Tyson, a 6-month-old castrated male Labrador retriever, was presented for lethargy, anorexia, vomiting, and diarrhea of 3 days’ duration. Frank blood was occasionally noted in both the vomitus and feces.
History
The owner reported no prior illness. Vaccination status was current and Tyson received a monthly heartworm preventive. He and his owner frequently visited a dog park.
Physical Examination
Tyson weighted 18 kg and had a body condition score of 4/9. His temperature was 102.9° F; pulse rate, 150 beats/min; respiration, 24 breaths/min; and capillary refill time, 2 seconds. His mucous membranes were pink. Examination abnormalities included depressed mentation; hypersalivation upon abdominal palpation; and watery, brown feces on rectal examination.
Laboratory Results
Complete blood count revealed mild neutropenia and serum biochemical profile revealed mild hypoalbuminemia and hyperphosphatemia. A parvovirus test (SNAP Parvo Test, idexx.com) was positive. Fecal examination did not reveal any parasite ova.
Related Article: Nutritional Support for Critically Ill Dogs & Cats
Initial Therapy
Tyson was admitted to the hospital. Initial treatment included Plasma-Lyte 148 (baxter.com), metoclopramide, maropitant, famotidine, sucralfate, metronidazole, and ampicillin/sulbactam. No food or water was offered.
Ask Yourself...
What nutritional plan is most appropriate for Tyson?
A. Stop all enteral feeding and initiate total parenteral nutrition
B. Allow Tyson to have free-choice food and water
C. Administer an appetite stimulant and continue NG tube feedings
D. Continue trickle feeding via NG tube and initiate partial parenteral nutrition
After admission, Tyson did not vomit for 12 hours. A nasogastric (NG) feeding tube was placed and continuous feeding was initiated with a veterinary enteral liquid diet at 1/3 resting energy requirement (RER). On day 2 of NG feeding, the amount was increased to 2/3 RER but Tyson began to vomit. Nasogastric feeding was discontinued for 12 hours, then resumed. Attempts to administer 2/3 RER without causing vomiting were unsuccessful, although Tyson continued to tolerate 1/3 RER.
Correct Answer:
D. Continue trickle feeding via NG tube and initiate partial parenteral nutrition
Critically ill patients are at risk for malnutrition. Caloric intake may be inadequate due to factors, such as anorexia, inability to eat, and vomiting. While healthy animals with inadequate caloric intake metabolize fat, sick animals experience a shift to a catabolic state that causes lean muscle loss. Malnourished patients have altered immune function, poor wound healing, altered energy metabolism, and increased morbidity and mortality.1
Nasogastric vs Nasoesophageal Tubes
An NG tube allows quantification of residual gastric volume, a potential concern in feeding a patient with altered GI motility, while a nasoesophageal tube does not. However, potential disadvantages of using NG tubes include esophagitis or esophageal stricture.
Related Article: Nasoesophageal & Nasogastric Tube Placement
Nutrition Assessment
Patients that have lost 10% of their body weight or have not consumed their RER for 3 to 5 days are likely to become malnourished.2 Other contributing factors include serious underlying disease (eg, sepsis, pancreatitis) or significant protein loss (eg, thermal burns, proteinuria, vomiting, diarrhea, wounds).
Physical examination findings are nonspecific and not seen in early stages of malnutrition. Findings include poor body condition, loss of muscle mass, poor hair coat, and delayed wound healing. Laboratory findings are poor indicators of nutritional status.
Feeding Options
Enteral Nutrition
- Enteral nutrition (EN) prevents villous atrophy, preserves mucosal integrity, decreases risk for GI bacterial translocation, and preserves GI immune function.3
- Contraindications include severe vomiting, GI obstruction, severe malabsorption or maldigestion, and an unprotected airway.
Related Article: Parenteral Nutrition
Parenteral Nutrition