Page 445 - Small Animal Clinical Nutrition 5th Edition

Enteral-Assisted Feeding 459

Table 25-6. Pharmacologic appetite stimulants.*
Box 25-4. Syringe Feeding.
VetBooks.ir Patients are often fed a liquid or moist homogenized product by Cyproheptadine Antihistamine and anti-serotonin effects.
Dose cats at: a) 2 to 4 mg per cat per os
syringe on a short-term basis. For dogs, the syringe tip is placed once or twice daily, b) 2 mg per cat every
between the molar teeth and cheek with the head held in a nor- 12 hours. May take up to 24 hours for a
response. Give at this dosage for one
mal or lowered position (Figure 1). For cats, the syringe tip is week and then taper.
placed between the four canine teeth (Figure 2). The patient Diazepam Short-lived appetite stimulant with sedative
may choose to swallow the liquid or allow it to flow down the properties. Dose in cats varies: a) 0.05 to
mouth into the esophagus by gravity. Some patients refuse to 0.15 mg/kg IV once daily to every other
day or 1 mg per os once daily, b) 0.05 to
swallow the liquid or food; therefore, force feeding may increase 0.4 mg/kg IV, IM or per os. Eating may
the risk of aspiration. Syringe feeding should be discontinued if begin within a few seconds after IV admin-
the patient does not swallow food voluntarily. istration. Food should be readily available.
Mirtazapine Increases central nervous system serotonin
while antagonizing serotonin activity in the
GI tract. Dose cats at: 3.5 mg per cat per
os every three days. May take up to 36
hours for a response.
Oxazepam Short-lived appetite stimulant with sedative
properties. Dose cats at 2 mg per cat (total
dose) every 12 hours.
Prednisolone Dose glucocorticoids at 0.25 to 0.5 mg/kg
per os every day, every other day or inter-
mittently as needed in dogs.
*Adapted from Plumb DC. Veterinary Drug Handbook, 3rd ed.
White Bear, MN: Pharma Veterinary Publishing, 1999.

PHARYNGOSTOMY/
ESOPHAGOSTOMY/
Figure 1. Syringe-feeding technique for administering liquid or GASTROSTOMY TUBES
moist homogenized foods to dogs. Pharyngostomy and esophagostomy tubes (8 to 19 Fr.) may
be placed in patients with disease or trauma to the nasal or oral
cavity.The tip of the tube is placed in the caudal esophagus and
the tube can be used for long-term (weeks to months) in-hospi-
tal or home feedings. Boxes 25-6 and 25-7 describe pharyngos-
tomy and esophagostomy tube placement, respectively.
For patients in which the pharynx and esophagus must be
bypassed, gastrostomy tubes (mushroom-tipped, 16 to 28 Fr.) e
can be placed either intraoperatively or percutaneously using an
endoscope or a gastrostomy tube introduction device (Clary et
f
al, 1996). Gastrostomy tubes are also recommended for long-
term feeding (weeks to months) if needed and have generally
replaced pharyngostomy tubes, even when the esophagus is
normal. Gastrostomy tubes are convenient and safe for in-hos-
pital and at-home feedings.
There are two basic techniques for percutaneous placement
Figure 2. Syringe-feeding technique for administering liquid or of gastrostomy tubes. One technique uses an endoscope,
moist homogenized foods to cats.
whereas the other involves a “blind,” nonendoscopic approach
using a gastrostomy tube placement device or applicator. The
advantages of percutaneous vs. surgical gastrostomy tube place-
ment are ease and speed of placement, lower cost and less tis-
sue trauma. Boxes 25-8 through 25-10 describe these three
patients that do not have nasal, oral or pharyngeal disease or methods of gastrostomy tube placement.
trauma. Anesthesia or tranquilization is not necessary to place Any tube that has been placed into the esophagus or stom-
a nasoesophageal tube, so this route provides enteral access to ach allows for bolus or meal-type feeding schedules because the
patients considered anesthetic risks.These tubes are most often stomach acts as a food reservoir. Some patients, however, can-
used in the hospital, although conscientious owners can use not tolerate bolus feeding into the stomach without vomiting.
nasoesophageal tubes at home (Box 25-5). Such patients may benefit from a slow, continuous drip admin-