Efeitos da nutrição parenteral ou enteral, associadas ou não à glutamina, sobre a motilidade gastrintestinal em equinos submetidos à inanição e realimentação / Effects of parenteral or enteral nutrition, associated or not with glutamine, on gastrointestinal motility in horses submmited to starvation and refeeding

Este estudo teve por objetivo avaliar os efeitos da nutrição parenteral total ou enteral, associadas ou não à glutamina, sobre a motilidade gastrintestinal em equinos submetidos à inanição e realimentação. Foram utilizados 16 equinos adultos hígidos, sem raça definida, de ambos os sexos, quatro machos e 12 fêmeas, com idade variando entre quatro e 14 anos e peso corporal médio de 248,40 + 2,28 kg, divididos em quatro grupos, quatro animais por grupo: Grupo I (ENTGL): fluidoterapia enteral com eletrólitos associada a glutamina; Grupo II (PARGL): Nutrição parenteral total (NPT) associada a glutamina; Grupo III (ENTFL): fluidoterapia enteral com eletrólitos; Grupo IV (PARFL): fluidoterapia parenteral. O delineamento experimental foi inteiramente ao acaso, em um esquema fatorial 4x12 (grupos x tempo de colheita), para cada fase, e suas médias comparadas pelo teste de Duncan ao nível de 5% de significância. Independente do grupo experimental ocorreu redução da motilidade gastrintestinal durante a fase de inanição, mais pronunciada nos grupos PARGL e PARFL. Uma vez restabelecida a alimentação a motilidade gastrintestinal retornou à normalidade.

This study aimed to evaluate the effects of enteral or total parenteral nutrition, associated or not with glutamine, on gastrointestinal motility in horses subjected to starvation and refeeding. 16 healthy, mixed-breed adult horses of both sexes, four geldings and 12 mares, with ages ranging from four to 14 years and an average body weight of 248.40 + 2.28 kg, were divided into four groups, four animals per group: Group I (ENTGL): enteral fluid therapy with electrolytes associated with glutamine; Group II (PARGL): total parenteral nutrition (TPN) associated with glutamine; Group III (ENTFL): enteral fluid therapy with electrolytes; Group IV (PARFL): parenteral fluid therapy. The experimental design was entirely randomized, in a 4x12 factorial scheme (groups x harvest time), for each phase, and their means compared by the Duncan test at the level of 5% significance. Regardless of the experimental group, there was a reduction in gastrointestinal motility during the starvation phase, which was more pronounced in the PARGL and PARFL groups. Once the food was restored, gastrointestinal motility returned to normal.

A porcine animal model to mimic the restart of enteral nutrition (refeeding-model).

With the aim towards establishing an animal model of total parenteral nutrition (TPN), 12 piglets aged 9 weeks (mean body weight 21 kg) were surgically provided with central venous catheters. Six piglets were nourished parenterally with the objective to reach a 14-d period of TPN; the other six piglets served as control and were fed normally. Only one animal from each group could be monitored over the whole period. Nine piglets were euthanised on d 13 and one on d 12. No animal showed fever or signs of septicaemia during the study. The levels of Ca, Mg, Na and P in the blood were within the normal range as were those for blood glucose and plasma creatinine. Symptoms of the TPN included: transient diarrhoea, occasional appearance of faecal blood and occasional absence of defecation. A reduced small intestine length and altered mucosal morphology and function were observed. One animal showed bile stasis at the end of the study. All TPN animals showed a remarkably high level of blood urea early in the morning. The intestinal symptoms observed may resemble the human situation during TPN. However, due to the fast growth rate, pigs aged 9 weeks have higher nutrient requirements per kg body weight. Consequently, the osmolality of the nutrient solution was necessarily high. Whether the significantly higher blood urea observed in the TPN group reflected a catabolic metabolism during the starving period at night-time could not be conclusively shown. Alternatively, it could reflect a slower growth rate and a resulting quantitative excess of amino acids (AA), or could have been the consequence of a suboptimal AA composition. A permanent infusion would be favourable in order not to overcharge the capacity for glucose uptake and amino acid metabolism during the infusion.

Retrospective evaluation of parenteral nutrition in alpacas: 22 cases (2002-2008).

BACKGROUND: Parenteral nutrition is an important method of nutritional support in hospitalized animals, but minimal information has been published on its use in camelids. HYPOTHESIS/OBJECTIVES: The purpose of this study was to characterize the use of total parenteral nutrition (TPN) in alpacas, evaluate the formulations used, and determine potential complications. ANIMALS: Twenty-two alpacas hospitalized at the Tufts Cummings School for Veterinary Medicine (site 1: n = 8) and the Ohio State University Veterinary Teaching Hospital (site 2: n = 14). METHODS: A retrospective analysis of all alpacas that received TPN between 2002 and 2008 was performed to assess clinical indications, clinical and clinicopathologic data, and outcome. RESULTS: The most common underlying diseases in animals receiving TPN were gastrointestinal dysfunction (n = 16), hepatic disease (n = 2), and neoplasia (n = 2). Several metabolic abnormalities were identified in animals (n = 20/22) before TPN was initiated, including lipemia (n = 12/22), hyperglycemia (11/22), and hypokalemia (n = 11/22). Median age was significantly lower for site 1 cases (0.1 years; range, 0.01-11.0) compared with those from site 2 (4.9 years; range, 0.1-13.7; P = .03). Animals at site 2 also had a longer duration of hospitalization (P = .01) and TPN administration (P = .004), as well as higher survival rate (P < .02). Twenty-one of 22 alpacas developed at least 1 complication during TPN administration. Metabolic complications were most prevalent (n = 21/22) and included hyperglycemia (n = 8/21), lipemia (n = 7/21), hypokalemia (n = 3/21), and refeeding syndrome (n = 3/21). CONCLUSIONS AND CLINICAL IMPORTANCE: TPN is a feasible method of nutritional support for alpacas when enteral feeding is not possible. Prospective studies are warranted to determine optimal TPN formulations for alpacas.

Evaluation of complications and prognostic factors associated with administration of total parenteral nutrition in cats: 75 cases (1994-2001).

OBJECTIVE: To determine frequency and types of complications, prognostic factors, and primary diseases affecting clinical outcome associated with administration of total parenteral nutrition (TPN) in cats. DESIGN: Retrospective study. ANIMALS: 75 cats that received TPN for > or = 12 hours. PROCEDURE: Medical records were reviewed, and information was obtained on signalment, history, problems at initial evaluation, physical examination findings, weight and changes in weight while receiving TPN, duration in the hospital before initiation of TPN, the type of TPN catheter used, duration of TPN administration, and final diagnosis. Laboratory results obtained immediately prior to TPN and at 24 and 96 hours following initiation of TPN administration were compared. RESULTS: Reports of weight loss at initial evaluation, hyperglycemia at 24 hours, or diagnosis of chronic renal failure were significantly associated with increased mortality rate. Greater serum albumin concentrations prior to and at 96 hours following TPN administration were significantly associated with decreased mortality rate. Mechanical and septic complications were infrequent and not associated with increased mortality rate. Most cats had multiple diseases. The overall mortality rate was 52%; among 75 cats, 36 recovered, 23 were euthanatized, and 16 died as a result of their primary illness or complications associated with their illness. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated high mortality rate in cats maintained onTPN that had multiple concurrent diseases associated with a poor prognosis. Indicators of poor prognosis included a history of weight loss, hyperglycemia at 24 hours following TPN administration, hypoalbuminemia, and chronic renal failure.

Use of buccal mucosal flaps for the correction of congenital soft palate defects in three dogs.

OBJECTIVE: To present an alternative surgical technique for the repair of soft palate defects in dogs. ANIMAL POPULATION: Three Foxhound cross dogs. METHODS: Bilateral buccal mucosal flaps, based at the palatoglossal arches, were raised. One flap was rotated so that the mucosal side created the floor of the nasopharynx. The second flap was rotated so that the mucosal side formed the roof of the oropharynx. The mucosa of the remnant of the soft palate and the pharyngeal walls was incised and the flaps sutured to these free mucosal edges. The caudal ends of the two flaps were sutured to each other. RESULTS: Complete closure of the soft palate defect was obtained in all three dogs. The dogs were monitored for between 1.5 and 3 years postoperatively, and no long-term problems were encountered. CONCLUSIONS: This surgical technique resulted in an excellent functional separation of the oropharynx and nasopharynx and allowed reconstruction of a large bilateral soft palate defect. CLINICAL RELEVANCE: By using the buccal mucosal flaps, as described in this report, a tension-free closure of large soft palate defects can be obtained, thereby eliminating a major cause of failure of this type of reconstructive surgery.

Fluid therapy in the hypoproteinemic patient.

Hypoproteinemia can result in many adverse consequences, including hypovolemia and the formation of edema. An understanding of the normal forces governing plasma will help the clinician tailor appropriate fluid therapy in these patients. Various fluids that can be used including crystalloids, colloids, and blood products will be discussed.

Effects of various feeding regimens on the energy balance of equine neonates.

OBJECTIVE: To determine the effect of diet on energy intake, loss, and metabolism in foals 2 to 7 days old. ANIMALS: 14 pony foals. PROCEDURE: Group-A foals suckled their dams, group-B foals were fed milk replacer, and group-C foals were fed by total parenteral nutrition (TPN). Energy balance studies were performed over 8-hour periods on postpartum days 2, 4, and 7. RESULTS: Mean gross energy (GE) intake of group-A foals increased between days 2 and 7. Approximately 3% of GE was excreted in urine and feces, and energy expenditure remained constant. These foals were in positive energy balance, and mean body weight increased. From day 4 onward, group-B foals consumed more energy than did group-A foals because the milk replacer had a higher energy content than did mares' milk. Mean energy loss in group-B foals was 14% of GE on day 2, but this value decreased subsequently. Energy expenditure in group-B foals was less than that in group-A foals, and energy balance was positive. Group-C foals had the lowest energy intake and expenditure; energy balance was negative on postpartum day 2. These foals also had gastrointestinal tract problems. CONCLUSIONS: Mares' milk is highly digestible and is correlated with positive energy balance in neonatal foals. Milk replacer initially is less digestible than mares' milk. In this study, TPN was associated with negative energy balance. CLINICAL RELEVANCE: The data indicate the advantages of enteral feeding with mares' milk and highlight the clinical and technical difficulties associated with TPN.

Zinc toxicity with pancreatic acinar necrosis in piglets receiving total parenteral nutrition.

Two Hampshire-Duroc cross piglets maintained on 100% total parenteral nutrition (TPN) for 3 weeks developed pancreatic epithelial cell necrosis, diffuse acinar atrophy, and marked interstitial fibrosis. In addition, the piglets had severe villus atrophy in the small intestine as a result of TPN. Atomic absorption spectrophotometric analysis of liver samples revealed toxic hepatic zinc levels (513.5 and 491.2 ppm) in the TPN piglets (40-90 ppm in control piglets). Administering TPN bypasses homeostatic control mechanisms regulating zinc absorption at the gastrointestinal level and may reduce pancreatic secretion contributing to the accumulation of zinc in tissues. Intestinal villus atrophy, a sequela to TPN, may have also affected zinc excretion by impairing intestinal flux and desquamation. These factors should be considered in formulating TPN solutions and zinc levels administered must be reduced accordingly to avoid toxicity. Furthermore, sources and tissue levels of zinc should be investigated when necrosis, acinar atrophy, and fibrosis of the pancreas are encountered in young pigs.