Starved/Critical

Question 1

Starved patients are often a result of mis-management and will have a ________ appetite

Answer 1

Good

Question 2

When it comes to lean tissue, how do starved and critical patients differ?

Answer 2

Starved patients try to preserve lean tissue

Critical patients are unable to preserve lean tissue

Question 3

A critical patient is often ___________

Answer 3

Hyporexic or anorexic (b/c unable or unwilling to eat)

Question 4

Why are critical patients unable to preserve lean tissue?

Answer 4

Pathologic catabolic processes breaking down muscle tissue

Question 5

What are some consequence of hyporexia/anorexia?

Answer 5

Malnutrition, weight loss, reduced BCS and MCS
GI dysfunction
Ketone production
Insulin resistance
Hepatic lipidosis

Question 6

A stray patient is brought into the animal clinic. The patient is a BCS 2/9, but maintains adequate muscling. Do you suspect that this patient is critically ill or just starved?

Answer 6

Likely starved b/c patients will preserve lean muscle

Question 7

What are some indications for nutritional support?

Answer 7

BCS <4/9 (don’t discount higher BCS tho)
Mild/moderate/severe muscle loss
Recent unintended weight loss (>10%)
Anorexia or hyporexia >3d
+/- lab abnormalities

Question 8

A patient presents with a BCS 3/9, moderate muscle loss, and a few week history of hyporexia. The patient is clinically dehydrated. Should nutritional support be considered? What should be done first?

Answer 8

Nutritional support is indicated

Correct dehydration and any electrolyte abnormalities first

Question 9

What is the initial goal behind nutritional support?

Answer 9

Cease further weight loss

Question 10

With nutritional support, how much fat and protein should be included in the diet?

Answer 10

Gotta meet that NRC requirement for life stage

Can be altered depending on complicating factors (Ex. Decrease protein w/ kidney disease or HE, increase with PLE)

Question 11

When are patients at the highest risk of refeeding syndrome?

Answer 11

During the first week of refeeding
Monitor BG and electrolytes

Question 12

Why does refeeding syndrome develop?

Answer 12

Starved or anorexic patients have been running off fat and protein, so when we reintroduce carbohydrates, patients have a hard time utilizing them

Question 13

What three chemistry changes might you see in a patient with refeeding syndrome?

Answer 13

Hyperglycemia
Hypokalemia
Hypophosphatemia

Question 14

T/F: the longer a patient has been anorexic, the faster you should increase RER

Answer 14

False - a patient that is anorexic for one day can be increased to RER over 2 days, but a patient that has been anorexic for >3 days may take up to 1 week to reach RER

Question 15

An anorexic patient has been at RER x 0.25 for 2 days. You increase to RER x 0.5 and the patient begins to experience diarrhea and vomiting. Is it okay to continue increasing RER?

Answer 15

No, only increase if no metabolic or GI complications present

Question 16

Once a patient is stable at RER, over what time period can you increase to DER?

Answer 16

1-2 weeks

Question 17

Describe how to estimate target body weight

Answer 17

Target BCS = 5/9
So if a 40lb patient is a 1/9, they must gain 4 BCS to reach target BCS
40lb/0.6 = 66.7lb

Question 18

You have a patient that is 25lb and a 2/9 BCS. What is this patient’s estimated target weight?

Answer 18

3 BCS short
25lb/0.7 = 35.7lb

Question 19

What kind of diet is required for starved patients?

Answer 19

Usually have good appetite
An energy dense food is likely not needed
A therapeutic/prescription/veterinary diet is likely not needed

Typically do ok with gradual introduction of a decent quality food

Question 20

When should assisted feeding be considered?

Answer 20

Critical patient with an underlying cause for anorexia/hyporexia that hasn’t been resolved/managed

Question 21

Capromorelin (Entyce) is a ________ agonist and can be used in _____

Answer 21

Ghrelin
Dogs

Question 22

Cyproheptadine is a __________ antagonist and is commonly used in ______

Answer 22

Serotonin
Cats

Question 23

Mirtazapine (Remeron) is a __________ antagonist and can be used in ________

Answer 23

Serotonin
Dogs and cats

Question 24

When is enteral assisted feeding indicated?

Answer 24

Working gut

Question 25

When is parenteral assisted feeding indicated?

Answer 25

Dysfunctional GIT (active vomiting, ileus, pipe stream diarrhea)

Question 26

What are some pros and cons to enteral feeding?

Answer 26

Pros: physiologic, long-term, can meet all essential nutrients

Cons: need a gag reflex

Question 27

Name some enteral routes

Answer 27

NE
NG
E
G
J

Question 28

What are some pros and cons to parenteral feeding?

Answer 28

Pros: no gag reflex needed

Cons: higher risk of metabolic complications, cost, short-term (1 week), does not meet nutritional requirements

Question 29

NE/NG routes require __________ diets

Answer 29

Liquid only

Can only be used for <1 week

Question 30

Esophagostomy tubes can be used for __________, but require ___________ food or _________

Answer 30

Months
Canned food or gruel

Question 31

G tubes can be used ____________ and require __________ food or __________

Answer 31

Life-long
Canned
Gruel

Question 32

T/F: NE/NG are the easiest to place and can be done with local anesthetic

Answer 32

True

Question 33

What is the stomach capacity of a HEALTHY dog and cat?

Answer 33

Cats: 20-45ml/kg/meal
Dogs: 90ml/kg/meal

Question 34

For the first few days of assisted enteral feeding, what is the stomach capacity?

Answer 34

5-10mL/kg/meal

Question 35

How frequent are feedings during the first few days of assisted enteral feeding?

Answer 35

Every 2-4 hours OR CRI (if volume intolerant or J tube)

Question 36

When can a patient be weaned from enteral feeding?

Answer 36

Patient is consistently consuming 75% RER daily
Remove tube when patient is consistently consuming 100% RER