NUTRITION - Nutritional Support Flashcards
Describe the physiological consequences of inadequate nutrition
When the blood glucose levels are low, glucagon is secreted which triggers hepatic glycogenolysis which breaks down glycogen into glucose. If anorexia continues, increased glucagon and glucocorticoid levels and decreased insulin levels trigger gluconeogenesis which mobilises protein and lipid stores. Prolonged fasting will result in ketosis due to triglycerides being oxidised in the liver to form ketone bodies, a process triggered by increased hormone sensitive lipase
How can acute illness amplify the consequences of inadequate nutrition?
Acute illness results in the increased release of glucagon, glucocorticoids and catecholamines, as well as contributes to insulin resistance which further triggers gluconeogenesis and mobilisation of protein and fat stores
Why does inadequate nutrition increase the risk of hepatic lipidosis in cats?
Inadeqate nutrition results in the mobilisation of fat stores which can increase the risk of hepatic lipidosis
Which liver marker can be indicative of hepatic lipidosis in cats?
An increased in alkaline phosphatase (ALP) on bichemistry can indicate hepatic lipidosis in cats
What are the three main consequences of inadequate nutrition?
Poor tissue repair
Immune dysfunction
Altered drug metabolism
How does malnutrition impact septic patients?
Patients with malnutrition will have poor tissue repair and immune dysfunction, which will increase their risk of sepsis. Sepsis will result in decreased food intake as the patient will be feeling unwell, which will worsen the malnutrition and thus worsen the sepsis
What are four key signs of a poor nutritional status that you should look out for when carrying out your nutritional assessment?
Body condition score of less than 3/9
Recent weight loss of over 10% body weight
Generalised muscle wastage
Hypoalbuminaemia
What risk should you be aware of in obese cats that suddenly lose lots of weight?
Obese cats that rapidly lose lots of weight are at an increased risk of hepatic lipidosis
What are five possible causes of anorexia?
Physical inability to eat
Underlying disease process
Nausea
Pain
Impaired olfaction/taste
Why is it so important to identify the underlying cause of anorexia?
Identifying the underlying cause allows for the most effective management i.e if the underlying cause is pain, begin analgesia, or if the underlying cause is nausea, begin anti-emetic therapy
Give an example of an appetite stimulant commonly used in the UK
Mitazepine
When should you begin nutritional support in a patient?
If the patient has been anorexic for over five days or if you anticipate the patient will have ongoing inadequate food intake, especially in patients undergoing surgery who may develop anorexia post-operatively
What are the two classifications of nutritional support?
Enteral nutritional support
Parenteral nutritional support
When is enteral nutrition the preferred method of nutritional support?
Enteral nutrition is the preferred method of nutritional support when the gastrointestinal system is still functioning normally and can absorb nutrients
What are the four methods that can be used to provide enteral nutritional support?
Naso-oesophageal/naso-gastric tube
Oesophagostomy tube
Gastrostomy tube
Jejunostomy tube
Why would a naso-oesophageal/naso-gastric tube not be appropriate for long term enteral nutrition?
Naso-oesophageal/naso-gastric tubes can become blocked making them inappropriate for long term enteral nutrition
When is parenteral nutrition the preffered method of nutritional support?
Parenteral nutrition is the preferred method of nutritional support when the patient’s gastrointestinal tract is not adequately functional
What is parenteral nutrition?
Parenteral nutrition is intravenous nutritional support
How is parenteral nutrition administered?
Parenteral nutrition is administered via central venous catherisation
Why is parenteral nutrition not administered via peripheral veins?
The content of parenteral nutrition has a high osmolarity which can irritate the peripheral veins and cause phlebitis
What are four of the catheter related complications associated with parenteral nutrition?
Phlebitis
Thrombosis
Infection
Mechanical failure of the catheter
What are two of the main complications associated with nutritional support?
Re-feeding syndrome
Hyperglycaemia
What is re-feeding syndrome?
Re-feeding syndrome is a metabolic disturbance which occurs as a result of reinstitution of nutrition in patients which have had negligible nutrient intake for many consecutive days. Hypokalaemia, hypophosphataemia and hypomagnesaemia result from a rapid rise in insulin and a shift of plasma potassium, magnesium, and phosphates into the intracellular compartment.
How does hypokaelaemia due to re-feeding syndrome commonly manifest?
Profound weakness
Gastrointestinal ileus
Neuromuscular disturbances
Cardiac rhythm disturbances
How does hypophosphataemia due to re-feeding syndrome commonly manifest?
Haemolysis resulting in haemolytic anaemia
How much should you be feeding patients on nutritional support?
The daily caloric goal is the patient resting energy requirement
How do you calculate the resting energy requirement?
Resting energy requirement = (30 x Body weight (Kg)) + 70kcal per day
How much should you feed patients on nutritional support that have been anorexic for a few days?
For the first day, begin with 25-50% of the resting energy requirement and if this is well tolerated, carry out incremental increases over the following 2-3 days
Which amino acids are essential to include in your nutritional support feed?
Arginine
Glutamine
Why is arginine so important for nutritional support?
Arginine is involved in immune function
Why is glutamine so important for nutritional support?
Glutamine has been shown to reduce infections/mortality rates
Why are B-vitamins so important for nutritional support?
B-vitamins are essential for hepatic metabolsim of glucose, fat and protein
