Page 620 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

608 SPECIAL THERAPY

BOX 25-1 Indications for
Parenteral Nutrition*

Vomiting
Regurgitation
Acute pancreatitis
Intestinal obstruction
Severe malabsorption
Prolonged ileus
Inability to guard airway

*Whenever possible, enteral nutrition should be used to
supplement parenteral nutrition (even if provided at a very low
rate) to prevent atrophy of the intestinal tract.
Figure 25-1 An obviously malnourished dog. This dog requires
aggressive nutritional support.
adequate calories and cannot tolerate enteral nutrition.
The specific indications for parenteral nutrition are shown
in Box 25-1. Proper patient selection is an important
aspect of nutritional assessment because administration
of parenteral nutritional support to patients unlikely to
benefit from this form of nutrition only subjects them
to risk of complications.

NUTRITIONAL ASSESSMENT

In critically ill animals, nutrition often is not considered
to be a priority during the early phases of resuscitation,
stabilization, and diagnostic testing. However, this pop-
ulation is at high risk for developing malnutrition, and
identification of animals that are already malnourished
or those that are at high risk for becoming malnourished
should be of high importance. Being aware of an animal’s
nutritional status at admission and of changes that occur A
during hospitalization will optimize patient care.
It is easy to recognize the classical picture of the starved
patient as being malnourished (Figure 25-1). However,
many of our patients have more subtle signs of malnutri-
tion or develop malnutrition while hospitalized because
the risk for malnutrition was not recognized early enough
to prevent it (Figure 25-2, A). Even obese animals are at
risk for malnutrition (Figure 25-2, B) because if they lose
weight, they will lose lean body mass rather than fat.
Assessment of nutritional status should be incorporated
into the daily examination of each patient. Nutritional
assessment identifies malnourished patients that require
nutritional support and also identifies patients at risk
for malnutrition in which nutritional support will help B
prevent malnutrition. 15,53 Figure 25-2 A, Malnutrition can be subtle in the early stages.
For many years, investigators have attempted to This dog has been eating reduced amounts of food for 1 week as a
develop a single measurement or group of measurements result of chronic renal failure. It is not obviously thin but is already
that will identify malnutrition in humans. Unfortunately, exhibiting muscle loss. Appropriate nutritional support can help to
few of these have worked well on a clinical basis. There- minimize further losses. B, Even an obese animal can become
fore, most nutritionists in human and veterinary medicine quickly malnourished in the hospital when ill or injured. If insufficient
use a subjective global clinical assessment to identify calories are supplied, the cat will lose weight but it will be functional
patients in need of nutritional support (Box 25-2). lean body mass, rather than fat, that is lost.