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Parenteral Nutrition 609

BOX 25-2 Indicators of
Malnutrition in Dogs
and Cats

Historical Findings
Vomiting
Regurgitation
Chronic diarrhea
Anorexia (total loss or reduced appetite)
Unintended weight loss of 10% or greater
Physical Examination Findings
Weight loss (although this may be masked by fluid shifts
in the critically ill patient)
Muscle loss Figure 25-3 This dog is anorectic and is being treated with an
Poor hair coat open abdomen for septic peritonitis. Although not yet
Signs of poor wound healing malnourished, it is at high risk for becoming so because of the lack of
Coagulopathy nutrient intake and the large protein losses via the abdomen.
Pale mucous membranes
Laboratory Findings*
Hypoalbuminemia
Lymphopenia
Anemia
Coagulopathies

*These laboratory abnormalities are not specific to malnutrition
and generally are not present early in the process of developing
malnutrition.

This assessment includes historical information (e.g.,
duration of clinical signs, history of anorexia or weight
loss), clinical parameters (e.g., underlying disease, degree
of weight and/or muscle loss, severity of illness, clinical
signs, anticipated course of recovery), and laboratory
results. Any clinical or laboratory findings that would spe- Figure 25-4 A cat with asthma that is not malnourished and is at
cifically alter the nutritional plan should be carefully con- low risk for becoming so. This cat does not require immediate
sidered. Examples include the presence of congestive nutritional support and can be monitored to ensure adequate food
heart failure (which would necessitate careful attention intake. However, if the underlying disease does not resolve quickly
to fluid volume), electrolyte abnormalities, hyperglyce- or the animal continues to be anorectic, nutritional support may be
mia, hypertriglyceridemia, or hepatic encephalopathy. required.
These factors then are incorporated into an overall assess-
ment of the degree of malnutrition or the animal’s risk for them for diagnostic or therapeutic procedures, a feeding
developing malnutrition. Prevention (or correction) of tubeshouldbeplaced.Factorsthatputananimalathighrisk
nutritional deficiencies and imbalances then can be for malnutrition include anorexia lasting longer than 3 days
accomplished by providing adequate energy substrates, (be suretoinclude the timethe animal has beenanorectic at
protein, and micronutrients. home before admission to the hospital), serious underlying
The authors categorize hospitalized animals into three disease (e.g., trauma, sepsis, peritonitis, pancreatitis, exten-
groups: (1) those that are already malnourished (see sive gastrointestinal surgery), and large protein losses (e.g.,
Figure 25-1); (2) those that are not malnourished but are protracted vomiting or diarrhea, open abdomen, or large
at high risk for developing malnutrition (Figure 25-3); draining wounds). Animals in the third group do not
and (3) those that are not malnourished and are at low risk require immediate nutritional support and can be moni-
for developing malnutrition (Figure 25-4). Animals in the tored to ensure adequate food intake. However, if the
first group require prompt nutritional support. Animals in underlying disease does not resolve quickly or the animal
thesecondgrouprequirenutritionalsupportinthefirst2to continues to be anorectic, nutritional support may be
3 days of hospitalization, or at the time of anesthetizing required. Indicators of malnutrition are listed in Box 25-2.