Parenteral Nutrition

2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat

“…Parenteral nutrition (infusing nutrients intravenously) can be used as an alternative in patients unable to tolerate enteral feeding; for example, those with intractable vomiting and diarrhoea, lack of gag reflex, presenting a high anaesthetic risk or recovering from severe gastric or intestinal disease and coagulopathy. Parenteral nutrition may be associated with a higher rate of complications than tube feeding, 74 is more expensive and limited in availability. For these reasons – as well as on a physiological level (see page 633) – enteral feeding remains preferable in the majority of cases.…”

Comparison of complication rates in dogs with nasoesophageal versus nasogastric feeding tubes

“…While there was no difference between the NE and NG groups in any of these factors, nor was an association found with outcome, larger randomized, prospective studies may reveal an association between energy intake and outcome. For example, overfeeding is now discouraged in both human and veterinary medicine and many veterinary nutritionists now recommend an initial daily calorie goal of RER . In the current study, 45 of the 46 dogs were fed at or below RER based on calories from tube feedings alone.…”

Nutritional management of acute pancreatitis in dogs and cats

“…In veterinary medicine, the premise that the gut plays an important role during critical illness and that EN is preferable to PN whenever possible is well established . Although studies prospectively evaluating tolerance of enteral feeding in dogs and cats with AP are limited, there is growing evidence supporting the benefits of EN in dogs and cats with AP.…”

“…It is also possible that hyperglycemia may serve as a surrogate marker of disease severity and that the relationship to outcome may be independent of PN administration. Nevertheless, as there are no known advantages for hyperglycemia, it may be prudent to devise protocols to address the development of hyperglycemia including reduction of the PN administration rate, reduction of the dextrose content in PN solution and administration of insulin to reduce blood glucose . Intensive insulin therapy in hyperglycemic human patients receiving PN has been associated with a reduction in morbidity, however, this approach has not been applied to veterinary patients.…”

“…The resting energy requirement (RER), also referred to as resting energy expenditure, “represents the energy requirement of a normal but fed animal at rest in a thermoneutral environment.” Although the precise amount of energy expenditure of animals with various diseases is unknown, the current convention is to use RER, as calculated by the Kleiber equation (RER = [body weight in kg] 0.75 × 70] as the initial starting point for initiating nutritional support in hospitalized animals . If patients have been anorexic for more than 3–5 days, it is recommended to feed only one third of the RER on day 1, and then gradually increase calories if tolerated, and reach full RER usually by day 3 .…”