Nutritional support for patients

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     

Nutritional support of hospitalized patients

Effective nutritional support requires sound knowledge of both basic and clinical nutrition of dogs and cats as well as familiarity with products and delivery systems. Case management includes assessment of nutritional status and estimation of fuel sources. Most starved or stressed patients use fatty acids for over 70 per cent kcalME and protein for over 20 per cent kcalME. Approximate kcal needs are calculated from maintenance energy equations. Most patients respond best to enteral nutrition. Meat-based pet foods, liquid enteral products, and nutrient modules are offered in slurries or are tube-fed. Management includes careful monitoring of patients and gradual transitions to diets with more complex nutrient sources.     

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.     

Nutritional support for neonatal foals.

In recent years, equine neonatal medicine has made significant advances. The importance of nutritional support for the sick neonatal foal has been recognized, and methods of providing that sup-port have been developed. Today, the clinician has many options when designing a nutritional plan for the neonatal foal. When the foal's gut permits, enteral diets are an inexpensive source of nutrients. Under conditions where the gut requires rest, methods for delivering nutrients by the parenteral route have also been developed. In this article, the nutrition of the normal and sick foal is described. Guidelines for designing a nutritional plan are also reviewed.     

Nutritional support of hospitalized animals.

Nutritional support of hospitalized animals is new and encouraging, although it is in need of rigorous evaluation. Principles and procedures of established value in human patients appear to be readily applied to other species, with due regard to comparative physiologic properties and medicine.     

Analgesia in critical care.

All medical interventions, including the provision of analgesia, are associated with risks and benefits, which, when considered together, comprise that intervention's risk/benefit ratio. All interventions have alternatives (including no intervention), and each alternative possesses its own risk/benefit ratio. Clinical decision making involves comparing and contrasting the risk/benefit ratios of alternative interventions (relative risk/benefit ratio). The most formidable limitations of drug treatment relate to their potential to produce pharmacologic side effects or complications. Careful monitoring and the use of strategies for preventing and managing drug side effects are often all that is required to maintain efficacy.     

Neonatal critical care.

The first few minutes after a neonate's birth may determine the quality of its entire life. Immediate care includes prevention of hypothermia, clearing of nasal and oral passages, stimulation of ventilation and oxygenation, and, in a few cases, advanced life support. Any additional stress during the first weeks of life can also result in neonatal morbidity and mortality. Care of the diseased newborn must focus not only on treatment of the underlying disease but on aggressive supportive care. A safe, warm, clean, proper environment and adequate nutrition are essential.     

Small mammal critical care.

In emergency situations, veterinarians often are presented with critical patients of any species. The principles for critical care in traditional species such as the dog or cat can be applied to other small mammals. Although there are many unique aspects of the anatomy and physiology of different species, emergency care of small mammals can be instituted with the adaptation of products found in many general practices. Careful assessment of the patient, prioritization of the injuries, and rapid intervention can be life saving in any species.     

Nutritional support of hospitalised animals

Effective nutritional support requires a sound knowledge of both basic and clinical nutrition of dogs and cats as well as familiarity with products and their administration. Management includes the assessment of a patient's nutritional status and estimation of fuel sources. Most starved or stressed patients utilise fatty acids at over 70 per cent kcalME (metabolisable energy) and protein at over 20 per cent kcalME; appropriate diets contain at least 30 per cent kcalME from protein as well as fat. Approximate calorie needs are based on maintenance energy requirements. Enteral nutritional support is superior to parenteral support in most patients as gastrointestinal integrity and enterocyte viability are maintained. Meat-based pet foods, liquid enteral products and nutrient supplements are offered in slurries and via tubes. Management includes careful monitoring of patients and the gradual transition to diets with more complex nutrient sources.     

Amphibian emergency and critical care.

Amphibians present unique challenges for the clinician in the diagnosis and treatment of life-threatening conditions. Their adaptability to both aquatic and terrestrial lifestyles leaves them vulnerable to dehydration and fluid overload, either of which may accompany serious disease. This article presents the most common emergency conditions in amphibians, the physiologic basis of disease, and a guide to the diagnosis and treatment of amphibian emergencies.     

Coagulopathy in the equine critical care patient.

Disseminated intravascular coagulation (DIC) is a clinicopathologic syndrome resulting from a multitude of underlying causes that manifests itself clinically as hemostatic/fibrinolytic failure. There is much debate on the definition, diagnosis, and treatment of DIC, a situation that is most likely the result of the multifaceted clinical presentation of the syndrome and the fact that patient outcome is often influenced by the underlying disease process. The fact that DIC increases morbidity and mortality in critical care patients is well established, but the exact mechanism of what specifically occurs on a microvascular level is still often argued.     

Emergency and critical care of fish.

The keeping of fish as pets is a hobby that has experienced increasing popularity over the past decade. The hobby has also become more sophisticated in recent years and a growing number of veterinarians are gaining clinical experience and knowledge in the area of pet fish medicine. The opportunity to apply this knowledge to a pet fish problem can be a rewarding experience. This article focuses on managing acute and critical problems of pet fish at times when veterinary intervention is required within an emergency time frame.     

Emergency and critical care of rodents.

Rodents may be presented on an emergency basis with various conditions causing debilitation and disease. Common causes of emergent presentations include trauma, respiratory disease, dental disease, gastrointestinal disease, reproductive disorders, and urinary tract obstruction. Emergency treatment should always include immediate stabilization of the patient until the patient is able to tolerate diagnostic testing and additional therapeutics. Rodent patients benefit from supportive care, including thermal, fluid, and nutritional support. Administration of cardiopulmonary resuscitation, antibiotics, and analgesics through various routes is also appropriate. This article presents an overview of emergency medicine in rodents, including emergency procedures, handling and restraint, triage and patient assessment, sample collection, and supportive care procedures. The most common emergency presentations for rodents are also discussed.     

Emergency and critical care of ferrets.

Gastrointestinal disease, neoplasia, cardiac disease, and endocrinopathy are among the most common syndromes affecting the ferret that presents in an emergency situation. Knowledge of these and other disease processes, indicated diagnostic testing, and immediate treatment protocols are critical to provide efficient and effective care to the ferret in crisis.     

Emergency and critical care of fish.

Most fish emergencies are the result of inappropriate environmental conditions and primary or secondary infectious disease or trauma. The immediate response should be to increase aeration, provide suitable water, and decrease stressors. A thorough history, evaluation of the fish and their environment, and some rapid diagnostic tests (particularly direct and stained cytology) often provide the information needed to make a diagnosis and render appropriate treatment. When cohorts are at risk and the patient is unlikely to recover, euthanasia and necropsy are recommended to reach a definitive diagnosis. Some common emergencies include ammonia and nitrite toxicity; low dissolved oxygen; copper and chlorine toxicity; gas supersaturation; and certain bacterial, protozoal, and viral diseases.     

Metabolic acid-base disorders in the critical care unit.

The recognition and management of acid-base disorders is a commonplace activity in the critical care unit, and the role of weak and strong acids in the genesis of metabolic acid-base disorders is reviewed. The clinical approach to patients with metabolic alkalosis and metabolic acidosis is discussed in this article.     

Respiratory pharmacotherapy in emergency and critical care medicine.

Successful pharmacologic management of most respiratory diseases is possible. All moderately to severely affected animals benefit from rest and supplemental oxygen. Careful identification of the underlying cause as well as an understanding of the pathophysiology behind various diseases is essential to successful patient outcome.     

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.