Page 477 - Small Animal Clinical Nutrition 5th Edition

Parenteral-Assisted Feeding 491

VetBooks.ir Table 26-8. Metabolic complications of parenteral-nutrition administration, treatment and potential patient considerations.
Complications are listed in descending order of likely occurrence and treatments are listed from immediate to longer term solutions.
To minimize complications, patients should be hemodynamically stable and any electrolyte and acid-base abnormalities, severe
tachycardia, hypotension and volume deficits should be corrected before starting PN.
Complication Treatment Patient considerations
Hyperglycemia Stop infusion, recheck in two to four hours, decrease PN Glucose intolerance
infusion by 50% until normal, then increase infusion
rate slowly
Subcutaneous insulin therapy
Change caloric sources:
Increase lipid fraction of calories
Decrease glucose fraction of calories
Hypokalemia Add KCl or KPO to PN bag GI or renal losses
4
Correct serum magnesium as needed Drug therapies that increase urinary excretion
Change caloric sources: Insulin therapy
Increase lipid fraction of calories
Decrease glucose fraction of calories
Hypophosphatemia Add NaPO or KPO to PN bag Diabetic ketoacidosis
4
4
Hyperlipidemia Stop infusion, recheck in two to four hours, decrease Decreased lipid clearance
infusion by 50% until normal, then increase infusion
rate slowly
Change caloric sources:
Decrease lipid fraction of calories
Increase glucose fraction of calories
Phlebitis Change catheter and infusion site Proper hydration
Lower PN osmolality: Endogenous site of infection
Increase lipid fraction of calories
Decrease glucose fraction of calories
Add heparin to PN bag
Hyperkalemia Change PN bag and decrease potassium Acidosis, renal failure, sepsis
Drug therapies that decrease urinary excretion
Hyperammonemia Decrease PN infusion by 50% until normal Liver dysfunction, GI bleeding
Change PN bag, decrease amino acid concentration
Use branched-chain amino acid sources
Hypomagnesemia Add MgSO to PN bag GI or renal losses
4
Drug therapies that increase urinary excretion
Hypoglycemia Piggyback 50% dextrose drip until normal Sepsis
Change caloric sources: Insulin therapy
Decrease lipid fraction of calories Insulinoma
Increase glucose fraction of calories
Infected catheter site Change catheter and infusion site Substandard catheter care
Culture catheter and PN solution Endogenous site of infection
Give antibiotics based on culture and antimicrobial Properly hydrated
sensitivity tests
Hot pack the site
Key: PN = parenteral nutrition, GI = gastrointestinal.

talized patients should be reviewed at least daily. Body weight Most parameters used to assess the nutritional status of
should be recorded daily. Body condition should be noted; patients will not change as a result of assisted feeding during
however, an animal’s body condition score is unlikely to change the course of hospitalization. Laboratory parameters (e.g., albu-
during the course of a hospital stay. Laboratory assessments min and total protein concentrations, RBC count and hemo-
specifically for patients receiving nutritional support are gener- globin content) are unlikely to change in less than two weeks.
ally not necessary beyond those tests already routinely per- The patient’s body weight and condition and some laboratory
formed for critically ill patients. The most common alterations parameters (albumin and total protein concentrations) should
that occur in laboratory parameters associated with nutrient improve over the course of weeks (McAdams et al, 1996).
administration are decreases in serum potassium and phosphate Laboratory parameters that change during a hospital stay as a
levels, increases in serum glucose concentrations and hyper- result of assisted feeding may be detected when acute-phase
triglyceridemia (Table 26-8). Even apparently stable patients proteins with half-lives between two and 12 hours can be meas-
might develop metabolic complications as a result of ongoing ured reliably in dogs and cats.
disease processes or from undiagnosed subclinical disease
states. However, most patients’ attitude improves subjectively Changing Foods
within 36 hours of refeeding. j Parenterally fed patients should be fed enterally as soon as pos-