Page 455 - Small Animal Clinical Nutrition 5th Edition

Enteral-Assisted Feeding 469

Table 25-8. Key nutritional factor content of selected commercial veterinary liquid foods, human liquid foods and moist veterinary foods
VetBooks.ir Factors Osmolarity Energy density CHO Protein Arginine Glutamine Fat
used for enteral-assisted feeding of critically ill dogs compared to key nutritional factor recommended levels.*
(mOsm/l) (kcal/ml) (g) (g) (mg) (mg) (g)
Recommended levels 250-400** 1-2*** 2-4 5-12 ≥146 ≥500 5-7.5
Liquid veterinary products
Abbott CliniCare Canine/Feline Liquid Diet 315 1.0 6.8 8.2 350 815 5.1
Abbott CliniCare RF Liquid Diet 235 1.0 5.9 6.3 350 615 6.8
PetAg Formula V Enteral Care HLP 312 1.2 4.2 8.5 413 na 4.8
PetAg Formula V Enteral Care MLP 256 1.1 5.8 7.5 392.6 na 5.7
Liquid human products
Glucerna Shakes 355 1.0 9.6 4.2 na na 5.4
Nestlé Impact Advanced Recovery 375 1.0 13.2 5.6 1,250 na 2.7
Nestlé Peptamen AF 390 1.2 8.9 6.3 na na 4.6
Novartis Resource Diabetic 300 1.1 10.0 6.3 na na 4.7
Moist veterinary foods †
Hill’s Prescription Diet a/d Canine/Feline - 1.2 3.2 9.2 495 1,077 6.3
Hill’s Prescription Diet n/d Canine - 1.6 3.7 7.0 544 na 6.1
Iams Veterinary Formula Maximum-Calorie
Canine & Feline - 2.1 2.2 7.2 534 940 6.4
Purina Veterinary Diets Cardiovascular (CV)
Feline Formula - 1.4 4.7 8.8 469 1,169 5.5
Purina Veterinary Diets Dietetic Management
(DM) Feline Formula - 1.2 1.7 11.9 568 1,825 5.0
Royal Canin Veterinary Diet Feline and
Canine Recovery RS - 1.0 1.9 12.3 683 na 7.7
Key: CHO = digestible carbohydrate, na = information not available from the manufacturer.
*Liquid and moist veterinary foods in this table are formulated to meet minimum requirements of the Association of American Feed
Control Officials; all nutrient values = units/100 kcal, unless otherwise stated; to convert kcal to kJ, multiply kcal by 4.184.
**250 is optimal.
***Energy density as fed basis.
† Table 25-11 contains recipes for blending these foods for tube feeding.

immunocompetence and drug metabolism are significant. phase proteins with half-lives between two and 12 hours can be
Therefore, reassessment of nutritional status is important measured reliably in dogs and cats. The patient’s body weight
whether the patient remains in the hospital or recovers at home. and condition and some laboratory parameters (albumin and
total protein concentrations) should improve over the course of
Monitoring Parameters weeks (McAdams et al, 1996).
Food intake or administration of nutritional support for hospi-
talized patients should be reviewed at least daily. Body weight Residual Volume
should be recorded daily. Body condition should be noted; how- Despite the numerous benefits of initiating enteral nutrition to
ever, a patient’s BCS is unlikely to change during the course of hospitalized patients soon after admission, many critically ill
a hospital stay. Laboratory assessments specific for patients patients are frequently intolerant of intragastric feeding due to
receiving nutritional support are generally not necessary beyond GI motility dysfunction. The incidence of intolerance in human
those tests already routinely performed for critically ill patients. ICU settings is 43 to 63%, with the development of high gastric
The most common alterations that occur in laboratory parame- residual volumes accounting for 30 to 51% of cases (MacLaren et
ters associated with nutrient administration are decreases in al, 2008). Although undocumented for veterinary patients, high
serum potassium, phosphate and magnesium levels, increases in gastric residual volume due to decreased GI motility is common-
serum glucose concentrations and hyperlipidemia. Even appar- ly encountered when refeeding. Adverse consequences for the
ently stable patients might develop metabolic complications as a patient include underfeeding needed calories, possible aspiration,
result of ongoing disease processes or from undiagnosed sub- increased mortality and prolonged hospital stay. Current thera-
clinical disease states. However, most patients show subjective peutic approaches for managing elevated gastric residual volumes
improvement in attitude within 36 hours of refeeding. involve administration of a prokinetic agent, alteration of the
Most parameters used to assess the nutritional status of enteral feeding regimen (i.e., decreased volume, increased fre-
patients will not change as a result of assisted feeding during quency, switch from intragastric to postpyloric site), or initiation
the course of hospitalization. Laboratory parameters (e.g., albu- of parenteral nutrition support.To maximize enteral support and
min and total protein concentrations, RBC count and hemo- limit complications associated with gastric residuals, measure the
globin content) are unlikely to change in less than two weeks. residual volume before each bolus tube feeding and intermittent-
Perhaps laboratory parameters that change during a hospital ly during CRI feeding, then adjust the feeding schedule accord-
stay as a result of assisted feeding may be detected when acute- ingly. Based on clinical experience, the authors suggest these