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Nutrition in critical care

02 July 2020
12 mins read
Volume 11 · Issue 6
Figure 1.


Veterinary professionals in emergency and critical care see the sickest and most unstable patients, and it is understandable that nutrition is not at the forefront of their minds. This article demonstrates why nutrition is important in the most critical patients, and why studies show it is no longer advisable to delay assisted nutrition. Absence of nutrition in the critical patient leads to muscle catabolism, protein deficiencies and increased risk of sepsis. There are options for enteral or parenteral nutrition, and various feeding tubes that can be used depending on the status of the patient. Both underfeeding and overfeeding can be detrimental to the critical patient; requirements should be calculated for each patient on an individual basis, considering the dietary requirements and risks associated with each presentation and disease process. There are also changes that can be made in the hospital to encourage patients to eat voluntarily; it is important not to forget holistic care in the critical patient.

The World Small Animal Veterinary Association (WSAVA) nutritional guidelines recommend including nutritional assessment into the five vital signs of patient assessment, along-side temperature, pulse, respiration and pain (Freeman et al, 2011). Nutritional assessment involves a multi-faceted approach, including duration of anorexia/hyporexia, ability to eat voluntarily, body and muscle condition scoring and risk factors. See Figure 1 for a downloadable checklist available from the WSAVA. Nutrition is often in the back of veterinary professionals' minds with many patients, not only critical patients. While they carry out stabilisation and investigations into the patient's current condition and presentation, they will rigorously investigate inappetence and treat the underlying cause, but implementing a nutritional plan and methods of assisted feeding generally comes much later.

Nutrition is described as the processes of food utilisation by a plant or animal (Merriam-Webster, 2020). The terms macro and micronutrients refer to the volume of each that is required. Macronutrients include protein, carbohydrates and fats, and they are predominantly responsible for energy provision. Protein is responsible for metabolic regulation, tissue growth, function and repair; carbohydrates are mostly converted to glucose and used for energy; fatty acids omega-3 and omega-6 are essential and significant in immunosuppression and inflammation (McCune and Girling, 2007). Micronutrients are the vitamins and minerals required to maintain healthy function and immunity; minerals are often collectively known as ash.

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