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.     

Nutritional support of hospitalised dogs and cats

SUMMARY Nutritional support of hospitalised dogs and cats improves recovery from illness, reduces mortality, and improves responses to trauma and stress. The primary goal of nutritional support is to prevent use of tissue protein. This is accomplished by the provision of sufficient calories and dietary protein in optimal proportions. For nutritional support, calorie intake is adjusted according to the patient's metabolic rate so that the animal may be fed above or below its usual intake. Nutritional support should always be started gradually, no matter what the final calorie goal may be. For many sick dogs fed enterally, diets provide about 30% of calories from fat and at least 27% of calories from protein. Carbohydrates in nutritional support diets should not include maize, wheat or, especially, soy. Sick cats fed enterally should receive at least 30% of calories from both fat and protein.     

Retrospective evaluation of partial parenteral nutrition in dogs and cats

The purpose of this retrospective study was to evaluate the use of partial parenteral nutrition (PPN) in dogs and cats. The medical records of all dogs and cats receiving PPN between 1994 and 1999 were reviewed to determine signalment, reasons for use of PPN, duration of PPN administration, duration of hospitalization, complications, and mortality. Complications were classified as metabolic, mechanical, or septic. One hundred twenty-seven animals (80 dogs and 47 cats) were included in the study, accounting for 443 patient days of PPN. The most common underlying diseases were pancreatitis (n = 41), gastrointestinal disease (n = 33), and hepatic disease (n = 23). Median time of hospitalization before initiation of PPN was 2.8 days (range, 0.2-10.7 days). Median duration of PPN administration was 3.0 days (range, 0.3-8.8 days). Median duration of hospitalization was 7 days (range, 2-20 days). In the 127 animals receiving PPN, 72 complications occurred. These included metabolic (n = 43), mechanical (n = 25), and septic (n = 4) complications. The most common metabolic complication was hyperglycemia (n = 19), followed by lipemia (n = 17) and hyperbilirubinemia (n = 6). Most complications were mild and did not require discontinuation of PPN. Ninety-three (73.2%) of the 127 patients were discharged. All 4 animals with septic complications were discharged from the hospital. The presence, type, and number of complications did not impact the duration of hospitalization or outcome. However, animals that received supplemental enteral nutrition survived more often than those receiving PPN exclusively. Although PPN seems to be a relatively safe method of providing nutritional support, future studies are warranted to determine its efficacy.     

Use of laparoscopic-assisted cryptorchidectomy in dogs and cats

A laparoscopic-assisted technique for localization and removal of retained testes was performed on 13 client-owned dogs and cats. Operative time and intraoperative complications were recorded. One month after surgery, follow-up examinations were performed on all animals and owners were asked to complete questionnaires concerning signs of illness and complications observed after surgery and their overall satisfaction with the procedure. The laparoscopic-assisted technique was effective in identifying and removing retained testes. Owners were satisfied with the procedure. Laparoscopic-assisted crytorchidectomy can be used to minimize the invasiveness of the procedure while maintaining the safety associated with good visibility of abdominal structures.     

Use of the Cell-Dyn 3500 to predict leukemic cell lineage in peripheral blood of dogs and cats

Background— Morphology and cytochemistry are the foundation for classification of leukemias in dogs and cats. Advances in automated hematology instrumentation, immunophenotyping, cytogenetics, and molecular biology are significantly improving our ability to recognize and classify spontaneous myeloproliferative and lymphoproliferative disorders. Objective— The purpose of this study was to assess the utility of flow cytometry‐based light scatter patterns provided by the Cell‐Dyn 3500 (CD3500) automated hematology analyzer to predict the lineage of leukemic cells in peripheral blood of dogs and cats. Methods— Leukemic cells from 15 dogs and 6 cats were provisionally classified using an algorithm based on the CD3500 CBC output data and were subsequently phenotyped by enzyme cytochemistry, immunocytochemistry, indirect flow cytometry, and analysis of antigen receptor gene rearrangement. Results— The algorithm led to correct predictions regarding the ontogeny of the leukemic cells (erythroid/megakaryocytic potential, myeloid leukemia, monocytic leukemia, chronic granulocytic leukemia, lymphoid leukemia) in 19/21 animals. Mismatches in the WBC impedance count and the WBC optical count in conjunction with microscopic assessment of blasts in the blood were useful for predicting myeloproliferative disorders with erythroid or megakaryocytic potential. The leukocyte light scatter patterns enabled distinction among myeloid leukemias (represented by acute myelomonocytic leukemia, acute monocytic leukemia, chronic granulocytic leukemia) and lymphocytic leukemias (including acute and chronic lymphocytic leukemias). One case of acute lymphocytic leukemia was misidentified as chronic lymphocytic leukemia. Conclusions— Algorithmic analyses can be applied to data generated by the CD3500 to predict the ontogeny of leukemic cells in the peripheral blood of dogs and cats. This rapid and quantitative technique may be used to improve diagnostic decisions, expand therapeutic choices, and increase prognostic accuracy.     

Use of anti-inflammatory and analgesic drugs in dogs and cats

SUMMARY: Responses (486) were collated from a survey of 5054 Australian veterinarians on their use of anti-inflammatory and analgesic drugs in dogs and cats. Almost all respondents used glucocorticoids (usually prednisolone) to treat allergic, pruritic dermatoses in dogs, while two-thirds also gave fatty acid supplements and one-half used antihistamines. Almost 60% of respondents initially injected a glucocorticoid (frequently a long-acting preparation) when treating inflammatory skin diseases in dogs. More than 90% of respondents used glucocorticoids to treat immunemediated haemolytic anaemia or thrombocytopenia, and about one-third also gave cytotoxic drugs. Administration of prednisolone on alternate days was generally favoured for long-term enteral steroid therapy. Phenylbutazone was the most preferred treatment for painful or inflammatory musculoskeletal disorders of dogs, but aspirin and pentosan polysulphate were also used widely. Regarding the use of analgesics drugs generally, both narcotic analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) were used more widely in dogs than in cats, but alpha-2 agonists were used similarly in both species. The most commonly used narcotic analgesics were pethidine and buprenorphine in both species, while the NSAIDs used most often were flunixin and dipyrone in dogs and ketoprofen in cats. More than 80% of respondents generally used analgesic drugs with potentially painful surgical procedures, with doses given usually before anaesthetic recovery. Analgesic use rates varied with the condition, ranging from 94% for patients with acute severe trauma, through 60% for cruciate ligament repair and 29% for perineal herniorrhaphy, to about 5% for ovariohysterectomy and dog castration. The three clinical signs most frequently nominated as indicators of pain in dogs and cats were (in descending order) vocalisation, response to handling or palpating the affected area, and mental depression. Other items mentioned frequently were behavioural changes and immobility (in both species), inappetence/anorexia in cats, and altered respiration in dogs.     

Factors associated with adverse outcomes during parenteral nutrition administration in dogs and cats

Background: Parenteral nutrition (PN) is increasingly used to support hospitalized dogs and cats. Published assessments of outcome are limited. Objective: Evaluate type and prevalence of complications and risk factors for death and complications in dogs and cats receiving PN. Animals: Three hundred and nineteen dogs and 112 cats that received PN at a teaching hospital between 2000 and 2008. Methods: Retrospective case review. Diagnosis, duration of PN administration, concurrent enteral feeding, death, and mechanical, septic, and metabolic complications were abstracted from medical records. Association of each parameter with complications and death was analyzed by binary logistic regression. Results: Pancreatitis was the most common diagnosis (109/319 dogs, 34/112 cats), and 137/319 dogs and 51/112 cats died. Dogs and cats received 113 ± 40% and 103 ± 32% of resting energy requirement, respectively. Mechanical (81/319 dogs, 16/112 cats) and septic (20/319 dogs, 6/112 cats) complications were not associated with death (P > .05). Hyperglycemia was the most common metabolic complication (96/158 dogs, 31/37 cats). Hypercreatininemia in dogs (8/79) was the only complication associated with death (P < .01). Chronic kidney disease in dogs, hepatic lipidosis in cats, and longer duration of inadequate caloric intake before PN in both species were negatively associated with survival (P < .05). Factors positively associated with survival included longer duration of PN administration in both species, enteral feeding in cats with any disease, and enteral feeding in dogs with respiratory disease (P < .05). Conclusions and Clinical Importance: PN can be effectively used to provide the energy requirements of most critically ill dogs and cats. Most complications accompanying PN administration do not affect survival.     

Evaluation of peripheral and central venous pressure in awake dogs and cats

OBJECTIVE: To determine whether peripheral venous pressure (PVP) was correlated with central venous pressure (CVP) when measured by use of different catheter sizes, catheterization sites, and body positions in awake dogs and cats. ANIMALS: 36 dogs and 10 cats. PROCEDURES: Dogs and cats with functional jugular and peripheral venous catheters were enrolled in the study. Peripheral venous catheters (18 to 24 gauge) were placed in a cephalic, lateral saphenous, or medial saphenous vein. Central venous catheters (5.5 to 8.5 F) were placed in the jugular vein and advanced into the cranial vena cava. Catheters were connected to pressure transducers and a blood pressure monitor capable of displaying 2 simultaneous pressure tracings. For each animal, the mean of 5 paired measurements of PVP and CVP was calculated. The relationship between PVP and CVP when measured by use of different catheter sizes, catheterization sites, and body positions was determined. RESULTS: Mean +/- SD PVP was 5.7 +/- 5.8 mm Hg higher than CVP in dogs and 6.0 +/- 6.9 mm Hg higher than CVP in cats. However, results of multiple regression analysis did not indicate a significant correlation between PVP and CVP, regardless of catheter size, catheter position, or body position. The relationship was weak in both dogs and cats. CONCLUSIONS AND CLINICAL RELEVANCE: The PVP was poorly correlated with CVP when different catheter sizes, catheterization sites, and patient positions were evaluated. Peripheral venous pressure should not be used to approximate CVP in awake dogs and cats.     

Bacterial and fungal colonisation of peripheral intravenous catheters in dogs and cats

Objectives : The purposes of this study were to determine the prevalence of intravenous catheter colonisation in a routine clinical setting, to identify pathogens involved and to explore factors associated with an increased risk of colonisation. Methods : A prospective study of 100 peripherally placed intravenous catheters from 13 cats and 78 dogs was conducted. The distal two‐thirds were removed and submitted for bacterial and fungal cultures. Antimicrobial susceptibility of each isolate was determined. Results : Nineteen peripheral catheters were positive for microbiologic culture from 14 animals. Twenty organisms were isolated among which Staphylococcus species was the most common. Isolates displayed lower levels of resistance against the antimicrobial agents amoxicillin‐clavulanate, cephalosporins and gentamicin than against other agents tested. Major risk factors predisposing to catheter‐related colonisation included dextrose infusion, duration of catheter placement, local complications and immunosuppressive diseases or drugs. Clinical Significance : In a routine clinical setting, the prevalence of microbial colonisation of peripheral intravenous catheters is comparable to that found in an intensive care unit. However, consequences on morbidity and mortality rates differ.     

Use of inhaled medications to treat respiratory diseases in dogs and cats

Noninfectious disorders of the respiratory tract, including laryngitis, tracheitis, bronchitis, and asthma are common problems in dogs and cats. Traditional therapies have often included corticosteroids and bronchodilators given by mouth or injection. Side effects of this form of treatment can be severe and can result in cessation of therapy. Inhaled corticosteroid drugs are not as absorbed into the systemic circulation, do not result in significant side effects, and are now the standard of care for dogs and cats with respiratory diseases that would otherwise be treated with systemic medications.     

A pilot study of protein sparing in healthy dogs using peripheral parenteral nutrition

Total parenteral nutrition is the standard nutritional support of dogs when the enteral route is contraindicated, but it can be difficult because of cost, technical difficulties, and potential complications. Peripheral parenteral nutrition (PPN) may be a feasible option for short-term support in some cases. The objectives of this study were to determine the effect of PPN on nitrogen balance (as an indicator of the effect on protein sparing), serum folate concentrations and serum insulin-like growth factor-I (IGF - I) concentrations in fasting dogs. The effect of PPN on these parameters has not previously been reported in dogs. Using a cross-over design, three healthy adult fasting dogs were randomly assigned to three treatments: 5 per cent amino acid solution, 5 per cent glucose solution, and a control electrolyte solution. The solutions were administered into a peripheral vein at 60 ml kg(-1)per day for 4 days. The amino acid infusion resulted in a positive nitrogen balance and the glucose infusion produced less nitrogen loss than the control. Amino acid, but not glucose or electrolyte infusions, decreased serum folate concentrations. Amino acid and glucose infusions resulted in higher serum IGF -I concentrations than electrolyte infusions, although the differences were small and IGF -I decreased in all cases. In conclusion, these findings suggest that PPN increases nitrogen balance in healthy dogs undergoing short-term fasting.     

Improved nasogastric intubation technique for administration of nutritional support in dogs.

Established procedures for nasogastric intubation are difficult to perform in dogs because of anatomic variation of nasal passages and turbinate structures. Twenty-five clinically normal dogs were used to improve and refine the technique of nasogastric tube placement, and 13 clinical patients at our teaching hospital were evaluated for malnutrition and were considered candidates for nutritional support by nasogastric tube feeding. An improved method for the placement of nasogastric tubes in dogs was used. By pushing the external nares dorsally while advancing the tube in a caudoventral, medial direction, the tube passed through the ventral meatus and into the oropharynx and esophagus easily. The procedure does not require chemical restraint, and the complication of epistaxis was not observed in any dog. Materials required to perform this technique are inexpensive, and the method can be used for the administration of nutritional support, fluids, drugs, or contrast material.