Critical Cases Benefit from Nutrition
by Kara M. Burns, MS, MEd, LVT, VTS (Nutrition)
Malnutrition in veterinary patients leads to increased morbidity and mortality. In the GI tract, transit times increase, absorptive capabilities decrease, villous atrophy, and there is an increased risk of bacterial translocation. Malnutrition has been documented to decrease humoral immunity and barrier function, inflammatory response, leukocyte motility, and bactericidal activity. Protein malnutrition may modify the normal or expected metabolism of certain drugs, which may alter their therapeutic effect, even when given at recommended dosages.
Additionally, evidence suggests that nutritional support should begin as soon as possible in the critical or hospitalized patient. The risk factors to consider are: history of inadequate nutritional intake; serious underlying disease (e.g., severe trauma, peritonitis, acute pancreatitis, major gastrointestinal surgery); and large protein losses (e.g., protracted vomiting, diarrhea, protein-losing nephropathies, burns, etc.). Patients with these risk factors are candidates for nutritional support and this nutritional support should begin as soon as possible.
How does critical care nutrition help dogs with Parvovirus?
Parvovirus is a nonenveloped, single-stranded DNA virus. Canine parvovirus frequently infects dogs aged 6 weeks to 6 months as well as unvaccinated adult dogs. Transmission occurs through the fecal–oral or oronasal route by exposure to fecal material, vomitus, or fomites. Clinical signs of parvoviral enteritis are vomiting and diarrhea resulting from enterocyte destruction, which is caused by the virus taking advantage of the high mitotic rate of intestinal crypt cells to replicate. Key signs of lethargy, inappetence, abdominal pain, and subsequent dehydration and hypovolemia are related to breakdown of the gastrointestinal mucosa and increased intestinal permeability; neutropenia can result from bone marrow involvement. Intestinal damage can lead to secondary bacterial infection, bacterial translocation, bacteremia, and sepsis.
Damage to the gastrointestinal lining (enterocyte destruction mentioned prior) makes it difficult for nutrients to be absorbed, thus creating a need for nutrients to be offered in their smallest forms, ‘the building blocks of protein (free amino acids, peptides, and/or hydrolyzed protein fractions), fats (fatty acids), and carbohydrates’ (mono-, di- and trisaccharides). This is known as a semi-elemental diet.
EmerAid® HDN™ formulas are species specific, semi-elemental diets. They provide easy to digest nutrients while minimizing the risk of diarrhea. EmerAid® HDN™ can be reconstituted as needed to be fed through a feeding tube, syringe, or as a calorically dense bite of nutrition.
EmerAid is also energy dense, which is extremely beneficial to critical patients and the GI tract. Energy dense foods provide higher energy delivered in smaller amounts of food. Thus, patients receive the nutrition they need in the proper amounts through multiple small ‘meals’. Smaller amounts put less strain on the gut while providing needed energy for healing.
Boomer is a 13 week old intact male mixed breed dog. Boomer presented with a 24 hour onset of vomiting and hemorrhagic diarrhea, anorexia, and lethargy. Upon examination, Boomer was 10% dehydrated, hypothermic (99⁰F/37.2C), hypoglycemic (67 mg/dL), laterally recumbent, BCS 2/5, and strongly positive for parvovirus antigen. Electrolytes and PCV were below normal range. Boomer was admitted to the hospital. Antibiotics, IV fluids, and anti-emetics were administered, and a nasoesophageal feeding tube was placed.
Vitals, electrolytes, and hematocrit were closely monitored. The patient began EmerAid Intensive Care HDN Canine through the NE tube within hours of admission. EmerAid is highly digestible and easily absorbed, thus aiding enterocytes in the GI tract. Getting nutrition into patients early in the treatment process helps to prevent bacterial translocation and bacteremia, while improving immune function.
Boomer tolerated treatment and EmerAid through the NE tube. After two days Boomer was responding well to the treatment plan and his PCV was WNL. Day 3 found his electrolytes, hypoglycemia, hydration status, and temperature had returned to normal. The NE tube remained in place, and he continued to receive EmerAid through the feeding tube until discharge 2 days later. At this time, he was transitioned to EmerAid Sustain HDN, which he readily ate out a bowl, and added to his puppy food, for another 7 days.
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