Page 454 - Small Animal Clinical Nutrition 5th Edition

468 Small Animal Clinical Nutrition

feeding and/or the blend is not of appropriate consistency to
VetBooks.ir Box 25-10. Percutaneous flow through the feeding tube. Patients may later consume the
Nonendoscopic Gastrostomy Tubes.
pet food orally, eliminating a food change when the patient’s
appetite returns and the tube has been removed. Blended pet
Percutaneous gastrostomy techniques have been developed to foods, particularly the “recovery,” “growth” or “performance”
allow convenient, cost-effective placement of feeding tubes type foods, are appropriate for patients in catabolic states that
without relying on availability of relatively expensive endo- are using fat and protein substrates from body stores.
scopes. One nonendoscopic technique uses a commercial feed- These foods can be blended with a liquid to form a diet with
ing tube applicator device (Figure 1) as described in Box 25- a consistency that flows easily through a feeding tube. Some
7. The other nonendoscopic technique uses a commercial gas- products have a blended texture, a high water content and very
trostomy tube placement device (Figure 2) pressed against the small particle size and may not need to be mixed with water or
stomach wall. Use of either device allows suture material to be can easily be mixed with water depending on the size of the
placed through the body wall into the stomach and retrieved
through the mouth, and a gastrostomy tube to be inserted as feeding tube. Most moist pet foods must be mechanically
described for PEG tube placement. blenderized with water (or an appropriate liquid food) and
strained to produce slurries or gruels that are administered
through medium- and large-bore feeding tubes (i.e., 14 Fr. or
larger). Table 25-11 summarizes food blends commonly used
for critical care tube feeding of feline and canine patients.
Examples of patients that may benefit from these blended ther-
apeutic formulas include those with renal or hepatic insuffi-
ciencies, diabetes mellitus, hyperlipidemia, pancreatitis, conges-
tive heart disease and severe trauma. Appropriate moist foods
are listed in the respective disease chapters.
Figure 1. A commercial gastrostomy tube applicator can be
used for percutaneous nonendoscopic gastrostomy tube place- Human Baby Foods
ment in dogs and cats. The rigid outer tube encloses a trocar
Some canine and feline patients voluntarily eat human baby
that can be pushed through the stomach and abdominal wall. A
suture is placed through the small hole in the trocar tip, pulled foods packed in jars. In general, the meat and/or egg baby foods
into the stomach and then pulled antegrade out through the are high in protein (30 to 70% DM) and fat (20 to 60% DM),
mouth. See Box 25-7, Figure 1 for use of this device in
which, at the lower end of these ranges compares favorably with
esophagostomy tube placement.
blended pet food products used for patients with increased pro-
tein and calorie needs. However, baby foods that provide
upwards of 45% DM protein and 35% DM fat exceed the
upper limits of veterinary critical care foods and would have lit-
tle clinical value. Additionally, baby foods contain only one or
two food types (protein, protein/grain) and do not contain a
balanced mixture of other essential nutrients (amino acids, vita-
mins and minerals). For example, these products contain only
10% of the calcium required by dogs and cats and, therefore,
Figure 2. Commercial gastrostomy tube placement devices in have a large inverse calcium-phosphorus ratio. Some products
various lengths and diameters can be used for percutaneous contain onion powder, which can cause Heinz body formation
nonendoscopic gastrostomy tube placement in dogs and cats.
in cats (Robertson et al, 1997). The human and veterinary liq-
uid products have a better nutritional profile for feline and
canine patients than do the human baby food products.

nutrient needs have been met, except when known losses of
particular nutrients occur (e.g., protein and electrolytes). REASSESSMENT
Commercial products used as blended pet foods should pro-
vide complete and balanced nutrition for dogs or cats and Regular reassessment is a critical step in successful nutritional
should have passed AAFCO or equivalent feeding trials.These management of hospitalized patients, regardless of whether the
products are more readily available, better tolerated and less enteral route, the parenteral route or both are used.
expensive than the human liquid foods. These pet food prod- Malnutrition in the form of insufficient nutrient intake to sup-
ucts contain essential amino acids and micronutrients properly port tissue metabolism undermines medical and/or surgical
balanced to the caloric density of the food. Fewer medical com- management of a case. Malnutrition is far more common in
plications (e.g.,diarrhea,hyperglycemia) are likely to result with veterinary patients than is currently recognized. Patients resting
blended pet foods. However, blended products are more likely in a cage have been mistakenly assumed to require little or no
to plug the feeding tube if the tube is not properly flushed after nutrition when, in fact, the nutrient costs of tissue repair,