Clinical Nutrition - Julie Hass, DVM, MS

Nutrition for our hospitalized patients is an important, although frequently overlooked, necessity for recovery from illness or injury. Patients who are acutely or chronically ill as well as those who are injured often have higher nutrient requirements compared to healthy patients. To make things more difficult, these patients often are unwilling or unable to eat. These patients will then rely on body tissue catabolism to supply the required nutrients for healing. Nutrition can be provided both through the gastrointestinal system (enteral nutrition) and through the venous system (parenteral nutrition). Enteral nutrition is the preferred method of nutrition provided that minimal to no compromise of the gastrointestinal tract is present. Since the lining cells of the gastrointestinal tact fulfill their nutritional requirements from ingested food, enteral nutrition helps to maintain the natural bacterial flora of the gut. Enteral nutrition can be provided though multiple methods, some of which can be as simple as feeding the patient, coercion feeding, or through the use of various feeding tubes. Feeding tube options can range from naso-gastric tubes, which can be placed in an awake patient, to esophagostomy tubes, which require general anesthesia, gastrotomy tubes, which require endoscopy or surgery, or finally, jejunostomy tubes, which require surgery. Decisions regarding which method of enteral feeding must be based on the patient’s current clinical condition, disease process, and anticipated duration of need for the feeding tube. An advantage to many of these feeding tubes is that owners can continue to provide nutrition to their pet at home while the pet is recovering from illness or injury. Several of these tubes can be maintained for prolonged periods of time. Equally important as the type of feeding tube are the type and amount of diet being fed. There are many types of patients and illnesses with unique nutritional requirements, and each diet must be formulated to meet the individual patient’s needs. Client involvement in the tube feeding process is often necessary. Since many feeding tubes are maintained for longer than the patient’s hospital stay, sound client education about use of the feeding tube and about potential complications of the feeding process are imperative. Even with quality client education, questions often arise. A staff knowledgeable and accessible to answer these questions often allows the client to feel more comfortable about undertaking the tube feeding process at home. Parenteral nutrition can be considered for short or long-term use in patients whose clinical condition dictates that enteral nutrition is not feasible or when enteral nutrition may not provide sufficient nutrient intake to assist recovery. Some of these conditions include severe pancreatitis, protracted vomiting or regurgitation, severely painful conditions, burns, sepsis, multiple trauma, or intestinal mal absorption. Parenteral nutrition can be provided through a peripheral or central vein, and in many different formulations. The most basic is a supplement consisting of a solution of amino acids and electrolytes in glycerol. This may be delivered by peripheral vein and can supply up to 25% of basal metabolic needs. Other formulations of parenteral nutrition are tailored to a patients needs, and consist of elemental formulations of amino acids, lipids, a carbohydrate source, vitamins, and trace minerals based on body weight, type of injury or illness, duration of parenteral nutritional supplementation, and type of nutrition being administered. It should also be noted that partial or peripheral parenteral nutrition (PPN) is delivered through a peripheral vein and can supply up to 50% of metabolic needs, while total parenteral nutrition (TPN) is delivered through a central vein and provides 100% of a patient’s nutritional needs. Since this type of nutrition is provided intravenously and there is potential for complications, patients receiving parenteral nutrition require hospitalization and extensive monitoring. Complications associated with parenteral nutrition have the potential to be extremely serious. Prevention of complications involves the use of strict aseptic technique when placing and managing the intravenous catheter, compounding the nutrition, and administering the diet, as well as judicious monitoring of the patient receiving the nutrition. Even with the use of aseptic technique and expert monitoring of the patient, complications may occur that require immediate attention. Potential complications of parenteral nutrition include the development of sepsis, peri-vascular extravasation of the diet, thrombo-phlebitis, and electrolyte, blood glucose, and biochemical abnormalities. Our staff has received training in the aseptic placement of central venous catheters, as well as the monitoring and management of patients receiving intravenous nutritional support. Veterinary Care Specialists has clinicians and staff with experience in formulating and administering both enteral and parenteral nutrition of various types. Please contact us for more information or referral of your critical patient to Dr. Mensack.

Posted on July 14, 2014
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