SA 4 - Tesse Flashcards
What are the clinical signs of protein energy malnutrition (PEM)
Weight loss, muscle wasting, pallor, chronic infections, poor hair coat
T/f: specific nutritional deficiencies are common in north american cats and dogs
false
what is the pathognomonic clinical signs of taurine deficiency in cats
dilated cardiomyopathy, central retinal degeneration
what is the pathognomonic clinical sign of vit K deficiency
coagulopathy
what is the pathognomonic clinical sign of thiamine deficiency in cats
brain stem necrosis leading to neurologic signs
Are there hematologic abnormalities that can be found on a nutritional assessment?
yes -> anemia and lymphopenia (PEM), regenerative to microcytic nonregenerative (iron deficiency), microcytic hypochromic anemia (copper deficiency), macrocytic hypochromic (folate deficiency), megaloblastic anemia (B12 deficiency)
Match the deficiency with the anemia:
1. copper
2. iron
3. B12
4. Folate
a. regenerative to microcytic nonregenerative
b. megaloblastic
c. macrocytic hypochromic
d. microcytic hypochromic
1 - d
2 - a
3 - b
4 - c
T/f biochemical abnormalities in nutritional assessments are often pathognomonic and super specific to the disease
FALSE. highly insensitive and nonspecific
what are some biochemical abnormalities that can be seen with obesity
hyperglycemia and glucose intolerance
hyperlipidemia
what are some biochemical abnormalities that can be seen with PEM
creatinine, albumin, BUN changes
What should you do with a nutritional assessment done on a healthy animal
make clear and specific recommendations (complete and balanced, ID food by brand name flavor and form, provide several choices, give exact amlount to be fed and frequency). These should be written and updated in the medical record
what should you do with a nutritional assessment done on a sick animal
pretty much the same as the healthy animal, except consider specialized or prescription diets, initiate assisted feeding early, and while complete and balanced rations are preferred, they are not always indicated for certain diseases (ie you want a low protein diet for CKD, even if it isnt balanced)
What are some measures you should monitor for response to a diet during a nutritional assessment
palatability
signs of dietary intolerance
assessment of BCS and weight
follow underlying disease of sick patients
What type of animal do nutritional deficiencies most commonlyl occur in
sick ones
What is Protein Energy Malnutrition (PEM)
a deficiency of protein and calories that is common in hospitalized patients
what are the well documented affects of PEM
anemia, hypoproteinemia, delayed wound healing, decreased immune function, GI, resp, cardio compromise, death
T/F healthy canids are well adapted to survive food deprivation
true
what are the two primary groups of starvation adaptation in canids
acute (maintain blood glucose concentration via hepatic glycogen and amino acids)
chronic (fat derived fuels preserve lean body mass)
lean body mass =
FUNCTION
what disease compromises adaptation to starvation
PEM
what type of starvation adaptation is blocked in patients with PEM
chronic (switch to fat derived fuels is blocked)
PEM lease to a relative _____ in metabolic rate, and an altered _____ milieu
increase, hormonal
what change in fuel utilization of preferences occurs in PEM patients
glucose»_space;» fats
why are amino acids and glucose so often deficient during illness?
there is a high demand for protein and energy in illness for protein synthesis (think of how many acute phase proteins, WBCs, immunoglobulins, clotting factors, etc are required for illness and wound healing). Adipose stores cannot meet the energy or synthetic substrate needs of illness, so lean body mass is rapidly catabolized
which species may be predisposed to protein energy malnutrition
cats, because they conserve their lean body mass less efficiently and have a high basal protein requirement
what is the common history for a PEM patient
critically ill (surgery, infection, cancer, thermal burns)
decreased food intake
what are common PE findings for PEM
body weight and BCS may be unchanged
nonspecific symptoms (muscle wasting pallor, poor coat, hepato/splenomegaly, chronic infection, peripheral edema, lymphadenopathy)
what are common laboratory testing findings for PEM
normocytic/normochromic nonregenerative anemia and lymphpenia
what are common serum biochemistry parameters in PEM
decreased creatinine (from muscle wasting)
hypoalbuminemia
what is common during critical illness
PEM
what are the steps of initiation of nutritional support in critically ill patients
1: determine fluid requirement
2: determine energy requirement
3. select calorie sources
4. micronutrient requirements
5. select route of administration
what is the daily fluid requirement in an average animal
~60 mL/kg
how can you supply fluids to an animal
voluntary intake, tube, or parenteral solution
what energy requirement parameter should be used during initiation of nutritional support of critically ill patients
resting energy requirement (RER)
what does RER do
maintains basal metabolic rate, maintains body temperature in thermoneutral environment, allows recovery from activity, no increment for food consumption
What are the two equations for RER
RER = 30(BW in kg) + 70 for animals over 2 kg and under 45 kg
RER = 70(BW in kg) ^3/4 for all animals
what are some factors that effect optimal distribution of calories
species, palatability, digestibility, cost and availability, ease of use, specific disease process
what is the optimal protein intake variable in dogs
25 -45% of calories
what is the optimal protein intake variable in cats
30 -50 % of calories
T/F critical care diets are often high in fats
true
optimal fat intake of fat in dgs
20-60 % of calories
optimal fat intake in cats
35-50% of calories
T/f carbohydrates are not required by dogs or cats
true
why does optimal intake of carbs vary in critically ill patients
they may not be used efficiently during illness, but can be an alternative calorie source for some patients with protein or fat restrictions
what should you consider first when selecting a ration for a critically ill patient
optimal caloric distribution
how can you best meet the micronutrient requirements for patients with critical illness
via commercial diets, with supplementation only if specifically indicated
what nutrients are important for immune response
protein, zinc, iron, vit A, arginine
what are the three possible routes for nutritional support
voluntary intake
enteral (tube) feeding
parenteral (intravenous) feeding
which route of administration is best if nutrient requirements are met
voluntary intake
what are some steps to maximize voluntary food intake
hand feed small frequent meals
offer highly palatable and aromatic foods
warm food prior to serving
use calorie/nutrient dense commercial rations
pharmacologic appetite stimulation
what are some examples of pharmacologic appetite stimulation that can be used to maximize voluntary intake
antidepressants (mirtazapine, diazepam)
cyproheptadine (periactin)
what are advantages of enteral feeding
more physiologic
prevents villous atrophy
prvents bacterial translocation
less complex
fewer complications
cheaper
what are disadvantages of enteral feeding
long periods of transition
contraindicated if GI tract non-functional
what are the various types of feeding tubes
nasoesophageal
pharyngostomy
esophagostomy
gastrostomy
jejunostomy
How do you choose which type of feeding tube to use?
- anatomic site of GI dysfunction
- expected duration of nutritional support
- patient conformation and concurrent diseases
- type of ration intended to be fed
- clinical status of the patient
okay… so what do we put in the feeding tubes?
-blenderized commercial pet food
- commerical paste-type formulations specifically designed for tube feeding
- commercial veterinary liquid formulations (for nasoesophageal and jejunostomy tubes only)
what are the general differences between critical care/tube feeding rations and normal diets?
CC/feeding tube rations will have much higher % protein kcals and %fat kcals, much lower %carb kcals, and slightly higher caloric density
which type of tube feeding requires CRI
jejunostomy
what is the ultimate goal of enteral feeding delivery
initial bolus feeding every 2 hours, to delivery of requirements in 4 to 6 daily feedings
what are the pros of parenteral feeding
bypasses GI tract
allows complete bowel rest
decreased risk of aspiration
may not require anaesthesia
decreased risk of bleeding
what are the cons of parenteral feeding
villous atrophy
bacterial translocation
increased complications (sepsis. hyperglycemia, hyperlipidemia)
requires specialized equipment and products
increased level of care
more expensive
T/F you should discontinue nutritional support after removing your feeding tube/catheter
FALSE. you should do it before removing the route of admin, and compare the patient’s food intake and make sure they still meet the requirements on their own
what type of diet should you transition to after discontinuing nutritional support in critical care patients
highly digestible, low residue rations via small and frequent feedings for days to 1-2 weeks
