Starved + Critical

Question 1

(T/F) Starved animals have a good appetite.

Answer 1

(T)

Question 2

(T/F) In starved animals, the body attempts to preserve lean tissue (muscle).

Answer 2

(T, exceptions to this are demanding life stages)

Question 3

Starved or critically ill (choose) patients have difficulty maintaining their muscle mass.

Answer 3

(Critically ill patients)

Question 4

What GI dysfunction can occur secondary to hyporexia/anorexia?

Answer 4

(Stasis, reduced digestive enzyme secretion, and dysfunction of enterocytes and colonocytes themselves)

Question 5

What are some indications the nutritional support is necessary for a starved and/or critically ill patient?

Answer 5

(BCS < 4/9, muscle loss, recent unintended weight loss that is > 10% of their body weight, anorexia/hyporexia especially if 3 days or more, and +/- laboratory abnormalities (hypoalbuminemia, anemia, low BUN, lymphopenia, electrolyte abnormalities))

Question 6

What are some laboratory abnormalities that can be nonspecific indicators of malnutrition?

Answer 6

(Hypoalbuminemia, anemia, low BUN, lymphopenia, electrolyte abnormalities)

Question 7

(T/F) Dehydration and electrolyte abnormalities should be corrected prior to starting nutritional support.

Answer 7

(T)

Question 8

When should protein be restricted vs supplemented in a nutritional plan?

Answer 8

(Restricted in cases of kidney dz or hepatic encephalopathy; supplemented in cases of PLE)

Question 9

Supplementation of glutamine is particularly important for what cells in the body?

Answer 9

(Enterocytes)

Question 10

When should the fat content of nutritional support be restricted?

Answer 10

(In cases of lymphangiectasia, hyperlipidemia, and +/- pancreatitis)

Question 11

What macronutrient increases the risk of metabolic complications such as refeeding syndrome?

Answer 11

(Carbohydrates bc they will be novel to a patient who has been starved or anorexic for a week or more)

Question 12

Why might a starved or critically ill patient be hyperglycemic after the commencement of nutritional support?

Answer 12

(Insulin resistance can develop during starvation/critical illness)

Question 13

What are the bloodwork hallmarks of refeeding syndrome?

Answer 13

(Hyperglycemia (insulin resistance), hypokalemia (intracellular shifting), and hypophosphatemia (malnutrition))

Question 14

If a critically ill patient has been anorexia for 1 day, what factor do you want to multiply RER by on the first day of refeeding?

Answer 14

(0.5, then you go up to 1 after that if there are no metabolic or GI complications)

Question 15

If a critically ill patient has been anorexic for 2-3 days, what factor do you want to multiply RER by on the first day of refeeding?

Answer 15

(0.25, you feed that for day 1 then move up to 0.5 for day 2 and then 1 for day 3 and on, again only increasing if no metabolic or GI complications)

Question 16

Explain the refeeding plan/schedule for a critically ill patient that came in after not eating for 5 days.

Answer 16

(Day 1-2: RER x 0.25, day 2-4: RER x 0.5, day 3-6: RER x 0.75, day 4-8: RER x 1; only increase RER multiplier if not metabolic or GI complications, if physically/metabolically stable at RER, gradually increase to DER over 1-2 weeks and continue until BCS 4-5/9)

Question 17

Enteral/parenteral (choose) assisted feeding is associated with a higher risk of metabolic complications.

Answer 17

(Parenteral)

Question 18

Which of the assisted enteral feeding routes can be used for the rest of an animal’s life?

Answer 18

(Gastrostomy tube)

Question 19

What is the initial stomach capacity in ml/kg/meal that should be respected when providing enteral nutrition to a critically ill patient?

Answer 19

(5-10 ml/kg/meal, once at 100% DER 20-45 ml/kg/meal for cats and 90 ml/kg/meal for dogs)

Question 20

How often should a critically ill patient you are providing enteral nutritional support be fed?

Answer 20

(Every 2-4 hours, once at 100% DER can transition to every 6-8 hours then slowly to every 8-12)

Question 21

Patients are weaned from enteral assisted feeding when the patient is consistently consuming what % of their RER on their own?

Answer 21

(75%, only remove the tube when patient is consistently consuming 100%)