Page 1006 - Small Animal Clinical Nutrition 5th Edition

1044 Small Animal Clinical Nutrition

and gum tragacanth). However, increased levels (>8% DM) of
Table 54-2. Key nutritional factors for foods for dogs and cats
VetBooks.ir with gastric motility and emptying disorders.* insoluble fiber (powdered cellulose) in dry foods fed to cats had
no effect on gastric emptying (Armbrust et al, 2003). Other
Factors
4.0 to 4.5 kcal/g (16.7 to 18.8 kJ/g)
Energy density Recommended levels reports show that the ratio of slowly to rapidly fermentable
fibers is important (Kritchevsky, 2001). Therefore, the crude
Potassium 0.8 to 1.1%
Chloride 0.5 to 1.3% fiber content of foods for patients with gastric motility or emp-
Sodium 0.3 to 0.5% tying disorders should be limited to no more than 5% DM.
Fat ≤15% for dogs
≤25% for cats
Crude fiber ≤5% crude fiber; avoid foods with gel- Meal Size, Food Form and Food Temperature
forming fiber sources such as pectins and In cats and probably dogs, larger meals are emptied more slow-
gums (e.g., gum arabic, guar gum, car- ly from the stomach than smaller meals (Goggin et al, 1998).
rageenan, psyllium gum, xanthan gum,
carob gum, gum ghatti and gum traga- Liquids are emptied from the stomach more quickly than solids
canth) due to lower digesta osmolality. Water is emptied most quick-
Food form Moist is best; initially liquid or semi-liquid ly, whereas liquids containing nutrients are emptied more slow-
consistency
Food temperature 70 to 100°F (21 to 38°C) ly. High-osmolality fluids are emptied more slowly than dilute
*Nutrients expressed on a dry matter basis. fluids. Solids are the slowest to be emptied from the stomach
(Fleming, 1997). A study in cats noted that dry foods emptied
more slowly than moist foods (Goggin et al, 1998).
The ideal food form for patients with gastric emptying dis-
Electrolytes orders has a liquid or semi-liquid consistency. Cold meals slow
Abnormalities in serum electrolyte concentrations, especially gastric emptying. Therefore, food should be offered between
°
°
potassium, sodium and chloride, are common in patients with room and body temperature (70 to 100 F [21 to 38 C]).
chronic vomiting and can adversely affect gastric motility and
emptying. Initial abnormalities should be corrected with appro-
priate parenteral fluid therapy. Foods for patients with gastric FEEDING PLAN
motility should contain levels of potassium, chloride and sodi-
um above the minimum allowances for normal dogs and cats. Dehydration, electrolyte and acid-base abnormalities and gas-
Recommended levels of these nutrients are 0.8 to 1.1% DM tric outflow obstruction should be corrected with appropriate
potassium, 0.5 to 1.3% DM chloride, and 0.3 to 0.5% DM fluid therapy and surgical intervention, respectively, before the
sodium. Thereafter, the food should contain levels of minerals feeding plan is initiated. For dogs or cats with functional gas-
appropriate for the patient’s lifestage. tric motility disorders, several prokinetic agents are available
(Table 51-1) and should be considered if dietary management
Fat is insufficient to control clinical signs.
Patients with chronic vomiting are often underweight due to
longstanding inadequate caloric intake. The energy density of Assess and Select the Food
foods is related to dietary fat content and increasing dietary fat The form and levels of key nutritional factors should be
typically results in increased caloric intake. However, both solid assessed in the current food and compared with the recommen-
and liquid foods containing increased fat levels generally are dations outlined in the key nutritional factors section (Table
emptied more slowly from the stomach than similar foods with 54-2). Most importantly, the food should be complete and bal-
lower fat content. Fat in the duodenum stimulates release of anced for the current lifestage of the patient.The food may not
cholecystokinin, which delays gastric emptying.Thus, foods for need to be altered for patients with mild disease or few clinical
cats and dogs with gastric emptying or motility disorders signs.
should not provide excess fat. Foods with 15% or less (dogs) or Tables 54-3 for dogs and 54-4 for cats provide information
25% or less (cats) DM fat are probably appropriate for patients about key nutritional factor content of selected commercial vet-
with gastric emptying or motility disorders. erinary therapeutic foods marketed for GI diseases and com-
pares them to the recommended levels. Moist foods are pre-
Fiber ferred and partially or fully liquefying the food may help pro-
Many grocery brand moist foods contain gelling agents such as mote gastric emptying. These techniques should be used ini-
gums or hydrocolloids to enhance the aesthetic characteristics tially in patients with gastric motility or emptying disorders.
of the food. Foods containing gel-forming soluble fibers should Add water to a moist veterinary therapeutic food and hand mix
be avoided in patients with gastric emptying and motility dis- or blend to produce a liquid or semi-liquid consistency. Al-
orders because they increase the viscosity of ingesta and slow ternatively, liquid enteral products with appropriate key nutri-
gastric emptying (Russell and Bass, 1985; Prove and Ehrlein, tional factor content may be used.
1982; Sandhu et al, 1987; Burger et al, 2006). Such fibers Feed or offer buffering foods rather than foods that contain
include pectins and gums (e.g., gum arabic, guar gum, car- acidifying salts to most patients with acute or chronic vomiting.
rageenan, psyllium gum, xanthan gum, carob gum, gum ghatti Hypochloremic metabolic alkalosis may occur in patients with