Page 428 - Small Animal Clinical Nutrition 5th Edition

442 Small Animal Clinical Nutrition

Table 25-1. Disorders and drugs that affect taste and smell in people.*
VetBooks.ir Disorders Cushing’s syndrome Nasal polyposis
Adrenocortical insufficiency
Allergic rhinitis Diabetes mellitus Niacin deficiency
Bronchial asthma Head trauma Radiation therapy
Burns Hepatic cirrhosis Sinusitis
Cancer Hypertension Viral hepatitis (acute)
Chronic renal failure Hypothyroidism Zinc deficiency
Cobalamin deficiency Influenza-like infections
Drugs
Drug classification Examples
Amebicides Metronidazole
Antiepileptic drugs Phenytoin
Anesthetics (local) Benzocaine, procaine hydrochloride, tetracaine hydrochloride
Antihistamines Chlorpheniramine maleate
Antimicrobial agents Amphotericin B, ampicillin, cephalosporins, chloramphenicol, gentamicin, griseofulvin,
kanamycin, lincomycin, neomycin, nitrofurantoin, sulfonamides, streptomycin, tetracyclines
Antineoplastic agents Doxorubicin, methotrexate, vincristine sulfate
Antirheumatic, analgesic, Allopurinol, azathioprine, colchicine, levamisole, D-penicillamine, phenylbutazone
antipyretic, antiinflammatory,
immunosuppressive agents
Antithyroid agents Propylthiouracil, thiouracil
Diuretics and antihypertensive agents Captopril, furosemide, thiazides
Opiates Codeine, morphine
Sympathomimetic drugs Amphetamines, ephedrine
Others Digitalis glycosides, estrogens, iron sorbitex, oral antidiabetic agents, vitamin D
*Adapted from Schiffman SS. Taste and smell in disease (first of two parts). New England Journal of Medicine 1983; 308: 1275-1279.
Schiffman SS. Taste and smell in disease (second of two parts). New England Journal of Medicine 1983; 308: 1337-1343.

tionists have recognized that cachexia and a resultant low body has been altered to establish a fragile homeostasis. This home-
condition score (BCS) are associated with increased risk of ostasis can be maintained until a new stress supervenes.
complications in people (Windsor, 1993). Loss of skeletal and Affected patients very often do not survive additional stresses
visceral proteins can have adverse anatomic and functional con- such as trauma, surgery, infection or tumors, as might a previ-
sequences in food-deprived patients. These adverse effects ously healthy dog or cat.
include anemia, reduced heart muscle mass and function,
decreased pulmonary mechanical function and diminished res- Metabolic Changes Through Days of Food
piratory drive, altered intestinal morphology and mildly Deprivation
impaired absorptive abilities (Biden and Taylor, 1983). Simple Starvation
Cachexia may affect dogs and cats with long-standing cancer, Simple starvation includes metabolic changes that occur in
cardiac disease or renal disease (Chapters 30, 36 and 37, respec- mammals, in the absence of disease, as days of food deprivation
tively). A state of metabolic “accommodation” that prolongs continue. The time course of metabolic changes and associated
survival has been recognized in people with chronic diseases. A alterations in nutrient usage should guide how these hospital-
similar state of metabolic accommodation probably occurs in ized patients are fed. An understanding of the metabolic
chronically ill dogs and cats. changes that take place (particularly in the liver) during starva-
Accommodation occurs when the energy equilibrium is tion is essential to understanding metabolic alterations present
reestablished at a constant but lower food intake and lean-tis- during anorexia and disease states.
sue wasting is arrested before protein deficiency becomes fatal. In the postprandial period of well-fed patients, exogenous
Accommodation in people is successful when: 1) total lean-tis- dietary nutrients are used to meet immediate metabolic needs,
sue depletion is less than that considered critical, 2) weight is thus sparing endogenous fuels stored as glycogen, adipose and
low but stable and 3) albumin levels and total peripheral WBC muscle protein. After these needs are met, replenishment of
counts are normal with an intact delayed cutaneous hypersen- glycogen reserves (in the liver, fat and muscle) as well as pro-
sitivity response (Hoffer, 1994). teins catabolized since the last meal, takes place. Any excess
Accommodation with the exception of an intact delayed energy in the form of carbohydrate, fat or protein is then con-
cutaneous hypersensitivity response accurately describes the verted to triglycerides for storage as fat in adipose, muscle and
condition of some chronically ill patients (i.e., those with liver tissue.In the fed state when serum glucose is high,the liver
chronic renal, hepatic or cardiac insufficiency). Some chronical- becomes a net importer of glucose, trapping it in hepatocytes by
ly ill, cachectic cats and dogs may be maintained at a less than phosphorylation via glucokinase. Glucokinase is an inducible
optimal body weight and condition for some time, even though hepatic enzyme whose maximal enzymatic activity (Km = 180
important organ function deficits are apparent. In these cases, mg/dl) for glucose is reached with the help of insulin, at high
metabolic rate has been down regulated and protein turnover blood glucose concentrations (Engelking and Anwer, 1992).