Principles of clinical nutrition

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Clinical nutrition is an often neglected but crucial part of patient management. Proper nutrition has a vital role in preventative medicine, and many commercial diets have been developed to decrease the risk of certain disorders. This chapter examines Nutritional requirements in illness after surgery; Selecting diets for sick animals; Enteral nutrition; Parenteral nutrition; and Nutrition in specific diseases.

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5.2 Example of a simple kennel sheet that allows daily recording of food consumed. A new sheet is used every day.
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5.8 Dog receiving partial parenteral nutrition in an intensive care setting.
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5.9 A typical PPN solution formulated for humans but which can be used in dogs. The white emulsion is lipid; the middle section contains an amino acid solution; and the right hand portion contains dextrose. The fluids have a long shelf life while separated like this. When they are administered, the internal seals between the bags are broken and the solutions mixed.
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5.10 How to calculate the infusion rate required for PPN using Vamin® 9 Glucose. PPN should ideally provide 40–70% of RER and should not be continued beyond 5 days.
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5.11 Lateral skull radiograph of a puppy with juvenile nephropathy and renal secondary hyperparathyroidism. Note the marked reduction in the bone density of the skull in the mandible particularly, which gives the appearance of the teeth ‘floating’ in very little bone. (Courtesy of the Diagnostic Imaging Department, Queen’s Veterinary School Hospital, University of Cambridge)
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5.12 A kitten with a portosystemic shunt (note the copper-coloured irises which are commonly seen in cats with PSS). This is the only liver disease in cats where dietary protein restriction would be considered.
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5.13 A Great Dane with cardiac cachexia.
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5.14 Struvite uroliths passed spontaneously from the bladder of a female Dachshund. Any struvite uroliths remaining in this dog’s bladder could be dissolved and recurrence prevented using a combination of dietary and antibiotic management, provided owner and patient compliance with both were good.
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