Page 653 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

640 SPECIAL THERAPY

TABLE 26-3 Nutrient Composition BOX 26-6 Recommended Rates
of Veterinary Liquid and Volumes for
Enteral Products Enteral Feeding

CliniCare CliniCare
Canine/ Feline 1. General Guidelines
Product Feline Renal A. Determine resting energy requirements (RER)
caloric needs from Figure 26-1
B. For formulas containing 1.5 kcal/mL, divide
Manufacturer Abbott Labs Abbott Labs
energy needs by 1.5 to get volume needed to feed
Kcal/8 oz can (g) 237 (1) 237 (1)
C. Increase feeding rate and volume only as patient
mOsm/kg 340 290
tolerance allows
Kcal/mL 1 1
2. Intermittent Bolus Feeding
Protein (g) 8.2 g/100 kcal 6.3 g/100 kcal
Protein source Casein, whey Casein, whey A. Day 1: feedings delivered at 1=3to1=2 RER
protein protein caloric goal q4-6h
Fat (g) 5.1 g/100 kcal 6.7 g per 100 kcal B. Day 2: feedings delivered at 2=3to 3=4 RER
Fat source Soybean oil, Soybean oil, caloric goal q4-6h
chicken fat chicken fat C. Day 3: feedings delivered at RER (100% of RER)
Carbohydrate (g) 6.8 g/100 kcal 6.3 g/100 kcal caloric goal q4-6h
Carbohydrate Corn maltodextrin Corn maltodextrin D. Feeding rate and volume can be increased as
source patient tolerance allows
Fiber 0.1 g/100 kcal 0.1 g/100 kcal 3. Continuous Feeding (hourly rate)
Na % Dry Matter 0.35 0.27 A. Day 1: delivery rate of enteral diet should be 1=3to
þ
Na (mg) 80 mg/100 kcal 62 mg/100 kcal 1=2 RER/24 hr
þ
K % dry matter 0.70 0.55 B. Day 2: delivery rate of enteral diet should be 2=3to
þ
3=4 RER/24 hr
K (mg) 160 mg/100 kcal 125 mg/100 kcal
þ
Ca 2þ % dry matter 0.61 0.55 C. Day 3: delivery rate of enteral diet should be 100
RER/24 hr
Ca 2þ (mg) 140 mg/100 kcal 125 mg/100 kcal
D. Feeding rate and volume can be increased as
P i (mg) 120 mg/100 kcal 104 mg/100 kcal
patient tolerance allows
Mg 2þ (mg) 10 mg/100 kcal 9 mg/100 kcal
RATE AND VOLUME OF
FEEDING study evaluating continuous infusion and intermittent
bolus feeding was performed in 10 healthy dogs with
Approach the calculated goal for nutrients and fluids over gastrostomy tubes. No difference was found in weight
approximately 24 to 72 hours to prevent vomiting, maintenance, gastrointestinal (GI) adverse effects,
abdominal distention or signs of colic, and diarrhea g-glutamyl transpeptidase, nitrogen balance, or feed
20
(Box 26-6). Slow rates of administration, particularly in digestibility. More recently, a retrospective study was
animals that have been inappetent for prolonged periods, performed at Michigan State University evaluating the
prevent the problems of diarrhea and cramping, and max- percentage of prescribed nutrition delivered (PPND) in
imize the uptake of nutrients. 37 dogs and 54 cats that were supported using
nasoenteric feeding tubes. 16 The PPND was not signifi-
ENTERAL NUTRITION cantly different between patients fed continuously
DELIVERY METHODS (99.0%) and patients fed intermittently (92.9%). This
study also found that the frequencies of GI complications
The two most common EN delivery methods for veteri- were not significantly different between the two delivery
nary and human patients are continuous infusion or inter- methods. Enterally fed dogs had a significantly higher fre-
mittent bolus feedings. Critically ill patients with quency of regurgitation and diarrhea than enterally fed
impaired gastrointestinal mobility may better tolerate cats. The retrospective nature of this study precluded
continuous infusion of nutrition, whereas intermittent the authors from making conclusions regarding the cause
bolus feeding resembles a more physiologic method of for discrepancy between prescribed and delivered
providing calories. Randomized, controlled trials in nutrition.
human patients have failed to determine which delivery Limitations associated with interpreting data from ret-
method is superior in providing prescribed calories with rospective research led Holahan and Abood to develop a
minimal complications.* Few studies have examined
EN delivery systems in critically ill small animals. A pilot *References 23, 42, 45, 55, 65, 88.