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Therapeutic Nutrition III:Lower Urinary Tract Disease
Gastrointestinal DiseaseLiver Disease
“Fella” 9 yrs old M(I) Beagle
Struvite Calcium Oxalate
Usually associated with bacterial urinary tract infection
High sodium, calcium and oxalate correlation
Source: University of California – San Diego
Canine ProfileAverage
AgeGender Breeds
CalciumCalcium
OxalateOxalate8 years
Males > Female
Min. Schnauzers, Min. Poodles, Yorkies, Bichons, Shih Tzus
StruviteStruvite 6 yearsFemale> Male
Min. Schnauzers, Min. Poodles, Cocker Spaniels, Bichons
Struvite Calcium Oxalate
Persistent alkaline urine pH Persistent acidic urine pH
Source: University of California – San Diego
Feline Profile
Avg. Age
Gender & Neuter Status
BCS & Environment
Breeds
CalciumCalcium
OxalateOxalateOldercats
Neutered Males
Obese, indoor,
multiple cats
Himalayan,Burmese, Persian
StruviteStruviteYounger
Cats
Non-specific
Neutered
Obese, indoor,
multiple cats
Non-specific
● Identify urolith type● Dissolve – struvite only● Treat infection if present● Target appropriate pH● Increase water intake in order to promote
diluted urine
Water, water, water!
Increases urine volume More dilute urine Decreased mineral concentration in urine Increased frequency of urinating Decreased urine retention Less time for crystals to form
DIETARY MANAGEMENT IS MOST EFFECTIVE!!!!
UR Urinary® St/Ox
Urinary S - Low pH/S Feline dry & canned
Urinary O - Moderate pH/O Feline dry & canned
Prescription Diet® c/d Multicare (for cats)
Prescription Diet® s/d Prescription Diet® u/d
Prescription Diet® x/d Prescription Diet® r/d
Prescription Diet® w/d
Urinary SO 30 Urinary SO 13Dissolution FormulaVegetarian Formula
Normal GI Function
Digestion of ingredientsAbsorption of nutrientsMove food through GI tractEliminate waste (undigested) or
by-products (bile acids, nitrogen)
Gastritis & Enteritis
• VomitingVomiting• DiarrheaDiarrhea
• VolumeVolume• ConsistencyConsistency• FrequencyFrequency
“Going to California” 2yrs F(n) Miniature Pinscher
Gastric Dilatation & Volvulus“Bloat”
• Secondary damage to GI mucosa
• Tissue necrosis• Impaired digestion,
absorption
Source: Long Beach Animal Hospital; Long Beach, CA
Maldigestion/Malabsorption
• Inability to absorb nutrients
• Inability todigest/metabolize
Mink, 14 yrs © G. Santiago 2002
Soluble vs.
Insoluble
Slowly Fermentable
Rapidly Fermentable
Fiber
pectinpectin
guar gumguar gum
soy fibersoy fiber
branbran
beet pulpbeet pulp
soybean hullssoybean hulls
peanut hullspeanut hulls
cellulosecellulose
Small Animal Clinical Nutrition, 4th ed. Hand, Thatcher, Remillard, Roudebush
1.1. Restore fluid and electrolyte losses via oral Restore fluid and electrolyte losses via oral or IV fluid therapyor IV fluid therapy
3.3. Initially NPO to “rest” the entire GI tractInitially NPO to “rest” the entire GI tract
5.5. Gradual introduction of highly digestible Gradual introduction of highly digestible nutrients in small, controlled quantitiesnutrients in small, controlled quantities
Inflammatory GI Disease: Goals
Examples: “Bloat”, Gastritis, Inflammatory Bowel Disease, Exocrine Pancreatic Insufficiency, GI Surgery
1.1. Provide low residue (low fiber) to reduce Provide low residue (low fiber) to reduce the work of the GI tract.the work of the GI tract.
3.3. High digestibility to increase absorptionHigh digestibility to increase absorption
5.5. High fiber in colitis & constipationHigh fiber in colitis & constipation
Inflammatory GI Disease: KNF
1.1. Reduce contributing causesReduce contributing causes2.2. Provide “bulk” to stoolProvide “bulk” to stool3.3. Highly digestible ingredientsHighly digestible ingredients4.4. Provide water absorption in colonProvide water absorption in colon
Examples: Obstipation, Constipation, Mega Colon, Fiber Responsive Diarrhea
Increase water consumption Increase insoluble fiber
Start low, then increase slowly each week Moderate fiber 10 – 15%; high fiber >15%
Highly digestible fat & carbohydrates Highly digestible protein
Would You Recommend an Increase or Decrease in Fiber?
Parvo Virus
Constipation
Bloat Surgery
Dietary Indiscretion
or
or
or
or
X
X
X
X
XX
EN Gastroenteric®
DCO Dual Fiber Control®
FortiFlora® Canine Nutritional Supplement
Low-Residue Feline & Canine formulas
Prescription Diet® d/d
Prescription Diet® z/d
Prescription Diet® i/d Prescription Diet® w/d
Hypoallergenic HP 19
Sensitivity RC, LR, RD 30, VRDiabetic HF 18
Drug and Toxin Metabolism Ammonia detoxification Protein catabolism Fat synthesis and fat-soluble vitamin
storage Glucose mobilization storage
Acute Toxins Feline Hepatic Lipidosis
Chronic Portosystemic Shunt Cirrhosis Glucocorticoid Induced Copper Storage Problems
● Highly digestible energy from carbohydrates and fat, to spare protein catabolism
● Moderate levels of high quality protein Milk, egg or vegetable proteins are best
● High vitamin level (Vitamins K, E, and C)
● Reduced selected minerals (especially copper in some dog breeds)
High energy density
High fat
Controlled, high quality protein
High vitamin content, including antioxidants
Carnitine
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