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Clinical nutrition

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Abstract

Small animal veterinary nutrition initially focused on the essential nutrients and minimal requirements needed to meet the basic biological needs of animals. It was later recognized that health and vitality could be further improved by modifying nutrient levels to the lifestage, lifestyle and breed of an individual animal. In addition, the metabolic changes associated with certain disease states could be corrected or controlled by adjusting levels of key nutrients. Complete nutrition is essential for maintaining good health and plays an important role in modulating many common diseases in animals. Clinical nutrition entails understanding basic nutritional principles and the application of nutrition in optimizing health and well being. This chapter considers diets for dogs and cats with specific conditions such as Hepatic disease; Renal disease; Cardiac disease; Pancreatitis; Diabetes mellitus; Neoplasia; Obesity; Skin disease; Urolithiasis; Gastrointestinal disease; and Degenerative joint disease. The chapter also considers a nutritional assessment, nutritional plan, special conditions, enteral nutrition, parenteral nutrition and monitoring for the hospitalized patient.

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Figures

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3.1 Some dogs with pancreatitis are subject to severe vomiting, which necessitates feeding via the parenteral route.
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3.2 Signs of severe malnutrition, including loss of muscle mass and poor haircoat quality, in a severely ill hospitalized patient.
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3.4 Placement of naso-oesophageal tubes can be achieved with the use of topical anaesthetic agents and can be an effective means of short-term nutritional support.
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3.5 An oesophagostomy tube is a very effective means of providing nutritional support and is generally less stressful to animals than syringe feeding.
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3.6 Selected diets for use with oesophagostomy and gastrostomy tubes often need to be mixed with water in a blender to ensure that they do not obstruct the tube.
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3.8 This radiograph shows a twisted oesophagostomy tube. This highlights the importance of obtaining a radiograph following placement of certain tubes to check appropriate placement.
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3.9 Some critically ill animals may benefit from a continuous infusion of feed through naso-oesophageal or oesophagostomy tubes.
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3.10 Parenteral nutrition is best administered via dedicated catheters designed for long-term use. A triple-lumen central catheter such as this is commonly used.
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3.11 Components of parenteral nutrition include (left to right) an amino acid source, a lipid source and a carbohydrate source.
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3.14 Parenteral nutrition requires absolute attention to aseptic technique. Bags and infusion lines must be handled with sterile gloves. Solutions are ideally mixed in a specially made total parenteral nutrition compounder, which mixes precise amounts of the components in a closed sytem, thereby maintaining absolute sterility of the solution. The solutions are held in specially made bags.
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3.16 Intravenous catheters used for parenteral nutrition must be checked daily for any abnormal discharge. This catheter is suspected of having become infected and must be removed and submitted for bacteriological culture.

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