Refeeding syndrome in a miniature donkey.

OBJECTIVE: To describe refeeding syndrome in an equid without a history of recognized risk factors. CASE SUMMARY: Refeeding syndrome with marked hypophosphatemia developed in an aged miniature donkey gelding during treatment of suspected enterocolitis. Hypophosphatemia (manifested clinically as ileus and neuromuscular weakness) developed despite a short (3 day) history of hyporexia, increased body condition (7/9), and adherence to nutritional recommendations for critically ill equids. Nutritional support included nasogastric enteral feeding with a commercial equine nutrition product claiming to provide 100% of the National Research Council's daily recommended protein, vitamin, and mineral requirements for equids. Hypophosphatemia developed despite this enteral supplementation and was ultimately corrected by intravenous administration of sodium phosphate solution. NEW OR UNIQUE INFORMATION PROVIDED: This case report suggests that risk factors for refeeding syndrome in equids may be broader than previously recognized. Specifically, critically ill equids at risk for insulin dysregulation may have unique nutritional co-morbidities and requirements. This report highlights the need for both broader recognition of risk factors for refeeding syndrome, and revised best-practice nutritional guidelines and supplementation products to improve equine critical care.

Early Enteral Administration of a Complex Lipid Emulsion Supplement Prevents Postnatal Deficits in Docosahexaenoic and Arachidonic Acids and Increases Tissue Accretion of Lipophilic Nutrients in Preterm Piglets.

BACKGROUND: Preterm delivery and current nutrition strategies result in deficiencies of critical long-chain fatty acids (FAs) and lipophilic nutrients, increasing the risk of preterm morbidities. We sought to determine the efficacy of preventing postnatal deficits in FAs and lipophilic nutrients using an enteral concentrated lipid supplement in preterm piglets. METHODS: Preterm piglets were fed a baseline diet devoid of arachidonic acid (AA) and docosahexaenoic acid (DHA) and randomized to enteral supplementation as follows: (1) Intralipid (IL), (2) complex lipid supplement 1 (CLS1) with an AA:DHA ratio of 0.25, or (3) CLS2 with an AA:DHA ratio of 1.2. On day 8, plasma and tissue levels of FAs and lipophilic nutrients were measured and ileum histology performed. RESULTS: Plasma DHA levels decreased in the IL group by day 2. In contrast, DHA increased by day 2 compared with birth levels in both CLS1 and CLS2 groups. The IL and CLS1 groups demonstrated a continued decline in AA levels during the 8-day protocol, whereas AA levels in the CLS2 group on day 8 were comparable to birth levels. Preserving AA levels in the CLS2 group was associated with greater ileal villus height and muscular layer thickness. Lipophilic nutrients were effectively absorbed in plasma and tissues. CONCLUSIONS: Enteral administration of CLS1 and CLS2 demonstrated similar increases in DHA levels compared with birth levels. Only CLS2 maintained AA birth levels. Providing a concentrated complex lipid emulsion with an AA:DHA ratio > 1 is important in preventing postnatal AA deficits.

Temporary Rumenostomy for the Treatment of Forestomach Diseases and Enteral Nutrition.

Temporary rumenostomy is a useful procedure for the treatment, management, and support of patients with forestomach disease of various types. The rumenostomy provides a mechanism for relief of chronic rumen tympany or distention, removal of rumen contents and lavage of the rumen, removal of some rumen foreign bodies, administration of rumen fluid transfaunation, and administration of enteral nutrition or other medications. When the rumenostomy is no longer necessary, it can be allowed to close by second intention or by surgical resection.

Lying behaviour and IgG-levels of newborn calves after feeding colostrum via tube and nipple bottle feeding.

Oesophageal tube feeding colostrum is used to ensure sufficient colostrum intake in newborn calves but the impact of tube feeding on animal behaviour is unclear. Therefore the objective of this study was to compare lying behaviour of tube-fed or bottle-fed dairy calves. Calves (n = 37) in 3 groups were offered 3·5 l colostrum 2 h after birth. Calves of the bottle group were fed with a nipple bottle. Calves of the placebo tubing group were tubed for 4 min but no colostrum was given and they were then fed with a nipple bottle. Calves of the tubing group received 3·5 l colostrum via tube feeding. Consumed amount of bottle and placebo tubing calves was recorded. If they refused some of the offered 3·5 l the rest was offered in a second feeding 2 h later. Lying behaviour was measured by data loggers fitted to right hind leg for 3 d. Blood samples were taken 24 h after birth for determination of IgG concentration. The voluntary colostrum intake differed significantly between bottle-fed and placebo tubed calves at first feeding. Considering both colostrum feedings, bottle-fed calves consumed 3·44 ± 0·14 l and placebo tubed calves consumed 3·20 ± 0·38 l colostrum. ImmunoglobulinG intake (255·6 ± 77·5 g IgG), serum IgG concentration 24 h after birth (22·8 ± 6·7 g/l) and total serum protein concentration (6·1 ± 0·6 g/dl) did not differ between groups. None of the calves had a failure of passive transfer. There was no effect of tubing on lying behaviour.

Peri-Surgical Nutrition: Perspectives and Perceptions.

Peri-surgical nutrition of veterinary patients is in its infancy, with considerable research to be performed to help improve quality of life in our small animal patients. Clues from human immunonutrition may be starting places for investigation. Considerations for future investigations should include essential nutrients, the underlying disease process, therapeutic goals, and species (dog or cat). There are guidelines for caloric requirements. Planning for nutritional support before surgery takes place is likely to be beneficial to patient outcomes. Taking into account case history, method of feeding, metabolic abnormalities, and possible immunonutrition should be part of a complete surgical nutritional plan.

Enteral administration of monosodium phosphate, monopotassium phosphate and monocalcium phosphate for the treatment of hypophosphataemia in lactating dairy cattle.

Hypohosphataemia is a frequent finding in early lactating and anorectic dairy cows. Sodium phosphate is commonly used for oral phosphorus (P) supplementation, although other phosphate salts may present useful treatment alternatives. Objectives of this study were to compare the efficacy of monopotassium phosphate (KH2PO4) and monocalcium phosphate (Ca(H2PO4)2) to monosodium phosphate (NaH2PO4) in P-depleted cows. Furthermore, the effect of concentrated NaH2PO4 on the reticular groove reflex was studied. Six healthy but P-depleted dairy cows underwent four treatments in randomised order. Treatments consisted of intraruminal administration of NaH2PO4, KH2PO4 and Ca(H2PO4)2 providing the equivalent of 60 g P. A fourth treatment consisting of concentrated NaH2PO4 combined with acetaminophen as a marker substance was administered orally to determine whether the reticular groove reflex could be induced. Intraruminal administration of NaH2PO4 and KH2PO4 resulted in similar increases in plasma Pi concentrations ([Pi]) while intraruminal Ca(H2PO4)2 resulted in lower increases in plasma [Pi]. Oral and intraruminal administration of NaH2PO4 resulted in similar times to peak plasma [Pi] and acetaminophen concentration, indicating that concentrated NaH2PO4 administered orally did not trigger the reticular groove reflex. These results suggest that oral administration of KH2PO4 is equally effective as NaH2PO4. Oral administration of Ca(H2PO4)2 in contrast has a less pronounced effect on the plasma [Pi].

Dietary fat modulates dl-α-tocopheryl acetate (vitamin E) bioavailability in adult cockerels.

1. A trial was designed to assess the effect of fat supplementation (amount and type of fatty acids) on vitamin E bioavailability in adult cockerels. 2. A total of 60 birds were force-fed three different diets: a semi-purified diet without added fat (Control diet) or supplemented with 3% fat as linseed (Linseed diet) or hydrogenated coconut oil (Coconut diet). The three experimental diets were also supplemented with dl-α-tocopheryl acetate to provide 40 mg vitamin E per bird. 3. After one week of depletion, blood was collected from the wing vein before (baseline) and 6, 12, 24 and 96 h after the gavage. Plasma samples were analysed for their α-tocopherol, cholesterol and triglycerides concentrations. 4. Results showed that the addition of 3% fat in the experimental diet increased post-gavage plasma α-tocopherol response by 153% for Linseed diet and by 75% for Coconut diet (P < 0.0001) compared to the Control group. Furthermore, the plasma α-tocopherol response observed with the Linseed diet was 44% greater than that observed with the Coconut diet (P < 0.0001). There was no effect of treatments on either plasma triglycerides (P = 0.91) or cholesterol (P = 0.45) responses. 5. In conclusion, this study shows that the addition of 3% fat to the diet significantly increases dl-α-tocopheryl acetate bioavailability in adult cockerels. Supplementation of fat rich in unsaturated fatty acids also leads to a higher dl-α-tocopheryl acetate bioavailability than fat rich in saturated fatty acids.

Proteolytic activity alterations resulting from force-feeding in Muscovy and Pekin ducks.

We investigated liver protease activity in force-fed and non-force-fed ducks using zymography gels to better understand mechanisms underlying liver steatosis in palmipeds. Male Muscovy and Pekin ducks were slaughtered before and after a short period (13 d) while they were conventionally fed or force fed. The force-fed regimen contained a high level of carbohydrates and was delivered in large doses. Main hepatic proteases (matrix metalloprotease-2, calpains, and cathepsins) were extracted from raw liver and specifically activated within electrophoretic gels. Both force-fed Muscovy and Pekin ducks presented higher liver weights and BW associated with lower matrix metalloprotease-2 and m-calpain hepatic activities. On the other hand, hepatic cathepsin activity was not affected by force feeding. It was concluded that Muscovy and Pekin duck hepatic proteases are affected similarly by the force feeding. Thus, this cannot explain differences observed between Muscovy and Pekin ducks regarding their ability to develop hepatic steatosis generally reported in literature.

Effect of 3',5'-cyclic diguanylic acid in a broiler Clostridium perfringens infection model.

In an effort to explore strategies to control Clostridium perfringens, we investigated the synergistic effect of a ubiquitous bacterial second messenger 3',5'-cyclic diguanylic acid (c-di-GMP) with penicillin G in a broiler challenge model. All chicks were inoculated in the crop by gavage on d 14, 15, and 16 with a mixture of 4 C. perfringens strains. Birds were treated with saline (control group) or 20 nmol of c-di-GMP by gavage or intramuscularly (IM) on d 24, all in conjunction with penicillin G in water for 5 d. Weekly samplings of ceca and ileum were performed on d 21 to 35 for C. perfringens and Lactobacillus enumeration. On d 35 of age, the IM treatment significantly (P < 0.05) reduced C. perfringens in the ceca, suggesting possible synergistic activity between penicillin G and c-di-GMP against C. perfringens in broiler ceca. Moreover, analysis of ceca DNA for the presence of a series of C. perfringens virulence genes showed a prevalence of 30% for the Clostridium perfringens alpha-toxin gene (cpa) from d 21 to 35 in the IM-treated group, whereas the occurrence of the cpa gene increased from 10 to 60% in the other 2 groups (control and gavage) from d 21 to 35. Detection of ß-lactamase genes (blaCMY-2, blaSHV, and blaTEM) indicative of gram-negative bacteria in the same samples from d 21 to 35 did not show significant treatment effects. Amplified fragment-length polymorphism showed a predominant 92% similarity between the ceca of 21-d-old control birds and the 35-d-old IM-treated c-di-GMP group. This suggests that c-di-GMP IM treatment might be effective at restoring the normal microflora of the host on d 35 after being challenged by C. perfringens. Our results suggest that c-di-GMP can reduce the colonization of C. perfringens in the gut without increasing the selection pressure for some ß-lactamase genes or altering the commensal bacterial population.

Ingluviotomy tube placement for lead-induced crop stasis in the California condor (Gymnogyps californianus).

Six free-flying California condors (Gymnogyps californianus) were diagnosed with acute lead toxicosis that caused crop distension and stasis. Between January 2006 and January 2007, the birds were referred to the Phoenix Zoo in Arizona for emergency treatment. In 5 birds, an ingluviotomy was performed to place a feeding tube from the crop to the proventriculus, which allowed a temporary bypass of the dysfunctional esophagus until normal function and motility were regained. A crop-support pressure bandage was placed in 4 birds to improve crop emptying into the proventriculus and to prevent crop distension. Although chelation therapy is the gold standard treatment for lead toxicosis, severe cases of lead-induced crop stasis are not acutely reversible with pharmaceuticals. In these condors, placement of a feeding tube was deemed prudent to ensure a viable enteric route of nutritional support during the standard treatment and recovery period in acute lead toxicosis with crop stasis.

Gastrointestinal complications of critical illness in small animals.

The gastrointestinal (GI) tract is one of the shock organs in dogs. GI dysfunction in critically ill veterinary patients manifests in mild problems such as hypomotility, anorexia, and nausea to more serious problems such as intractable vomiting, severe diarrhea, and septicemia. Septicemia is a serious complication of GI dysfunction because intestinal flora gains access to a patient's bloodstream, leading to infections in other organ systems and a systemic inflammatory response. The therapy for GI dysfunction is mainly supportive, treating nausea and dehydration although supporting the ailing GI tract with adequate enteral nutrition and, in some cases, dietary supplements and antibiotics.

Nutrition of critically ill horses.

Nutritional supplementation is becoming the standard of practice in equine medicine, although there are minimal data on nutritional support in critically ill horses and its association or effect on morbidity and mortality or length of hospital stay. Horses can be fed orally and when that is not possible, intravenously or parenterally. Enteral feeding is less expensive, more physiologic, improves immunity, and is easier and safer. This article reviews available information on the development of a nutritional plan for critically ill horses, and describes methods for and complications of enteral and parenteral feeding.

Feeding management of sick neonatal foals.

Nutritional support of the foal can be challenging because of the constant changes in nutritional requirements and dietary composition during the transition from neonate to weanling. Additional complexity arises because of dilemmas regarding the means and route of delivery of nutrition to the foal, and the possibility that metabolic dysfunction may impair the ability of the foal to use nutrients appropriately. This article provides practical information on enteral and parenteral nutritional support of sick neonatal foals. The potential benefits of a conservative, hypocaloric feeding strategy, particularly in the very sick patient, are also discussed.

Early enteral nutrition in young dogs suffering from haemorrhagic gastroenteritis.

The purpose of this study was to investigate clinical and metabolic effects of combined parenteral and oral nutrition compared with parenteral nutrition in young dogs with haemorrhagic gastroenteritis in a prospective clinical study. Dogs with acute gastroenteritis received either parenteral nutrition (group PN, n = 9) or combined parenteral and early enteral nutrition (group EN, n = 10). Infusions were compounded from amino acids, lipids, glucose and electrolyte/glucose solutions [149 g/l glucose, 20 g/l triglycerides, 40 g/l amino acids and 4009 kJ metabolizable energy/l (957 kcal ME/l)], and supplemented with potassium, phosphate and trace elements. Group EN received additionally a hydrolysed diet (74 kJ/kg BW(0.75) on day 2 and 148 kJ/kg BW(0.75) on days 3 and 4). Glucose, triglycerides, protein, albumin, fibrinogen, urea, creatinine, alkaline phosphatase, glutamate dehydrogenase and glutamate pyruvate transaminase were measured before and during the infusions, haematological traits only before the infusions. Statistics included two-factorial anova and subsequent t-test or Wilcoxon test (P < 0.05). All dogs of group EN survived compared with seven of nine patients in group PN. Most dogs in the EN group vomited within half an hour after introduction of oral feeding on day 2 but tolerance for food increased on days 3 and 4. The general health status and faecal and blood parameters of the surviving dogs were similar (P > 0.05) between the groups. In all dogs leucocytes increased during the treatment period, haematocrit and haemoglobin levels declined. Infusions increased blood glucose and triglycerides (P < 0.05); however, no adverse signs were observed. Early enteral nutrition was possible after a short period of adaptation, however, vomiting can be a severe problem. The evaluation of clinical benefits of early enteral nutrition in young dogs with haemorrhagic gastroenteritis requires further investigations.

Parenteral and enteral routes of feeding in neonatal piglets require different ratios of branched-chain amino acids.

The requirements for total branched-chain amino acids (BCAA), isoleucine, leucine and valine, in neonatal piglets receiving parenteral and enteral nutrition was determined recently. The optimum ratio among BCAA during different routes of feeding is not yet known. In this study, the ratio of BCAA during parenteral and enteral feeding was tested using the indicator amino acid oxidation (IAAO) technique. Male Yorkshire piglets (n=24) received amino acid-based diets containing adequate nutrients for 5 d. Phenylalanine oxidation and kinetics were determined from a 4-h primed, constant infusion of L-[1-14C]-phenylalanine on d 6 and 8. On d 6, all piglets received a BCAA diet which met 75% of the total BCAA requirement, based on our previous research, with a ratio of 1:1.8:1.2 of isoleucine/leucine/valine. On d 8, the piglets were randomly assigned to receive one of the 3 test diets supplemented with isoleucine (+isoleucine), leucine (+leucine) or valine (+valine) to meet 100% of requirement, with the remaining two BCAA at 75% of requirement. The difference in phenylalanine oxidation (% of dose) between d 6 and 8 was used as an indicator of BCAA adequacy. In enterally fed piglets, the change in the percentage of the dose oxidized was minimal for all 3 test diets (mean=1.15%). In parenterally fed piglets, the difference in phenylalanine oxidation (% of dose) between d 6 and 8 was +isoleucine (12.6%), +leucine (2%) and +valine (6.6%). The ratio of 1:1.8:1.2 of isoleucine/leucine/valine is appropriate for enteral feeding, but during parenteral feeding, isoleucine was first limiting and valine was second limiting.

[Nitrogen detoxification in artificially-fed zinc-deficient rats]. / Stickstoffdetoxifikation bei künstlich ernähtren Zn-Mangelratten.

The aim of this investigation was to determine if the hyperammonaemia shown in previous zinc-deficiency experiments was the result of disturbed enzyme activities for urea synthesis caused by zinc deficiency per se or was a secondary effect of the reduced feed intake accompanying energy and protein deficiency. For this, 24 male Sprague-Dawley rats with an average body weight of 109 g were divided into two groups of 12 animals each. Both groups were force fed by intragastric tube four times daily over 11 experimental days. Group 1 received a zinc-deficient diet (1.3 mg Zn/kg diet) in a total amount of 11.6 g/day/animal. Group 2 received the zinc sulphate-supplemented control diet (25 mg Zn/kg diet) in the same amount. This technique made it possible to supply even the zinc-deficient rats with sufficient nutrients over the whole experimental period in the same manner as for the control rats, at the same time and with the same dietary amounts. At the end of the experiment, the serum zinc concentration and the alkaline phosphatase activity were significantly reduced in the zinc-deficient rats by 59 and 37%, respectively, in comparison with control animals. This showed a severe alimentary zinc-deficiency status of the animals. The concentrations of ammonia and urea, as well as the activity of glutamate dehydrogenase in serum, were not influenced by the zinc-deficient nutrition within the experimental time. Likewise, the mitochondrial activities of glutamate dehydrogenase and carbamoylphosphate synthetase in the liver were not affected by the alimentary zinc concentration. On the contrary, the activities of ornithine carbamoyltransferase and cytosolic liver enzymes argininosuccinate synthetase, argininosuccinase and arginase were significantly increased in comparison with control rats. In the case of a sufficient supply of nutrients, alimentary zinc deficiency did not cause hyperammonaemia owing to disturbed urea synthesis, as previously hypothesized.

The principles and practical application of enteral nutrition.

The enteral route is the preferred method of nutritional support in patients with functional gastrointestinal tracts. Many techniques for obtaining enteral access are available, and the decision regarding which one to use depends on several issues, including the functional integrity of each part of the gastrointestinal tract, the duration of anticipated nutritional support, and the risk of aspiration and gastroesophageal reflux. Nasoesophageal tubes are useful for short-term supplementation; however, patients needing nutritional support for longer than 2 weeks may be better served with a more permanent tube. Blenderized pet food diets are recommended for nutritional support because these diets do not need to be supplemented with protein or micronutrients. Commercial human enteral formulas provide a useful alternative for patients with specific nutrient requirements or for feeding via nasoesophageal or jejunostomy tubes.

Hypophosphatemia associated with enteral alimentation in cats.

Hypophosphatemia is uncommon in cats, but it has been reported in association with diabetes mellitus and hepatic lipidosis, where it can cause hemolysis, rhabdomyopathy, depression, seizures, and coma. The purpose of this article is to describe 9 cats that developed low serum phosphorus concentrations (< 2.5 mg/dL) subsequent to enteral alimentation. Serum biochemical analyses from more than 6,000 cats were reviewed. The medical records of all cats with hypophosphatemia were examined for history of enteral alimentation; diabetic cats were excluded from the study. Nine cats, ranging in age from 3 to 17 years, were identified. All cats had normal serum phosphorus concentrations before tube feeding began. Onset of hypophosphatemia occurred 12 to 72 hours after initiation of enteral alimentation, and the nadir for phosphorus concentrations ranged from 0.4 to 2.4 mg/dL. Hemolysis occurred in 6 of the 9 cats. Hypophosphatemia secondary to enteral alimentation is an uncommon clinical finding in cats. Cats with high alanine aminotransferase activity, hyperbilirubinemia, and weight loss should be closely monitored for hypophosphatemia during the first 72 hours of enteral alimentation.

Intubation of weight-selected chicks with soybean oil or residual yolk: effect on early growth and development.

Experiments were conducted to study the role of residual yolk on growth and development of chicks during the 1st wk after hatch. Surgical removal of the yolk sac at hatch reduced early body weight gains. Intubating chicks with a mixture of soybean meal and soybean oil or with residual yolk obtained from chicks at hatch increased body weights and enhanced development of the liver and pancreas. Whereas intubation with residual yolk reduced absorption of yolk sac contents, absorption was similar for chicks that consumed mash ad libitum or were intubated with the soybean meal-soybean oil diet. After cessation of yolk intubation, absorption of residual yolk resumed. Removal of the yolk sac decreased amylase and lipase activity in the pancreas. In the intestinal chyme, activity of amylase, trypsin, and chymotrypsin was reduced by yolk sac removal. Intubation with yolk increased enzyme activity (amylase excepted) in the pancreas or intestinal chyme only in chicks that had their yolk sacs removed. There was evidence that contents of the yolk sac did not enter the intestine via the yolk stalk, but were absorbed directly via the blood.

Effect of level of input of different proportions of volatile fatty acids on energy utilization in growing ruminants.

Four steers were maintained wholly by intragastric infusion of volatile fatty acids (VFA) and protein, together with a mineral-vitamin supplement. The infusion was given at three levels of energy, namely 450, 675 and 900 kJ/kg live weight0.75, calculated to supply energy at 1.0, 1.5 or 2.0 times that required for maintenance. The VFA provided 0.837 and the protein 0.163 of the energy infused. The molar proportions of individual VFA were varied so that the infusate contained 0.36-0.91 of acetic acid, 0.56-0.01 of propionic acid and a constant 0.08 of butyric acid. Heat production was measured in respiration chambers. Urine was analysed for N, urea, beta-hydroxybutyrate and VFA. Blood plasma was analysed for beta-hydroxybutyrate, free fatty acids, insulin and glucose. As the proportion of acetic acid was increased, and propionic acid reduced, there was no change in blood or urine metabolites or in heat production until acetic acid exceeded a proportion of about 0.75. At higher proportions beta-hydroxybutyrate increased in plasma and urine, blood glucose and insulin tended to fall and urinary N excretion rose. At a proportion of acetic acid of > 0.80, acetate appeared in the urine and at > 0.86 heat production declined. The effect of level of infusion on the molar proportion at which plasma and urine metabolites changed was less clear. There was a tendency for the increase in beta-hydroxybutyrate to occur at a slightly lower proportion of acetic acid at the highest level of infusion. It is concluded that differences in heat production that are observed between diets are probably not caused by differences in rumen VFA proportions.(ABSTRACT TRUNCATED AT 250 WORDS)