Parenteral nutrition in small animals

Practical relevance: Inappetence may have many origins and, as a presenting sign or observation in the hospitalised patient, is common in feline practice. Nutritional assessment of every patient is encouraged, to identify the need for, and appropriate type of, intervention indicated. The impact of malnutrition may be significant on the feline patient, perpetuating illness, delaying recovery, slowing wound healing and negatively impacting gut health and immunity. Delayed intervention may result in the cat’s deterioration; hence prompt control of contributing factors such as the underlying illness, pain, nausea, ileus and stress is vital to optimise voluntary food intake. Management is multimodal, comprising reduction of stress, medications and assisted nutrition in the form of tube feeding or parenteral nutrition. Use of antiemetic, analgesic, prokinetic and appetite stimulant medications may restore appetite, but placement of feeding tubes should not be delayed. Feeding tubes are generally well tolerated and allow provision of food, water and medication with minimal stress, although clinicians must be aware of complications such as stoma site infections and refeeding syndrome. Clinical challenges: Cats are vulnerable to malnutrition owing to their unique metabolism and specific nutritional requirements. Moreover, their nature as a species means they are susceptible to stress in the hospital environment, which may result in reduced food intake; previous negative experiences may compound the problem. In particular, an inappropriate clinic environment and/or handling may cause or exacerbate inappetence in hospitalised patients, with negative impacts on recovery. Postponing interventions such as feeding tube placement to await improvement, owing to clinician or caregiver apprehension, may hinder recovery and worsen nutritional deficits. Evidence base: The 2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat have been created by a panel of experts brought together by the International Society of Feline Medicine (ISFM). Information is based on the available literature, expert opinion and the panel members’ experience.

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“…However, safe administration of parenteral nutrition is possible and readers are referred to other sources for further details. 18…”

Section: Nutritional Support Of the Hospitalised Cat: Feeding Tubesmentioning

confidence: 99%

2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat

Taylor¹,

Chan

Villaverde³

et al. 2022

Journal of Feline Medicine and Surgery

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“…Ensure, Abbott Australasia Pty Ltd., Macquarie Park, Australia. liquid enteral diets with no significant difference in outcome (90,92,100,101). Other diets have been described in two dogs receiving EN at 25% RER (Royal Canin Convalescence Support Instant Diet and Enteral Care KC ) (90).…”

Section: Nutritionmentioning

confidence: 99%

“…Patients who are likely to tolerate EN should be given a balanced, digestible commercially available veterinary diet ( 99 ). One study in hospitalized dogs requiring nasogastric or nasoesophageal feeding described the use of veterinary (Clinicare 2 and Clinicare RF 3 ) and human (Ensure 4 ) liquid enteral diets with no significant difference in outcome ( 90 , 92 , 100 , 101 ). Other diets have been described in two dogs receiving EN at 25% RER (Royal Canin Convalescence Support Instant Diet 5 and Enteral Care KC 6 ) ( 90 ).…”

Section: Ancillary Considerationsmentioning

confidence: 99%

Section: Ancillary Considerationsmentioning

confidence: 99%

“…Parenteral nutrition (PN) can be provided as adjunctive nutrition for patients that may not tolerate EN (such as those with severe ileus) or require supplementation to an EN feeding plan ( 100 ). Administration requires strict aseptic technique, intensive monitoring, and a specific catheter to reduce the risk of complications ( 100 , 101 ). PN has not been evaluated in mechanically ventilated veterinary patients but based on human literature, it should not be used before or in preference to EN ( 90 , 92 , 93 ).…”

Section: Ancillary Considerationsmentioning

confidence: 99%

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Mechanical ventilation in snake envenomation of dogs and cats

Morris¹,

Donaldson²

2023

Front. Vet. Sci.

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Envenomation by snakes in Elapidae and Viperidae families have been associated with respiratory failure in dogs and cats. Mechanical ventilation may be required for hypoventilation due to neuromuscular paralysis or hypoxemia due to pulmonary hemorrhage or aspiration pneumonia. Median incidence of dogs and cats with snake envenomation that require mechanical ventilation is 13% (0.06–40%). Standard treatment of snake envenomation in dogs and cats includes prompt administration of appropriate antivenom and management of envenomation complications such as coagulopathy, rhabdomyolysis and acute kidney injury. When mechanical ventilation is required, overall prognosis is good with appropriate treatment. Standard anesthetic protocols and mechanical ventilator settings are generally appropriate, with lung protective ventilation strategies typically reserved for patients with pulmonary disease. Median survival to discharge for cats and dogs with elapid envenomation is 72% (76–84%) with 33 h (19.5–58 h) median duration of mechanical ventilation and 140 h (84–196 h) median hospitalization. This article reviews indications for mechanical ventilation in cats and dogs with snake envenomation, and discusses ventilator settings, anesthetic and nursing considerations, complications and outcomes specific to this disease.

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Nutritional Support for the Critically Ill Feline Patient

Chan¹

2022

Feline Emergency and Critical Care Medicine

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Parenteral nutrition in small animals

Cited by 4 publications

References 42 publications

2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat

2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat

Mechanical ventilation in snake envenomation of dogs and cats

Nutritional Support for the Critically Ill Feline Patient

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