Page 639 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

626 SPECIAL THERAPY

TABLE 26-1 Body Condition Score In sick animals, increased water losses via the urine may
occur in some settings (e.g., diabetes mellitus, polyuric
Score Classification Description renal failure, hyperadrenocorticism, hyperthyroidism).
Water also is lost in vomitus, diarrhea, burns, or hemor-
1 Cachexic Severely underweight, rhage. Insensible water losses (e.g., respiratory, cutane-
decreased muscle mass, no
ous, fecal) may account for 20% to 40% of total water
subcutaneous fat present, 5
loss, which may be increased in the presence of fever,
skeleton prominent.
hyperventilation, hypermetabolism (e.g. sepsis), third-
2 Thin Muscle mass adequate, little
spacing of fluids and burn wounds.
subcutaneous fat, skeleton
Energy needs of anorexic patients are estimated by
apparent but not prominent.
3 Normal Muscle mass adequate, ribs not summing requirements for basal metabolic functions,
seen but easily felt, obvious activity, and the effects of disease. Basal metabolic rate
waist present when viewed (calories per day required for protein turnover and main-
from lateral or dorsoventral tenance of ionic gradients across semipermeable
aspect. membranes) is usually estimated by exponential
4 Overweight Individual ribs and spinous method: 3,46,54 97 x BW kg O.655 (Figure 26-2)or70x
processes of vertebrae O.75
BW kg . A linear method (30 x BW kg þ 70) should only
palpable only with moderate be used for animals weighing between 2 to 45
pressure, obvious fat pads 46
present. kilograms.
5 Obese Palpation gives feeling of We estimate the energy needs of our patients by assum-
extensive fat cover over body. ing that those resting in a hospital cage have resting
Large fat pads, respiratory energy needs, determined from Figure 26-2. Although
and/or locomotor sepsis and burn injuries were found experimentally to
compromise. increase energy expenditure 25% to 35% in dogs, 101 more
recent clinical studies found that the energy needs of rest-
ing critically ill, postoperative, and severely traumatized
dogs were not higher than the basal needs of healthy
feeds over the next 48 to 72 hours in humans. 70 In criti- animals. 97 Based on these considerations and the
cally ill patients, nutritional support should commence as
soon as the patient is hemodynamically stable, since many
How Much to Feed
of these patients are already in a catabolic state. Although (kcals/day)
EEN remains controversial in dogs with acute pancreati- 1600
tis, positive effects associated with EEN have been
1400
demonstrated in dogs diagnosed with parvoviral enteritis.
Mohr, et al. randomized dogs with parvoviral enteritis 1200
into 2 groups: 15 dogs received no food until vomiting 1000
had stopped for 12 hours, and 15 dogs received early 400
EN by nasoesophageal tube from 12 hours after admis- Kilocalories per day 800 300
sion. 75 The EEN group demonstrated clinical 600
improvements and had faster weight gains. 75 Some veter- Kilocalories per day 200
inary nutritionists recommend nutrition support be 400 100
instituted for any veterinary patient that is anorexic or 200 Body weight (lbs)
anticipated to be hyporexic for longer than 3 days. 0 0 10 20
0
0 20 40 60 80 100 120 140 160
NUTRIENT NEEDS Body weight (lbs)
To meet basal needs: use graph
Dogs and cats that are eating require 50 to 100 mL of
water per kilogram of body weight for daily maintenance, To meet needs of stress:
1. Mild stress 25% increase
depending on environmental temperature, type of food,
2. Moderate stress 50% increase
and amount of activity. Water requirements of normal 3. Severe stress 100% increase
fasting animals are only 5 to 10 mL/kg body weight Figure 26-2 Approximate basal energy needs of dogs and cats.
per day (10% of the requirement of animals that are (From Abood SK, Mauterer JV, McLoughlin MA, Buffington
eating). 83 This is because the solute load ingested with CA. Nutritional support of hospitalized patients. In: Slatter DH,
the diet and ultimately excreted by the kidneys is editor. Textbook of small animal surgery, 2nd ed. Philadelphia:
reduced. 103 WB Saunders, 1993.)