Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.
Issue link: http://todaysveterinarypractice.epubxp.com/i/591321
tvpjournal.com | November/December 2015 | ToDay's VeTeriNary PracTice symPTomaTic maNagemeNT of Primary acuTe gasTroeNTeriTis Peer reviewed 51 NUTRITIONAL MANAGEMENT Fasting The concept of complete fasting has been questioned in recent years for dogs with acute gastroenteritis. Complete restriction of food may be reasonable for a short period, but an early return to appropriate oral intake is advised unless contraindicated, such as in cases suspected to have foreign bodies. Diet Considerations A wide variety of commercially available diets is marketed for dogs and cats with gastroenteritis. Each is formulated with slightly different protein and carbohydrate sources and fat content; some contain other potentially benefcial constituents, such as fructooligosaccharides or omega-3 fatty acids. Cats should receive enteral nutrition as soon as possible to avoid protein calorie malnutrition, which can lead to feline hepatic lipidosis. A commercially available, highly digestible diet is recommended. The goal of feeding a highly digestible diet is to reduce the risk for malabsorption. Dietary Fiber For patients with large bowel diarrhea, dietary fber is an important component of dietary management. While the optimal amount and type of dietary fber for treatment of dogs and cats with acute gastroenteritis are not known, there is general agreement that, in dogs and cats: • Dietary fermentable fiber enhances normal colonic function by providing a fuel source for colonocytes • Dietary nonfermentable fiber increases fecal bulk, which promotes normalized colonic motor function and defecation. Potential sources include canned pumpkin, brown rice, peas, and carrots. There are no established guidelines for fber supplementation in cases of small bowel diarrhea. In one study, dogs with colitis that received added dietary fber experienced signifcant clinical improvement compared with dogs fed diets without added fber. 25 FLUID THERAPY Acute gastroenteritis can lead to fuid losses and electrolyte imbalances that necessitate fuid therapy. Subcutaneous Therapy SC fuid therapy may be appropriate for mild dehydration or when outpatient therapy is elected due to fnancial concerns; however, it would be considered inappropriate for signifcant dehydration or hypovolemia. SC fuids should not be supplemented with dextrose because bacterial contamination and cellulitis can develop. Where supplementation with dextrose is needed IV administration is preferable. Oral Therapy Oral electrolyte solutions can be used in cases of mild dehydration. In a recent study, this route of administration was safe and effective in dogs with hemorrhagic diarrhea. 26 Intravenous Therapy Goal-directed, targeted IV fuid therapy to correct an estimated percent dehydration over a specifc time frame and to achieve normovolemia is recommended for moderate to severe dehydration or hypovolemia. Balanced replacement crystalloid solutions, such as lactated Ringer's solution, are an appropriate choice in most patients. Ongoing monitoring of serum electrolyte concentrations is recommended because supplementation is sometimes required. H 2 = histamine-2; NK-1 = neurokinin-1; NSAID = nonsteroidal anti-infammatory drug; PPI = proton pump inhibitor YURI LAwREnCE Yuri Lawrence, DVM, MA, MS, Diplomate ACVIM (Small Animal Internal Medicine), is enrolled in the Texas A&M; University Gastrointestinal PhD program and also serves as a senior clinician at the institution's small animal hospital. Dr. Lawrence received his DVM from Tufts University; then completed an MA in anatomy and neurobiology at Boston University, internship in small animal medicine and surgery at North Carolina State University, and residency in small animal internal medicine and MS in veterinary science at Oregon State University. J O n AT h An LIDBURY Jonathan Lidbury, BVMS, MRCVS, Diplomate ACVIM (Small Animal Inter- nal Medicine) & ECVIM (Companion Animal), is an assistant professor of vet - erinary small animal internal medicine at Texas A&M; University. Dr. Lidbury received his BVMS from University of Glasgow in Scotland and completed his small animal internal medicine res- idency at Texas A&M; University. His clinical and research interests include small animal hepatology and gastro- enterology.