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.     

Bacterial translocation in critical illness

Bacterial translocation involves the passage of intestinal bacteria to extraintestinal sites and has been shown to increase morbidity and mortality in critical illness. This review outlines the pathophysiology of bacterial translocation, host defence mechanisms, and reviews the evidence for the clinical management of critically ill patients in order to minimise the negative outcomes associated with bacterial translocation.     

Relative adrenal insufficiency in critical illness

Objective: To review the effects of critical illness on hypothalamic–pituitary–adrenal (HPA) function in human and veterinary medicine. Data sources: Data from human and veterinary literature was reviewed. Human data synthesis: Relative adrenal insufficiency (RAI) appears to be common in critically ill human patients with sepsis or septic shock. Hypotension that is refractory to fluid therapy and requires vasopressors is the most common presentation of RAI in the human intensive care unit (ICU). Many investigators now advocate the use of a low‐dose adrenocorticotropin hormone stimulation test to diagnose RAI. It is important to evaluate for the presence of adrenal dysfunction, because current data suggest that treatment with ‘stress’ or low doses of glucocorticoids (200–300 mg hydrocortisone daily) may improve patient outcome in humans. Veterinary data synthesis: There is a paucity of controlled studies in the veterinary literature regarding the effects of critical illness on HPA function. The results of these studies are varied. However, research models of sepsis and hemorrhagic shock suggest the existence of RAI in animals. Prospective clinical studies are needed to further examine pituitary–adrenal response to severe illness in veterinary patients, and to determine if there are therapeutic options, including glucocorticoid administration, which will improve patient outcome in animals. Conclusions: RAI is well documented in critically ill human patients, yet little is known about adrenal dysfunction in veterinary critically ill patients. A small number of studies suggest that RAI may exist in certain subpopulations of veterinary patients. The syndrome of RAI could be considered as a differential diagnosis in seriously ill veterinary patients that fail to respond to appropriate therapy, especially when hypotension refractory to fluid and vasopressor therapy is encountered. This disorder may represent a previously unidentified syndrome in critically ill veterinary patients with important therapeutic implications.     

Pituitary-adrenal function in dogs with acute critical illness

OBJECTIVE: To evaluate pituitary-adrenal function in critically ill dogs with sepsis, severe trauma, and gastric dilatation-volvulus (GDV). DESIGN: Cohort study. ANIMALS: 31 ill dogs admitted to an intensive care unit (ICU) at Washington State University or the University of Pennsylvania; all dogs had acute critical illness for < 48 hours prior to admission. PROCEDURES: Baseline and ACTH-stimulated serum cortisol concentrations and baseline plasma ACTH concentrations were assayed for each dog within 24 hours after admission to the ICU. The change in cortisol concentrations (Delta-cortisol) was calculated for each dog. Morbidity and mortality data were recorded for each patient. RESULTS: Overall, 17 of 31 (55%) acutely critically ill dogs had at least 1 biochemical abnormality suggestive of adrenal gland or pituitary gland insufficiency. Only 1 (3%) dog had an exaggerated response to ACTH stimulation. Dogs with Delta-cortisol < or = 83 nmol/L were 5.7 times as likely to be receiving vasopressors as were dogs with Delta-cortisol > 83 nmol/L. No differences were detected among dogs with sepsis, severe trauma, or GDV with respect to mean baseline and ACTH-stimulated serum cortisol concentrations, Delta-cortisol, and baseline plasma ACTH concentrations. CONCLUSIONS AND CLINICAL RELEVANCE: Biochemical abnormalities of the hypothalamic-pituitary-adrenal axis indicative of adrenal gland or pituitary gland insufficiency were common in critically ill dogs, whereas exaggerated responses to ACTH administration were uncommon. Acutely ill dogs with Delta-cortisol < or = 83 nmol/L may be more likely to require vasopressors as part of the treatment plan.     

Llama medicine. Nutrition

The NWC are capable of assimilating a much lower plane of nutrition than we are accustomed to offer conventional domestic herbivores. Their unique gastric anatomy and physiology no doubt contribute to this apparent superiority, which is most evident when compared with sheep under lesser planes of nutrition. Llamas tend to be "cafeteria style" eaters, with some preference being given to taller, coarser forages. Absolute maintenance requirements for caloric, protein, fiber, and mineral content of NWC rations are yet to be finalized using North American feedstuffs, but some guidelines are offered. Proper assessment of body condition, acknowledgment of any nutritional problems, ration analysis, and assessment of management procedures likely will keep NWC nutrition on an even plane here in their new-found environment.     

Nutrition of rodents.

Access to a diet that provides adequate nutrition is one of the most important environmental factors influencing the well-being of rodent colonies. The dietary ingredient and nutrient composition, as well as the potential biological and chemical contaminant concentrations, are factors for consideration in selecting diets for a specific rodent colony. Estimated nutrient requirements have been published for the rodent species that are commonly used in biomedical research. The nutrient concentrations in adequate diets for other captive rodent species that are not used in biomedical research are more difficult to obtain. However, reasonable estimates of their nutrient requirements can be obtained by extrapolation of data from rodent species of a similar metabolic weight and size or from nutrient concentrations of diets that have a history of acceptable performance in the species of interest. Captive rodent colonies should be provided with nutritionally balanced diets with only limited amounts of succulent foodstuffs. The practice of feeding rodent colonies specific cereal grains is discouraged, since no single grain provides a balanced rodent diet.     

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.     

Nutrition of aquaculture species.

Dietary requirements for amino acids and fatty acids have been reported for channel catfish (Ictalurus punctatus), salmonids (Oncorhynchus spp.), common carp (Cyprinus carpio), tilapias (Oreochromis spp.), and eel (Anguilla japonicus). Most of the vitamin and mineral requirements are available for channel catfish and salmonids, and some are available for common carp, tilapia, eel, and other finfish and crustaceans. From this available information, cost-effective feeds can be formulated for the major commercial aquaculture species. Major differences in nutrient requirements between fish and mammals or birds are as follows: fish have a lower digestible energy:protein ratio (8 to 10 kcal of DE/g of CP for fish vs 15 to 20 kcal of DE/g of CP for livestock); fish require n-3 fatty acids and land animals require n-6; fish can absorb minerals from the water, which negates the need for some minerals in the diet; and fish have limited ability to synthesize vitamin C and must depend on a dietary source. Areas for further research include 1) refinement of nutrient requirements of the major culture species considering effects of fish size, temperature, and management; 2) nutrient requirements of crustaceans; 3) effects of nutrition on fish health and product quality; and 4) feeding technology.     

Nutrition of captive reptiles.

In reptile practice, most nutritional problems arise from improper husbandry, including poor feeding management and provision of imbalanced diets. Each reptile species has its own requirements for temperature and humidity, space and social interaction, lighting, and habitat components. Failure, to provide these requirements often results in failure to thrive and secondary nutritional disorders. Common dietary problems include deficiencies of energy, calcium, vitamin D3, vitamin A, and fiber.     

Nutrition of ornamental fish.

Because thousands of species comprise the aquarium hobby, ornamental fish nutrition is an art and a science that must be approached systematically and holistically. Examinations of species-specific anatomy and natural history are useful starting points. Food fish research provides fundamental nutritional information, but food fish are not ideal models for all ornamentals. This article briefly addresses freshwater and marine fish issues, including considerations for pond fish and live foods.     

Nutrition and immune function.

The complexity of the immune system allows for a multitude of potential avenues for nutrient modulation, but this also increase the challenge of producing a predictable in vivo response. Because the immune response is a cascade of biologic events, development of nutritional support paradigms cannot and should not be made in a vacuum or with the expectation of a singular response. It is absolutely imperative that the clinician/nutritionist understand the differences in metabolIc and physiologic responses to disease states (ie, shock, trauma, organ-specific dysfunction) so as to maximize immunocompetence through specialized feeding practices. This level of understanding is invaluable, especially when considering the possible benefit of nutrient combinations for immunomodualtion.     

Nutrition of orphan marsupials.

Marsupial milk has been found to be high in fats, protein and ash compared to eutherian milk. The generally low lactose content of marsupial milk and the corresponding low intestinal lactase activity of pouch young marsupials, when considered with the incidence of diarrhoea and the occasional formation of cataracts in orphan kangaroos fed on cow's milk (which has a high lactose content), suggests that a lactose-free milk be fed to orphan marsupials. Of the lactose-free milk substitutes for children now available, it is recommended that Pregestimil, Glucose Nutramigen and particularly CFI be used for very young orphan marsupial herbivores (especially kangaroos), as these are both lactose- and sucrose-free. Isomil, Prosobee and Triglyde, containing sucrose, may be suitable for older kangaroos which are also ingesting solids and brush-tailed possums of all ages. The appropriate natural diet of the orphan marsupial should be available at the time when initial solid food ingestion would occur in the natural state. It is suggested that milk substitute continue to be given until the orphan animal reaches the age where, in the natural state, it would be full independent.     

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.