Starved/Critical Flashcards
Starved patients are often a result of mis-management and will have a ________ appetite
Good
When it comes to lean tissue, how do starved and critical patients differ?
Starved patients try to preserve lean tissue
Critical patients are unable to preserve lean tissue
A critical patient is often ___________
Hyporexic or anorexic (b/c unable or unwilling to eat)
Why are critical patients unable to preserve lean tissue?
Pathologic catabolic processes breaking down muscle tissue
What are some consequence of hyporexia/anorexia?
Malnutrition, weight loss, reduced BCS and MCS
GI dysfunction
Ketone production
Insulin resistance
Hepatic lipidosis
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?
Likely starved b/c patients will preserve lean muscle
What are some indications for nutritional support?
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
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?
Nutritional support is indicated
Correct dehydration and any electrolyte abnormalities first
What is the initial goal behind nutritional support?
Cease further weight loss
With nutritional support, how much fat and protein should be included in the diet?
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)
When are patients at the highest risk of refeeding syndrome?
During the first week of refeeding
Monitor BG and electrolytes
Why does refeeding syndrome develop?
Starved or anorexic patients have been running off fat and protein, so when we reintroduce carbohydrates, patients have a hard time utilizing them
What three chemistry changes might you see in a patient with refeeding syndrome?
Hyperglycemia
Hypokalemia
Hypophosphatemia
T/F: the longer a patient has been anorexic, the faster you should increase RER
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
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?
No, only increase if no metabolic or GI complications present
Once a patient is stable at RER, over what time period can you increase to DER?
1-2 weeks
Describe how to estimate target body weight
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
You have a patient that is 25lb and a 2/9 BCS. What is this patient’s estimated target weight?
3 BCS short
25lb/0.7 = 35.7lb
What kind of diet is required for starved patients?
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
When should assisted feeding be considered?
Critical patient with an underlying cause for anorexia/hyporexia that hasn’t been resolved/managed
Capromorelin (Entyce) is a ________ agonist and can be used in _____
Ghrelin
Dogs
Cyproheptadine is a __________ antagonist and is commonly used in ______
Serotonin
Cats
Mirtazapine (Remeron) is a __________ antagonist and can be used in ________
Serotonin
Dogs and cats
When is enteral assisted feeding indicated?
Working gut
When is parenteral assisted feeding indicated?
Dysfunctional GIT (active vomiting, ileus, pipe stream diarrhea)
What are some pros and cons to enteral feeding?
Pros: physiologic, long-term, can meet all essential nutrients
Cons: need a gag reflex
Name some enteral routes
NE
NG
E
G
J
What are some pros and cons to parenteral feeding?
Pros: no gag reflex needed
Cons: higher risk of metabolic complications, cost, short-term (1 week), does not meet nutritional requirements
NE/NG routes require __________ diets
Liquid only
Can only be used for <1 week
Esophagostomy tubes can be used for __________, but require ___________ food or _________
Months
Canned food or gruel
G tubes can be used ____________ and require __________ food or __________
Life-long
Canned
Gruel
T/F: NE/NG are the easiest to place and can be done with local anesthetic
True
What is the stomach capacity of a HEALTHY dog and cat?
Cats: 20-45ml/kg/meal
Dogs: 90ml/kg/meal
For the first few days of assisted enteral feeding, what is the stomach capacity?
5-10mL/kg/meal
How frequent are feedings during the first few days of assisted enteral feeding?
Every 2-4 hours OR CRI (if volume intolerant or J tube)
When can a patient be weaned from enteral feeding?
Patient is consistently consuming 75% RER daily
Remove tube when patient is consistently consuming 100% RER
