Page 724 - Small Animal Clinical Nutrition 5th Edition

Cardiovascular Disease 751

Table 36-6. Levels of key nutrients in selected commercial foods for cats with cardiovascular disease compared to the recommended
levels.*
VetBooks.ir Energy

Na
density
K
P
Mg
(%)***
Dry foods (kcal/cup)** (%) Taurine (%) (%)*** (%)***
Recommended levels – 0.07-0.30 ≥0.3 0.3-0.7 ≥0.52 ≥0.04
Hill’s Prescription Diet g/d Feline 297 0.32 0.14 0.54 0.77 0.049
Hill’s Prescription Diet k/d Feline 477 0.24 0.16 0.46 0.75 0.058
Hill’s Science Diet Mature Adult
Active Longevity Original 475 0.32 0.2 0.69 0.88 0.069
Medi-Cal Mature Formula 355 0.4 0.4 0.8 1.0 na
Medi-Cal Reduced Protein 440 0.3 0.4 0.6 0.8 na
Medi-Cal Renal LP 409 0.2 0.2 0.5 1.0 na
Purina Veterinary Diets
NF KidNey Function 398 0.2 0.18 0.41 0.88 0.10
Energy
density Na Taurine P K Mg
Moist foods (kcal/can)** (%) (%)*** (%) (%)*** (%)***
Recommended levels – 0.07-0.30 ≥0.3 0.3-0.7 ≥0.52 ≥0.04
Hill’s Prescription Diet g/d Feline 165/5.5 oz. 0.32 0.44 0.52 0.72 0.088
Hill’s Prescription Diet k/d
with Chicken Feline 183/5.5 oz. 0.3 0.42 0.38 1.18 0.049
Hill’s Science Diet Mature Adult
Active Longevity 87/3 oz.
Gourmet Turkey Entrée Minced 160/5.5 oz. 0.28 0.48 0.64 0.84 0.072
Iams Veterinary Formula
Stress/Weight Gain Formula
Maximum-Calorie 333/6 oz. 0.24 0.33 0.83 1.01 0.089
Medi-Cal Mature Formula 205/170 g 0.3 0.3 0.6 0.7 na
Medi-Cal Reduced Protein 265/170 g 0.2 0.3 0.5 0.7 na
Medi-Cal Renal LP 125/85 g pouch 0.6 0.8 0.5 1.1 na
Purina Veterinary Diets
CV Cardiovascular Formula 223/5.5 oz. 0.2 0.31 0.92 1.33 0.07
Purina Veterinary Diets
NF KidNey Function 234/5.5 oz. 0.16 0.45 0.52 0.96 0.10
Key: Na = sodium, P = phosphorus, K = potassium, Mg = magnesium, na = information not available from the manufacturer.
*Values are on a dry matter basis unless otherwise stated.
**As fed energy values (kcal/cup or can) are useful for determining amount to feed; These values can be converted to an amount of food to
feed by dividing the energy density of the food (as fed basis) by the patient’s daily energy requirement (DER); cup = 8-oz. measuring cup; to
convert kcal to kJ, multiply kcal by 4.184. Providing the right amount of food is vital for managing patients with cardiovascular disease.
Overweight patients should be fed foods with reduced energy as part of a weight-reduction program (Chapter 27). Patients suffering from
cardiac cachexia may need more energy than otherwise normal pets. Body condition scoring should be used frequently to determine the
patient’s response to the amount of food fed.
***See discussion under “Adjunctive Management: Drugs and Supplements” in the “Feeding Plan” section if additional supplementation is
required beyond that present in foods in this table.

Diuretics to 460 mg sodium or 1.2 g sodium chloride per day) (Kokko,
Diuretics continue to be a pharmacologic mainstay of acute 1994).This level of sodium restriction in people is equivalent to
therapy for heart failure. Sodium restriction, ACE inhibition, that achieved with use of foods formulated for patients with
venodilating drugs and diuretics represent the major available cardiovascular disease (Tables 36-5 and 36-6).
methods for preload reduction. Blood volume contraction and circulatory impairment are
Sodium chloride restriction is a key component of CHF potential complications of aggressive diuretic therapy. These
treatment even with the use of diuretics. Well-controlled stud- complications can exacerbate pre-existing renal disease, alter
ies have demonstrated that loop diuretics such as furosemide excretion of drugs dependent on renal elimination and reduce
given once daily fail to achieve a negative sodium balance in cardiac output by reducing cardiac filling pressures (Fox, 1992).
people with high sodium intake (Wilcox et al, 1983). Although Reduced levels of sodium in the food have been implicated, but
there is an impressive natriuresis for several hours after have not been proven to contribute to volume depletion from
furosemide administration, a compensatory increase in sodium excessive diuresis (Fox, 1992). Fractional excretion of sodium in
reabsorption in the next 24 hours exactly matches the earlier urine actually decreases in normal dogs fed a sodium-restricted
losses (Wilcox et al, 1983). Thus, it is essential to limit sodium food (Navar et al, 1982). The influence of diuretics on sodium
intake to ensure negative sodium balance. Balance studies with and chloride balance in dogs with heart disease and failure fed
normal people have demonstrated that significant negative sodium- and chloride-restricted foods has not been evaluated.
sodium balance can be predictably obtained with loop diuretics Furosemide contributes to hypokalemia and hypomagne-
if sodium intake is limited to 20 mEq/day (roughly equivalent semia because of increased urinary loss of potassium and mag-