SA Critical Care Nutrition Flashcards
Define nutritional support
Method to support metabolic status of hospitalised patients
What types of nutritional support do we have?
Enteral vs parenteral
What is enteral nutritional support?
Pros and cons
Methods which utilise the GI tract
it is the preferred method
Easier fewer complications more economical more physiological If the gut works, use it = use enteral
What is parenteral nutritional support?
- Intravenous feeding with elemental diets
- Deliver in central (jugular vein)
- If a peripheral causes damage
- Constant perfusion
- Needs to be protected from light – wrap bag up
- Glucose and lipis therefore risk of bacterial contamination = high risk for sepsis
- Only if no other choice
Why do we use nutritional support?
A healthy animal can reduce nutritional utilisation if not enough food to compensate so can cope with a short period of starvation
however sick animals cannot compensate therefore malnutrition can occur quickly and nutritional deficiencies are magnified
When should you use nutritional support?
ALL THE TIME!!
Nutrition should automatically be part of hospitalisation plan
Malnutrition develops early in illness therefore we need to think about it immediately, not a few days down the line
General rule for nutrition intervention
- Recent weight loss >10% BW
- Partial/complete anorexia for ≥ 3days – 3 days from START of illness, not from when entered the hospiral
- Diseases causing excess catabolism – metabolic rate amplified
- Treat obese patients the same – doesn’t have a “greater reserve” if anything has a greater demand
What are the ways you can provide enteral nutrition?
- encourage feeding
- force feeding (discouraged)
- drugs to stimulate appetite
- tube feeding
How can we encourage feeding?
v May not be eating as stressed, unusual environment, minor surgery, particularly relevant for cats
v Privacy – blanket over cage
v Comfortable environment
v Favourite foods in small amounts – ask owner
v Fresh food and try warming – increases palatability
v Don’t “overface” – don’t have 8 bowels around the cat!!
v This should be at entry level
v RECORD CLOSELY HOW MUCH EATING
What diet should you feed your patient?
- highly digestible diet
- Cooked meat or fish (however not completely balanced so this is a short term fix
- Critical care diet - much more energy dense than standard = don’t need to feed as much
- Therapeutic diet - adapted for a particular illness = may not be as palatable
What drugs can we use to stimulate appetite, pros and cons
Only use if patient is partially anorexic, if really sick don’t use
Mirtazapine – first line, safest (both dogs and cats) – BUT partial/short term anorexia
o Best tolerated/ appetite stimulant
o Only for partial/short term anorexia
o Cat = every 3 days as long half life. Dogs = daily dose
Diazepam – stimulates cats to feed
o Is Valleum – only works in cats – short phase where appetite goes up
o Can have side effects (hepatitis necrosis)
Cyproheptadine
o H1 antagonist, not sued much in other situations. Side effect = can stimulate appetite
o Side affect – haemolytic anaemia
- North America have a grelin agonist “entice” which is licensed over there not here yet
What types of feeding tubes do we use?
• Naso-oesophageal tubes • Oesophagostomy tubes • Gastrostomy/ PEG tubes • Enterostomy tubes (pharyngostomy tubes not used anymore as danger complications as close to lots of nerves, BV)
When would we use a nasopesophageal tube?
Where is the tip?
When the patient is going to need nutritional care short to medium term - 1-2 weeks MAX
Can be placed when conscious - if too ill to go under GA
simplest to place
Cheapest
Through nose, through varies and nasal passage, tip remains in oesophagus
What are contraindications of nano-oesophageal tube?
• Vomiting, no gag reflex
• Disease of nose or pharynx
- limited type of food used as such a small tube. Must be liquid
- it is placed very proximally therefore any disease affecting the head, mouth, nose, pharynx cannot use this tube
How is an oesophagostomy tube placed?
Placed through left side of neck, directly into oesophagus, tip of tube in distal oesophagus
