Intermittent and Continuous Enteral Nutrition in Critically Ill Dogs: A Prospective Randomized Trial

Background: Malnutrition is a common problem in critically ill dogs and is associated with increased morbidity and mortality in human medicine. Enteral nutrition (EN) delivery methods have been evaluated in humans to determine which is most effective in achieving caloric goals. Objectives: To compare continuous infusion and intermittent bolus feeding of EN in dogs admitted to a critical care unit. Animals: Fifty‐four dogs admitted to the critical care unit and requiring nutritional support with a nasoenteric feeding tube. Methods: Prospective randomized clinical trial. Dogs were randomized to receive either continuous infusion (Group C) or intermittent bolus feeding (Group I) of liquid EN. The percentage of prescribed nutrition delivered (PPND) was calculated every 24 hours. Frequencies of gastrointestinal (GI), mechanical, and technical complications were recorded and gastric residual volumes (GRVs) were measured. Results: PPND was significantly lower in Group C (98.4%) than Group I (100%). There was no significant difference in GI or mechanical complications, although Group C had a significantly higher rate of technical complications. GRVs did not differ significantly between Group C (3.1 mL/kg) and Group I (6.3 mL/kg) and were not correlated with the incidence of vomiting or regurgitation. Conclusions and Clinical Importance: There was a statistically significant difference in the PPND between continuously and intermittently fed dogs, but this difference is unlikely to be clinically relevant. Critically ill dogs can be successfully supported with either continuous infusion or intermittent bolus feeding of EN with few complications. Increased GRVs may not warrant termination of enteral feeding.     

Effect of the probiotic Enterococcus faecium SF68 on presence of diarrhea in cats and dogs housed in an animal shelter

Background: Beneficial effects of probiotics have never been analyzed in an animal shelter. Hypothesis: Dogs and cats housed in an animal shelter and administered a probiotic are less likely to have diarrhea of ≥2 days duration than untreated controls. Animals: Two hundred and seventeen cats and 182 dogs. Methods: Double blinded and placebo controlled. Shelter dogs and cats were housed in 2 separate rooms for each species. For 4 weeks, animals in 1 room for each species was fed Enterococcus faecium SF68 while animals in the other room were fed a placebo. After a 1‐week washout period, the treatments by room were switched and the study continued an additional 4 weeks. A standardized fecal score system was applied to feces from each animal every day by a blinded individual. Feces of animals with and without diarrhea were evaluated for enteric parasites. Data were analyzed by a generalized linear mixed model using a binomial distribution with treatment being a fixed effect and the room being a random effect. Results: The percentage of cats with diarrhea ≥2 days was significantly lower (P= .0297) in the probiotic group (7.4%) when compared with the placebo group (20.7%). Statistical differences between groups of dogs were not detected but diarrhea was uncommon in both groups of dogs during the study. Conclusion and Clinical Importance: Cats fed SF68 had fewer episodes of diarrhea of ≥2 days when compared with controls suggests the probiotic may have beneficial effects on the gastrointestinal tract.     

Endoscopically assisted nasojejunal feeding tube placement: technique and results in five dogs

Interest in noninvasive feeding tube placement in companion animals led to the adaption of a human technique utilizing endoscopy to place nasojejunal feeding tubes. Data from medical records in which nasojejunal feeding tubes were attempted were reviewed. Feeding tubes were attempted and successfully placed in five dogs within a median of 35 min. Feeding tubes remained in place for approximately 7 days. Complications included facial irritation (5/5), sneezing (5/5), fractured facial sutures (4/5), vomiting (3/5), diarrhea (3/5), crimping of feeding tube (3/5), regurgitation (1/5), epistaxis (1/5), clogging of the feeding tube (2/5), and oral migration with premature removal of the feeding tube (1/5). The deployment technique used in this study was found to be cumbersome. Despite minor complications, endoscopy can be used to rapidly and accurately place nasoenteric feeding devices.     

Retrospective Study: Trends in plasma transfusion at a veterinary teaching hospital: 308 patients (1996–1998 and 2006–2008)

Objectives – To describe changes in fresh frozen plasma (FFP) utilization over a 10‐year period at a veterinary teaching hospital. To evaluate the effect of FFP administration on specific laboratory parameters. Design – Retrospective observational study. Setting – University teaching hospital. Animals– Two hundred and eighty‐three dogs and 25 cats. Interventions – A hospital database search was performed for all animals receiving FFP during the study periods. Measurements and Main Results – Medical records of patients receiving plasma transfusions from 2006 to 2008 and from 1996 to 1998 were reviewed. Data collected included indications for transfusion, transfused volume, concurrent therapies, clinicopathologic data pre‐ and post‐transfusion, transfusion reactions, days of hospitalization, and outcome. FFP was administered to 112 dogs and 23 cats from 2006 to 2008 and to 171 dogs and 2 cats from 1996 to 1998. Significantly fewer patients received FFP for the treatment of hypoalbuminemia (2006–2008: 15% versus 1996–1998: 53%; P<0.001) or pancreatitis (2006–2008: 2% versus 1996–1998: 13%; P=0.001) and significantly more patients received FFP for coagulopathy (2006–2008: 80% versus 1996–1998: 31%; P<0.001) in the 2006–2008 group compared with the 1996–1998 group. For all patients receiving FFP, there was no difference in mean serum albumin concentration pre‐ and post‐transfusion. Median prothrombin time and activated partial thromboplastin time were significantly decreased post FFP administration. No association was found between the volume of plasma administered and outcome. Conclusions – FFP utilization has changed significantly over a 10‐year period. FFP was used most commonly in 2006–2008 for the correction of coagulopathy. FFP administration was associated with significant reduction in prothrombin time and activated partial thromboplastin time but did not significantly alter albumin concentration when administered at median doses of 15–18 mL/kg.     

The prevalence of albuminuria in dogs and cats in an ICU or recovering from anesthesia

Objective – To evaluate the prevalence of albuminuria in dogs and cats admitted to the ICU or recovering from an anesthetic event. Design – Prospective clinical study over a 10‐week period in 2003. Setting – Veterinary teaching hospital. Animals – One hundred and five dogs and 22 cats. Interventions – Urine was collected from dogs and cats admitted to the ICU or recovering from an anesthetic event. When possible, a second urine sample was collected approximately 48 hours later from those animals that had albuminuria during the initial screening. Measurements and Main Results – All dog samples and most cat samples were screened for albumin using a commercial point‐of‐care immunoassay. Aliquots of samples that tested positive were stored at –20°C until subsequent albumin quantification via antigen capture ELISA. Albuminuria was detected in 63 of 105 (60.0%) dogs and in 14 of 22 (63.6%) cats; the prevalence was higher in animals admitted to ICU than in those recovering from anesthesia. In subsequent samples from 26 dogs, urine albumin decreased in 20 (76.9%) when compared with the first sample; urine albumin was undetectable in 5 (19.2%). In subsequent samples from 6 cats, 4 (66.7%) had decreases in urine albumin when compared with the first sample; 1 (16.7%) was negative for urine albumin. Eleven of 12 dogs (91.7%) and 3 of 4 cats (75%) that died within 3 days of admission to the ICU had abnormal urine albumin; whereas 52 of 93 (55.9%) and 11 of 18 (61.1%) dogs and cats, respectively, who survived more than 3 days had abnormal urine albumin. Dogs with albuminuria were at increased risk of death. Conclusions – The prevalence of albuminuria in animals admitted to the ICU or recovering from anesthesia is higher than reported previously and transient in some patients. The presence of albuminuria may be a negative prognostic indicator in this population.     

Effect of diets differing in fat content on chronic diarrhea in cats

Background: Fat‐restricted diets have been advocated for dogs with diarrhea for many years. Recommendations for cats with diarrhea have varied between low‐fat and high‐fat diets, but there have been no published studies to support either recommendation. Objectives: The objective of this study was to compare the clinical responses of cats with chronic diarrhea to dietary management using either a high fat or a low fat, highly digestible diet. Animals: Sixty pet cats with chronic diarrhea were recruited; 55 cats completed the study. Methods: Randomized, double‐blinded, controlled clinical trial. Upon completion of baseline measures, cats were fed 1 of 2 diets for 6 weeks, during which the owners recorded fecal scores daily using an illustrated fecal score chart ranging from 0 (very watery) to 100 (firm and dry). After 6 weeks, cats were reevaluated by the attending veterinarians. Results: Fecal scores improved significantly, with 78.2% of cats improving by at least 25 points on the 100‐point scale or having a final fecal score of at least 66. Over one third of the cats developed normal stools. There were no differences in clinical responses between the diets. Clinical improvement was noted within the 1st week, and maximized within 3 weeks. Conclusions and Clinical Importance: These results show that dietary management can be helpful in cats with chronic diarrhea, but dietary fat content does not appear to affect the outcome. Cats that do not respond within 3 weeks should be evaluated further.     

Case Series: Continuous electroencephalographic monitoring of status epilepticus in dogs and cats: 10 patients (2004–2005)

Objective – To describe the use of continuous electroencephalographic (EEG) monitoring for management of status epilepticus (SE) in dogs and cats. Design – Retrospective study. Setting – University teaching hospital. Animals – Ten patients (7 dogs, 3 cats) with SE of differing etiology (idiopathic epilepsy, n=3; toxicity, n=4; meningoencephalitis, n=2; undefined, n=1). Interventions – The EEG was recorded continuously from 5 stainless‐steel needle electrodes inserted SC. Animals were treated with diazepam and phenobarbital followed by either propofol (n=3) or pentobarbital (n=7) as a continuous rate of infusion. Measurements and Main Results – Clinical seizures stopped after induction of anesthesia in each animal. The EEG, however, still showed distinct epileptiform patterns (spikes, polyspikes) in all animals. Paroxysms were suppressed by increasing the infusion rate of either pentobarbital or propofol. A burst‐suppression pattern was achieved in 5 animals. EEG epileptiform activity reappeared in 4 animals when attempting to taper the dose after >6 hours of anesthesia. This was interpreted as ongoing EEG seizure activity and an increased risk for clinical seizures, and the anesthetic dosage was adjusted accordingly. Conclusion – Continuous EEG monitoring appears to be a useful tool for therapeutic monitoring of SE in dogs and cats. It allows the detection of EEG seizures without the appearance of clinical seizures. Further investigations with blinded investigators and homogeneous animal groups to define therapeutic endpoints are warranted.     

Enteral feeding of dogs and cats: 51 cases (1989-1991).

Feeding commercial enteral diets to critically ill dogs and cats via nasogastric tubes was an appropriate means for providing nutritional support and was associated with few complications. Twenty-six cats and 25 dogs in the intensive care unit of our teaching hospital were evaluated for malnutrition and identified as candidates for nutritional support via nasogastric tube. Four commercial liquid formula diets and one protein supplement designed for use in human beings were fed to the dogs and cats. Outcome variables used to assess efficacy and safety of nutritional support were return to voluntary food intake, maintenance of body weight to within 10% of admission weight, and complications associated with feeding liquid diets. Sixty-three percent of animals experienced no complications with enteral feedings; resumption of food intake began for most animals (52%) while they were still in the hospital. Weight was maintained in 61% of the animals (16 of 26 cats and 15 of 25 dogs). Complications that did occur included vomiting, diarrhea, and inadvertent tube removal. Most problems were resolved by changing the diet or adhering to the recommended feeding protocol. Nutritional support as a component of therapy in small animals often is initiated late in the course of the disease when animals have not recovered as quickly as expected. If begun before the animal becomes nutrient depleted, enteral feeding may better support the animal and avoid serious complications.     

Evaluation of acute congestive heart failure in dogs and cats: 145 cases (2007–2008)

Objective – To characterize the clinical presentation, management, and in‐hospital outcomes of dogs and cats diagnosed with acute congestive heart failure (CHF). Design – Retrospective study of animals seen between January 2007 and May 2008. Setting – Emergency service at a university teaching hospital. Animals – Ninety dogs and 55 cats with CHF. Measurements and Main Results – Patient characteristics, including age, clinical signs, clinicopathologic abnormalities, diagnostic testing, and outcome were recorded. Forty‐eight of the animals already were receiving cardiac medications at the time of presentation. The most common diseases represented were chronic valvular disease and cardiomyopathies. Cats had significantly lower median body temperature at admission compared with dogs (P<0.001). The most common abnormalities were elevated lactate (64%), elevated BUN (52%), hypochloremia (31%), hyperglycemia (27%), and elevated liver enzymes (26%). Many of these became even more prevalent during hospitalization. One hundred and sixteen animals were discharged from the hospital, for a survival rate of 80%. There was no survival difference between dogs and cats (P=0.39). Dogs that developed hypokalemia during hospital stay (P=0.04) were more likely to survive compared with those without hypokalemia and initial body temperature was lower for those cats that did not survive (P=0.02). Of those that did not survive, the majority were euthanized (n=25), while 4 dogs died. Conclusions – Dogs and cats presented to the emergency service with CHF had a high survival rate. In cats, initial body temperature was lower for those cats that did not survive. Although clinicopathologic abnormalities were common in both species, only dogs with hypokalemia had improved survival to hospital discharge.     

Comparison of Continuous Versus Intermittent Enteral Feeding in Dogs

In humans, continuous intragastric feeding has been suggested to cause fewer gastrointestinal (GI) adverse effects, better weight gain and nitrogen balance, and less glucose intolerance than bolus feeding. The aim of this study was to compare the GI adverse effects and the metabolic and nutritional consequences of intragastric feeding of an enteral formula (Jevity; Ross Laboratories, Columbus, OH) intermittently or continuously to dogs. Using a cross-over study design, 10 healthy dogs were randomly assigned to be fed Jevity via gastrostomy tube either continuously (CFI or in 3 bolus meals/day (IF) for 10 days. The dogs were weighed daily. Serum chemistry and glucose tolerance tests (GlT were performed before and after each 10–day trial period. Fecal dry matter (FDM), serum osmolality (sOsm), and serum electrolytes (sElec) were determined 5 times during each 10 day trial period. Urine specific gravity was checked intermittently. Hydrogen breath tests were performed on days 0, 3, and 10. During the last 6 days of each trial period, nitrogen balance and digestibility of the Jevity were determined. There were no GI adverse effects noted on either protocol, and no significant ( P > .05) differences in body weights, serum chemistry results, sElec, sOsrn, GTT, hydrogen breath tests, digestibility trials, or nitrogen balance. There was a significant (P < .051 decrease in FDM over time for both protocols, and a significant (P < .051 increase in urine volume for IF compared with CF. In summary, there were no significant differences between treatments in weight maintenance, GI adverse effects, GTT, nitrogen balance, or feed digestibility. Changes in FDM suggest that the dogs received excess water. In conclusion, this study of healthy dogs provides no support for the preferential use of continuous intragastric feeding over bolus feeding. J Vet Intern Med 1996;10:133–138. Copyright © 1996 by the American College of Veterinary Internal Medicine .     

Clinical experience utilizing a novel fluoroscopic technique for wire‐guided nasojejunal tube placement in the dog: 26 cases (2006–2010)

Objective – To describe the clinical use of a novel, minimally invasive fluoroscopic technique for the wire‐guided placement of nasojejunal tubes (NJT) in dogs. Design – Retrospective study (September 22, 2006–October 2, 2010). Setting – University veterinary teaching hospital. Animals – Twenty‐six consecutive dogs with intolerance of, or contraindications to gastric feeding that underwent attempted fluoroscopic NJT placement. No dogs were excluded from analysis. Interventions – All dogs underwent attempted fluoroscopic NJT placement using a novel fluoroscopic wire‐guided technique. Measurements and Main Results – Patient data were collected in concert with information about the NJT placement procedure as well as the maintenance and utilization of the tube. The primary diagnosis in dogs undergoing NJT placement was pancreatitis in 60%. The ability to achieve transpyloric passage of the tube was 92.3% (24/26) and the ability to achieve jejunal access was 78.2%. In the second half of the study period, the ability to achieve jejunal access was significantly higher than in the first half of the study period suggesting that technical proficiency improves over time. Mean duration of the procedure was 35.3±20 minutes. Significant oral migration was a complication of NJT placement in some dogs. The median duration of feeding was 3.3 days (range 0.3–10.5). Conclusions – Fluoroscopic wire‐guided NJT placement is a viable method for sustained postpyloric feeding in dogs. Success in acquiring jejunal access improves with experience. The NJT may be utilized as a strategy to provide enteral nutritional support to the population of dogs with contraindications to, or intolerance of gastric feeding.     

Evalution of a Commerical Canned Lamb and Rice Diet for the Management of Adverse Reactions to Food in Dogs*

Abstract— A commercial canned lamb and rice diet was fed to 20 dogs with previously diagnosed determatologic problems due to adverse reactions to food. Fifteen of the 20 dogs had concurrent atopy and flea allergy which were being treated with hyposensitization and agressive flea control. Palatability and acceptability were good in most of the dogs. Recurrent of previous dermatologic signs did not occur in 75 per cent (15/20) of the dogs while they were fed the diet. Gastrointestinal side effects, specifically diarrhea, caused the owners to stop feeding the diet in four dogs. Overall, 60 per cent (12/20) experienced some gastrointestinal signs during the diet trail.     

Comparisons between endoscopic and histologic evaluation of the gastrointestinal tract in dogs and cats: 75 cases (1984-1987)

Observations made during endoscopic evaluation of the stomach, duodenum, and colon of 58 dogs and 17 cats with a history of regurgitation, vomiting, and/or diarrhea were compared with results of histologic examination of tissues obtained during the procedures. Endoscopic observations included normal mucosa, alternations in mucosal color and texture, and luminal masses. Although endoscopy alone is a useful technique for detecting alterations of the gastrointestinal mucosa, histologic assessment of tissues obtained is necessary to confirm either an inflammatory or a neoplastic process.     

Nutritional Support In Pancreatitis: A Retrospective Study

The medical records of animals with pancreatitis that received nutritional support were evaluated. Over a five year period (1989–1994), 16 patients with pancreatitis (14 dogs and 2 cats) received nutritional support. Affected animals commonly exhibited vomiting, diarrhea, and weight loss, as well as multiple clinicopathological abnormalities.
Total parenteral nutrition (TPN) was used in 13 of the cases, while two animals received partial parenteral nutrition (PPN), and one was fed through a jejunostomy tube. The duration of nutritional support ranged from one to 13 days, with a mean of 6.6 days. Three of the animals receiving TPN had complications resulting from the nutritional support, including hyperglycemia, hyperammonemia, and hyperlipidemia. The survival rate for all 16 cases was 56% (9 of 16).
A variety of nutritional support techniques can be successfully used in animals with pancreatitis and are associated with few complications, most of which can be managed with adjustments in treatment regimen.     

Radiopaque Markers to Evaluate Gastric Emptying and Small Intestinal Transit Time in Healthy Cats

Determinations of gastric emptying time (GET) and small intestinal transit time (SITT) are useful in detecting gastrointestinal motility disorders and partial obstructions of the pylorus or small intestine. Barium-impregnated, polyethylene radiopaque spheres with diameters of 1.5 mm and 5.0 mm have been developed for quantitative assessment of gastrointestinal transit.
The purpose of this study was to evaluate GET and SITT using these radiopaque spheres in 10 healthy cats. The cats were randomly assigned to 1 of 3 treatment groups: fasted, fed, and fed plus sedation (acetylpromazine maleate 0.10 mg/kg subcutaneously). A repeated measures study design was used.
The mean GETs of 50%, 75%, and 90% of the 1.5-mm and the 5-mm spheres in the unfed cats were 0.36, 0.58, and 0.74 hours, and 0.41, 0.68, and 1.02 hours, respectively. These values were significantly (P ±.05) more rapid than the GETs of 50%, 75%, and 90% of the 1.5-mm and 5-mm spheres of either the sedated fed cats (4.39, 5.68, 6.65 and 5.15, 5.99, 6.91 hours) or the unsedated fed cats (6.43, 8.12, 9.06 and 7.49, 8.49, 9.22 hours).
The mean GETs of 50% and 75% of the 1.5-mm and 5-mm and of 90% of the 1.5-mm spheres were significantly ( P ±.05) more rapid in sedated than in unsedated fed cats. The GET of 50% of the 1.5-mm spheres was significantly more rapid ( P ±.05) than that of the 5-mm spheres in the fed cats. The mean SITTs, which ranged from 2.25 to 3.05 hours, were not significantly different ( P > .05) among the treatment groups or between the 1.5-mm and 5-mm spheres.
The GET of spheres given to fasted cats is significantly more rapid than that of fed cats. Subcutaneous injection of acetylpromazine speeds GET in fed cats. The SITT of small and large spheres was not influenced by feeding or by acetyl-promazine injection.