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Nutrition Assessment in a Puppy with Parvovirus

Martha G. Cline, DVM, DACVN, Red Bank Veterinary Hospital, Tinton Falls, New Jersey

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

Gregg K. Takashima, DVM, WSAVA Global Nutrition Committee Series Editor

July 2017|Nutrition|Peer Reviewed

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Nutrition Assessment in a Puppy with Parvovirus

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 104F (40C), 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.

Related Articles Canine Parvovirus Exposure Enteral Nutrition: Tube Feeding

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/L [109/L]; range, 5.05-16.76 103/L [109/L]) characterized by neutropenia (2.9 103/L [109/L]; range, 2.95-11.64 103/L[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 careincluding 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 ampicillinsulbactam (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 patients outcome and allow for earlier clinical recovery.1 A nasogastric feeding tube was placed, and the patients 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

Suggested Reading

  • RER = 70 (body weight kg)0.75 70 (2.4 kg)0.75 = 135 kcal/day
  • MER = RER life stage factor (see ) 135 3* = 405 kcal/day
  • *Patients life stage factor (ie, 3) was determined based on the life stage factor chart presented in Small Animal Clinical Nutrition, 5th edition (see ).
  • RER = 70 (body weight kg)0.75 70 (2.4 kg)0.75 = 135 kcal/day
  • MER = RER life stage factor (see ) 135 3* = 405 kcal/day
  • *Patients life stage factor (ie, 3) was determined based on the life stage factor chart presented in Small Animal Clinical Nutrition, 5th edition (see ).

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 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8
Voluntary intake (1.016 kcal/g) 66 g None None 30 g 62 g 100 g 132 g 200 g
Nasogastric feeding (1 kcal/mL) None 34 mL 68 mL 68 mL 68 mL 34 mL None None
Total kcal per day 67 kcal 34 kcal 68 kcal 98 kcal 131 kcal 136 kcal 136 kcal 203 kcal
% RER (135 kcal/day) achieved 50% 25% 50% 73% 97% 100% 100% 150%*
Body weight 5.3 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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Appropriately written feeding instructions for hospitalized patients should detail:

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What should an initial energy intake goal be for a hospitalized patient?

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In hospitalized parvovirus patients, early enteral nutrition is associated with:

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To avoid negative energy balance in hospitalized dogs and to attain shorter hospitalization periods, the veterinary team must ensure:

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Which nutrition orders should be reviewed by the team during hospitalization?

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

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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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