Page 652 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

Enteral Nutrition 639

BOX 26-5 Criteria for Selection of Liquid Enteral Diets

A. Categories of enteral diets a. Increased (>50% of kcal) due to diarrhea (high
1. Polymeric—intact macronutrients (protein, fat, carbohydrate feedings) or increased energy needs
carbohydrates) for use in patients with normal or near- b. Decreased (<30% of kcal) due to prolonged
normal gastrointestinal function (caloric density is anorexia, fat maldigestion, or fat malabsorption
about 1 kcal/mL) 3. Triglycerides—long chain or medium chain. Long
a. High fat (>50% of kcal)—caloric density is about chain for patients with adequate pancreatic and
1.5 kcal/mL; use for high energy needs, volume intestinal function; medium chain for patients with
restriction, or diarrhea caused by high (>50% of severely impaired pancreatic or liver function
kcal) carbohydrate products C. Protein
b. Fiber containing—improved feces consistency over 1. Total intake
high-carbohydrate diets a. Restricted (<18% of kcal) due to impaired liver or
2. Defined-formula diets—diets specifically modified for kidney function
use in patients with impaired organ function b. Increased (>22% of kcal) due to increased losses via
a. Impaired gastrointestinal function (including intestinal tract, draining wounds, trauma
anorexia for >2 weeks); contains peptides, medium- D. Form of Diets
chain triglyceride, and glucose polymers versus 1. Intact—patients with adequate pancreatic and
intact macronutrient sources; may cause diarrhea intestinal function
b. Impaired liver function—high branched-chain/ 2. Hydrolyzed—patients unable to tolerate intact protein
aromatic amino acid content E. Specific Amino Acids for Cats
c. Impaired kidney function—supplemented with 1. Arginine—recommend 2.5 mg/kcal/day; human
B-ketoacids of some essential amino acids enteral formulas should be supplemented with
d. “Stress”—high branched-chain amino acid content, 1 mg/kcal
high caloric density (>1 kcal/mL); efficacy 2. Taurine—not necessary for short-term feeding; for
disputed long-term feeding, the requirement is 0.1 mg/kcal/
B. Energy day
1. Total calories F. Electrolytes—sodium, potassium, and chloride at about
a. Restricted (<1 kcal/mL) due to obesity or 40 mEq/L have been adequate; should be adjusted based
uncontrollable hyperglycemia (rare) on laboratory determinations
b. Increased (>1 kcal/mL) because of disease- G. Minerals and Vitamins—follow NRC recommendations
induced increases in requirements; severe trauma, in absence of specific information to the contrary
burns, sepsis, hyperthyroidism H. Osmolality—hypoalbuminemia: 250-650 mOsm/kg,
2. Carbohydrate depending on severity

A local nutrition support service dietitian may also be of
help; these professionals may have nutritional products
and delivery apparatus available, and possess extensive
training and experience in nutritional support.
Blenderized gruels made with commercial canned dog
or cat diets are suitable for use in feeding tubes larger than
14 Fr in size. Specific products marketed for critically ill
dogs or cats have been recently published. 86 Table 26-3
presents the nutrient compositions of the liquid enteral
products currently used in the Critical Care Unit at
Michigan State University and in the Small Animal Inten-
sive Care Unit at The Ohio State University. None of the
human enteral products appear to contain adequate argi-
nine for cats. Signs compatible with arginine deficiency
have been reported after prolonged feeding of enteral Figure 26-16 Clinicare and Clinicare RF liquid enteral diets.
diets designed for humans and those designed specifically
for cats. In the absence of data to support other diets fed to cats. Arginine (as the hydrochloride salt) is
recommendations, we add 1 mg arginine/kcal (approxi- inexpensive and readily available at health food stores
mately 200 to 300 mg/cat/day) to human enteral liquid and at many pharmacies.