Advanced Clinical Nutrition

Question 1

What are the indicators of malnutrition?

Answer 1

Poor MCS (cachexia)
Poor BCS
Unexplained weight loss over 5-10%
Poor coat condition
Reduced appetite for more than 2-3 days
Anorexia

Question 2

Describe simple starvation.

Answer 2

Healthy patient without access to food
Normal metabolic adaptations - utilisation of glycogen stores
Conservation of protein
Fat usage increased

Question 3

Describe stress starvation.

Answer 3

Unwell patient
Hypermetabolism
Breakdown of protein/muscle wastage - catabolism
Less time to state of malnutrition
Cachexia
Poorer prognosis for recovery

Question 4

Define sarcopenia vs cachexia.

Answer 4

Sarcopenia = muscle loss in old age without presence of disease
Cachexia = muscle loss in presence of disease

Question 5

What are our short-term nutritional aims?

Answer 5

Provide for any ongoing nutritional requirements
Prevent/correct nutritional deficiencies/imbalances
Minimise metabolic derangements
Prevent further catabolism of lean body mass

Question 6

What are our long-term nutritional aims?

Answer 6

Restoration of optimal body condition
Provision of required nutrients to animal within its own environment

Question 7

What 4 types of tubes can be used for assisted enteral feeding?

Answer 7

NO/gastric - short-term
Oesophagostomy - long-term
Gastrostomy - long-term
Jejunostomy - long-term

Question 8

What factors affect which enteral feeding tube we choose?

Answer 8

Patient - tolerance, anaesthetic risk, duration required
Technical - clinician experience, risk of complications, type of diet
Owner - cost, ability to use at home if required

Question 9

Define re-feeding syndrome.

Answer 9

Complex metabolic derangements that occur when enteral/parenteral nutrition is fed to severely malnourished patients, or those following a period of prolonged starvation

Question 10

What metabolic changes are associated with re-feeding syndrome?

Answer 10

Severe hypophosphataemia
Hypokalaemia
Hyponatraemia
Hyperglycaemia
Hypocalcaemia

Question 11

What are the clinical signs of re-feeding syndrome?

Answer 11

Peripheral oedema (pitting)
Haemolytic anaemia
Cardiac failure
Neurological dysfunction
Respiratory failure
Death within 2 days of starting to eat again

Question 12

How can we avoid re-feeding syndrome?

Answer 12

Wait until patient is haemodynamically stable
Micro-enteral nutrition (oral rehydration fluid with electrolytes)
Small, frequent meals
Tube feed until patient voluntarily eating >85% of calculated energy requirements daily

Question 13

Describe parenteral nutrition.

Answer 13

Providing patients with nutrition via IV route when enteral nutrition is not possible
Supported enteral nutrition must be first line of nutritional support

Question 14

What is parenteral nutrition composed of?

Answer 14

Lipid
Amino acids (proteins)
Carbohydrate (dextrose/glycerol)

Question 15

How is parenteral nutrition delivered?

Answer 15

Only by peripheral lines
Monitor twice daily for signs of phlebitis/infection
Delivered via CRI pump
Manage bags to avoid separation, not open and in use for more than 24-48hrs
Discard line and bag to replace, protect from light (B vitamins)

Question 16

What are some possible complications with parenteral nutrition?

Answer 16

Metabolic (most common)
Mechanical e.g. occlusion, dislodgement, patient interference
Septic

Question 17

How can we prevent complications occurring with parenteral nutrition?

Answer 17

Experienced personnel
Clear protocols and procedures in place
Aseptic techniques
Prevent patient interference
Regular monitoring and recording

Question 18

What are some risks associated with raw diets?

Answer 18

Imprecise nutritional measurements
Low vitamin and mineral content
Microbiological infection
Salmonella, Listeria, Toxoplasma, Mycobacterium
Ingested throat tissue leading to hyperthyroidism

Question 19

How can owners minimise risk from raw feeding?

Answer 19

Irradiated diets to remove some pathogens
NOT ground meat (increased surface area and processing)
Cook food prior to consumption (74 degrees Celsius)
Scrupulous hygiene
Regular anthelmintic therapy
Home freezing NOT effective

Question 20

What are some issues with vegetarian diets?

Answer 20

Increased protein requirement than people
Limited essential amino acids
Essential feline dietary nutrients (taurine, arginine, vitamins A, B and niacin)
Reduced palatability, digestibility, biological value