Page 726 - Small Animal Clinical Nutrition 5th Edition

Cardiovascular Disease 753

py. Feeding patients foods without excess sodium chloride may Table 36-8. Low sodium commercial treats for dogs with
VetBooks.ir allow lower dosages of diuretics to be used for control of the cardiovascular disease. Sodium (%DM)
clinical signs of CHF.
Treats
Sodium, chloride, potassium and magnesium levels vary in
commercial veterinary therapeutic foods for dogs and cats with Recommended sodium range for dogs 0.08 to 0.25
with cardiac disease
cardiovascular disease (Tables 36-5 and 36-6). These nutrients Hill’s Science Diet Adult Treats Medium/Large
Bone with Real Chicken 0.23
in regular commercial foods vary markedly. Mineral levels Hill’s Science Diet Adult Light Treats Medium/Large
should be considered when using concurrent diuretic therapy. Bone with Real Chicken 0.24
Long-term furosemide therapy may be associated with clin- Hill’s Science Diet Jerky Plus with Real Beef
and Vegetables 0.29
ically significant thiamin deficiency, due to excessive urinary Medi-Cal Medi-Treats 0.1
loss of thiamin, and may contribute to impaired cardiac per- Purina Veterinary Diets Lite Snackers Canine Formula 0.21
formance in patients with CHF (Seligman et al, 1991). Patients Royal Canin Veterinary Diet Treats for Dogs 0.21
Key: DM = dry matter.
receiving long-term diuretic therapy should be given supple-
ments containing thiamin and other water-soluble vitamins or
be fed a commercial food with increased concentrations of
these vitamins. Veterinary therapeutic foods for patients with Table 36-9. Daily sodium intake for a dog and a cat
cardiac and renal disease are often formulated with higher lev- eating various foods.
els of water-soluble vitamins to offset excessive urinary losses.
Daily sodium consumption for a 15-kg dog eating 935
kcal/day
ACE Inhibitors Sodium intake
Enalapril, benazepril, ramipril and lisinopril, all ACE inhibitors, Food a (mg/day)
Grocery moist food 2,338
are commonly used to treat dogs and cats with CHF. Inhibition Grocery dry food b 944
of the conversion of angiotensin I to angiotensin II results in Specialty dry food d c 552
vascular dilatation and decreased circulating plasma aldosterone Geriatric dry food e 430
Renal moist food 468
concentrations. Angiotensin II and aldosterone play important Cardiac dry food f 159
roles in the maintenance of vascular volume and potassium bal- Cardiac dry food and 1 slice bread 370
ance. Both increase the reabsorption of sodium and chloride, Renal moist food and 30 g cheese 700
a
Pedigree with Chopped Beef
and aldosterone promotes the excretion of potassium. b Purina Dog Chow
The use of ACE inhibitors in human patients with severe c Hill’s Science Diet Adult Original Dog Food
d Hill’s Science Diet Mature Adult 7+ Original Dog Food
renal insufficiency or in patients given potassium supplements e Purina Veterinary Diets NF KidNey Function Canine Formula
may increase the risk for hyperkalemia (Warren and O’Connor, f Hill’s Prescription Diet h/d Canine
1980; Dzau et al, 1980; Rotmensch et al, 1988). In a study, Daily sodium consumption for a 4-kg cat eating 270
more than half the dogs with CHF developed mild serum kcal/day
Sodium intake
potassium elevations when treated with a commercial sodium- Food (mg/day)
restricted veterinary therapeutic food, furosemide and captopril Grocery moist food g 823
h
(Roudebush et al, 1994). Another study confirmed that heart- Grocery dry food i 405
Specialty dry food 232
failure dogs treated with furosemide, digoxin and an ACE Geriatric moist food j 184
inhibitor had significantly higher mean serum potassium con- Renal moist food k 135
l
centrations when compared with clinically normal dogs, dogs Renal dry food 151
Renal dry food and 1/2 can tuna 295
with heart failure before any treatment, heart-failure dogs treat- g Fancy Feast Elegant Medleys White Meat Chicken Florentine
ed only with furosemide and heart-failure dogs treated with h Purina Cat Chow Complete Formula
i Hill’s Science Diet Adult Original Cat Food
furosemide and digoxin (O’Keefe and Sisson, 1993). Mild ele- j Hill’s Science Diet Turkey Entrée Mature Adult 7+ Cat Food
vations in serum potassium concentrations have also been k Purina Veterinary Diets NF KidNey Function Feline Formula
observed in dogs treated with enalapril (COVE, 1995). In l Hills Prescription Diet k/d Feline
another study, serum potassium concentration decreased in a
subset of heart-failure dogs treated with ACE inhibitors and
furosemide, although the specific feeding history was not
reported (Cobb and Mitchell, 1991). Functional renal insufficiency occurs in up to one-third of
When mild hyperkalemia occurs in people with heart failure, human patients with severe CHF treated with sodium chloride
reducing oral potassium intake and discontinuing potassium- restriction, ACE inhibitors and diuretics (Parker et al, 1987).
sparing diuretics is recommended (Rotmensch et al, 1988). This decline in renal function has been attributed to loss of
Although clinically significant hyperkalemia (serum potassium angiotensin II-mediated systemic and intrarenal vasoconstric-
6.5 mEq/l) is uncommon, the use of ACE inhibitors in dogs tor effects, which maintain renal perfusion pressure and
with CHF or renal insufficiency fed commercial or veterinary glomerular filtration rate in low-output heart failure. Func-
therapeutic foods with high potassium content may increase tional renal insufficiency appears to be alleviated in human
the risk for hyperkalemia (Roudebush et al, 1994). patients when efforts are made to replenish total body stores of