Free ebooks ==> www.Ebook777.com www.Ebook777.com Free ebooks ==> www.Ebook777.com Nutritional Management of Hospitalized Small Animals www.Ebook777.com Free ebooks ==> www.Ebook777.com This title is also available as an e‐book For more details, please see www.wiley.com/buy/9781444336474 or scan this QR code: www.Ebook777.com Free ebooks ==> www.Ebook777.com Nutritional Management of Hospitalized Small Animals Edited by Daniel L Chan, DVM, DACVECC, DECVECC, DACVN, FHEA, MRCVS Professor of Veterinary Emergency and Critical Care Clinical Nutritionist, Head of Nutritional Support Service Section Head of Emergency and Critical Care Department of Veterinary Clinical Science and Services The Royal Veterinary College, University of London, UK www.Ebook777.com Free ebooks ==> www.Ebook777.com This edition first published 2015 © 2015 by John Wiley & Sons, Ltd Registered Office John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Offices 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley‐blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher Designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book It is sold on the understanding that the publisher is not engaged in rendering professional services If professional advice or other expert assistance is required, the services of a competent professional should be sought The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions Readers should consult with a specialist where appropriate The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read No warranty may be created or extended by any promotional statements for this work Neither the publisher nor the author shall be liable for any damages arising herefrom Library of Congress Cataloging‐in‐Publication Data Nutritional management of hospitalized small animals / edited by Daniel L Chan p ; cm Includes bibliographical references and index ISBN 978-1-4443-3647-4 (cloth) 1. Animal nutrition. 2. Veterinary nursing. 3. Animal feeding. 4. Veterinary diet therapy. I. Chan, Daniel L., 1973– , editor [DNLM: 1. Animal Nutritional Physiological Phenomena. 2. Nutritional Support–veterinary. 3. Nutritional Requirements. 4. Nutritional Status. 5. Veterinary Medicine–methods. SF 95] SF95.N888 2015 636.08′52–dc23 2015007221 A catalogue record for this book is available from the British Library Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books Set in 9.5/12pt Meridien by SPi Global, Pondicherry, India 1 2015 www.Ebook777.com Free ebooks ==> www.Ebook777.com Contents Contributors, vii Preface, ix Acknowledgements, xi Nutritional assessment in small animals, Kathryn E Michel Estimating energy requirements of small animal patients, Daniel L Chan Routes of nutritional support in small animals, 14 Sally Perea Nasoesophageal feeding tubes in dogs and cats, 21 Isuru Gajanayake Esophagostomy feeding tubes in dogs and cats, 29 Laura Eirmann Gastrostomy feeding tubes in dogs and cats, 41 Isuru Gajanayake and Daniel L Chan Jejunostomy feeding tubes in dogs and cats, 54 F A (Tony) Mann and Robert C Backus Minimally invasive placement of postpyloric feeding tubes, 65 Matthew W Beal Tube feeding in small animals: diet selection and preparation, 80 Iveta Becvarova 10 Intravenous access for parenteral nutrition in small animals, 92 Sophie Adamantos 11 Parenteral nutrition in small animals, 100 Daniel L Chan and Lisa M Freeman 12 Pathophysiology and clinical approach to malnutrition in dogs and cats, 117 Jason W Gagne and Joseph J Wakshlag 13 Appetite stimulants in dogs and cats, 128 Lisa P Weeth 14 Adverse food reactions in small animals, 136 Cecilia Villaverde and Marta Hervera v www.Ebook777.com Free ebooks ==> www.Ebook777.com vi Contents 15 Nutritional management of short bowel syndrome in dogs and cats, 152 Daniel L Chan 16 Refeeding syndrome in small animals, 159 Daniel L Chan 17 Feeding small animal patients with gastrointestinal motility disorders, 165 Karin Allenspach and Daniel L Chan 18 Immune modulating nutrients in small animals, 172 Daniel L Chan 19 Nutritional management of superficial necrolytic dermatitis in dogs, 183 Andrea V Volk and Ross Bond 20 Nutritional support in acute kidney injury in dogs and cats, 193 Denise A Elliott 21 Nutritional support in hepatic failure in dogs and cats, 199 Renee M Streeter and Joseph J Wakshlag 22 Nutritional management of the septic patient, 210 Daniel L Chan 23 Nutritional support during acute pancreatitis, 219 Kristine B Jensen and Daniel L Chan 24 Nutritional support in the mechanically ventilated small animal patient, 228 Daniel L Chan 25 Nutritional support in exotic pet species, 234 Jeleen A Briscoe, La’Toya Latney and Cailin R Heinze Index, 247 www.Ebook777.com Free ebooks ==> www.Ebook777.com Contributors Sophie Adamantos, BVSc, DACVECC, DECVECC, MRCVS, FHEA Langford Veterinary Services, University of Bristol, UK Karin Allenspach, Dr.med.vet., FVH, DECVIM‐CA, PhD, FHEA, MRCVS Professor of Internal Medicine, Department of Clinical Science and Services, The Royal Veterinary College, University of London, UK Robert C Backus, MS, DVM, PhD, DACVN Associate Professor, Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, USA Matthew W Beal, DVM Diplomate ACVECC Associate Professor, Emergency and Critical Care Medicine, Director of Interventional Radiology Services, College of Veterinary Medicine, Michigan State University, USA Iveta Becvarova, DVM, MS, Diplomate ACVN Director, Academic Affairs, Hill’s Pet Nutrition Manufacturing, Czech Republic Ross Bond, BVMS, PhD, DVD, DECVD, MRCVS Professor of Dermatology, Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, UK Jeleen A Briscoe, VMD, DABVP (Avian) Animal Care Program, United States Department of Agriculture Animal and Plant Health Service, Riverdale, MD, USA Daniel L Chan, DVM, DACVECC, DECVECC, DACVN, FHEA, MRCVS Professor, Veterinary Emergency and Critical Care, Clinical Nutritionist, Department of Veterinary Clinical Sciences and Services, The Royal Veterinary College, University of London, UK Laura Eirmann, DVM, DACVN Oradell Animal Hospital; Nestle Purina PetCare, Ringwood, NJ, USA Denise A Elliott, BVSc (Hons) PhD, DACVIM, DACVN Head of Research, Waltham Centre for Pet Nutrition, Waltham on the Wolds, Leicestershire, UK Lisa M Freeman, PhD, DVM, DACVN Professor of Nutrition, Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA vii www.Ebook777.com Free ebooks ==> www.Ebook777.com viii Contributors Jason W Gagne, DVM, DACVN Nestle Purina Incorporated, St Louis, MO, USA Isuru Gajanayake, BVSc, CertSAM, DACVIM, MRCVS Willows Veterinary Centre and Referral Service, Shirley, Solihull, West Midlands, UK Cailin R Heinze, VMD, MS, DACVN Assistant Professor, Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA Marta Hervera, BVSc, PhD, DECVCN Servei de Dietètica i Nutrició, Fundació Hospital Clínic Veterinari, Universitat Autịnoma de Barcelona, Bellaterra, Spain Kristine B Jensen, DVM, MVetMed, DACVIM, MRCVS Djursjukhuset Malmö, Cypressvägen Malmö, Sweden La’Toya Latney, DVM Exotic Companion Animal Medicine and Surgery, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, USA F A (Tony) Mann, DVM, MS, DACVS, DACVECC Professor, Veterinary Medical Teaching Hospital, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA Kathryn E Michel, DVM, MS, DACVN Professor, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA Sally Perea, DVM, MS, DACVN Mars Pet Care, Mason, OH, USA Renee M Streeter, DVM Liverpool, NY, USA Cecilia Villaverde, BVSc, PhD, DACVN, DECVCN Servei de Dietètica i Nutrició, Fundació Hospital Clínic Veterinari, Universitat Autịnoma de Barcelona, Bellaterra, Spain Andrea V Volk, DVM, Dr med.vet, MVetMed, DipECVD, MRCVS Dermatology Service, Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, UK Joseph J Wakshlag, DVM, PhD, DACVN, DACVSMR Cornell University College of Veterinary Medicine, Ithaca, NY, USA Lisa P Weeth, DVM, DACVN Weeth Nutrition Services, Edinburgh, Scotland, UK www.Ebook777.com Free ebooks ==> www.Ebook777.com Preface After many years of nutritional support in many veterinary hospitals amounting to “too little and too late” there is finally concrete recognition that nutritional support is a key aspect of successful patient recovery The application, techniques and strategies of nutritional support in small animals have gone through many changes in the past several years and effective nutritional support is a hallmark of high quality standard of care Perhaps it is the close interface between nutrition and all other aspects of care that ensures that the art and science of nutrition remains dynamic as it evolves with advances in patient care This is what makes nutritional support a very exciting and challenging field in which to practice In the management of many ill animals, clinicians face numerous challenges of providing optimal nutritional care In formulating the best plans, clinicians must not only possess a keen understanding of nutritional principles, techniques and strategies, but also have a strong foundation in physiology, pathophysiology and therapeutics It is worth emphasizing that no single nutritional therapeutic plan will be applicable to all patient populations Medical treatments and interventions, including nutritional therapies, vary significantly among different patient populations and veterinary facilities With various disease states, there may be significant alterations in the physiologic and metabolic pathways that can impact the nutritional plan The goals of this book are to provide a comprehensive reference on the principles and practice of nutritional support in small animals that require hospitalization The primary target for this book includes general practitioners, advanced practitioners, specialists, veterinary nurses, technicians, support staff and those studying and researching the science of nutritional support The first section of the book comprises chapters exploring techniques for assessing the nutritional status and energy needs of small animal patients, routes of nutritional support, the various options for feeding tubes, the techniques for placing these feeding tubes, and the formulation and use of parenteral nutrition The second section of the book deals with the issues and the strategies for providing nutritional support in various conditions affecting hospitalized small animals There are chapters that discuss the pathophysiology of malnutrition, appropriate use of appetite stimulants, common conditions requiring specific nutritional alterations, such as kidney disease, hepatic failure, acute pancreatitis, and less common situations where nutritional recommendations are sparse and largely untested, such as sepsis, short‐bowel syndrome, respiratory failure, refeeding syndrome and patients with gastrointestinal motility disorders The final chapter is devoted to the nutritional management of hospitalized small exotic species, which are becoming more popular in practice and present particular challenges in terms of nutritional support ix www.Ebook777.com Free ebooks ==> www.Ebook777.com 240 Nutritional Management of Hospitalized Small Animals Figure 25.6 Green iguana (Iguana iguana) receiving a tube feeding Assisted gavage feeding through a tube in reptiles requires proper handling and secure restraint of the jaw Herbivorous reptiles, such as this iguana, can be fed an herbivorous convalescent diet (see Table 25.1) diluted enough to be administered through a feeding tube are well described elsewhere (de la Navarre, 2006; Martinez‐Jimenez and Hernandez‐Divers, 2007; Sykes and Greenacre, 2006) One equation for estimating RER for reptiles is kcal/day = 10(body weight in kg)0.75 (Martinez‐Jimenez and Hernandez‐Divers, 2007) The daily volume of food to administer is RER ÷ kcal/mL divided into the number of meals per day (Martinez‐Jimenez and Hernandez‐Divers, 2007) Note that these calculations represent an artificial generalization across numerous species, and thus should be considered basic guidelines until further research on bioenergetics of individual species becomes available All animals should be fed enough while hospitalized to at least maintain body weight Birds The anatomy of the avian gastrointestinal tract varies depending on the feeding strategy of the species This section will focus on the species more commonly kept as pets, such as psittacines and passerines The feeding strategies of these species range from mostly granivorous (e.g finches, cockatiels and budgerigar parakeets) to omnivorous (e.g Grey and Amazon parrots), with some tending more towards frugivorous (e.g macaws) or nectivorous (e.g lorikeets) (Klasing, 1999) Although many parrot species will often accept meat as part of a captive diet, this practice has not been well‐evaluated Information on nutrient requirements for commonly kept avian species is limited, particularly when considering the vast range of species kept in captivity For example, a study of Grey parrots (Psittacus erithacus) suggested a protein requirement of 10–15% DM, while that of a budgerigar parakeet (Melopsittacus undulatus) is 6.8% (McDonald, 2006) Duplicating the wild diet is often impossible, as domestic fruits are higher in sugar and water and lower in nutrients while seeds from domestic plants are higher in fat and lower in protein and nutrients than those found in the natural environments of many companion species’ wild counterparts Additionally, companion birds generally have lower energy requirements than free‐living birds due to decreased activity Based on similarities between the gastrointestinal morphology of psittacines and passerines and domestic poultry (e.g chickens and turkeys), it is assumed, however erroneously, that many of the nutritional requirements may be the same across these species Although commonly fed, commercially available seed diets have been found to be deficient in numerous essential nutrients including amino acids, calcium, phosphorus, sodium, manganese, zinc, iron, vitamins A, D, and K, B‐vitamins, www.Ebook777.com Free ebooks ==> www.Ebook777.com Nutritional support in exotic pet species 241 Figure 25.7 Cockatiel (Nymphicus hollandicus) perched on a food bowl containing a commercial extruded‐ pelleted diet Commercially available extruded‐pelleted diets have been shown to be higher in vitamins and minerals and lower in fat than seed diets choline, iodine, and selenium (Ullrey, Allen and Baer, 1991) Fat often provides more than 50% of the calories in nut and seed diets (Stahl and Kronfeld, 1998) and can contribute to obesity Commercial “complete” extruded‐pellet diets (Figure 25.7) for psittacines and passerines (initially based on poultry requirements) have been available for decades and while these diets are not perfect, they are usually an improvement over seed or seed plus fruit and vegetable diets One study showed improved fledgling success in a variety of parrot species fed an extruded‐pelleted diet versus seeds (90% success for extruded‐pellets versus 66% for seeds) (Ullrey et al., 1991) In another study, a variety of commercially‐ available extruded‐pelleted diets were found to contain much less fat than seed mixtures (8.6% in pelleted feeds vs 31.7% in seed mixtures), as carbohydrate, rather than fat, is the main energy source in pelleted diets (Werquin, De Cock and Ghysels, 2005) Despite their nutritional inferiority, seed diets are very palatable and may be more eagerly consumed by hospitalized birds Assisted feeding in birds Options for assisted feeding include syringe feeding, gavage feeding into the crop using a gavage needle (Figure 25.8) or, more rarely, esophagostomy or duodenostomy tubes Indications and techniques for these procedures are well described elsewhere (Powers, 2006a; de Matos and Morrisey, 2005; Lennox, 2006) Powdered convalescent diets made for psittacines or chick hand‐feeding diets can be reconstituted with a liquid human enteral product to increase calorie content, but the overall mixture may need to be diluted with enough water for the solution to pass through the tube being used Convalescent and hand‐feeding diets are not meant to be fed to healthy adult birds long‐term (Lennox, 2006) The energy requirement of birds depends on the environmental climate of the species’ natural environment A proposed RER calculation for tropical psittacines is 73.6(body weight in kg)0.73 while species from temperate climates www.Ebook777.com Free ebooks ==> www.Ebook777.com 242 Nutritional Management of Hospitalized Small Animals Figure 25.8 Gavage feeding of a cockatiel (Nymphicus hollandicus) Assisted feeding into the crop through a specialized metal gavage tube takes proper handling and expertise but is a convenient, expedient way to meet nutritional requirements in hospitalized, anorexic birds (e.g., Australia) have 21% higher energy requirements due to greater environmental temperature variation (Koutsos et al., 2001) As these equations can be quite complex, many practitioners rely on the more general range of 20–50 mL/ kg per feeding, depending on the amount the bird is eating on its own and how much food the crop can accommodate (Powers, 2006b); this does not take into consideration the caloric density of the diet provided Regardless of the initial feeding amount chosen, close monitoring of body weight and adjustment of intake are essential to ensure that adequate calories are being provided Small mammals Herbivorous mammals primarily eat plant material, the digestion of which requires a specialized microbial population and large bowel in which to break down fiber and extract nutrients from the diet Fiber is essential to the herbivorous diet of monogastric hind‐gut fermenters, such as rabbits, guinea pigs and chinchillas Low‐fiber diets have been linked to caecocolonic hypomotility, which can lead to over‐population of Clostridia and E coli (Cheeke, 1987) and dysbiosis Because of this, a common recommendation is to offer all species free‐choice timothy or other grass hays, with limited to no pellets for rabbits At least some pellets should be offered to guinea pigs and chinchillas since they have been shown to eat hay more slowly than rabbits and may not be able to meet their nutritional requirements on hay alone (Donnelly and Brown, 2004) Similar to non‐human primates, guinea pigs must have a dietary source of vitamin C (Donnelly and Brown, 2004) The daily vitamin C dose range is from 10 mg/kg body weight to 50 mg daily for any size guinea pig Published nutritional requirements are available for small rodents such as rats, mice, and gerbils, due to their extensive use in biomedical research www.Ebook777.com Free ebooks ==> www.Ebook777.com Nutritional support in exotic pet species 243 (National Research Council, 1995) However, these guidelines were designed for laboratory animals and may not be applicable to companion animals with their different nutrition end‐goals Laboratory animal guidelines are often designed to optimize lactation or reproduction, rather than health and longevity Commercial ”rodent chow” and other formulated diets are readily available and contain a minimum of 16% protein and 4–5% fat on a DM basis (Kupersmith, 1998) These diets can be supplemented for enrichment and variety with small amounts of seed and nuts as well as fresh produce Specialized rodent blocks with plant‐ based protein sources are available and, with more research, may be proven to be more appropriate for overweight or growing animals or those with certain disease conditions Ferrets are obligate carnivores and thus have a relatively short intestinal tract and colon (approximately half the length of that of a cat), and lack a caecum and ileocolic valve Ferret diets should be highly digestible (i.e., low in fiber), as the gastrointestinal transit time is only 3–4 hours (Kupersmith, 1998, Bixler and Ellis, 2004) Ferrets require at least 30% high quality protein on a dry matter basis in their diets (Kupersmith, 1998) and should be fed minimal carbohydrates Assisted feeding in small mammals Because hindgut fermenters need to maintain constant food intake to stimulate proper motility (Cheeke, 1987), and ferrets have such a rapid gut transit time, in cases of hyporexia or anorexia, assisted feeding must be instituted as soon as the animal is stabilized Options for assisted feeding of small mammals include syringe feeding (Figure 25.9), nasogastric, or esophagostomy tubes Indications and techniques are well described elsewhere (Bixler and Ellis, 2004; Brown, 1997a,b; de Matos and Morrisey, 2006; Graham, 2006; Klaphake, 2006; Paul‐ Murphy, 2007; Powers 2006c) Canned convalescent diets designed for cats can be fed to ferrets, either offered for free‐feeding (Figure 25.10) or mixed with water or a commercial liquid cat enteral formulation as needed to pass through a syringe or tube Commercially available powdered convalescent diets designed for mammalian carnivores may also be used Similar products are available for mammalian herbivores that can also be diluted with water or a liquid human enteral formulation as needed to obtain the consistency that can fit through a feeding syringe or tube (Bixler and Ellis, 2004; Powers 2006c) Further study is needed to address the impact simple sugars in human enteral formulations have on these species, but such products have been used extensively by exotic pet veterinarians with no obvious ill‐effects Resting energy requirements for most mammals can be estimated by the equation RER = 70(body weight in kg)0.75 Calories administered should be adjusted to maintain body weight during hospitalization Many practitioners rely on more general guidelines, focusing on maintaining food intake to stimulate gut motility rather than meeting precise caloric requirement Ferrets can be fed as much as they will take in a feeding (usually 12–25 ml per 2–4 feedings a day) (Bixler and Ellis, 2004), and the herbivorous/omnivorous mammals can be fed 20 ml/kg in each feeding up to times a day, depending on how much they are eating on their own Daily weighing is critical to ensure that the appropriate amount of calories is provided www.Ebook777.com Free ebooks ==> www.Ebook777.com 244 Nutritional Management of Hospitalized Small Animals Figure 25.9 Syringe feeding of a chinchilla (Chinchilla laniger) Anorexic monogastric hind‐gut fermenters, such as rabbits, chinchillas and guinea pigs, should be syringe fed a convalescent diet designed for herbivores to stimulate gut motility and restoration to health Figure 25.10 Assisted feeding of a ferret (Mustela putorius furo) with a canned convalescent diet Unlike herbivorous small mammals, ferrets are less likely to tolerate restraint for syringe feeding, thus encouraging them to eat a canned diet without restraint is ideal Summary Addressing the nutritional needs of exotic pets in practice need not be difficult, as long as protocols are in place for stocking, safe food preparation, expiration date monitoring, and product replacement as needed It is imperative for hospital staff to have an appreciation for (i) different feeding strategies for exotic pets and how to address them, (ii) species‐specific behaviour patterns and food intake and (iii) subtle changes in body condition and weight across the range of commonly kept exotic pets Currently much of the approach to nutrition for exotic pets is based on extrapolation from domestic animals, but as more research is performed and the understanding of ethology and comparative gastrointestinal morphology expands, our ability to address nutritional needs at the species level will improve Key points • Species‐specific research on which to rely for nutritional guidance in exotic pets is ideal but limited • Addressing the nutritional needs of exotic pets in practice need not be difficult, as long as protocols are in place for stocking, safe food preparation, expiration date monitoring and product replacement as needed • It is imperative for hospital staff to have an appreciation for (i) different feeding strategies for exotic pets and how to address them, (ii) species‐specific behaviour www.Ebook777.com Free ebooks ==> www.Ebook777.com Nutritional support in exotic pet species 245 patterns and food intake, and (iii) subtle changes in body condition and weight across the range of commonly kept exotic pets • One of the goals for successful treatment of hospitalized exotic pets is to have them consume the appropriate diet without assistance If they are anorexic, nutritional supplementation is imperative, especially for those species with high metabolic rates, such as birds and small mammals Gavage and syringe feeding are preferred for ease of administration and lower stress on the animal, as compared to more invasive methods such as nasoesophageal or pharyngostomy tube placement • Taking into account the feeding strategy and ethology of the species in the wild is ideal for determining which diets to feed in hospital Convalescent diets tailored to carnivorous and herbivorous species are readily available and easy to administer Note Exotic pet species include small animals, other than dogs and cats, which are commonly kept as pets, including birds, such as canaries and parrots, reptiles, amphibians and small mammals, such as rabbits, guinea pigs, ferrets, chinchillas, and rats References Bixler, H and Ellis, C (2004) Ferret care and husbandry Veterinary Clinics Exotic Animal Practice, 7, 227–255 Brown, S A (1997a) Clinical techniques in rabbits Seminars Avian and Exotic Pet Medicine, 6, 86–95 Brown, S A (1997b) Clinical techniques in domestic ferrets Seminars Avian and Exotic Pet Medicine, 6, 75–85 Cheeke, P R (1987) Rabbit Feeding and Nutrition Harcourt Brace Jovanovich Publishers (Academic Press), Orlando Crissey, S D., Slifka, K A., Shumway, P and Spencer, S B (2001) Handling Frozen/Thawed Meat and Prey Items Fed to Captive Exotic Animals: A Manual of Standard Operating Procedures U S D A AWIC, Beltsville, MD de la Navarre, B J S (2006) Common procedures in reptiles and amphibians Veterinary Clinics Exotic Animal Practice, 9, 237–267 de Matos, R and Morrisey, J K (2005) Emergency and critical care of small psittacines and passerines Seminars Avian and Exotic Pet Medicine, 14, 90–105 de Matos, R and Morrisey, J K (2006) Common procedures in the pet ferret Veterinary Clinics Exotic Animal Practice, 9, 347–365 Donnelly, T M and Brown, C J (2004) Guinea pig and chinchilla care and husbandry Veterinary Clinics Exotic Animal Practice, 7, 351–373 Donoghue, S (1998) Nutrition of pet amphibians and reptiles Seminars Avian and Exotic Pet Medicine, 7, 148–153 Finke, M D., Dunham, S and Kwabi, C (2005) Evaluation of four dry commercial gut loading products for improving the calcium content of crickets, Acheta domesticus Journal of Herpetological Medicine and Surgery, 15, 7–12 Fisher, P G (2005) Equipping the exotic mammal practice Veterinary Clinics Exotic Animal Practice, 8, 405–426 Graham, J (2006) Common procedures in rabbits Veterinary Clinics Exotic Animal Practice, 9, 367–388 Klaphake, E (2006) Common rodent procedures Veterinary Clinics Exotic Animal Practice, 9, 389–413 www.Ebook777.com Free ebooks ==> www.Ebook777.com 246 Nutritional Management of Hospitalized Small Animals Klasing, K C (1999) Avian gastrointestinal anatomy and physiology Seminars Avian and Exotic Pet Medicine, 8, 42–50 Koutsos, E A., Matson, K D and Klasing, K C (2001) Nutrition of birds in the order Psittaciformes: A review Journal of Avian Medicine and Surgery, 15, 257–275 Kupersmith, D S (1998) A practical overview of small animal nutrition Seminars Avian and Exotic Pet Medicine, 7, 141–147 Latney, L V., Toddes, B T., Wyre et al., (2009) Improving the nutrition of insectivorous animals: evaluation of the nutrient content of Tenebrio molitor and Zophobas morio fed four different diets Proceedings of the Association of Zoo Veterinarians Nutritional Advisory Group October 24 to 28, Tulsa, OK, USA pp 22–23 Lennox, A M (2006) Common procedures in other avian species Veterinary Clinics Exotic Animal Practice, 9, 303–319 Martinez‐Jimenez, D and Hernandez‐Divers, S J (2007) Emergency care of reptiles Veterinary Clinics Exotic Animal Practice, 10, 557–585 McDonald, D (2006) Nutritional considerations: nutrition and dietary supplementation in Clinical Avian Medicine (eds G J Harrison and T L Lightfoot) Spix Publishing, Inc., Palm Beach, pp 86–107 Mitchell, M A (2004) Snake care and husbandry Veterinary Clinics Exotic Animal Practice, 7, 421–466 National Research Council, B o A C o L N., Subcommittee on Laboratory Animal Nutrition (1995) Nutrient Requirements of Laboratory Animals, National Academy Press, Washington, D.C Paul‐Murphy, J (2007) Critical care of rabbit, Veterinary Clinics Exotic Animal Practice, 10, 437–461 Pollock, C (2002) Postoperative management of the exotic animal patient Veterinary Clinics Exotic Animal Practice, 5, 183–211 Pough, F H (2004) Herpetology as a field of study in Herpetology, 3rd edn, (eds F H Pough, R M Andrews, J E Cadle et al., Pearson Education, Inc., Upper Saddle River, pp 1–228 Powers, L V (2006a)Techniques for drug delivery in psittacine birds Journal of Exotic Pet Medicine, 15, 193–200 Powers, L V (2006b) Common procedures in psittacines Veterinary Clinics Exotic Animal Practice, 9, 287–302 Powers, L V (2006c) Techniques for drug delivery in small mammals Journal of Exotic Pet Medicine, 15, 201–209 Rossi, J V (2006) General husbandry and management in Reptile Medicine and Surgery, 2nd edn, (eds S.J Divers and D.R Madar) Elsevier, St Louis pp 25–41 Schmidt, D A., Travis, D A and Williams, J J (2006) Guidelines for creating a food safety HACCP program in zoos or aquaria Zoo Biology, 25, 125–135 Stahl, S and Kronfeld, D (1998) Veterinary nutrition of large psittacines Seminars Avian and Exotic Pet Medicine, 7, 128–134 Sykes, J M and Greenacre, C B (2006) Techniques for drug delivery in reptiles and amphibians Journal of Exotic Pet Medicine, 15, 210–217 Ullrey, D E., Allen, M E and Baer, D J (1991) Formulated diets versus seed mixtures for psittacines Journal of Nutrition, 121, S193–S205 Werquin, G J., De Cock, K J and Ghysels, P G (2005) Comparison of the nutrient analysis and caloric density of 30 commercial seed mixtures (in toto and dehuled) with 27 commercial diets for parrots Journal of Animal Physiology and Animal Nutrition, 89, 215–221 www.Ebook777.com Free ebooks ==> www.Ebook777.com Index Note: Page numbers in italics refer to Figures; those in bold to Tables acid-base balance, 193, 194, 197 acid-base disorders, 193 acidosis, consequences of, 193, 194, 195 acute hepatotoxicosis, 205 management, 206 acute infection, stress response to, 210 acute lung injury (ALI), 173, 231 mechanical ventilation, 228–33 feeding strategies, 230–231 nutritional support recommendations, 230–231 antioxidants, 231 tube feeding, 231 acute kidney failure, 193–8 acute pancreatitis, 219–27 enteral feeding, 220–222 management strategies, 220–223 parenteral nutrition, 222–3 pathophysiology, 219 acute phase proteins, 103, 120 C-reactive protein (CRP), 224 adverse food reactions, 42, 136–51 gastrointestinal disease, 112 acute kidney injury, 193–8 acute respiratory distress syndrome (ARDS), 231 albumin as antioxidant, 174 indicator of nutrition status, 1, 153 negative acute phase protein, 120 amino acids aromatic, 130 branched-chain, 124 conditionally essential, 123, 176 essential, 102, 182 intravenous administration, 102 in superficial necrolytic dermatitis, 187, 190 amino acid solutions for parenteral nutrition, 102–3 for hepatocutaneous syndrome, 187, 190 ammonia decreased production, 202 increased concentration, 201–4 anemia, 153, 156, 159, 161, 162, 175, 186 anorexia, 3, 51–5, 74, 89, 101, 112, 117–29, 132–4, 159, 160, 163, 170, 178, 195–6 in rabbits, 235 in ferrets, 243 antioxidants, 172–5 benefits of, 201, 172–5 supplementation, 201 appetite stimulants, 128–33, 189, 195 arachidonic acid (AA), 87, 124, 173, 185, 196 ARDS see acute respiratory distress syndrome arginine, 175, 176, 196 supplementation 221, 224 aromatic amino acids (AAA), 130 aspiration complication, 4, 38, 66, 165, 196, 215, 229 dysmotility disorders, 165, 229 pneumonia, 215, 229 tube feeding, 4, 14, 16, 17, 21, 50, 51, 230 assisted feeding in birds, 241–2 in reptiles, 239–40 in small mammals, 243 azotemia, 87, 193, 194 complication of parenteral nutrition, 12 BCAAs see branch chain amino acids blood urea nitrogen (BUN), body condition score, 1–3, 120, 121, 156, 194, 198, 200, 239 body mass index (BMI), 161 branch chain amino acids (BCAAs) 86, 124, 124 Nutritional Management of Hospitalized Small Animals, First Edition Edited by Daniel L Chan © 2015 John Wiley & Sons, Ltd Published 2015 by John Wiley & Sons, Ltd 247 www.Ebook777.com Free ebooks ==> www.Ebook777.com 248 Index burns, 10, 122 B vitamins, 125, 162, 203, 204 in parenteral nutrition, 104 supplementation, 205 in birds, 240 cachexia, 117, 125–6 cancer, 118 cardiac, 124 pathophysiology of, 118–22 calories defined, calorimetry see indirect calorimetry cancer, 118, 121, 124, 132 cachexia, 118 capnography, 24, 25, 34, 35 carbohydrates, 84, 88, 103, 215 in ferrets, 243 in parenteral nutrition, 103 in reptiles, 239 over-feeding of, 213 respiratory quotient, role in refeeding syndrome, 161 cardiac cachexia, 124 cardiovascular disease, 119, 128, 130, 159, 160, 162, 196 cardiovascular instability, 42, 101, 176, 177, 213, 216, 228, 230 carnitine see also L-canitine, 84, 204, 205, 206 catabolic state in uremia, 194, 195 catheters, 14, 18, 102 acute complications, 25, 26, 36, 81 selection for parenteral nutrition, 92–3 central venous catheters, 94–7 central parenteral nutrition (CPN), 18, 196 central venous access, 18, 92, 93 cholecystokinin (CCK), 129, 200 cholesterol, 200 cholestyramine, 155 cirrhosis, 183, 199–203, 205, 207 coagulopathy, 30, 30, 39, 42, 43, 52, 93, 120, 203 colon, 153, 155, 157, 169, 203, 220 in small animals, 242, 243 colonic microflora, 88, 178, 213 colonic motility, 165–166 compounding, parenteral nutrition, 106, 106, 107, 113, 222 congestive heart failure (CHF), 112, 175 copper in hepatic disease, 200–201, 206 in parenteral nutrition, 104, 206, 207 Corticosteroids, 118, 194 CPN see Central parenteral nutrition (CPN), 18, 103, 196 creatinine kinase, critical illness, 4, 86, 98, 118, 174, 211–24, 229 CRP see C-reactive protein (CRP) cutaneous adverse food reactions (CAFR), 136 description of, 136, 137, 137 management, 137–8 pathophysiology, 137–8 cytokines in critical illness, 118–19 in inflammatory conditions, 173, 174 in relation to anorexia, 129 in sepsis, 210–12 dehydration, 153 dextrose, 102, 103, 197, 221, contribution to osmolality, 106 hyperglycemia, 103 dextrose solutions, for parenteral nutrition, 102–5, 107, 111 DHA see docosahexaenoic acid Diabetes mellitus, 185, 188 diarrhea, 54, 120, 136, 153 in adverse food reactions, 136, 139, 150 in dysmotility disorders, 166, 168, 170 in enterally fed patients, 17, 19, 26, 38, 50, 62, 71, 74, 85, 88, 89, 221 in kidney failure, 89, 195–7 in liver disease, 200 in short bowel syndrome, 152, 153, 155, 156 management of, 138–9,154–7 osmoic, 153 probiotics, 179 Diet history in elimination diet trial, 140, 148–50 digestibility, 86, 139, 154–5, 168, 169 doxosahexaenoic acid (DHA), 82, 87, 124, 124–5, 173–4 EFAs see essential fatty acids (EFAs) eicosapentaenoic acid (EPA), 87–8, 103, 184, 187 electrolytes deficiencies, 160, 161 disturbances, 89, 111 in parenteral nutrition, 102, 104 monitoring, 112, 159, 204 refeeding syndrome, 51, 159, 162 short bowel syndrome, 153 elimination diets for adverse food reaction, 138–40, 138 elizabethan collar in exotic animals, 235 in tube feeding, 14, 15, 15, 23, 24, 48, 70, 113 www.Ebook777.com Free ebooks ==> www.Ebook777.com Index 249 EN see enteral nutrition Encephalopathy see hepatic encephalopathy energy, 118, 119, 204, 210, 211, 214–16 calculation of energy requirements, 10, 114 in birds, 241 in reptiles, 240 balance, 129 expenditure, 7, 8, 122, 125, 160, 194 methods of determination, 8–9, 10–11 requirements, 7–11 calculation, 10, 231 in birds, 240, 242 in mammals, 243 in reptiles, 238 enteral nutrition (EN) accidental intravenous administration prevention, 25 benefits of, 213 complications, 16, 17, 26–7, 65 aspiration pneumonia, 4, 16, 66, 215, 229 gastrointestinal, 10 mechanical, 14, 15 metabolic, 10 contraindications, 29 diet choices, 80, 88, 89 elimination diets, 139–50, 141–147 liquid diets, 88, 221 early enteral nutrition, 168, 210, 212–14, 229 feeding devices 230 esophagostomy feeding tube, 29, 31, 37–8 gastrostomy feeding tubes, 50, 52 jejunal feeding tubes, 62, 65, 71, 74, 75 nasoesophageal feeding tubes, 195 post pyloric, 76 in acute pancreatitis, 219, 220–222 in adverse food reactions, 138–50 in combination with parenteral nutrition, 18 in reptiles, 239 in birds, 241 in small mammals, 243 in hepatic disease, 204 in kidney failure, 194–6 in sepsis, 213–15 intolerance to, 229 osmolality of enteral feeds, 84, 86, 88, 90 residual volume, 230 routes of feeding, 230 transition to, 113 EPA see eicosapentaenoic acid (EPA) esophageal motility disorders, 165–6, 229 esophagitis, 21, 27, 30, 38, 42, 197, 229 esophagostomy feeding tubes, 29–40, 195, 221, 222 in birds, 241 in small mammals, 243 essential amino acids, 86, 102 essential fatty acids, 87, 88, 103, 184, 187 fasting, 118, 166 alterations in metabolism during, 118 starvation, 103, 117–19, 159–61 fat absorption of, 168 in acute gastroenteritis, 168–70 in pancreatitis management, 221, 223 in parenteral nutrition, 103–4 in sepsis, 211, 214 fat-soluble vitamins, see also vitamins; 125 fatty acids see also polyunsaturated fatty acids absorption, 153 metabolism of, 173–4 omega-3, 124, 173, 174, 195, 215 omega-6, 124, 173 feeding complications, 27, 37–8, 50–52, 62, 71, 76, 74 tube blockage, 27 delivery methods continuous rate infusion, 36, 98, 169, 221 intermittent boluses, 14, 169 feeding tubes esophagostomy, 29–39 gastrostomy, 41–52 jejunostomy, 54–63 nasoenteric, 21–8 post-pyloric, 65–77 feline idiopathic hepatic lipidosis, 184, 199, 204–5 fiber, 62, 207 fermentable, 154–6 in small mammals, 242, 243 short bowel syndrome management and, 135 soluble, 84, 88–9, 169 fish oils, 61, 87, 210 fluid balance, 85, 162, 196, 197 fluid requirements, 85 fluoroscopic nasojejunal tube, 67 food allergy see also cutaneous adverse food reaction (CAFR), 136, 137, 137, 145 food aversion, in cats, 128, 129, 204 food hypersensitivity see food allergy free radicals, 201 gastric emptying 153, 165–70 gastric residual volume, 229, 230 Management, 230 tube feeding, 14, 167 ventilated patients, 229–30 www.Ebook777.com Free ebooks ==> www.Ebook777.com 250 Index gastroesophageal reflux, 31, 38, 165, 229 gastrointestinal disease dysmotility, 229 feeding recommendations, 229–30 intestinal permeability, 65, 177, 213 adverse food reactions, 136–149 inflammatory bowel disease, 137 protein-losing enteropathy, 138 short bowel syndrome, 152–7 gastrojejunostomy tubes, 17, 66 gastrostomy feeding, 41–52 complications, 50–52 disadvantages, 42t low profile, 41, 42f, 42t, 52 overview, 41–42 placement, 43–48 glucagon-like peptide-1 (GLP-1), 166 glucagon-like peptide-2 (GLP-2), 154, 156 gluconeogenesis, 7, 103, 118, 185, 211 glucose administration, excess of, 109 homeostasis, 88, 111, 118 metabolism, 125 oxidation, 109 glutamine depletion, 176 fuel for enterocytes and immune cells, 155 in enteral feeding, 155–6, 177 gastrointestinal health, 177 supplementation, 89, 124, 156, 176 in critical care, 86, 176, 215, 223 glutathione (GSH), 201 glycogen, 118, 211 depletion in liver disease, 199, 200 growth hormone, 118, 156 GSH see glutathione (GSH) gut function altered barrier function, 18, 88, 124, 176, 178, 179, 220 bacterial translocation, 65, 220, 222 gut dysmotility, 229, 231, 165–8, 170 immune system, 172, 234 HCS see hepatocutaneous syndrome (HPS) hepatic encephalopathy, 201–3 management, 202–3 portosystemic shunts, 202–3 protein restriction, 202–3 hepatic lipidosis, 204 assessment of coagulation, 199 feeding tubes, 204 management, 204 hepatitis, 199, 205, 206 hepatobiliary disease, 200 feline idiopathic hepatic lipidosis, 29, 130, 199, 201, 204, 205, 206 hepatic encephalopathy, 203 liver failure, 199, 207 hepatocutaneous syndrome, 183 hydrolyzed protein diets, 140–147, 147–9 in elimination diet trial, 139 hyperammonemia in liver failure, 204, 206 hyperbilirubinemia, 112 hyperglycemia as complication of parenteral nutrition, 103, 109, 110, 111 in critical illness, 118, 210, 211 in refeeding syndrome, 159, 162 hyperkalemia associated with parenteral nutrition, 111 hyperphosphatemia, 193–5 hypoalbuminemia, 49, 125, 120, 153, 186 hypoallergenic diet, 141–147 hypocaloric feeding, 214 hypoglycemia, 101, 214, 211 hypokalemia, 111 in refeeding syndrome, 111, 159, 162, 163, 236 hypomagnesemia, 111 in refeeding syndrome, 111, 159, 160, 162, 163 hypophosphatemia, 111 in refeeding syndrome, 159, 161, 162, 163, 236 in hepatic lipidosis, 204 n parenteral nutrition, 104, 111 IBD see inflammatory bowel disease (IBD) IED see immune-enhancing diet (IFD) IgE mediated type I hypersensitivity, 137, 137 Ileus, 4, 29, 42, 50, 165, 166, 170, 212 intestinal dysmotility, 167 management, 51, 177 nutritional strategy, 221 illness factors, 10 relationship to complications, 10, 11 immune-enhancing diet (IED), 86, 178, 224 Immunomodulating nutrients, 180, 215, 216 arginine, 80, 82, 84, 86, 122–4, 124, 175–6, 196, 221, 223 glutamine, 82, 86, 89, 118, 123–4, 124, 155–8, 172, 175–8, 210, 215, 223–4 nucleotides, 178, 215 omega-3 fatty acids, 172–6 indirect calorimetry, 9–10, 194 measurement, 8–9, 194 infectious complications, 39, 65, 101, 173–4, 177, 211–12, 222, 224 catheter related, 65, 92, 94, 97–8, 98, 112 feeding tube stomas, 15–16, 37–8, 42, 49–51, 52, 62, 66, 74, 75 www.Ebook777.com Free ebooks ==> www.Ebook777.com Index 251 inflammation, 10, 38, 66, 87, 174–8, 219 manipulation of, 169, 172, 180 response to omega-3 fatty acids, 173–4, 195 inflammatory bowel disease (IBD), 137, 148 diagnosis, 137, 138 management recommendation, 138–48 nutritional derangements IBD, 138 insulin, 118, 129 requirement in parenteral nutrition, 103 resistance, 88, 118, 122, 176, 194, 211 role in refeeding syndrome, 111, 159–61, 163, 236 therapy, 211, 215 intensive insulin therapy, 215 intestinal permeability, 177, 213 intralipids, 187, 188 jejunal feeding tubes, 62, 76, 220, 230–231 complications, 62 indications, 54, 220, 230 placement techniques, 17, 55 ketone, 204 bodies, 118 in starvation, 118, 119 kidney disease, 103, 112, 128, 172, 193, 197 acid-base balance, 193–7, 198 acute kidney injury (AKI), 193 chronic kidney failure, 195 electrolyte abnormalities, 193 energy, 197 nutritional management, 193–7 omega-3 fatty acids, 195 phosphorus, 172, 195, 240 potassium, 195 protein, 195 Kleiber’s energy equation, L-carnitine, 84, 205, 206, 240 lipid emulsions for parenteral nutrition, 103–4, 107 Lipids emulsion, 103–4, 107 metabolic alterations in liver disease, 200 metabolism, 119, 120, 194 lipoprotein lipase, 119, 212 liquid diets for enteral nutrition, 26, 27, 36, 42, 61–2, 76, 80, 82–83, 84–90, 168, 221–2, 231, 237 Liver see hepatobiliary diseases long-chain fatty acids, 61, 87, 103, 172, 173 lower esophageal sphincter, 27, 168 magnessium in refeeding syndrome, 51, 111, 159–62, 163 maintenance energy requirement (MER), 200 malnutrition, 1–7, 103–4, 113, 117, 120–122, 125, 159, 161, 193–4, 198, 210, 220–223, 228, 234 cachexia, 117–18, 120, 121, 124, 125, 125, 130 indicators of, 1–3, 119–20 management, 121–5 pathophysiology, 118–19 protein-calorie, 193–4 protein-energy, 223 uremia, 193–4 medium-chain triglycerides (MCT), 87, 88, 104 megaesophagus, 21, 30, 42 MER see maintenance energy requirement (MER) metabolic acidosis, 193–5 metabolic epidermal necrosis (MEN), 183 metabolizable energy, 61, 87, 122, 239 metoclopramide, 71, 168 microminerals see trace minerals milk thistle extract, 202 minerals see also trace minerals;, 84, 89, 162, 207 in parenteral nutrition, 104 motility disorders, 66, 165–70, 214, 229 muscle mass, 3, 197 scoring system, 3–4, N-acetylcysteine, 205 N-3 fatty acids see also Omega-3 fatty acids, 124, 130, 172–4, 195, 215–16, 231 mechanism of action, 173 ratio to N-6, 124 nasoenteral feeding see nasoesophageal feeding nasoesophageal feeding, 14 complications, 26–7 overview, 14–15 placement technique, 21–3 nasojejunal feeding, 17, 54, 65–6, 222, 230, 231 complications, 71 overview, 65–6, 77 placement technique, 67–70 uses, 65–6 nausea, 37, 54, 55, 128, 167, 193 antiemetics for, 132 barrier to feeding, 37, 65, 170 management of, 71, 131, 168, 189 necrolytic migratory erythema (NME), 183, 187 neoplasia, 21, 30, 42, 66, 120, 121, 128, 130, 174 niacin, 104 nitric oxide, 176 arginine, 80, 82, 84–6, 122–4, 175–6, 188, 196, 221, 223 www.Ebook777.com Free ebooks ==> www.Ebook777.com 252 Index nitrogen balance, 119, 122, 124, 126, 194, 212 NME see necrolytic migratory erythema (NME) nonesterified fatty acids, 212 nonprotein calorie to nitrogen ratio, 103 nonprotein calories, 103, 194 nutritional assessment, 1–5 body condition score, 1–3 nutraceuticals, 201 omega-3 fatty acids, 124, 124, 130, 173, 195, 215, 216, 231 immunonutrition, 172–6 in respiratory failure, 231 mechanism of action, 173–4 omega-6 fatty acids, 176 n-6 to n-3 ratio, 124 osmotic diarrhea, 85, 153 overfeeding, 10, 214, 231 complications, 8, 10, 105, 106, 214, 231 consequences, 214 oxidative stress, 10, 103, 174–5, 177, 195 pancreatitis, 17, 128, 219–26, 174–5, 189, 213 nutritional management, 42, 66, 88, 220–224 parenteral nutrition for, 222–3 pathophysiology, 219 parenteral nutrition, 100–115 administration, 107–9 catheter care, 97–8 catheter placement, 93–7 catheter selection, 94 common solutions, 102–7 compared with enteral nutrition, 100–101 complications, 110–113 mechanical, 112 metabolic, 110–112 septic, 112 components of carbohydrates, 103 electrolytes, 104 fat, 103 protein, 102–3 trace minerals, 104 vitamins, 104 compounding, 106–7 concurrent enteral feeding, 113 discontinuing, 113 energy requirements, 105, 105 formulation calculations, 105 lipid-free solution, 107 monitoring, 110 nomenclature, 101 Nutritional Assessment, 100–101 in pancreatitis, 100–101 patient selection, 100–101 peripheral administration, 101–102 worksheet, 105 percutaneous endoscopically guided gastrostomy(PEG) tube, 41–52, 71, 72 complications, 50–53 overview, 41–2 placement technique, 43–8 removal, 49–50 tubes, 43 peripheral parenteral nutrition (PPN), 18, 101–3, 109, 196 peritonitis see septic peritonitis pharyngostomy feeding, 235, 239, 245 complications, 29 phosphorus, 81, 89, 104, 111, 195 in refeeding syndrome, 51, 159, 160, 236 monitoring, 81, 162 polyenylphosphatidylcholine (PEP), 201, 206 polymeric formulations, 61,76, 84 polyunsaturated fatty acids (PUFAs), 87, 172–3, 180, 201 portosystemic shunts, 202, 203 diets, 202–3 hepatic encephalopathy, 202, 203 nutritional management, 202 protein restriction, 202 potassium, 81 depletion, 160, 161 in acute kidney failure, 195 in parenteral nutrition, 104 in refeeding syndrome, 51, 111, 159, 160, 236 supplementation, 162 PPN see peripheral parenteral nutrition(PPN) prebiotics, 88 probiotics, 88–9, 178, 179 procalAmine, 107, 109 prokinetic, 113 agents, 168 in dysmotility disorders, 51 in ventilated patients, 230, 232 protein, 7, 123, 124, 175 acute phase, 103, 120 allergy to, 137 calorie malnutrition, 193–4, 223 C–reactive protein, 224 in kidney disease, 172, 194 in elimination diets, 139, 140 in hepatic encephalopathy, 199, 200, 202, 207, 207 in hepatic lipidosis, 199, 204 in gastrointestinal disease, 168 in parenteral nutrition, 110 www.Ebook777.com Free ebooks ==> www.Ebook777.com Index 253 in superficial necrolytic dermatitis, 185, 187 hydrolyzed, 139, 140, 147 requirements, 105 in critical illness, 61, 103, 122, 215 respiratory quotient, restriction for acute kidney disease, 195 for hepatic encephalopathy, 199, 203, 207 sparring effect, 106 protein-energy malnutrition, 223 protein hydrolysate diets, for IBD, 140 in adverse food reactions, 127, 140, 140 protein-losing enteropathies, 138 protein-losing nephropathies, 138 reactive oxygen species (ROS), 174, 201 antioxidants, for management of, 201 modulation of, 174 refeeeding syndrome, 51, 88, 159–63, 196 complications, 159–60 carbohydrates, 88 electrolytes, 159–60 derangements, 111, 159 insulin, 159, 160, 236 management, 161–2 prevention strategy, 122, 161, 196, 204, 235 risk factors, 161–2 starvation, 159–62 thiamine supplementation, 161 renal failure see kidney failure RER see Resting Energy Requirements (RERs) residual volume see also gastric residual volume), 167 guidelines, 167 respiratory quotient (RQ), Resting Energy Requirements (RER) calculation, 10, 11, 105, 109, 243 feeding plans, 37, 49, 61, 122, 155, 204, 231 formulas, 10, 11t illness factors, 214 ROS see reactive oxygen species (ROS) S-adenosylmethionine (SAMe), 201, 205, 206 supplementation for cirrhosis, 201 SCFA see short-chain fatty acids(SCFA) Sepsis, 118, 210–216 complications of parenteral nutrition, 92, 97, 113 enteral nutrition, 121, 173 feeding strategies, 214 nutritional management, 173, 174, 212–16 protein requirements, 215 short bowel syndrome (SBS), 152–8 feeding recommendations, 154–6 intestinal adaptation, 155–6 pathophysiology, 153–4 short-chain fatty acids (SCFAs), 88, 153, 154 silymarin, 201, 202, 205 skin testing, 1–2 small intestinal disease adverse food reactions, 42, 136–51 inflammatory bowel disease, 137, 148 proteinlosing enteropathies, 138 short-bowel syndrome, 152–8 sodium, 86 disorders, 25, 88, 89, 153 soybean oil, 87, 103 starvation malnutrition, 117–26 superficial necrolytic dermatitis (SND), 183–90 amino acid infusion, 187–8 clinical presentation, 184 description, 185 diagnosis, 183–5 treatment, 188 superoxide, 89 superoxide dismutase, 174 supplements, 89, 117, 122, 124, 205 systemic inflammatory distress syndrome (SIRS), 61, 175, 193 taurine, 80, 81, 84, 86, 89, 155, 188, 196 thiamin deficiency, 204 supplementation, 104, 162, 204 in hepatic lipidosis, 204 in refeeding syndrome, 111, 160, 161 TNA see total nutrient admixture (TNA) total nutrient admixture (TNA) see parenteral nutrition total parenteral nutrition (TPN) see parenteral nutrition trace elements, 89 trace minerals, 104, 162 in parenteral nutrition, 104 triglycerides excess of, 105, 119, 120, 211, 223 in acute pancreatitis, 223 recommendations when increased, 110 tube feeding see enteral nutrition complications, 16–17, 26–7, 65 feeding tubes esophagostomy, 29, 38, 31, 37 www.Ebook777.com Free ebooks ==> www.Ebook777.com 254 Index tube feeding see enteral nutrition (cont’d) gastrostomy, 50, 52 jejunal, 62, 65, 71, 74, 75 nasoesophageal, 195 pharyngostomy, 235, 239, 245 uremia, 193–5, 197, 198 ursodiol, 202, 206 ventilated patients, 173, 224, 228 nutritional management, 228–31 vitamins, 89 deficiency, 154, 159 fat soluble, 125 for parenteral nutrition, 104 supplements, 81, 84 water soluble, 195, 203–4 vitamin A, 89, 236, 240 vitamin B12, 153, 204 deficiency, 153, 204 treatment, 155–6 supplementation, 203–4 vitamin B complex in parenteral nutrition, 125 vitamin C, 89, 174, 242 vitamin D, 240 vitamin E, 89, 124, 174, 175 as antioxidant, 201, 202 supplementation, 201, 206 vitamin K, 203, 205, 240 deficiency, 205 supplementation, 205, 206 in hepatic lipidosis, 205 vomiting as complication, 8, 15–17, 26–7, 30, 37–8, 51, 231 in enterally fed patients, 4, 14, 42, 50 water soluble vitamins, 195, 203–4 weight gain, 132, 236 weight loss, 110, 117, 118–21, 125 Weir equation, wounds exudative, 215 zinc, 129, 187 in copper-associated hepatopathies, 201–2 requirements, 201 supplementation, 187, 201, 206 www.Ebook777.com ... Acknowledgements, xi Nutritional assessment in? ?small? ?animals, Kathryn E Michel Estimating energy requirements of small animal patients, Daniel L Chan Routes of nutritional support in? ?small animals, 14... science of nutritional support The first section of the book comprises chapters exploring techniques for assessing the nutritional status and energy needs of small animal patients, routes of nutritional. .. Routes of nutritional support in? ?small animals Sally Perea Mars Pet Care, Mason, OH, USA Introduction Determination of the route of nutritional support is an important step in the assessment and management