EmerAid® Sustain™ HDN Canine
or “Highly Digestible Nutrition” is a therapeutic diet scientifically designed to support canines that are recovering from critical illness, suffering from chronic medical conditions, or underweight. It is also designed to transition the debilitated dog from intensive care nutrition to normal feeding. As a recovery diet, it contains more whole nutrients than EmerAid Intensive Care HDN Canine. Developed by an expert panel, including critical care veterinarians and nutritionists, this therapeutic diet is easily absorbed and highly digestible.
- Available in 100-gram, 400-gram, and 2-kg pouches
- Powder is easily mixed with water to create a formula that can pass through tubes as small as 5-French
- Meets AAFCO nutritional requirements for all canine life stages
How to Administer EmerAid Canine Sustain
Indications & Contraindications
EmerAid® Sustain™ HDN™ Canine is a recovery diet that contains more whole nutrients than EmerAid® Intensive Care HDN Canine. EmerAid® Sustain™ HDN™ Canine is indicated for patients recovering from a critical illness but are not ready for their normal diet.
- Convalescence
- Malnutrition, cachexia
- Anorexia or poor appetite
- Nutritional support during the pre- or post-operative period
- Failure to thrive or gain weight
- Acute kidney disease
- Neglect
- Severe parasitic infestations
- Infectious disease
- Autoimmune disease
- Anemia
- Peritonitis
- Malabsorption/maldigestion
Contraindications
- Chronic kidney disease
- Hepatic encephalopathy
Features & Benefits
- High energy (2.21-1.67 kcal/ml ME)
- One month shelf life after opening
- Goes through tubes as small as 5 Fr without clogging
- Excellent for bolus tube feeding or syringe feeding
- Species-specific nutritional formulation
- More whole proteins than Intensive Care HDN
- Essential and conditionally essential amino acids to meet the needs of the metabolically stressed patient
- L-carnitine, branched chain amino acids and highly digestible proteins promote lean body mass and wound healing
- Balanced levels of omega 3:omega 6 polyunsaturated fatty acids
- Omega-3 fatty acids to modulate the inflammatory response and aid in tissue synthesis
- Synergistic antioxidants vitamin E, vitamin C, zinc and taurine to defend against oxidative stress
- Glutamine and arginine support immunity and antioxidant systems
- L-tryptophan, a precursor for the synthesis of serotonin to reduce stress
- Maintains and promotes enterocyte health to allow for the maximum absorbable nutrition in the gastrointestinal tract (GIT)
- Dietary nucleotides provide RNA and DNA precursors to support the immune system, nourish the GIT, and assist in weight gain
- Hydrolyzed soy protein minimizes gastrointestinal hypersensitivity. These highly digestible macronutrients prevent and manage osmotic diarrhea, as is associated with completely elemental diets
- Casein aids in the digestion of fats and tissue synthesis while providing anxiolytic properties
- Fiber levels appropriate to maintain intestinal motility and commensal microflora
- Cellulose serves as a source of insoluble fiber and acts as a prebiotic
- Hydrolyzed starch supplies glucose, disaccharides, and oligosaccharides, to avoid the osmotic problems associated with glucose only feeding. Vital for the acute carbohydrate needs associated with debilitation
- Balanced electrolytes
- Stabilized vitamins and chelated minerals
- Neutral pH
- Free of artificial colors and preservatives
- Naturally preserved with mixed tocopherols and citric acid
- Meets canine adult maintenance requirements
Storage, Handling & Expiration Date
Store EmerAid® Sustain™ HDN™ Canine in a cool, dry space. The shelf life of unopened EmerAid® Sustain™ HDN™ Canine is approximately 18 months from the date of manufacturing (see the “Best Before” label). Refrigerate after opening, and use EmerAid® Sustain™ HDN™ Canine within 1 month of opening
***WARNING*** EmerAid® Sustain™ HDN™ Canine has been scientifically designed to be highly digestible. Avoid contamination by handling the product carefully. Keep the powder dry until ready to mix with water, and use a clean, dry scoop. Do not cross-contaminate with scoops using non-EmerAid foods as contamination can cause harmful bacterial growth.
Ingredients & Nutrient Profile
Cooked Chicken, Potato Starch, Dried Hydrolyzed Casein, Ground Rice, Hydrolyzed Soy Protein, Glucose Syrup Solids, Dried Chicken Liver, Dried Whole Egg, Corn Oil, Canola Oil, Dicalcium Phosphate, Defatted Wheat Germ, Cellulose, Potassium Chloride, Ground Limestone, Iodized Salt, Dextrose, Choline Chloride, DL-Methionine, Citric Acid, L-Lysine, Magnesium Sulfate, Taurine, Vitamin E Supplement, Zinc Oxide, Copper Methionine Chelate, L-Carnitine, Niacin Supplement, Ascorbic Acid, Tocopherols, D-Calcium Pantothenate, Sodium Selenite, Vitamin A Supplement, Vitamin B12 Supplement, Manganous Oxide, Thiamine Hydrochloride, Riboflavin Supplement, Pyridoxine Hydrochloride, Biotin, Folic Acid, Vitamin D3 Supplement.
Download the Canine EmerAid HDN Nutrient Profile PDF (229 KB)
| Nutrient | As Fed | Units | Per 100 kcal |
|---|---|---|---|
| ME | 4329.00 | kcal/kg | |
| Protein | 30.20 | % | 6.98 g/100 kcal |
| Fat | 24.90 | % | 5.75 g/100 kcal |
| Fiber | 3.70 | % | 0.85 g/100 kcal |
| Moisture | 7.50 | % | 1.73 /100 kcal |
| Calcium | 1.35 | % | 0.31 g/100 kcal |
| Phosphorus | 1.12 | % | 0.26 g/100 kcal |
| Potassium | 0.70 | % | 0.16 g/100 kcal |
| Chloride | 0.86 | % | 0.20 g/100 kcal |
| Magnesium | 0.08 | % | 0.02 g/100 kcal |
| Sodium | 0.36 | % | 0.08 g/100 cal |
| Iron | 409.79 | mg/kg | 9.47 mg/100 kcal |
| Manganese | 20.00 | mg/kg | 0.46 mg/100 kcal |
| Copper | 20.00 | mg/kg | 0.46 mg/100 kcal |
| Zinc | 125.00 | mg/kg | 2.89 mg/100 kcal |
| Vitamin A | 10337.78 | IU/kg | 239 IU/100 kcal |
| Vitamin D3 | 693.73 | IU/kg | 16 IU/100 kcal |
| Vitamin E | 71.44 | IU/kg | 2 IU/100 kcal |
| Vitamin K | 30.11 | IU/kg | 1 IU/100 kcal |
| Biotin | 0.26 | mg/kg | 0.01 mg/100 kcal |
| Choline | 2600.00 | mg/kg | 60.06 mg/100 kcal |
| Folic Acid | 36.61 | mg/kg | 0.85 mg/100 kcal |
| Niacin | 121.50 | mg/kg | 2.81 mg/100 kcal |
| Panto Acid | 36.43 | mg/kg | 0.84 mg/100 kcal |
| Pyridoxine | 8.76 | mg/kg | 0.20 mg/100 kcal |
| Riboflavin | 12.00 | mg/kg | 0.28 mg/100 kcal |
| Thiamin | 5.62 | mg/kg | 0.13 mg/100 kcal |
| Vitamin B12 | 1.58 | mg/kg | 0.04 mg/100 kcal |
| Vitamin C | 82.91 | mg/kg | 1.92 mg/100 kcal |
| Lysine | 2.71 | % | 0.63 g/100 kcal |
| Methionine | 1.04 | % | 0.24 g/100 kcal |
| Taurine | 0.10 | % | 0.02 g/100 kcal |
| Carnitine | 0.01 | % | 0.005 g/100 kcal |
| Linoleic, n-6 | 6.39 | % | 1.48 g/100 kcal |
| Linolenic, alpha n-3 | 0.56 | % | 0.13 g/100 kcal |
| 20:4 arachidonic | 0.20 | % | 0.05 g/100 kcal |
a. Available Phosphorous b. When made as a 3:2 part ratio
Mixing Directions
Use a syringe to draw up the mixture. When finished, flush and clean the feeding syringe. Make fresh mixture for each feeding. Discard remaining food after each feeding.
For your convenience and your patient’s benefit, standard mixing directions have been updated in 2016:
| Feeding Style | EmerAid Powder (parts)* | Water** (parts) | ME*** (kcal/ml) |
|---|---|---|---|
| Syringe | 3 | 2 | 2.21 |
| Tube (10Fr or larger) | 2.5 | 2 | 1.93 |
| Tube (5Fr-8Fr) | 2 | 2 | 1.67 |
| * “Parts” indicate the proportions needed. To mix EmerAid, you can use the scoop provided, a syringe cap, any measuring implement of your choice as long as the proportions described above remain consistent ** Mix with hot water measuring 122°F (50°C) *** Metabolizable energy when made as directed |
|||
| EmerAid Sustain HDN pouch (g) | Number of tablespoons a per container b |
|---|---|
| 100 | 12.5 |
| 400 | 50.0 |
| 2000 | 250.0 |
| a 1 scoop = 1 tablespoon (tbsp) b 1 tbsp of EmerAid Sustain HDN Canine weighs 8 (7.5) grams |
|
| How many kcal per scoop of EmerAid Sustain Canine? | |||
|---|---|---|---|
| 1 scoop*= 7.5 grams | 4329 kcal/kg | 4.329 kcal/g x 7.5 g | 32.47 kcal/scoop |
| *1 scoop = 1 TBSP | |||
Feeding Recommendations
Adult Dog Feeding Recommendations
See our Basic Use Guide
EmerAid® Sustain™ HDN™ Canine is a therapeutic product to be used only under the supervision of a veterinarian. Begin with 25% to 30%
of the resting energy requirement and gradually adjust the volume and number of feedings based on patient condition. A volume of 5-10 ml/kg/feeding is generally well tolerated via esophagostomy or gastric tube. Calculation for Resting Energy Requirement: RER = [70 x BW(kg)0.75]
Table 1. In adult dogs, EmerAid® Sustain™ HDN™ Canine feeding recommendations are based on predicted resting energy requirements (RER)a
| BW (kg) | BW (lb) | RER (kcal/day) | Feed (G/day)b | Feed (ml/day)c |
|---|---|---|---|---|
| 1 | 2.2 | 70 | 16.1 | 32 |
| 2 | 4.4 | 118 | 27.3 | 53 |
| 4 | 8.8 | 198 | 45.7 | 90 |
| 6 | 13.2 | 268 | 61.9 | 121 |
| 8 | 17.6 | 333 | 76.9 | 156 |
| 10 | 22 | 394 | 91.0 | 178 |
| 15 | 33 | 534 | 123.3 | 242 |
| 20 | 44 | 662 | 152.9 | 300 |
| 25 | 55 | 783 | 180.9 | 354 |
| 30 | 66 | 897 | 207.2 | 406 |
| 35 | 77 | 1007 | 232.6 | 456 |
| 40 | 88 | 1113 | 257.1 | 504 |
| 45 | 99 | 1216 | 280.9 | 550 |
a From Ramsey JJ. Determining energy requirements. In: Fascetti AJ, Delaney SJ (eds). Applied Veterinary Clinical Nutrition. Wiley-Blackwell: Ames, IA, 2012: 33-36 and Thatcher CD, et al. Small Animal Clinical Nutrition: An Iterative Process. In Hand MS, Thatcher CD, Remillard RL, Roudebush P, and Novotny BJ (eds). Small Animal Clinical Nutrition 5. MMI, Topkea, KS, 2010. Maintenance energy requirements listed are for inactive dogs.
b EmerAid Sustain HDN Canine contains 4.414 kcal/grams (1 scoop = 1 tbsp = 7.5g)
c Recommendations based on 3.5:2 mixing ratio and RER. See our Feeding Example below.
Puppy Feeding Recommendations
Puppies have relatively high energy requirements when compared to adult dogs. EmerAid Sustain HDN Canine meets or exceeds requirements for all canine life stages. Begin with 25% to 30% of Daily energy requirements and gradually adjust the volume and number of feedings based on patient condition. A volume of 5-10 ml/kg/feeding is generally well tolerated via esophagostomy or gastric tube. Daily energy requirements can be calculated using the following equation [70 x BW(kg)0.75] x 3.
Table 2. In puppies, EmerAid Sustain feeding recommendations are based on predicted daily energy requirements (DER)
| BW (kg) | BW (lb) | Est DER (kcal/day)d | Max Fed (G/day)e | Max Fed (ml/day)f |
|---|---|---|---|---|
| 0.2 | 0.44 | 63 | 14.5 | 29 |
| 0.4 | 0.90 | 106 | 24.5 | 48 |
| 0.6 | 1.3 | 143 | 33.0 | 65 |
| 0.8 | 1.8 | 178 | 41.1 | 81 |
| 1.0 | 2.2 | 210 | 48.5 | 95 |
| 1.8 | 4.0 | 328 | 75.8 | 148 |
| 2.7 | 6.0 | 445 | 102.8 | 201 |
| 3.6 | 8.0 | 552 | 127.5 | 250 |
| 4.5 | 10.0 | 653 | 150.8 | 295 |
| 6.8 | 15.0 | 885 | 204.4 | 400 |
| 9.1 | 20.0 | 1098 | 253.6 | 497 |
| 11.3 | 25.0 | 1298 | 299.8 | 587 |
| 13.6 | 30.0 | 1488 | 343.7 | 673 |
| 18.1 | 40 | 1846 | 426.4 | 835 |
| 22.7 | 50 | 2182 | 504.0 | 987 |
| 27.2 | 60 | 2502 | 577.9 | 1132 |
d Daily energy requirements for puppies less than 4 months of age were calculated as 3 x RER where RER = 70 x BW (kg)0.75
e EmerAid Sustain HDN Canine contains 4.414 kcal/grams (1 scoop = 1 tbsp = 7.5g)
f Recommendations based on 3.5:2 mixing ratio and RER. See our Feeding Example below.
Feeding Example
Seven-year-old, male, castrated, Bla
ck Lab mix dog that has recovered from critical illness, but exhibits failure to gain weight. Body weight 23 kg (51 lb); BCS 2/5.
| BW (kg) | BW (lb) | Est RER (kcal/day) | Feed (G/day) | Feed (ml/day) |
|---|---|---|---|---|
| 20 | 44 | 662 | 150.5 | 297 |
| 25 | 55 | 783 | 178.0 | 351 |
Unless the patient has been previously syringe fed or tube fed, begin cautiously with 30% to 50% of this estimated volume for the first feeding: ~25 ml to 50 ml. Patient body weight falls midway between the guidelines listed above. Therefore the recommended volume to be fed falls between 297 ml and 351 ml per day. The median value is 324 ml and this number represents the maximum estimated volume to be fed daily. Begin feedings cautiously every 4 to 6 hours in this patient. Dividing 324 ml by 4 gives us approximately 80 ml per feeding. Estimated volume for the first feeding should fall between 30-50%: ~24 ml to 40 ml.
| First meal: | 1/3 of calculated energy requirements | ~ 24 ml |
Evaluate the Patient’s Feeding Response
Did the patient accept this feeding well? Does the food appear to be tolerated by the patient’s GI tract? If yes, increase the volume fed gradually over the course of two to three feedings. Frequency and volume should be adjusted based upon patient response, but a cautious plan could be:
| First Meal | 1/3 of calculated energy requirements | ~24 ml |
|---|---|---|
| Second Meal | 2/3 of calculated energy requirements | ~48 ml |
| Third Meal | 3/3 of calculated energy requirements | ~80 ml |
If patient tolerates the increase in frequency and in volume of EmerAid® Sustain HDN™ Canine, continue feeding per below:
Daily meals: 80 ml, four times/day
Long-Term Feeding
Under the direct supervision of a veterinarian, canine patients may be fed EmerAid® Sustain™ HDN™ long-term. When the patient has fully recovered, they may transition to their regular diet as recommended by their veterinarian.