Cachexia and pregnancy toxemia

Question 1

What is cachexia?

Answer 1

A metabolic wasting disorder accompanied primarily by loss of lean body mass

Question 2

What diseases is commonly linked with cachexia?

Answer 2

• Cancer
• Congestive heart failure
• Chronic kidney disease
• COPD

Question 3

Characteristics of cachexia

Answer 3

• Decrease in skeletal muscle mass
• With or without weight loss
• Loss of appetite
• Increased metabolic rate

Question 4

Difference between cachexia and starvation

Answer 4

In cachexia patients, nutrients are readily available to them but they don’t have the correct response. Protein degradation begins early on even though there are carbohydrates and lipids present.

Question 5

What hormone responsible for cachexia?

Answer 5

Tumour necrosing factor-alpha (TNF-alpha)- highly elevated in many diseases.

Question 6

Role of tumour necrosing factor-alpha

Answer 6

• Acts on CNS. Triggers brain to decrease food intake which can lead to anorexia.
• Activates NF which leads to activation of ubiquitin-proteosome system (protein breakdown), triggers inflammation, and inhibits myogenesis

Question 7

TNF-alpha metabolic effects

Answer 7

• Increases muscle loss
• Decreases food intake= anorexia
• Impaired glucose control by inhibited protein phosphatase 1 and IRS-1 (used to form glycogen, create fat, and increase GLUT 4)
• Increases lipid mobilization/lipolysis (by inhibiting protein phosphatase 1)

Question 8

Congestive heart failure and cachexia

Answer 8

• Inadequate blood pumping to the body (Hypoxemia)
• ~50% of dogs with CHF display cachexia
• Strong triangular relationship between heart failure, increasing TNF-alpha levels, and muscle loss

Question 9

Multifactorial cause of muscle and fat loss

Answer 9

• Lack of appetite
• Decreased perfusion of GI system
• Increase in inflammatory factors (enhancing muscle protein and degradation)
• Increased resting energy requirement

Question 10

Cachexia with edema and ascites

Answer 10

Cachexia dogs show a decreased level of serum albumin which is due to an increased use of amino acids for energy, and a reduction of protein synthesis function of the liver

Question 11

How do animals with cachexia lose muscle without losing weight?

Answer 11

Cachexia animals have increased fluid retention which can mask the muscle and fat loss in terms of overall weight.

Question 12

Obesity paradox with cachexia

Answer 12

Animals that are diagnosed with different conditions have a decreased morbidity when they have a lower BCS (more lean). Obese animals will have an improved survival rate; the excess fat storage may be protective.

Question 13

What is pregnancy toxemia?

Answer 13

A metabolic disease in pregnant animals caused by an imbalance between dam nutritional intake and fetal demand.

Question 14

When does pregnancy toxemia occur?

Answer 14

Commonly occurs during late gestation.

1. Large fetus size, can compress the mothers stomach and reduce appetite and therefore nutritional intake
2. Negative energy imbalance created by exponential energy requirement of fetus at late gestation and reduced food intake

Question 15

Primary markers of pregnancy toxemia

Answer 15

• Lethargy
• Anorexia (starvation response)
• Blood chem test should show hypoglycemia and hyperketonemia

Question 16

Pregnancy toxemia starvation pathway

Answer 16

When glucose levels decrease, the fetus must use ketones. Often the mother must produce lots of ketones to be able to produce one ketone for the fetus. Therefore, the mother will have severe hyperketonemia leading to excess fetal ketone, metabolic acidosis and increased birth defects of the fetus.

Question 17

Ruminants and Ketones during pregnancy toxemia

Answer 17

Pregnancy toxemia is very common in ruminants. Firstly because they often have multiples, but also because it takes the mother producing 10 ketone molecules for every 1 ketone molecule to be transferred to the fetus. Mother would need to have very high levels of ketogenesis resulting in environment change of fetus.

Question 18

How do you supplement for pregnancy toxemia?

Answer 18

1. Glucose supplements (corn syrup or polyethylene glycol)
2. Fluid and electrolyte therapy