Use of a human enteral feeding preparation for treatment of hyperlipemia and nutritional support during healing of an esophageal laceration in a miniature horse.

Nasogastric infusion of a human enteral feeding preparation was effective in reversing hyperlipemia in an anorectic miniature horse with an esophageal laceration. The nutrient preparation was delivered every 4 hours by gravity flow through a 12 F enteral feeding tube. Within 48 hours of initiating enteral nutrition, the hyperlipemia had resolved. Signs of intolerance to the preparation were not observed, and further weight loss was prevented. The use of a human enteral formula was a convenient and successful alternative for the treatment of hyperlipemia in the horse.     

益生菌对肠内营养治疗并发腹泻的调节作用

为研究益生菌对行肠内营养治疗患者肠道适应性的调节作用,采用随机数表将157 例患者分为研究组（n＝101）和对照组（n＝56）,进行双盲、随机对照研究。根据Harris-Benedict公式测算基础能量消耗,氮供给量0.2 g/（kg?d）,研究组给予肠内营养＋益生菌,对照组给予肠内营养,治疗期10 d。统计患者的基础人口学资料及临床信息,于肠内营养治疗前和治疗后第10天观察并记录患者的体质量、体质量指数等指标,评价肠道及肾脏等重要脏器的营养代谢状况。结果表明：肠内营养治疗后第10天,2 组患者的营养不良     

Nutrition for critical gastrointestinal illness: feeding horses with diarrhea or colic.

Horses with GI diseases such as colic and diarrhea are often intolerant of adequate enteral nutrition. Nutritional intervention should be an early part of therapeutic management in such cases. Protein and energy malnutrition in critically ill horses can have deleterious effects, including poor wound or incisional healing, reduced immunity, and weight loss. Early enteral or parenteral support should be provided to supply resting DE requirements in the equine ICU.     

Dysautonomia in a cat

Autonomic dysfunction was diagnosed in a 2.5-year-old spayed domestic shorthair cat. The cat had an 8-day history of progressive anorexia, signs of depression, constipation, weight loss, and intermittent regurgitation. Physical examination findings were signs of depression, dehydration, cachexia, bradycardia, bilateral nonresponsive mydriasis, prolapse of both nictitating membranes, dry oral and nasal mucous membranes, and urinary bladder atony. Thoracic radiography revealed megaesophagus. The cat lacked esophageal motility and had a decreased gastric emptying rate. Providing adequate fluid intake, electrolyte balance, and nutrition is a major problem in the management of dysautonomic cats. We were able to provide adequate nutritional support for this patient, using total parenteral feeding and, later, enteral nutrition using a nasogastric tube. Results of an ocular pharmacologic study indicated that the mydriasis and prolapse of the nictitating membrane were attributable to complete autonomic denervation of the eye. Using the method described, topical, autonomic-stimulating agents may assist the clinician in diagnosing dysautonomia in the feline. This report describes a syndrome that is well recognized in the United Kingdom and has the potential to develop in the United States.     

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.     

Evaluation of body condition and weight loss in dogs presented to a veterinary oncology service

Cancer cachexia is a well-recognized syndrome in human patients that is characterized by progressive involuntary weight loss. The prevalence of this syndrome in veterinary cancer patients is unknown. This study's objective was to investigate the occurrence of weight loss and cachexia, as characterized by body condition scoring, in dogs presented to a veterinary oncology service. Information collected on 100 dogs included signalment, diagnosis, weight at time of diagnosis, and, when available, weight from a time approximately 12 months before diagnosis. Body condition was assessed by using a 9-point system based on body silhouette and palpation of adipose tissue (4-5 = optimal, 1 = extreme cachexia, 9 = extreme obesity). Muscle wasting was scored based on palpation of skeletal muscle (3 = no wasting, 2 = mild, 1 = moderate, 0 = severe). Only 4% of the dogs exhibited cachexia as defined by a body condition score < or = 3, whereas 29% were classified as markedly overweight (> or = 7). Fifteen percent had evidence of clinically relevant muscle wasting (< or = 1). Body weight from a time before the diagnosis of cancer was available for 64 dogs. At the time of diagnosis, 31% had maintained or gained weight, 31% had lost up to 5%, 14% had lost between 5 and 10%, and 23% had lost >10% of body weight. Overall, the percentage of dogs with signs indicating a decline in nutritional status was less than what has been reported for human cancer patients. Future studies should investigate the extent to which weight loss occurs in canine patients on an appropriate plane of nutrition as well as to establish whether an association exists between poor nutritional status and outcome in canine cancer patients.     

Candida albicans urocystitis in a cat.

Candida albicans urocystitis secondary to urethral stricture and administration of antibiotics was diagnosed in a cat by fungal culturing of urine and examination of specimens. Surgical repair of the stricture and administration of 5-fluorocytosine resulted in resolution of the cystitis. Related problems included anorexia and severe weight loss, which necessitated enteral nutritional support, dehydration, renal disease, and nosocomial Pseudomonas aeruginosa urocystitis.     

Nutritional management of the foal with diarrhoea

Diarrhoea is a common problem in the neonatal and suckling foal. In certain circumstances supplemental nutrition is necessary depending on the age of foal, severity of diarrhoea and presence of other systemic manifestations. Nutritional supplementation can be provided either enterally or parenterally. Enteral nutrition is superior to parenteral nutrition because it is the most natural and physiologically sound means to provide nutritional support. Parenteral nutrition may be warranted if the foal is unable to receive or tolerate enteral nutrition. Dextrose alone or with amino acids and lipids can provide appropriate nutrition when enteral feeding is not tolerated. As soon as the foal stabilises enteral feeding can be reintroduced.     

Parenteral nutrition in the mature horse

Parenteral nutrition is an important component of the management of critically ill horses unable or unwilling to eat. It provides dextrose, amino acids, vitamins and minerals and, in some cases, lipids for nutritional support until enteral nutrition can be reinstituted. It can also be used as a supplement to enteral nutrition, where horses are not ingesting at least 80% of digestible energy (resting) requirements for more than 2–3 days. This review discusses the indications, applications, monitoring and complications of parenteral nutrition in mature horses.     

A pilot study to assess tolerability of early enteral nutrition via esophagostomy tube feeding in dogs with severe acute pancreatitis

Background: The putative role of the gut in amplification of systemic inflammation in acute pancreatitis is gaining credence, and intraluminal nutrition has been shown to decrease inflammation in experimental models of pancreatitis. Prepyloric feeding often is used in people with acute pancreatitis, but has not been evaluated in dogs. Hypothesis: Early intervention with enteral nutrition (EN) delivered proximal to the pylorus will be well tolerated in dogs with acute pancreatitis and provide justification for further larger trials. Animals: Ten dogs with severe acute pancreatitis in an open‐label, prospective pilot study. Methods: Dogs were treated with plasma transfusion and standard care, and then consecutively assigned to receive either EN via esophagostomy tube feeding or parenteral nutrition (PN). Outcome was used to determine optimal study size for future studies, and complications were compared between the 2 groups. Results: A significantly greater number of vomiting or regurgitating episodes occurred in dogs receiving PN. The dogs receiving EN did not demonstrate any noticeable postprandial pain. There were more catheter‐related complications in the PN group. There was no difference in outcome between the 2 treatments, and 43 dogs for each treatment would be required in future studies to determine a difference in outcome. Conclusions and Clinical Relevance: Early EN delivered proximal to the pylorus is well tolerated in dogs with severe pancreatitis and resulted in fewer complications than PN. Prospective trials in a larger cohort are justified to fully establish the potential benefit of early EN, preferably compared with minimal enteral nutrition.     

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.     

Nutritional considerations for horses with colitis. Part 1: Nutrients and enteral nutrition

The equine colon is the primary site of fibre digestion and water absorption. It is therefore not surprising that colitis and associated colonic dysfunction can result in severe nutritional derangements, which can be exacerbated by reduced feed intake in affected horses. Dietary management of colitis is important for optimum recovery. In broad terms, it should prioritise provision of nutrients to horses that otherwise have reduced appetites. In some forms, such as right dorsal colitis, as well as those with chronicity, nutritional recommendations include restricting or eliminating long‐stem roughage from the diet and feeding a complete pelleted diet. Voluntary enteral nutrition is preferred, but horses that are not ingesting enough to meet the minimum recommended requirements as outlined, should be fed via nasogastric tube (if tolerated – no reflux, no ileus and no colic present; faecal output present). Parenteral nutrition may be necessary in some cases, as some colitis cases do not tolerate enteral feeding for reasons such as colic, intestinal dysmotility or abdominal distension. Timing and constitution of nutritional intervention is vital and should be tailored to the individual patient to prevent further complications of the disease process.     

USE OF A GASTROSTOMY AND JEJUNOSTOMY TUBE FOR MANAGEMENT OF GASTRIC DISTENTION FOLLOWING PYLORIC OUTFLOW OBSTRUCTION IN A FERRET (MUSTELA PUTORIUS FURO)

An 8-month-old spayed female ferret (Mustela putorius furo) was presented for evaluation of persistent, severe gastric distention following gastrotomy to retrieve several foreign bodies. A structural cause of gastric outflow obstruction was not identified ultrasonographically or surgically. A 14 Fr gastrostomy and an 8 Fr jejunostomy tube were used to facilitate medical management of severe gastric stasis and to allow enteral nutrition. The ferret tolerated the feeding tubes well and recovered completely following intensive medical therapy. This report describes successful management of idiopathic gastric distention using gastric and jejunal feeding tubes in a ferret. Feeding tubes and supplemental nutrition plans should be considered for management of ferrets with compatible disease processes.     

Nutritional support of the foal during intensive care

Provision of adequate nutritional support to the sick neonatal foal is a vital part of intensive care; frequently, however, it is very difficult to accomplish. In this article, current recommendations concerning both enteral and parenteral nutrition are discussed.     

The problem of gastric atony

Normal gastrointestinal motility is crucial for maintaining an appropriate balance of microorganisms within the gut. Disruption of this system results in bacterial overgrowth and associated complications such as bacterial translocation, aspiration pneumonia, and sepsis. Critically ill animals are at increased risk of developing gastroparesis caused by primary gastrointestinal disturbances or severe metabolic derangements that impact gastrointestinal function. In the intensive-care setting, delayed gastric emptying complicates enteral nutrition, and the catabolic effects of severe illness further deplete the patient's caloric reserves, resulting in impaired wound healing, decreased immune function, and increased morbidity and mortality. The use of promotility drugs in critically ill patients is a safe, effective means to circumvent the problem of gastric atony and improve patient recovery. Understanding the drugs available and their interaction with the receptors involved in neuromuscular transmission within the gastrointestinal tract will aid the clinician in selecting the optimal prokinetic therapy.     

Acute Pancreatitis in Dogs: Advances in Understanding,Diagnostics, and Treatment

Acute pancreatitis in dogs is a potentially reversible condition, but in severe forms it can cause systemic and local complications. These complications are driven by the cytokine, complement, and kinin systems, with the roles of these systems along with other substances such as nitric oxide being increasingly studied. The intestinal tract and altered pancreatic microcirculation also contribute greatly to the perpetuation of disease. Diagnosis remains difficult, because the true diagnostic utility of the current tests available is problematic to establish. Further understanding of the pathophysiology of this disease has opened up new areas of research into optimal treatments. In particular, the role of enteral nutrition has been the focus of much attention, and current recommendations are to feed earlier in the disease than previously thought.     

A Retrospective Study of the Use of Total Parenteral Nutrition in Dogs and Cats

The records of all dogs and cats receiving total parenteral nutrition (TPN) over a 43-month period were examined retrospectively. Dextrose, amino acids, lipids, electrolytes, and vitamins were administered by central venous catheter according to published nutrient recommendations; 72 dogs and 12 cats were studied, accounting for 380 patient days of TPN. Duration of TPN administration was 1–14 days with a mean of 4.5 days. Most animals required TPN because of gastrointestinal dysfunction, and more than half of them gained weight during TPN administration. Mechanical complications were frequent. Metabolic complications, especially lipid and glucose intolerance, were also commonly seen. Septic complications were the least frequently encountered, but resulted in patient morbidity and may have contributed to mortality. Most animals receiving TPN were returned to enteral nutrition and discharged. For critically ill animals unable to tolerate enteral alimentation, TPN can be supportive therapy in the treatment of the primary disease.     

Anthelmintic resistance in a herd of alpacas (Vicugna pacos)

A herd of alpacas was examined because of a history of severe endoparasitism, anemia, hypoproteinemia, and weight loss. Resistance of gastrointestinal nematodes to albendazole, fenbendazole, and doramectin was documented. This report suggests that anthelmintic resistance may be an emerging problem in South American camelids in North America.     

Total parenteral nutrition in clinically normal cats

Seven clinically normal cats were maintained on total parenteral nutrition (TPN) with nothing given PO for 2 weeks. The TPN solution consisted of a mixture of dextrose, amino acids, soybean oil emulsion, electrolytes, and vitamins. Three cats were fed calories in excess of published maintenance requirements, and they gained some weight, vomited occasionally, had oral ulcerations, and had signs of depression after 10 to 13 days on TPN. Four cats that were not overfed did well clinically and maintained stable body weights. All cats developed anemia and thrombocytopenia to varying degrees during TPN administration and had polyuria and serum triglyceride concentrations higher than normal fasting values. Some cats had changes in liver-specific biochemical variables. Hepatocellular swelling and vacuolation and small intestinal villous atrophy and fusion were the most common histopathologic changes seen after TPN. These changes were reversible when TPN was discontinued and the cats were returned to enteral nutrition.     

Severe hypophosphataemia associated with the management of hyperlipaemia in a miniature pony

This report describes a case of severe hypophosphataemia associated with the management of hyperlipaemia in a miniature pony following colic surgery. Clinical signs attributed to hypophosphataemia included obtundation, anorexia, tachycardia, tachypnoea and generalised muscle fasciculations. Hyperlipaemia was managed with enteral and partial parenteral nutrition; insulin was also administered to control hyperglycaemia after the initiation of caloric support. Specific therapy for hypophosphataemia consisted of parenteral potassium phosphate at 0.03 mmol/kg bwt/h (i.v.). The pony made a full recovery without further complications. Hypophosphataemia may be an under‐recognised clinical problem in certain populations of critically ill equids, such as those with hyperlipaemia and receiving insulin as part of their management. The routine measurement of phosphate concentration in these cases is recommended.