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THE CASE

A 9-week-old intact male French bulldog was presented to an emergency service for vomiting, diarrhea, and hyporexia of 24 hours’ duration. The client reported that the puppy, which had been adopted from a pet store 4 days before, had been playful and eating and drinking well before clinical signs developed. The patient received a DA2PP vaccine at 4 and 8 weeks of age. 

Physical examination revealed normal heart rate and respiratory rate values and normal pulses; the patient had a body temperature of 104°F (40°C), was approximately 7% dehydrated, and weighed 5.3 lb (2.4 kg), with a BCS of 5/9 and normal muscle condition score (3/3).  

Dietary History

The client reported that the patient, since weaning, had been consuming ad libitum a commercial dog food formulated to meet the nutrition requirements established by the Association of American Feed Control Officials (AAFCO) Dog Food Nutrient Profiles for all life stages. However, 24 hours before presentation, the puppy would not approach his bowl when offered food and would not drink water. Later, after consuming a small portion of food, he vomited and then developed diarrhea. No treats or table food were offered before presentation; all toys were accounted for, and nothing else was believed to have been ingested.

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Diagnostic Results

In-house canine parvovirus ELISA test (IDEXX SNAP Parvo Test) results were positive, and the patient was admitted to the hospital. CBC and serum chemistry profile results revealed leukopenia (3.83 × 103/µL [109/L]; range, 5.05-16.76 × 103/µL [109/L]) characterized by neutropenia (2.9 × 103/µL [109/L]; range, 2.95-11.64 × 103/µL [109/L]) with suspected band neutrophils, and hypoglycemia (70 mg/dL [3.88 mmol/L]; range, 75-116 mg/dL [3.88 mmol/L]). Electrolyte abnormalities, including hyponatremia (138 mEq/L [mmol/L]; range, 142-149.3 mEq/L [mmol/L]), hypochloremia (109.5 mEq/L [mmol/L]; range, 112.7-118.3 mEq/L [mmol/L]), and hypokalemia (3.6 mEq/L [mmol/L] range, 3.62-4.60 mEq/L [mmol/L]), were also present. Fecal flotation results were negative.

DIAGNOSIS:

Presumptive parvovirus infection/parvoviral enteritis 

Treatment & Outcome

Supportive care—including IV fluid support with 2.5% dextrose (16 mL/hr IV), potassium chloride (20 mEq/L), and metoclopramide (0.02 mg/kg/hr IV CRI)—was instituted. Broad-spectrum antibiotics, including ampicillin–sulbactam (20 mg/kg IV q8h) and enrofloxacin (12 mg/kg IV q24h), were administered. Enrofloxacin (extra-label due to patient age) was instituted for broad-spectrum coverage because of presumed sepsis. Additional medications, including maropitant (1 mg/kg IV q24h, extra-label) and dolasetron (0.6 mg/kg IV q24h, extra-label), were added for further control of vomiting.

On patient admission, the emergency veterinarian recommended nutritional support if the patient was unwilling to eat rather than withholding food until vomiting ceased, as providing early enteral nutrition can potentially improve a patient’s outcome and allow for earlier clinical recovery.1 A nasogastric feeding tube was placed, and the patient’s resting energy requirement (RER) and maintenance energy requirement (MER) were calculated (see How to Calculate RER & MER in Growing Dogs). A highly digestible GI therapeutic diet nutritionally adequate for growth based on AAFCO feeding trials was recommended to be offered q6h at 100% RER per day. 

How to Calculate RER & MER in Growing Dogs7

  • RER = 70 × (body weight kg)0.75
    70 × (2.4 kg)0.75 = 135 kcal/day
  • MER = RER × life stage factor (see Suggested Reading)
    135 × 3* = 405 kcal/day

*Patient’s life stage factor (ie, 3) was determined based on the life stage factor chart presented in Small Animal Clinical Nutrition, 5th edition (see Suggested Reading).

The patient consumed 100% of the food offered orally during the first 12 hours of hospitalization (Table). The following meal was given 6 hours later, after which the patient again became unwilling to eat and vomiting worsened. A liquid enteral diet formulated to meet the nutritional requirements by AAFCO for adult canine maintenance was initiated at 25% RER per day bolus q6h via nasogastric tube. A liquid enteral diet was preferred for ease of administration through the nasogastric tube. Although this liquid enteral diet was not approved for growth, the crude protein content (82 g/1000 kcal) exceeded the AAFCO minimum requirement for growth in puppies2 (56.3 g/1000 kcal) and was therefore deemed superior to alternative nonveterinary options available in the hospital at the time. 

Table
Nutrient Intake During Hospitalization
 Day 1 (12 hours)Day 2Day 3Day 4Day 5Day 6Day 7Day 8
Voluntary intake (1.016 kcal/g)66 gNoneNone30 g62 g100 g132 g200 g
Nasogastric feeding (1 kcal/mL)None34 mL68 mL68 mL68 mL34 mLNoneNone
Total kcal per day67 kcal34 kcal68 kcal98 kcal131 kcal136 kcal136 kcal203 kcal
% RER (135 kcal/day) achieved50%25%50%73%97%100%100%150%*
Body weight5.3 lb (2.4 kg)5.3 lb (2.4 kg)4.7 lb (2.1 kg)5.1 lb (2.3 kg)5.3 lb (2.4 kg)5.1 lb (2.3 kg)5.6 lb (2.5 kg)5.3 lb (2.4 kg)

*Patient was discharged after 15 hours of hospitalization; feeding amounts calculated to meet MER

Vomiting improved in 24 hours, and feeding was increased to 50% RER per day. Sixty hours after admission, the patient began to eat on his own, and vomiting resolved. Assisted feedings were adjusted until the patient was voluntarily eating 100% RER. Body weight decreased to 4.7 lb (2.1 kg) 48 hours after hospitalization, likely due to fluid losses; however, body weight improved to original admission weight of 5.3 lb (2.4 kg) on day 5 after RER was achieved, as hydration status was maintained (Table). 

The patient was discharged on day 8 of hospitalization, which was day 5 of eating the GI therapeutic diet fed to meet MER (see How to Calculate RER & MER in Growing Dogs). On the day of discharge, the patient had no vomiting or diarrhea, was normothermic, maintained hydration status, and demonstrated resolution in clinicopathologic abnormalities. The patient was doing well at home at a 5-day recheck. He continued to eat the GI therapeutic diet for 2 weeks postdischarge before transitioning to an over-the-counter commercial puppy food.  

Conclusion

A proactive, team-based nutrition approach and client communication at the time of admission ensured the puppy was provided the proper nutritional support. Identifying patients at risk for malnutrition during initial assessment is essential when developing a nutrition plan (see Nutritional Support Resources).

Nutritional Support Resources

Resources to help identify and manage hospitalized patients in need of nutritional support are available on the WSAVA Nutrition Toolkit website*: 

*Global Nutrition Committee Toolkit provided courtesy of the WSAVA

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AAFCO = Association of American Feed Control Officials, MER = maintenance energy requirement, RER = resting energy requirement

Diet in Disease is a series developed by the WSAVA, the Academy of Veterinary Nutrition Technicians, and Clinician’s Brief.

References and author information Show
References
  1. Mohr AJ, Leisewitz AL, Jacobson LS, Steiner JM, Ruaux CG, Williams DA. Effect of early enteral nutrition on intestinal permeability, intestinal protein loss, and outcome in dogs with severe parvoviral enteritis. J Vet Intern Med. 2003;17(6):791-798.
  2. Association of American Feed Control Officials. Nutrient profiles. In: Association of American Feed Control Officials, ed. AAFCO 2016 Official Publication. 2016:150-176. 
  3. Freeman LM. New tools for the nutritional assessment and management of critical care patients. J Vet Emerg Crit Care (San Antonio). 2015;25(1):4-5.
  4. German AJ, Holden SL, Mason SL, et al. Imprecision when using measuring cups to weigh out extruded dry kibbled food. J Anim Physiol Anim Nutr (Berl). 2011;95(3):368-373.
  5. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211.
  6. Remillard RL, Darden DE, Michel KE, Marks SL, Buffington CA, Bunnell PR. An investigation of the relationship between caloric intake and outcome in hospitalized dogs. Vet Ther. 2001;2(4):301-310.
  7. Debraekeleer J, Gross KL, Zicker SC. Feeding growing puppies: postweaning to adulthood. In: Hand MS, Thatcher CD, Remillard RL, Roudebush P, Novotny BJ, eds. Small Animal Clinical Nutrition. 5th ed. Topeka, KS: Mark Morris Institute; 2010:311-319.

 

Suggested Reading

Debraekeleer J, Gross KL, Zicker S. Feeding growing puppies: postweaning to adulthood. In: Hand MS, Thatcher CD, Remillard RL, Roudebush P, Novotny B, eds. Small Animal Clinical Nutrition. 5th ed. Topeka KS: Mark Morris Institute; 2010:311-319.

Authors

Martha G. Cline

DVM, DACVN Red Bank Veterinary Hospital, Tinton Falls, New Jersey

Martha G. Cline, DVM, DACVN, is a clinical nutrition veterinarian at Red Bank Veterinary Hospital in Tinton Falls, New Jersey, and the vice president of the American Academy of Veterinary Nutrition. She earned her DVM from University of Tennessee, where she also completed a clinical nutrition residency, and her bachelor’s degree from Lipscomb University. Dr. Cline completed a small animal medicine and surgery internship at Oradell Animal Hospital in Paramus, New Jersey. Her interests are in obesity management, critical care nutrition, renal disease, urolithiasis, and alternative feeding practices. 

Kara M. Burns

MS, MEd, LVT, VTS (Nutrition), VTS-H (Internal Medicine, Dentistry) Academy of Veterinary Nutrition Technicians

Kara M. Burns, MS, MEd, LVT, VTS (Nutrition), VTS-H (Internal Medicine, Dentistry), is director of nursing for Brief Media, editor of Veterinary Team Brief, and founder and president of the Academy of Veterinary Nutrition Technicians. She teaches nutrition courses across the country and is a member of many national, international, and state associations. Ms. Burns has authored many articles, textbooks, and chapters on nutrition, leadership, and veterinary nursing.

Gregg K. Takashima

DVM WSAVA Global Nutrition Committee Series Editor

Material from Clinician’s Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.

This article is published as part of the Global Edition of Clinician's Brief. Through partnership with the World Small Animal Veterinary Association, the Global Edition provides educational resources to practitioners around the world.

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