SA Clinical Nutrition 1 Flashcards
What is the resting energy requirement (RER).
Calculation formula?
Energy used in thermoneutral conditions at rest e.g. in hospital.
70(BW in kg)^0.75 (for any weight).
30(BW in kg) + 70
(for animals 2-30kg).
RER very similar to basal metabolic rate (BMR).
Calculating food intake (RER).
Calculate RER for patient (kcals ME/day).
Calculate food intake weight/day.
- divide evenly between meals.
- How many calories do protein and carbohydrates provide?
- How many calories does fat provide?
- 3.5 kcal per gram.
- 8.5 kcal per gram.
- What is maintenance energy requirement?
- RER multiplied by what for entire dog?
- RER multiplied by what for neutered dogs?
- RER multiplied by what for entire cats?
- RER multiplied by what for neutered cats.
- Energy used i thermoneutral conditions by a moderately active animal including energy required to obtain and use the food. e.g. at home.
- 1.8.
- 1.6.
- 1.4.
- 1.2.
* these just starting point. variation of +/- 50% may be required in an individual.
* must actively assess BCS and weight post-neutering.
Life-stage factors for pets in home environment and effect on MER…
1. Pregnancy.
2. Lactation.
3. Working.
4. Growth.
- 3 x RER (last trimester) in dogs.
2 x RER (by parturition; gradual increase throughout pregnancy).
Discourage calcium supplementation during pregnancy as prevents normal metabolic adaptations and can lead to an increased risk of preeclampsia. - 4-8 x RER or free choice in dogs.
2-6 x RER or free choice in cats. (peak ~6w post-partum).
- Can feed a puppy/kitten diet as has a greater energy provision. - 2-8 x RER in dogs.
- <4m = 3 x RER.
50-80% of expected adult weight kg = 2.5 x RER.
>80% expected adult weight kg = 1.8-2 x RER.
2.5 x RER in cats.
- Causes of obesity in dogs.
- Why are owners frequently unaware their pet is overweight?
- What should form part of every CE?
- Overfeeding.
Inadequate exercise.
May be secondary to disease e.g. osteoarthritis.
Always consider whether health reason for apparent weight gain. - Owners frequently unaware as obesity so common that they see overweight pets as ‘normal’.
- Weighing the patient.
Feeding for weight loss.
Not appropriate for growth, pregnancy, lactation.
Dogs 1-2 x RER for current weight.
Cats 0.8-1 x RER for current weight.
Regularly re-weigh i.e. q2-4w.
- aim 1-2% loss per week in dogs.
- nearer 0.5-1% loss per week in cats.
– risk of hepatic lipidosis.
If loss slower than desirable, decrease caloric intake by 5-10%.
Calorie restriction and lifestyle modification.
Ideally 90% daily ration should be complete diet and 10% should be complimentary foods.
May help to use a weight management food that helps provide enough nutrients with restricted calories.
Feed veg as treats.
Increased exercise - walks and play.
Feeding games.
Timed feeding.
How does the owner feel?
Precontemplation - O not aware of obesity or need to change.
Contemplation - O aware of obesity but ambivalent to change.
Preparation - O committed to change and seeking advice.
Action - O making overt changes with some successes.
Maintenance - Sustained changes, o continuing to monitor.
Owner engagement and compliance.
Nurse clinics.
Involve whole family:
- check compliance.
- cats; alternative food source from hunting or neighbour?
Use images:
- BCS charts / photos.
- Photo diary / monitoring.
Set targets.
Pre-book regular review appointments.
Play/exercise reward.
NB. drug therapy for weight loss NOT advised.
Oral feeding of the patient.
Most physiologically normal.
Offer food early on.
Record food intake - hospital charts.
Monitor BC / weight.
- effect of fluid balance.
Nutritional support needed if:
- >10% BW loss (outwith fluid balance)
- >3d hyporexia less than 80% RER.
- underlying disease that increases calorie requirement (head trauma, sepsis, severe burns, large wound that are exudating – associated with protein loss).
Encouraging oral intake.
Address:
- underlying disease.
- fluid deficits, electrolyte imbalances.
- nausea, pain, stress.
Highly palatable, highly digestible.
Flat bowls, no bowls.
NEVER syringe feed as creates aversions and risks inhalation pneumonia.
Many anorexic cats are B12 +/- potassium deficient.
- may exacerbate anorexia.
- so correct these beforehand.
Feeding for illness.
IER~RER.
Illness factors rarely applicable.
Most hospitalised patients require their RER.
- hypermetabolic states may be an exception.
– e.g. sepsis, burns, head trauma.
- overfeeding is detrimental too.
Monitor BC / weight.
- if losses continue, consider 25% increase in offered food.
- reassess every few days.
How to feed?
If gut works, use it and use as much of it as possible.
Voluntary oral feeding.
Feeding tubes.
- naso-oesophageal, oesophagostomy, gastrostomy tube, jejunostomy tube.
Micro-enteral nutrition.
- still offer water, electrolytes and add in amino acid glutamine.
– energy source for enterocytes in gut who take it up direct from the gut.
Parenterial nutrition.
IV amino acid, lipid solution and usually dextrose.
- referral level, complications.
- Naso-oesophageal feeding time frame.
- When would N-O feeding be unsuitable?
- Advantages of N-O feeding?
- Disadvantages of N-O feeding?
- Suitable for short term (<7d) nutritional assistance.
- Unsuitable if:
- regurgitating/vomiting.
- nasal, oral, pharyngeal, oesophageal disease.
- (laryngeal incompetence). - Simple to place - can be conscious patient.
Reasonably well-tolerated - most patients happy to eat orally at the same time.
Easy removal - no healing required. - Can only feed liquid diet as narrow bore tube, esp. cats.
- risk of blocking.
- time consuming to feed.
Cannot be managed at home
- problematic if dislodges.
Aspiration risk.
Irritating and can inhibit eating.
