NUTRITIONAL LIQUID DIETS IN PETS
By Dr. Mangesh Nakade (DVM MS PhD Post DOC)*
Generally, nutritional support should be considered for any animal that has been anorexic or has had an inadequate voluntary caloric intake for ≥ 3 days, has lost ≥ 10% of its body weight or has other signs of malnutrition like poor hair coat, muscle wasting, poor wound healing, hypoalbuminemia, lymphopenia etc.
In addition, many dogs and cats don’t get hydrated with balanced electrolytes and energy supplementation during surgery and then post-operative recovery that is marked by pain, discomfort, and drug-induced nausea further deprives their body of energy.
In this scenario, a high energy oral nutrition is essential for providing nutritional support to animals, which are either unwilling or unable to consume sufficient calories on their own during convalescence.
CURRENT PRACTICES – INDIAN VETERINARY CLINICS:
Currently in India, a completely balanced clinical nutritional liquid diet is NOT available for pets suffering from convalescence. Hence, veterinary surgeons and doctors are compelled to provide high doses of saline and glucose (through IV) as early enteral treatment. It is to be noted that these saline solutions can at the best provide and partially satisfy energy requirements of a sick dog, but they are unable to provide all the essential micro & macronutrients required for quickest recovery of sick pets at the same time.
Though some mineral liquid diets are available in abroad, they can be at best used for hydrating a dog; as they are made up of only minerals, they are certainly NOT a completely balanced diet.
In some instances, recovery tins (paste products) are being fed to ICU dogs. But, they cannot be easily swallowed and digested by sick dogs because of their inherently weak digestive tract. In some acute cases, these improper nutritional practices are resulting in liquid blood motion, which is aggravating the already critical state of respective dogs.
THE NEED OF THE HOUR:
Considering the above-mentioned problems, there is an urgent need for a high energy, complete natural food-based Indian liquid diet, which will provide all essential nutrients in an easily digestible manner and will also aid in quickest recovery from sickness.
Completely balanced clinical nutritional liquid diet for dogs and cats have been found to decrease complications, prevent gut permeability and increase the bursting strength of intestinal surgical site and decreased mortality chances.
A veterinary study looked at dogs with septic peritonitis and found that dogs that got a completely balanced early nutrition (those that ate, had supported enteral nutrition, or parenteral nutrition) had a shorter hospitalization by 1.6 days.
For ICU pets, completely balanced clinical liquid enteral nutrition (EN) will aid in maintaining functional integrity of their gut by maintaining tight junctions between the intraepithelial cells, stimulating blood flow and inciting the release of trophic endogenous agents (agents that increase cell growth). They also maintain structural integrity of gastrointestinal tract by maintaining villous height and supporting immune cells of intestinal tract.
In addition, they may decrease inflammatory cytokine production, modulate inflammatory acute phase response and decrease catabolism (protein breakdown) to preserve protein.
When should this be prescribed?
Patients should be hemodynamically stable before nutritional intervention is initiated. It is suitable for patients who require precise feeding orders, including route, diet amount and frequency. Assisted feeding techniques should be instituted in patients with:
- Inadequate food intake for longer than 3–5 days.
- Days of anorexia/hyporexia.
- Critical illness or injury, weight loss, muscle loss.
- GI dysfunction or disease (acute diarrohea, vomiting etc).
- Jaw fracture / Neurological movement disorders that increase caloric requirements.
- Intensive critical care required diseased conditions.
- Kidney diseases in which diet change may be temporary, but the dog will have to get a wet diet that will give less work to its kidneys, which will be permanent.
- Diabetes may require liquid nutrition until the blood sugar is normalized.
- A liver condition, as liquid nutrition will allow the liver tissue to recover.
- In case of senile dogs that may have a difficult time eating.
What is the optimal feeding route?
The optimal feeding route (Oral or Tube Feeding) depends upon a number of patient-dependent issues:
- Function of the GI tract
- Patient’s ability to tolerate tube placement
- Risk of aspiration
(Please refer WSAVA Feeding Guide for Hospitalized Dogs and Cats).
Oral syringe feeding, Nasogastric/nasoesophageal tubes (for short-term use) or esophagostomy/gastrostomy tubes (for long-term use) are excellent options for animals that are unable to or are unwilling to eat adequate amounts voluntarily.
*If an animal is going to be anesthetized for diagnostic or therapeutic procedures, it is recommended to place a feeding tube if there is any indication that one may be needed.
What is the appropriate intake amount?
Resting energy requirement (RER) should be the initial caloric goal for hospitalized patients. RER can be calculated using following formulas:
70 × (weight in kg)‸ 0.75 or (30 × weight in kg) + 70
(The WSAVA RER chart 5 can be a useful tool for quick and easy reference for hospitalized patients.)
For feeding, you can refer WASVA guidelines for more information.
*Author is DVM MS PhD Post DOC, SZIE, Budapest, Hungary.
