Most problems were resolved by changing the diet or adhering to the recommended feeding protocol. Complications that did occur included vomiting, diarrhea, and inadvertent tube removal. Weight was maintained in 61% of the animals (16 of 26 cats and 15 of 25 dogs). Sixty-three percent of animals experienced no complications with enteral feedings resumption of food intake began for most animals (52%) while they were still in the hospital. Outcome variables used to assess efficacy and safety of nutritional support were return to voluntary food intake, maintenance of body weight to within 10% of admission weight, and complications associated with feeding liquid diets. Four commercial liquid formula diets and one protein supplement designed for use in human beings were fed to the dogs and cats. Twenty-six cats and 25 dogs in the intensive care unit of our teaching hospital were evaluated for malnutrition and identified as candidates for nutritional support via nasogastric tube. In vivo studies to evaluate the effectiveness of methods to unclog feeding tubes are warranted to further investigate these findings.įeeding commercial enteral diets to critically ill dogs and cats via nasogastric tubes was an appropriate means for providing nutritional support and was associated with few complications. The least successful solution was ½ teaspoon pancreatic enzymes and sodium bicarbonate in water.ĭespite anecdotal reports of using carbonated beverages, cranberry juice, and ½ teaspoon pancreatic enzymes to unclog feeding tubes, all were significantly less effective than water. Water was significantly better than all carbonated beverages and cranberry juice (P < 0.001). The solution that resulted in the greatest dissolution was ¼ teaspoon pancreatic enzymes and 325 mg sodium bicarbonate in 5 mL water, which was significantly better than all other solutions (water: P = 0.03 ¼ teaspoon pancreatic enzymes in water: P = 0.002 all others: P < 0.001). Various solutions were tested for their ability to dissolve enteral feed clots, including water, meat tenderizers in water, predetermined amounts of pancreatic enzymes (with and without sodium bicarbonate) in water, carbonated beverages, and cranberry juice. The goal of this study was to determine which solution is most effective at dissolving in vitro clots made using a veterinary canned critical care diet. Information is based on the available literature, expert opinion and the panel members' experience.Įnteral feeding tubes are frequently placed in animals to provide assisted nutritional support however, one major reported complication is clogging of the tubes. The 2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat have been created by a panel of experts brought together by the International Society of Feline Medicine (ISFM). Postponing interventions such as feeding tube placement to await improvement, owing to clinician or caregiver apprehension, may hinder recovery and worsen nutritional deficits. In particular, an inappropriate clinic environment and/or handling may cause or exacerbate inappetence in hospitalised patients, with negative impacts on recovery. Moreover, their nature as a species means they are susceptible to stress in the hospital environment, which may result in reduced food intake previous negative experiences may compound the problem. Feeding tubes are generally well tolerated and allow provision of food, water and medication with minimal stress, although clinicians must be aware of complications such as stoma site infections and refeeding syndrome.Ĭats are vulnerable to malnutrition owing to their unique metabolism and specific nutritional requirements. Use of antiemetic, analgesic, prokinetic and appetite stimulant medications may restore appetite, but placement of feeding tubes should not be delayed. Management is multimodal, comprising reduction of stress, medications and assisted nutrition in the form of tube feeding or parenteral nutrition. Delayed intervention may result in the cat's deterioration hence prompt control of contributing factors such as the underlying illness, pain, nausea, ileus and stress is vital to optimise voluntary food intake. The impact of malnutrition may be significant on the feline patient, perpetuating illness, delaying recovery, slowing wound healing and negatively impacting gut health and immunity. Nutritional assessment of every patient is encouraged, to identify the need for, and appropriate type of, intervention indicated. Inappetence may have many origins and, as a presenting sign or observation in the hospitalised patient, is common in feline practice.
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