsis, but human studies show mixed results
What is the significance of antioxidants in critical illness?
Oxidative damage is common in critical illness
Human studies show mixed results – some suggest benefits, while others indicate potential harm
What is the proposed benefit of Glutamine in critically ill patients?
Has anti-inflammatory, pro-metabolic & antioxidant effects in humans
Minimal veterinary evidence available
Are probiotics beneficial for critically ill veterinary patients?
Evidence in critical care is weak
No veterinary studies available
Some probiotics (e.g., Enterococci) may contribute to antibiotic resistance
How are horses different from small animals in terms of starvation tolerance?
Horses can tolerate 2-3 days of starvation (common in colic treatment)
Fat horses, ponies & donkeys struggle due to hyperlipaemia risks
Why do fat horses, ponies & donkeys struggle with starvation?
Increased lipolysis & reduced lipid clearance from blood –> triglyceride accumulation –> hyperlipaemia –> inappetence
Why is feeding essential for gastrointestinal (GI) motility in horses?
Horses require continuous food intake to stimulate GI movement
Prolonged fasting can slow gut motility & increase risk of complications
What are key factors to consider when assessing equine nutrition needs?
Duration of anorexia
Nutritional state before illness
Physiological state (growth, pregnancy, lactation)
Signs of catabolism (e.g., hyperlipaemia)
Presence of sepsis
Why is enteral nutrition preferred in horses?
Maintains gut motility
Prevents gut barrier dysfunction
Requires a working GIT
What are different methods of enteral feeding in horses?
Free choice – hay, haylage, grass, pelleted feeds
Syringe feeding – karosyrup, molasses, complan
Nasogastric tubing – liquid feeds (Equidgel), soaked feeds
Feed 4-6x daily, assess for tolerance (gastric reflux)
When is Partial Parenteral Nutrition (PPN) used in horses?
When enteral feeding is not possible (e.g., ileus)
To prevent severe malnutrition and catabolism
Helps correct hypertriglyceridaemia
Usually just glucose supplementation +- insulin
What is the calorie goal for PPN in horses?
5-10 kcal/kg/day
When is Total Parenteral Nutrition (TPN) required in horses?
When gut rest needed for >24h
To provide entire energy requirements (22 kcal/kg/day)
If gut function is impaired (e.g., severe ileus, diarrhea)
What is in TPN for horses?
Combination of glucose, protein and fats
What are the risks of TPN in horses?
Hyperglycaemia (may require insulin)
Bacterial contamination risk
Jugular thrombophlebitis
Mixture is light-sensitive (must be covered)
Why do foals need more frequent feeding?
Limited energy reserves → Hypoglycaemia is common
High metabolic rate
Frequent meals of milk are needed to meet energy needs
What are the feeding options for foals?
Mare’s milk (preferred)
Milk replacer
Bucket feeding
Nasogastric tube feeding if not suckling
PPN/TPN if enteral feeding is not tolerated
What is trophic feeding, and why is it beneficial for foals?
Small amounts of milk/food given to promote gut development
Helps stimulate GI growth and motility
What key parameters should be monitored in horses on nutritional support?
Daily weight checks
Total protein (TP), PCV, electrolytes
Triglycerides and glucose levels
How should horses transition back to normal feeding after PPN/TPN?
Slowly decrease enteral/parenteral feeding
Introduce small amounts of palatable feed
Stop assistance once they reach 75% of maintenance requirements
What is enteral feeding?
Using tube to deliver liquid diet into the gastrointestinal tract
Used when parts of the GIT are still functional but need support
What is parenteral feeding?
Nutrients are given intravenously, bypassing GIT
Contains proteins, fats, and carbohydrates in simple form
When is assisted feeding required?
When animal can’t eat normally or absorb nutrients properly
What are the two types of parenteral nutrition?
Total Parenteral Nutrition (TPN) – Provides 100% of nutritional needs intravenously
Partial Parenteral Nutrition (PPN) – Provides partial support while allowing some enteral feeding
What factors help decide between enteral vs. parenteral feeding?
GIT function (if functional → enteral is preferred)
Severity of illness
Tolerance to enteral feeding
Risk of infections (parenteral increases risk)
What are the different types of feeding tubes used in enteral nutrition?
Naso-oesophageal/Naso-gastric – Short-term, minimal invasion
Oesophagostomy tube – Medium-term, bypasses mouth & throat
Gastrostomy (PEG tube) – Long-term feeding, placed in stomach
Enterostomy tube – For direct intestinal feeding, rare use
What types of food are used in enteral nutrition?
Liquid diets
Diluted clinical diets
Critical care formulas
How much do we feed an animal?
- Calculate patients RER (30 x (body weight (kg) + 70)
- Look at the food you have chosen to use & find KCal/ml
- 10ml/kg per meal, Maximum of 50ml/kg/feed
What kind of tube is this?
Naso-oesophageal or naso-gastric
What kind of tube is this?
Oesophagostomy
What kind of tube is this?
Percutaneous endoscopic gastrotomy
What are common complications with feeding tubes?
Blockages – Prevented by flushing
Tube dislodging – Caused by vomiting, movement, coughing, biting
Trauma – Due to poor tube placement or excessive movement
Infection – Poor site care can lead to infection
Over-granulation – Can occur at the surgical site
What are the advantages of enteral nutrition over parenteral nutrition?
Maintains gut integrity
Less infection risk
More physiological (uses the normal digestive route)
Cheaper than parenteral nutrition
When is parenteral nutrition preferred over enteral feeding?
GIT is non-functional (e.g., severe ileus, GI obstruction).
Severe malnutrition requiring immediate support.
Post-operative gut rest needed
Naso-oesophageal
RER 199kcal = 181ml/day 8 hour day 46ml/ml per meal
Stop & check position of tube (could have moved into trachea or lungs)
