Effect of Early Enteral Nutrition on Intestinal Permeability, Intestinal Protein Loss, and Outcome in Dogs with Severe Parvoviral Enteritis

Abstract

A randomized, controlled clinical trial investigated the effect of early enteral nutrition (EN) on intestinal permeability, intestinal protein loss, and outcome in parvoviral enteritis. Dogs were randomized into 2 groups: 15 dogs received no food until vomiting had ceased for 12 hours (mean 50 hours after admission; NPO group), and 15 dogs received early EN by nasoesophageal tube from 12 hours after admission (EEN group). All other treatments were identical. Intestinal permeability was assessed by 6-hour urinary lactulose (L) and rhamnose (R) recoveries (%L, %R) and L/R recovery ratios. Intestinal protein loss was quantified by fecal alpha1-proteinase inhibitor concentrations (alpha1-PI). Median time to normalization of demeanor, appetite, vomiting, and diarrhea was 1 day shorter for the EEN group for each variable. Body weight increased insignificantly from admission in the NPO group (day 3: 2.5 +/- 2.8%; day 6: 4.3 +/- 2.3%; mean +/- SE), whereas the EEN group exhibited significant weight gain (day 3: 8.1 +/- 2.7%; day 6: 9.7 +/- 2.1%). Mean urinary %L was increased, %R reduced, and L/R recovery ratios increased compared to reference values throughout the study for both groups. Percent lactulose recovery decreased in the EEN group (admission: 22.6 +/- 8.0%; day 6: 17.9 +/- 2.3%) and increased in the NPO group (admission: 11.0 +/- 2.6%; day 6: 22.5 +/- 4.6%, P = .035). Fecal alpha1-PI was above reference values in both groups and declined progressively. No significant differences occurred for %R, L/R ratios, or alpha1-PI between groups. Thirteen NPO dogs and all EEN dogs survived (P = .48). The EEN group showed earlier clinical improvement and significant weight gain. The significantly decreased %L in the EEN versus NPO group might reflect improved gut barrier function, which could limit bacterial or endotoxin translocation.

Prognostic value of systemic inflammatory response syndrome and serum concentrations of acute phase proteins, cholesterol, and total thyroxine in cats with panleukopenia

“…In our opinion, clinical evidence suggests that in cats gastrointestinal signs caused by FPV are less common and milder when present, as compared to CPV infection in dogs. In fact, parvoviral infection in dogs historically is known as canine parvoviral enteritis, whereas parvoviral disease in cats traditionally is named feline panleukopenia . Thus, because hypocholesterolemia is also a marker of severity of gastrointestinal signs, it is not surprising that dogs with hypocholesterolemia, and possibly a more severe form of the disease, also have a worse outcome …”

Serum D‐lactate concentrations in dogs with parvoviral enteritis

“…Baseline data obtained from each dog included age, sex, breed, duration of clinical signs before hospital presentation, pertinent medical history, baseline vital signs (rectal temperature, pulse rate, and respiratory rate), body weight (kg), physical examination findings, PCV, and total solids (TS). A baseline clinical severity score using a previous composite scoring system, hydration status (% dehydration), and baseline pain score also were assigned to each patient (Data S1‐S2) by the authors …”

Biology and Diseases of Dogs

“…Early nutritional support continued throughout the disease has been shown to decrease recovery times (Mohr et al, 2003). Antimicrobial therapy is recommended due to intestinal compromise and risk of sepsis.…”