Page 1132 - Small Animal Clinical Nutrition 5th Edition

1178 Small Animal Clinical Nutrition

VetBooks.ir Table 68-11. Levels of key nutritional factors in selected commercial veterinary therapeutic foods marketed for canine patients with
hepatobiliary disease compared to recommended levels.*
Dry foods
Energy
Vit. E
Vit. C
density Energy Protein Taurine Sodium Copper Zinc Iron (IU/kg) (mg/kg)
(%)
(%)
(%)***
density
(mg/kg) (mg/kg) (mg/kg)
(kcal/cup)** (kcal ME/g)
Recommended levels – ≥4.0 15-20 ≥0.1 0.08-0.25 ≤5 >200 80-140 ≥400 ≥100
Hill’s Prescription Diet
l/d Canine 399 4.4 18.1 0.08 0.22 4.9 301 170 385 116
Medi-Cal Hepatic LS 14 342 na 17.6 na 0.2 na 300 na na na
Medi-Cal Vegetarian Formula 317 na 20.9 na 0.4 na na na na na
Purina Veterinary Diets
EN GastroENteric 397 4.2 27.0 na 0.60 na na na 577 na
Royal Canin Veterinary
Diet Hepatic LS 14 333 4.4 17.6 0.22 0.21 4.4 253 187 725 na
Moist foods Energy Energy Protein Taurine Sodium Copper Zinc Iron Vit. E Vit. C
density density (%)*** (%) (%) (mg/kg) (mg/kg) (mg/kg) (IU/kg) (mg/kg)
(kcal/can)** (kcal ME/g)
Recommended levels – ≥4.0 15-20 ≥0.1 0.08-0.25 ≤5 >200 80-140 ≥400 ≥100
Hill’s Prescription Diet
l/d Canine 472/13 oz. 4.5 17.6 0.10 0.20 4.2 258 118 693 190
Iams Veterinary Formula
Stress/Weight Gain 333/6 oz. 5.8 41.8 0.33 0.24 na na na na na
Formula Maximum-Calorie
Medi-Cal Vegetarian
Formula 319/396 g na 26.4 na 0.5 na na na na na
Purina Veterinary Diets
EN GastroENteric 423/12.5 oz. 4.0 30.5 na 0.37 na 260 na 505 139
Key: ME = metabolizable energy, Vit. E = vitamin E, Vit. C = vitamin C, na = information not available from manufacturer.
*From manufacturers’ published information or calculated from manufacturers’ published as fed values; all values are on a dry matter basis
unless otherwise stated.
**Energy density values are listed on an as fed basis and are useful for determining the amount to feed; cup = 8-oz. measuring cup. To
convert to kJ, multiply kcal by 4.184.
***For liver disease patients with signs of hepatic encephalopathy (HE), dietary protein levels should be limited to 10 to 15% dry matter
until signs resolve. In these cases, several commercial veterinary therapeutic foods designed for patients with kidney disease that provide
less protein than the foods intended for liver disease may be appropriate (Chapter 37). If these foods are used, the patient should be tran-
sitioned to the selected food specifically formulated for liver disease after signs of HE have subsided.

lators, nonabsorbable disaccharides and bile “altering” agents digestibility are usually high. Also, as discussed above, these
(Table 68-10). In acute hepatic failure, correction of fluid and foods still exceed minimum requirements. Thus, these foods
electrolyte imbalances and treatment of other complications provide adequate protein to support hepatic function and hepa-
such as metabolic acidosis, excessive bleeding, hypotension, hy- tocyte repair and regeneration while avoiding higher protein
poglycemia, cardiac dysfunction, renal failure, cerebral edema levels that exacerbate hyperammonemia. However, further
and infections take precedence over nutritional support. Sur- short-term protein reduction may be necessary in patients with
gical management can include partial or total ligation of con- HE. In these cases, some commercial veterinary therapeutic
genital PSS, correction of bile duct obstruction or removal of foods designed for patients with renal disease that provide less
focal liver masses. protein than the foods intended for liver disease may be appro-
priate (Chapter 37). If these foods are used, the patient should
Assess and Select the Food be transitioned to the selected food specifically formulated for
A wide variety of foods are typically used or recommended for liver disease after signs of HE have subsided (Tables 68-11 and
patients with hepatic disease (Marks et al,1994a; Michel,1995). 68-12). Lactulose may be considered for patients with HE.Box
Tables 68-11 and 68-12 list the recommended levels of key 68-4 provides information about lactulose products, their use
nutritional factors for canine and feline hepatobiliary disease and their mode of action.
patients, respectively, and compare them to the key nutritional Supplemental treatment should also be considered for dogs
factor content of selected veterinary therapeutic foods. This in- with hepatic copper toxicosis. Copper is considered a key nutri-
formation will help the veterinary health care team select the tional factor for liver disease in dogs and the recommended
best food for patients with liver disease. Special consideration DM level in foods is less than 5 mg/kg.This level may still pro-
should be given to young patients with congenital PSS. vide too much copper for some patients with hepatic copper
Although the total protein content of some veterinary thera- toxicosis. In these instances, adjunctive use of copper chelating
peutic foods formulated for patients with liver disease is lower agents should be considered. Copper chelating agents are dis-
than that of regular commercial pet foods, protein quality and cussed in Box 68-3. Box 68-5 reviews other cytoprotective