Page 478 - Small Animal Clinical Nutrition 5th Edition

492 Small Animal Clinical Nutrition

sible, but may continue to receive PN as enteral intake increas- tothenic acid, 0.4 µg B12 per ml. Butler Co., Columbus,
VetBooks.ir es to meet RER.The food offered enterally may be a fixed-for- e. MTE-4 contains 1.7 mg zinc, 0.42 mg copper, 0.37 mg
OH, USA.
mula therapeutic food intended as the food to be fed to the
manganese and 6 µg chromium per ml containing the preser-
patient at home because of an ongoing disease condition
(Chapter 25). When the patient has a decreased appetite, a vative benzyl alcohol. Abbott Laboratories, Chicago, IL,
highly palatable, fixed-formula food may be offered initially to USA.
stimulate oral consumption. This food may then be mixed in f. Remillard RL, Angell Animal Medical Center, Boston, MA,
gradually decreasing proportions with the food to be fed on a USA. Unpublished data.
long-term basis (Chapter 1). Vomiting and diarrhea are the g. L-Cath (16 and 18 ga.). Luther Medical Products, Inc.,
most common problems seen when refeeding patients orally. Santa Ana, CA, USA. Central venous (20 to 16 ga.)
Foods should be introduced in amounts equal to RER in small catheters. Cook Veterinary Products, Bloomington, IL,
frequent meals, and the amounts increased if well tolerated over USA.
several days. h. Silicone (20 to 16 ga.) catheters (50 to 60 cm) can be cut to
appropriate lengths. Cook Critical Care, Bloomington, IL,
ENDNOTES USA.
i. Remillard RL, Angell Animal Medical Center, Boston, MA,
a. Prescribing information for Intralipid Intravenous Fat USA; Saker K, North Carolina State University, Raleigh,
Emulsion, 1981. Cutter Laboratories, Berkeley, CA, USA. NC, USA. Unpublished data.
b. Remillard RL, Angell Animal Medical Center, Boston, MA, j. Remillard RL, Armstrong PJ, Guilford WG. Personal clini-
USA. Unpublished data. cal experience.
c. Vital E-A+D containing 100 IU of D and 300 IU of alpha-
tocopherol per ml. Schering-Plough Animal Health Corp., REFERENCES
Kenilworth, NJ, USA.
d. B-Vitamin Complex containing 50 mg thiamin, 2 mg The references for Chapter 26 can be found at
riboflavin, 100 mg niacin, 2 mg pyridoxine, 10 mg pan- www.markmorris.org.

CASE 26-1

Peripheral Parenteral Nutrition in a Dog
Korinn E. Saker, MS, DVM, PhD, Dipl. ACVN
College of Veterinary Medicine
North Carolina State University
Raleigh, North Carolina, USA

Patient Assessment
A six-year-old, intact male, mixed-breed dog weighing 29.5 kg with a body condition score (BCS) of 3/5 was presented for eval-
uation of suspected sepsis following a severe neck wound. A large open wound on the right side of the dog’s neck was first
a
noticed five days earlier. The local veterinarian flushed and closed the wound and initiated antibiotic therapy (enrofloxacin ,
b
c
amoxicillin and a single dose of cephalexin ). The dog’s clinical condition continued to deteriorate; therefore, the dog was
referred for further evaluation.
On physical examination, the dog was depressed and laterally recumbent.The wound on the right side of the dog’s neck extend-
ed from the dorsal margin of the ear pinna to the ventral midline. There was a necrotic odor originating from the wound. A fluid-
filled pocket ventral to the wound was incised, releasing a large volume of purulent material. Specimens were collected for bacteri-
ologic studies. When skin sutures were removed, a large wound extending deep into the tissues on the left side of the neck was
found. The trachea, jugular vein and several nerves were visible at the wound margins, along with large amounts of green necrotic
tissue. Skin surrounding the wound was indurated and necrotic.The dog’s right ear was swollen and edematous with a creamy exu-
date originating from wounds on the medial aspect. Crackles could be auscultated in the right caudal lung field and the patient was
mildly dyspneic.
Laboratory abnormalities included neutrophilia with a left shift, thrombocytopenia, decreased total protein (5.2 g/dl [normal 5.5
to 7.4 g/dl]) and albumin (2.3 g/dl [normal 2.8 to 3.6 g/dl]) values, lymphopenia, elevated bilirubin (5.0 mg/dl [normal 0.1 to 0.5
mg/dl]) concentration and increased alanine aminotransferase (367 U/l [normal 13 to 100 U/l]) and alkaline phosphatase (2,954
[normal 20 to 167 U/l]) activities.