Audit of the provision of nutritional support to mechanically ventilated dogs and cats.

OBJECTIVES: To evaluate the use of enteral and parenteral nutrition in a population of mechanically ventilated cats and dogs, identify factors associated with implementation of nutrition, and assess the frequency of nutritional support within 72 hours of absent caloric intake. DESIGN: Retrospective, single-center audit from June 2013 to June 2016. SETTING: ICU of a veterinary university teaching hospital. ANIMALS: Fifty-eight animals (50 dogs, 8 cats) that underwent mechanical ventilation for ≥6 hours with complete medical records. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data collected included nutritional provision, time to initiation of nutrition, period of absent caloric intake, percentage of caloric intake obtained, and possible factors contributing to the delay or failure to implement nutrition. Thirty-one percent of patients (dogs 16/50, 32%; cats 2/8, 25%) received nutritional support during mechanical ventilation with all but 2 dogs receiving parenteral nutrition. Of those patients that did not receive nutrition (dogs 34/50, 68%; cats 6/8, 75%), documented contraindications or notations within the medical record for its omission were present in 16 of 34 dogs (47%) and 4 of 6 cats (66.7%). Thirteen animals (11 dogs, 2 cats) had >72 hours of absent caloric intake with only a small number of these receiving nutrition (dogs 4/11, 36.4%; cats 0/2, 0%). CONCLUSIONS: Only 18 of 58 (31%) mechanically ventilated dogs and cats at our institution received nutritional support, and the majority of these were fed parenterally (16/18, 88.9%). For animals that did not receive nutrition, there was no clear reason for its absence in many cases. Animals with absent caloric intake >72 hours had poor implementation of nutritional support in contrast to current guidelines. A repeat audit after implementing changes to institutional protocols for nutritional provision is warranted to assess the impact on morbidity and mortality.

Dietary osteopontin-enriched algal protein as nutritional support in weaned pigs infected with F18-fimbriated enterotoxigenic Escherichia coli.

This study investigated the effects of dietary osteopontin (OPN)-enriched algal protein on growth, immune status, and fecal fermentation profiles of weaned pigs challenged with a live infection of F18-fimbriated enterotoxigenic E. coli (ETEC). At 21 d of age, 54 pigs (5.95 ± 0.28 kg BW; blocked by BW) were allotted to 1 of 3 experimental groups combining dietary and health statuses. A control diet, containing 1% wild-type algal protein, was fed to both sham-inoculated (NC) and ETEC-inoculated (PC) pigs, while the test diet contained 1% OPN-enriched algal protein as fed only to ETEC-inoculated pigs (OA). All pigs received their assigned dietary treatment starting at study initiation to permit a 10-d acclimation period prior to inoculation. Growth performance, fecal dry matter, as well as hematological, histopathological, immune, and microbiota outcomes were analyzed by ANOVA, where treatment and time were considered as fixed effects and pig as a random effect; significance was accepted at P < 0.05. Overall, ETEC-inoculated pigs (PC and OA) exhibited decreased (P < 0.05) ADG and G:F, as well as increased (P < 0.05) peripheral blood helper T-cells and total leukocyte counts, compared with NC pigs during the postinoculation period. The OA treatment also elicited the highest (P < 0.05) concentrations of circulating tumor necrosis factor-α and volatile fatty acid concentrations in luminal contents at various postinoculation time-points, compared with other treatments. A principal coordinate analysis based on Unifrac weighted distances indicated that NC and OA groups had similar overall bacterial community structures, while PC pigs exhibited greater diversity, but infection status had no impact on α-diversity. Osteopontin-specific effects on microbial community structure included enrichment within Streptococcus and Blautia genera and decreased abundance of 12 other genera as compared with PC pigs. Overall, ETEC-infected pigs receiving 1% OPN-enriched algal protein exhibited changes immunity, inflammatory status, and colonic microbial community structure that may benefit weanling pigs experiencing F18 ETEC infection.

Nutritional Support of the Critically Ill Small Animal Patient.

Over the past couple of decades, a component of veterinary critical care was simply to ensure that nutritional support formed some part of the treatment plan. Great emphasis was made on early placement of feeding tubes in critically ill veterinary patients to facilitate enteral feeding. Progress has been made on techniques for nutritional provision, establishing feasibility of nutritional interventions in various patient populations and establishing that nutritional support does have an important role in veterinary critical care. Some refinement of appropriate caloric targets in critically ill animals has decreased complications relating to overfeeding, but further work is required to establish optimal feeding regimes.

Clinical Management of Avian Renal Disease.

Treatment of avian renal disease relies on supportive care, such as fluid therapy and nutritional support. Analgesia and adaptations of the environment are indicated in cases of renal disease associated with painful joints. Other treatments vary with the underlying etiology and may include systemic antibiotics, antifungal therapy, vitamin A supplementation, or chelation therapy.

Systemic and Local Management of Burn Wounds.

Management of severe burn injury (SBI) requires prompt, complex, and aggressive care. Despite major advances in the management of SBI-including patient-targeted resuscitation, management of inhalation injuries, specific nutritional support, enhanced wound therapy, and infection control-the consequences of SBI often result in complex, multiorgan metabolic changes. Consensus guidelines and clinical evidence regarding specific management of small animal burn patients are lacking. This article aims to review updated therapeutic consideration for the systemic and local management of SBI that are proven effective to optimize outcomes in human burn patients and may translate to small animal patients.

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.

Dietary management of feline endocrine disease.

When treating cats with endocrine disease, most veterinarians concentrate on medical or surgical treatments that can be used to manage or cure the disease. Dietary issues are frequently ignored or not properly addressed. However, nutritional support can play an integral role in the successful management of feline endocrine diseases. Furthermore, because most cats with endocrine disease are senior or geriatric, they may also have concurrent health conditions that warrant dietary intervention. This article discusses recommendations for nutritional support of the 2 most common endocrine problems of cats seen in clinical practice: hyperthyroidism and diabetes mellitus.

Estudo longitudinal da infecção por enteropatógenos em bezerros neonatos, com diarreia, sob diferentes estratégias de aleitamento / Longitudinal study of infection by enteropathogens in newborn calves with diarrhea under different feeding strategies

Foram utilizados 17 bezerros, recém nascidos, da raça Holandesa, com o objetivo de avaliar a influência do volume de sucedâneo nos principais patógenos causadores de diarreia neonatal. [...] Foram coletadas amostras de sangue dos bezerros com cinco dias de idade para dosagem da proteína total. A média da proteína total foi 6,33 e 6,21g/dL nos grupos 1 e 2 respectivamente. O grupo 2 apresentou tendência (p<0,1) de maior consumo de sucedâneo no período avaliado. A quantidade de sucedâneo oferecida aos animais não influenciou a incidência de diarreia e sua etiologia, ou seja, não foi observada diferença (p>0,05) na frequência das amostras positivas para cada agente entre os grupos. A frequência dos enteropatógenos nas amostras foi de 100 e 75 por cento para Cryptosporidium spp.; 28,5 e 43,7 por cento para Salmonella spp.; 28,5 e 15,6 por cento para patotipos de E. coli; 3,5 e 6,2 por cento para Rotavírus e 10,7 e 9,4 por cento para Giardia sp. nos grupos 1 e 2 respectivamente. Foram encontrados os sorotipos de Salmonella infantis e muenster. Os patotipos de E. coli isolados foram classificados como E. coli enterohemorrágica, enteropatogênica, enterotoxigênica e produtoras de toxinas Shiga 1 e 2. Foi observada associação entre o Cryptosporidium spp. e os patotipos de E. coli em 30 por cento das amostras do grupo 1 e Cryptosporidium spp. e Salmonella spp. em 45,5 por cento no grupo 2. Os resultados do presente trabalho demonstraram que o fornecimento de diferentes volumes de sucedâneo não apresentou influência sobre a incidência e etiologia da diarreia neonatal. A avaliação longitudinal dos enteropatógenos durante o período de patência da diarreia demonstrou que a associação entre eles ocorre a partir do primeiro dia da doença e destacou a importância da infecção pelo Cryptosporidium spp. agente encontrado em todos os momentos e animais.

Seventeen Holstein newborn calves were used with the objective of evaluating the influence of milk replacer volume in the pattern of pathogens causing neonatal diarrhea. […] Were collected blood samples from calves with five days of age for determination of total protein. The average total protein was 6.33 and 6.21g/dL in groups 1 and 2, respectively. The group 2 tended (p<0.1) higher consumption of milk replacer during the study period. The volume of milk replacer did not influenced the incidence of diarrhea and the frequency of positive samples for each etiologic agent between the two groups (p>0.05). Also, there was no difference (p>0.05) on the pattern of the frequency of positive samples for evaluated pathogens. The frequency of pathogens in the samples was 100 and 75 percent for Cryptosporidium, 28.5 and 43.7 percent for Salmonella spp., 28.5 and 15.6 percent for E. coli pathotypes, 3.5 and 6.2 percent for Rotavirus and 10.7 and 9.4 percent for Giardia in groups 1 and 2, respectively. Serotypes of Salmonella infantis and muenster were found. The isolated pathotypes of E. coli isolates were classified as Escherichia coli enteropathogenic, enterotoxigenic and Shiga-toxin-producing 1 and 2. Associations between Cryptosporidium spp. and E. coli pathotypes, and between Cryptosporidium spp. and Salmonella spp. were found in 30 percent of the samples in group 1 and in 45.5 percent in group 2, respectively. Our results showed that the different volumes of milk replacer did not influence the incidence and etiology of neonatal diahrrea. Longitudinal evaluation of enteropathogens during patency demonstrated that the association between the etiologic agents starts from the first day of disease. This result highlighted the great importance of the infection by Cryptosporidium spp. which was present in every moments and animals evaluated.

Nutritional support of reptile patients.

Providing nutritional support to reptile patients is a challenging and often misunderstood task. Ill reptiles are frequently anorexic and can benefit greatly from appropriate nutrition delivered via a variety of assist-feeding techniques. Neonatal reptiles can also be very challenging patients because many fail to thrive without significant efforts to establish normal feeding behaviors. This article presents ideas supporting the benefit of timely nutritional support as well as specific recommendations for implementation of assist feeding. Also discussed are a few nutritional issues that affect captive reptile species.

Chronic kidney disease in dogs and cats.

Chronic kidney disease (CKD) occurs commonly in older dogs and cats. Advances in diagnostics, staging, and treatment are associated with increased quality and quantity of life. Dietary modification has been shown to increase survival and quality of life and involves more than protein restriction as diets modified for use with CKD are lower in phosphorous and sodium, potassium and B-vitamin replete, and alkalinizing, and they contain n3-fatty acids. Additionally, recognition and management of CKD-associated diseases such as systemic arterial hypertension, proteinuria, and anemia benefit patients. This article summarizes staging and management of CKD in dogs and cats.

[Nutritional support for patients]. / Nutritionele ondersteuning van de opgenomen patiënt.

A good intake of fluids and essential nutrients in the first fourteen days is of vital importance to recuperating animals. Moreover, it is important to encourage cats and dogs to eat after illness or surgery, in order to promote optimal functioning of the gut and the immune system. Enteral nutrition is to be preferred to nasogastric feeding or parenteral nutrition. In the first stage of recovery, during the first 24 to 48 hours, it is important to feed the gut' with nutrients, and thereafter, in the second stage of recovery (after day 3), the calorie intake can be increased. Timely nutritional support with nutraceuticals, such as arginine, glutamine, taurine, long-chain polyunsaturated omega-3 fatty acids, and prebiotic fibres, can considerably shorten the recovery period of cats and dogs after illness or surgery

Protein-losing enteropathies in dogs.

Protein-losing enteropathy is common in dogs but rare in cats. In the vast majority of cases, it is associated with inflammatory bowel disease, intestinal lymphoma, or intestinal lymphangiectasia. The diagnosis is based on identification of hypoalbuminemia and ruling out urinary loss and liver failure. Identification of the intestinal lesion with appropriate biopsy method is important to rule out neoplasm or infectious causes. The treatment is based on intensive nutritional support, therapy for the causative condition, and early monitoring of possibly life-threatening complications, such as hypocobalaminemia, massive pleural or abdominal fluid collection, thromboembolism, and hypocalcemia or hypomagnesemia.

Factors affecting the seroprevalence of lagovirus infection in wild rabbits (Oryctolagus cuniculus) in Southern Spain.

Cross-sectional studies were carried out on wild rabbit (Oryctolagus cuniculus) populations in Southern Spain to assess the prevalence of lagovirus infection and to identify potentially associated risk factors. A total of 619 blood and 487 liver samples from wild rabbits were collected from seven hunting areas with different Mediterranean ecosystems. Logistic regression analysis was used to assess associations between seropositivity and an extensive set of variables. The seroprevalence was 29.2% (95% CI: 25.6-32.8) and lagoviruses were not detected in liver samples. Logistic regression indicated that seropositivity to lagoviruses was associated with seropositivity to myxomatosis, wild rabbit density, the existence of artificial feeding sites, mean maximum monthly temperatures of 20-30 °C, and annual accumulated rainfall of >600 mm.

Effects of nutritional support on hospital outcome in dogs and cats.

OBJECTIVE: Investigate the effects of assisted nutritional support on hospital outcome in dogs and cats, and the relationship between hospital outcome and energy intake, body condition score (BCS), physical status score, and type of nutritional support used. DESIGN: Retrospective analysis of hospitalized animals. SETTING: Teaching Veterinary Hospital. ANIMALS: Four hundred and sixty-seven dogs and 55 cats. INTERVENTIONS: Routine clinical nutritional support. MEASUREMENTS AND MAIN RESULTS: The following variables were recorded for each animal: energy intake, body weight at admission and discharge, BCS, physical status score, and type of nutritional support used. Disease severity was negatively associated with hospital outcome and energy intake (P=0.009). Energy intake was positively associated with hospital discharge (P<0.001). Outcome may be related to BCS, with discharge rates of 73% for animals with low BCS, and 84.7% for those at an ideal BCS or overweight (P=0.04). Sixty-four percent of animals showed voluntary food intake (92.9% were discharged), 19.0% received enteral support (71.8% were discharged), 7.0% were forced fed (75.0% were discharged), 6.0% received parenteral support (61.9% were discharged), and 4.0% did not receive calories (38.4% were discharged), suggesting a possible relationship between the type of nutritional support, energy intake, and outcome (P=0.009). CONCLUSIONS: Energy supply, even if modest and close to resting energy requirements appears to be positively associated with hospital discharge. However, disease severity was the main negative factor on outcome and also had a negative effect on energy intake, making it difficult to separate the effects of both factors when interpreting hospital discharge. Thin animals with low BCS had greater mortality.

The Inappetent Hospitalised Cat: clinical approach to maximising nutritional support.

PRACTICAL RELEVANCE: Inappetence is one of the most common presenting complaints in clinically ill cats requiring hospitalisation. When prolonged, poor food intake can lead to malnutrition and may be associated with impaired metabolic function, immunosuppression, compromised wound healing, and increased morbidity and mortality. It is important to recognise that inappetence or anorexia is always secondary to another condition, and that treatment goals should be targeted at the primary condition. The current emphasis in the nutritional support of hospitalised inappetent cats is to provide more effective means of increasing nutritional intake--for example, by initiating enteral nutrition via feeding tubes-- rather than rely solely on traditional approaches such as increasing palatability of foods or using appetite-stimulating drugs. CLINICAL CHALLENGES: Cats that are ill enough to require hospitalisation are at increased risk of becoming malnourished because of the combined catabolic effects of their disease and poor nutritional intake. This article highlights some of the problems encountered in treating inappetent cats and discusses a clinical approach to providing better nutritional support. PATIENT GROUP: Inappetence and anorexia are associated with a myriad of clinical conditions in cats and can be seen in individuals of any age or breed. EQUIPMENT: Provision of nutritional support to cats may involve the use of feeding tubes such as naso-oesophageal or oesophagostomy tubes. In cases where enteral nutrition is not feasible (eg, cats with gastrointestinal failure), parenteral nutrition should be considered. EVIDENCE BASE: Various studies have documented the high prevalence of inappetence or anorexia in clinically ill cats. Additional studies have linked poor food intake in cats with serious sequelae such as immunosuppression and hepatic lipidosis. More recently, techniques for providing more effective nutritional support, such as oesophagostomy tubes, have been clinically evaluated and shown to be associated with minimal complications.

Critical care nutrition for feline patients.

Nutritional treatment in critical care patients is an important component of the complete treatment plan. Assessment of nutritional status and careful consideration of the disease course will help guide the selection of the most appropriate assisted-feeding method. Enteral nutrition is favored over parenteral nutrition when the gastrointestinal tract is functional. Common routes of enteral feeding include nasoesophageal, esophagostomy, gastrostomy, and jejunostomy feeding tubes. Parenteral nutrition is indicated for patients who cannot tolerate enteral feedings, or are poor anesthetic candidates for proper feeding tube placement. Appropriate diet selection and implementation of proper feeding guidelines and monitoring will aide in limiting complications associated with enteral and/or parenteral feeding.

Delayed primary surgical treatment in a dog with a persistent right aortic arch.

A 5-year-old, 1.36-kg, neutered male Yorkshire terrier was referred for evaluation of a persistent right aortic arch with concurrent megaesophagus. The dog was 3 months old when clinical signs were first noted, 2 years of age when diagnosed with megaesophagus, and 4 years of age when diagnosed with vascular ring anomaly (VRA). Surgical correction of the VRA was performed when the dog was 5 years of age, after gastrostomy tube feeding for 1 year to maintain nutritional requirements and mitigate the degree and duration of the esophageal distention. Thirteen months after surgery, the dog was eating soft dog food with no vomiting or regurgitation.

Nutritional considerations for animals with pulmonary disease.

Recent publications in the human and veterinary literature have indicated that patients with pulmonary disease require specific nutritional consideration to ensure that optimal benefit is derived with nutrition support. Although additional research is needed in this area, preliminary recommendations can be made using information from the scant studies performed thus far in veterinary medicine and from information extrapolated from the human literature. These recommendations are likely to provide significant clinical benefit to patients with pulmonary disease. This article aims to provide the reader with a summary of the available information and links to other relevant sources.