Page 1235 - Cote clinical veterinary advisor dogs and cats 4th

616.e4 Malnutrition

inflammatory bowel disease, infiltrative bowel • Determine a feeding regimen that can deliver as well as with CBC, serum chemistry panel,
disease (e.g., GI lymphoma, histoplasmosis) the estimated caloric goal over a 24-hour and urinalysis) are recommended to be
VetBooks.ir • Cachexia: cancer or cardiac RER at current weight for the first day, based home-prepared diets.
performed q 6 months for all animals fed
period. Start with 10%-50% of calculated
severe parasite infestation (e.g., hookworms)
on patient status as well as the severity and
• Renal disease: end-stage chronic kidney
time course of the previous caloric deficit.
disease, protein-losing nephropathy
Slowly increase to 100% of calculated RER PROGNOSIS & OUTCOME
Initial Database over 2-5 days. The initial goal is to prevent • Prognosis is good to excellent with timely
• A thorough diet history should include further loss of body mass, rather than to identification and correction of nutrient
sufficient information to purchase all food encourage gain of body mass. deficiencies or excesses.
items necessary to feed the patient exactly • Monitor for signs of refeeding syndrome • Prognosis is poor to good with delayed
as the owner does at home. during the first week (hypokalemia, hypo- identification and correction of nutrient
• Physical exam with body weight, body phosphatemia, and hypomagnesemia), and deficiencies or excesses.
condition score (5- or 9-point scale), and supplement accordingly. The rate of feeding • Prognosis is impacted by the underlying cause
muscle mass score (normal, mild, moderate, may need to be decreased, depending on of malnutrition and the ability to resolve or
or severe wasting) tolerance. control comorbid conditions.
• Laboratory evaluation is valuable for assess- • Administer nutrition to patients using enteral
ing overall systemic health and ruling out feeding tube until patient is maintaining PEARLS & CONSIDERATIONS
comorbidities. Common abnormalities weight by voluntary feeding for ≥ 1 week.
seen with chronic malnutrition include • After the animal is eating well, gradually Comments
anemia, hypocalcemia, hypoalbuminemia, increase caloric intake in 10%-20% incre- • The AAFCO Nutritional Adequacy State-
thrombocytosis, and increased blood urea ments to facilitate weight gain. Rapid weight ment on commercial pet food labels should
nitrogen (BUN). gain adds only fat, whereas muscle takes always be identified to avoid selecting a
longer. nutritionally inadequate formulation, unless
TREATMENT • For animals with specific nutrient deficien- specific dietary modifications are necessitated
cies, supplement those nutrients orally or by a health condition (e.g., renal disease,
Treatment Overview parenterally as appropriate. copper-associated hepatopathy).
Goals: • Home-prepared diet recipes found on the
• Correct nutrient deficiencies or excesses Chronic Treatment Internet and in books have repeatedly been
• Return patient to a normal plane of nutrition • Identify dietary, animal-related, owner- shown to be nutritionally inadequate, and
and an appropriate body weight and body related, or environmental issues that caused use of recipes from these sources should be
condition or contributed to the nutritional deficiency discouraged.
or excess. • Thorough laboratory analysis for all essential
Acute General Treatment • Educate owner(s) about nutritional needs nutrients in home-prepared diets is usually
For patients with moderate to severe calorie/ of their animal, given the species, age, life cost prohibitive for pet owners. Computer
nutrient malnutrition: stage, and lifestyle. analysis and comparison with current
• Stabilize patient: rehydrate, correct electrolyte nutrient recommendations (AAFCO or the
imbalances, hemodynamic abnormalities, and Nutrition/Diet National Research Council) are typically used
hypothermia before initiating nutritional • Ensure that a complete and balanced diet is to assess diet adequacy.
support. Consider parenteral B vitamin fed that is formulated to meet Association of
supplementation. Separate thiamin admin- American Feed Control Officials (AAFCO) Prevention
istration is recommended for cats with a nutrient profiles or that has passed AAFCO • Body weight, body condition, and a thorough
history of days to weeks of inadequate intake feeding trials for the appropriate life stage diet history should be recorded in the medical
or an unbalanced diet. and species. record for every patient visit.
• Estimate an initial daily caloric goal for • Refer clients who prefer to feed home- • Hospitalized patients’ nutrient and calorie
resting energy requirement (RER) based prepared diets to appropriate resources (e.g., intake should be recorded and assessed daily
on animal’s current weight (rather than an www.balanceit.com, other board-certified to preemptively identify patients at risk for
ideal weight), using the equation 70 × (body veterinary nutritionists). malnutrition.
weight [kg]) 0.75 • Clients should be educated on the basic
• Select a diet or food type that meets the Drug Interactions nutrient needs of animals, considering
nutritional needs of the patient, taking into Medical therapies instituted for primary condi- species, age, life stage, and environmental
account any comorbidities. tions are often less effective without adequate conditions.
• For patients unable or unwilling to eat nutrition support.
on their own, choose the type of assisted Technician Tips
feeding delivery that fits the patient (e.g., Recommended Monitoring • Technicians can be instrumental in providing
gastrostomy tube for patients with persistent • Animals recovering from malnutrition should client education about the proper diet and
regurgitation, esophagostomy tube for facial be monitored regularly until they attain feeding management of dogs and cats.
trauma). Severe calorie/nutrient malnutrition appropriate body condition and demonstrate • In the outpatient setting, technicians should
can inhibit wound healing and increase clinical recovery. ensure that every patient is weighed, body
potential complications from some types • All home-prepared diets should be evalu- condition is scored, and has a diet history
of tubes (gastrostomy, jejunostomy). ated by a board-certified or PhD-trained recorded.
• Severely compromised patients with GI veterinary nutritionist yearly to ensure that • Technicians can aid in identifying in-patients
abnormalities may require or benefit from they adhere to current nutritional recom- at risk of malnutrition.
parenteral nutrition. Parenteral nutrition mendations and are still appropriate for the
requires considerable expertise with 24-hour animal. Client Education
monitoring and nursing care and should be • Nutritional assessment (including diet history • All clients should be educated on impor-
used only until it is possible to meet energy and physical exam with body weight, body tance of AAFCO Nutritional Adequacy
and nutrient needs through the GI tract. condition score, and muscle condition score Statements on pet food labels and taught

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