Small Animal Nutrition Chapter 12 Tagged PDF

CHAPTER 12 Small Animal Nutrition VENDETTA 1 2  LEARNING OBJECTIVES List the energy-producing and non-energy-producing components of List food Differentiate Differentiate between essential and nonessential amino acids Explain E...

CHAPTER 12 Small Animal Nutrition VENDETTA 1 2  LEARNING OBJECTIVES List the energy-producing and non-energy-producing components of List food Differentiate Differentiate between essential and nonessential amino acids Explain Explain the importance of water in nutrition Differentiate between microminerals and macrominerals and give Differentiate examples of each Be able to read pet food label- AAFCO Statement Be Nutrient profile vs ingredient list Feeding according to life stages 3  LEARNING OBJECTIVES Define the following terms: nutrient, ingredient, formula, nutrient Define profile, calorie, and kilocalorie List the legal requirements of pet food labels and considerations in List evaluating pet food label information Describe Describe the components of a nutritional assessment for dogs and cats List special considerations in feeding adult, pediatric, geriatric, List pregnant, lactating, injured, and ill dogs and cats 4 NUTRIENT S 5  Energy and metabolic Nutrient substrate classified as essential or nonessential Raw material Ingredient used in food compounding NUTRIENT TERMS Ingredient Formula portions for a particular diet type Quantitative distribution of Nutrient individual nutrients profile within finished formula 6  NUTRIENT TERMS Nutritional value Cannot be identified solely on an ingredient statement Analysis of a particular food Can only give an indication of nutrient content and availability of a particular nutrient Nutritional value Based on the absorptive capability of a nutrient Based on availability Digestibility of a food A measure of biological availability 7  BALANCED DIET Supplies energy needed to meet daily Supplies all key requirements of nutrients the animal at its particular stage of life 8  PALATABILITY Involves sensory factors such as: Taste Smell Color 9  Moisture Odor Fat & protein levels PALPABILIT Y FACTORS Temperature OF FOOD Texture Shape (cats) Acidity 10  Non-energy substances Non-nutrient substances Purposely ADDITIVES added to foods to enhance: Color Flavor Texture Stability 1 1  PROTECTION AGAINST MICROBES (PRESERVATIVES) Physical Dehydration (dry food) Heat (moist and dry food) Chemical treatments Preservatives (semi-moist and some dry food) 1 2  ANTIOXIDANTS Chemical agents Protect fatty acids and fat-soluble vitamins from becoming rancid By inhibiting oxidation Ex: Vitamins C and E 1 3  Carbohydrates Broken down into simple sugars ENERGY- Fats PRODUCING NUTRIENTS Broken down into triglycerides Proteins Broken down into amino acids 1 4  Provide body with energy C A R B O H Y D RAT E S Excess stored as glycogen or converted to fat Include: Starch Sugars Fibers es 1 5  FIBER Major energy source Role of fiber in diet for grazing animals Digested by Depends on bacteria and physiology of protozoan microbes animal’s digestive in large intestine of tract rumen, cecum, and large intestine 1 6  ROLE OF FIBER IN COMPANION ANIMALS Increases bulk and water content of intestine Reduces caloric density for weight-control food while maintaining satiety Stabilizes blood sugar levels by extending time the nutrients are absorbed (diabetes mellitus) Assists in regulating bowel function 1 7  FATS Serve Serve as primary sources of energy Supply Supply essential fatty acids Facilita Facilitate digestion te Act as carriers for fat-soluble vitamins Act (A, D, E, K) Provide Provide palatability and texture to food 1 8  WHAT IS A LIPID? Fat—if solid at room temperature Oil—if liquid at room temperature Dietary fat Composed of units called triglycerides Highly digestible Twice the caloric density of similar quantity of protein or carbohydrate 1 9  Long chains of amino acids Roughly 22 known amino PROTEIN acid groups STRUCTUR Arranged in countless E number of ways, each having unique properties and characteristics Considered building blocks for plant and animal protein 2 0  Principal structural component of all body organs and tissues Serve as enzymes, hormones, and antibodies PROTEINS Essential to all living cells Functions Construction Growth and Regulation of Formation of of cell repair of metabolism muscle fiber membranes tissue 2 1  Nonessential Can be synthesized from other sources AMINO Essential ACIDS Cannot be synthesized in the body in adequate quantities Must be supplemented in diet 2 2 ESSENTIAL AMINO ACIDS MUST BE ADDED TO FOOD 10-canine, 11-feline 23  TAURINE Essential amino acid in cats Deficiency results Retinal Reproduction Impaired immune Dilated degeneration insufficiency system cardiomyopathy Deficiency signs Owners typically report visual changes or Occur after prolonged periods of poor depth perception (“miscalculating” depletion jumps) 2 4  All proteins are not of equal worth Proportion utilized for BIOLOGICA growth and maintenance of normal L VALUE OF body systems is PROTEIN measure of its biological value Animal proteins vs. plant-based proteins 2 5  Protein is added to most commercial pet foods Correct balance of amino acid composition necessary to classify protein high in biological value DIETARY PROTEIN Greater the protein quality (biologic value), the less is needed Digestibility is an important factor 2 6  Often a Provides multiple mix of protein sources animal Improves overall and quality of food by plant providing wide substan amino acid profile ces COMMERCIAL PET FOOD High- Growth quality Physical exertion protein Pregnancy and needed lactation for Repair of periods damaged tissues of 2 7  CATS Specifically adapted to high-protein, low- carbohydrate diets Continuous protein catabolism 2 8 THE NUTRIENT- WATER 29  WATER Does not produce energy Most important nutrient Functions: Essential for almost every chemical reaction Transports solutes and gases Regulates temperature Lubricates joints and eyes Balances electrolytes 30  Inorganic chemicals Important part of a balanced diet More than 18 mineral MINERALS elements are essential for mammals Macrominerals Microminerals 3 1  Include calcium, Concentration phosphorous, s are of magnesium, fundamental sodium, importance potassium, chlorine, and sulfur M A C R O M I N E RA L S Minerals Electrolyte circulate as functions electrolytes 3 2  Calcium Results in nutritional secondary hyperparathyroidism Deficiency frequently MINERAL develops when DEFICIENCIE inappropriate homemade S foods are prepared for dogs, cats, and reptiles Phosphorus Impairs growth Impairs normal physiological processes 3 3  Nutrients that are required in relatively small amounts Essential for normal M I C R O M I N E RA L S health in companion animals Examples Iron, manganese, copper, iodine, and selenium 3 4 35  Organic Most cannot be compoun ds synthesized in necessar the body y for Therefore, normal must be physiolo present in the gical function diet VITAMINS Fat-soluble: A, Classifie D, E, K d in two categorie Water-soluble: s B-complex and C 3 6  Not energy nutrients Not all types are essential for every species Intake in excess of VITAMINS requirements does not improve performance Water-soluble vitamin toxicity Commercial pet foods 3 7  ANTIOXIDANT ADDITIVES IN PET FOODS carnitine, carotenoids, and bioflavonoids Natural alternative to synthetic preservatives Improve palatability Protect immune function Improve cognitive dysfunction in senior dogs 3 8  Endogenous substances that may provide medical or health benefits Emerging area of food and food technology N U T RA C E U T I C A L S Examples: chondroitin sulfates, glucosamines May inhibit inflammatory mediators and promote joint stability Contain omega-3 fatty acids 3 9  What is the best food to feed my pet? What are the differences between commercial brand foods? COMMON CLIENT QUESTIONS Is home cooking suitable? ABOUT PET FOOD Can I supplement an existing diet with table food? Raw diets 4 0  Most commercial pet foods are superior in nutrient content, convenience, cost, and overall quality Published homemade pet food recipes are generally imbalanced PROPER ANSWERS Energy and nutrient requirements are not linear; long-term use of homemade pet food will result in nutrient deficiencies or excesses Raw diets not recommended 4 1  Complete diet COMMERCIA L PET FOOD Balanced diet TERMS Combining the two types of diets— animals fulfill both nutrient and energy requirements 4 2 COMPLEMENTARY DIET Combines two or more food sources to improve outcome 4 3  Marketed under premise that one particular diet type meets nutritional demands at every life stage ALL- PURPOSE DIET Typically provides nutrients in excess of what is required by adult or geriatric animal 4 4  Typically found in grocery stores Targets uninformed consumers ALL- Generally sold as off-brand or PURPOSE generic foods DIET Formulated for growth and lactation periods of companion animals Not appropriate for the other stages of life! 4 5  Provides specialized nutrition for individual needs SPECIAL- Designed for animals with PURPOSE specific FOOD nutritional needs Often sold in veterinary hospitals 4 6  Dry foods 3%-11% water FORMS OF Semi-moist COMMERCIAL foods 25%-35% PET FOODS water Moist foods 70%-83% water 4 7  DRY FOODS Characteristically have lower protein, Produced with fat, and minerals on higher caloric a dry matter basis density than moist foods Typically cost less Provide a dental than most moist hygiene benefit foods 4 8  Less palatable than moist forms results in less chance of overeating Cost of feeding a Which has a lower pet per day, or true cost ? cost per year PROS OF DRY PET Cost effective FOODS Convenient Easy to use; allow owner to leave food out for extended periods 4 9  Pets may eat on an ad- lib basis CONS OF Access to unlimited dry DRY PET food may contribute to obesity FOODS Annual health examinations should include body condition scoring and pet food consultation as animal ages 5 0  DRY FOODS Water may be added to create “gravy” to increase palatability Palatability may also be improved by mixing dry food with canned food If food is moistened with water and left outside in high temperatures, bacterial proliferation is possible 5 1  Warn pet owners not to add water to dry pet foods and leave them exposed for prolonged periods at high ambient temperatures FOOD- Bacteria from water-saturated dry or canned food can produce a BORNE potent toxin that causes vomiting ILLNESSES and diarrhea Can be avoided by ensuring consumption of moist food within a few hours 5 2  SEMI-MOIST AND SOFT- DRY FOODS Moisture content ranges from 25%-40% Composed of a meat and cereal mixture extruded into small, attractive shapes Contain artificial flavors Humectant preservatives and cellophane wrapping Antimicrobial additives 5 3  Contain soluble sugars Contain simple SEMI- carbohydrate MOIST sources FOODS Not recommended in obese or diabetic animal May also contain high sodium 5 4  CANNED OR MOIST FOODS Typically 70%-83% water Most sold as complete diets, with all nutrients present Three forms: ration loaf, all-meat appearance, and processed meats/flours bound into jellied matrix High palatability Requires portion-controlled feeding to avoid overconsumption 5 5  Preserved with heat sterilization and vacuum techniques to ensure anaerobic environment Enamel liners insulate the product and provide excellent nutrient stability CANNED Shelf-life ranges from 12-18 OR MOIST months FOODS Storage at normal temperatures Palatability may decrease toward end of shelf life 5 6  Low caloric density Expensive on a per-calorie basis Meat by-product MOIST ingredients more costly FOODS than equivalent meals and flours Higher packing costs Mixing dry with moist foods Increase palatability Control cost 5 7  Small food rewards Training aide, or to reinforce love Commercially prepared treats should not be given in excess TREATS Chocolate not recommended—toxic in high concentrations Commercial treats are not subject to testing, as are pet foods 5 8  Should not be confused with treats Generally given to SUPPLEMENT S correct a nutritional deficiency Routine use is not necessary if pet is provided with a balanced commercial pet food 5 9  Many owners prefer to prepare homemade foods despite the ease, less-expense, and better overall nutritional balance of commercial foods HOME- Homemade recipes may not be PREPARED appropriate for individuals with unique physiological requirements DIETS Close monitoring of the diet’s efficacy is essential 6 0  Pet food regulation varies from country to country Labels represent contract between the manufacturer and the PET FOOD consumer LABELS Standards for label information established by The Association of American Feed Control Officials (AAFCO) AAFCO Statement 6 1  Net weight Product designator (e.g., cat food) Name and address of manufacturer or distributor REQUIRED Guaranteed PET FOOD analysis in For crude protein, fat, fiber, and moisture percentages L ABEL INFO List of ingredients in descending order of predominance by weight Nutritional adequacy statement Feeding guidelines 6 2  Feeding instructions Caloric content OP T I ON AL P E T Nutritional L AB E L adequacy IN FO R M AT ION statements: Totally nutritious Or, complete and balanced Not needed on treats or snacks intended for intermittent feeding 6 3  Manufacturer can often supply a more reliable source of data EVALUATING Ingredients on labels are listed by PET FOOD weight L ABELS Heaviest ingredients listed first; lightest last Pitfalls Percentages don’t Conservative reflect exact guaranteed nutrient amount of nutrient levels 6 4  Only one At least 70% total product ingredient is named named ingredient Modifying words 10% for moist foods and accompany 25% for dry INGREDIENT named foods ingredient PERCENTAGE S “With” modifies 3% named ingredient Flavor must Term flavor is be detectable used only by animal 6 5  Amount of heat (energy) needed to raise temperature of 1 kilogram of water 1 degree Celsius KILOCALORIE Energy requirements (food) Calculated Expressed in in kilocalorie kilocalorie s s 6 6  Number of calories needed to maintain an animal’s weight Increases in exercise, lactation, and growth will increase energy DA I LY E N E R GY requirements R E Q UI RE M E N T S Decreases in these activities will lower energy requirements Increased energy demands over and above the needs for maintenance = production energy requirements 6 7  FEEDING OF DOGS Dogs typically omnivores Advertising emphasizes carnivorous aspects Some dogs eat grass and feces (natural behavior) Nutritional energy requirements Calculations based on metabolic body weight Variations in body composition considered Variations in breed considered Based on life stage 6 8  FEEDING AMOUNTS FOR DOGS Calculated from energy value of the food Each dog evaluated individually due to differences in both activity and environment Based on regular weighing and body condition scoring 6 9  Once a day supplies daily energy requirements 2-3 times a day coincides with family FR E QU E N CY meal times I N FE E D IN G N ORM AL DO GS Avoid late Avoid inconvenience evening of middle of night feeding eliminations Avoid large Minimizes gastric meals before dilation and torsion, exercise especially in large breeds 7 0  Milk Complete food source for neonates Contains water, protein fat, vitamins, minerals CANINE PEDIATRIC Colostrum NUTRITION Key nutritional factor immediately after birth Provides fluid for vital postpartum circulatory expansion Carries protective maternal antibodies 7 1  COLOSTRUM Somewhat sticky and viscous Owners should ensure that dam is producing colostrum, and that puppies are consuming it 7 2  Most are healthy and capable of active nursing In general, no assistance needed from technician or owner NURSING Exceptions are toy-breeds Ensure mothers are lactating PUPPIES well Ensure mothers are attentive to puppies 7 3 G R O W T H RAT E OF PUPPIES Normal rate is 2-4 grams/day of anticipated adult weight Lesser rate is an indication that puppies are not receiving adequate amounts of milk 7 4  FEEDING ORPHAN PUPPIES DOSE INITIALLY 15% OF FEED VIA SYRINGE AND PUPPY’S WEIGHT PER DAY, RUBBER FEEDING TUBE, OR DIVIDED INTO SEVERAL SMALL ANIMAL NURSING DOSES BOTTLE 7 5  First 3 days of life are most critical FEEDING Careful placement TUBES techniques Proper amounts of formula 7 6  GENERAL FEEDING GUIDELINES Stomach is full when belly is distended, or animal turns its head away from bottle New formula made at each feeding Formula at room temperature before administration Equipment meticulously cleaned or sterile Monitor weight gain by use of gram scale 7 7  CONSIDERATIONS FOR FORMULA FEEDING Patient response to feeding may not be typical Gag reflex not developed for 10 days Diarrhea may occur Dilute formula until resolved Record baseline birth weight Record healthy puppy weight gain Assist elimination every 2-4 hours (or after each feeding) 7 8  2 TO 3 WEEKS OF AGE Food dose Small amounts of approximately food given 25% of body incrementally weight divided when puppies are into 4-6 daily able to eat solid feedings food on their own 7 9  3 weeks of age Puppies introduced to semisolid gruel 4 weeks of age Peak lactation occurs WEANING OF 5 weeks of age PUPPIES Intake of mother’s milk reduced Larger amounts of semisolid to solid food eaten 6-8 weeks of age Weaning concludes 8 0  Proper nutrition is essential for normal growth and development Excessive intake can lead to medical complications! FEEDING GROWING DOGS Feed 4-5 times daily during post- weaning period (until about 10 weeks old) Cut to 3 meals daily until 50% of adult body weight is reached (about 4 months old) 8 1  Have higher ratio of surface area to body weight Have higher energy requirements per unit of body weight SMALL AND Have relatively small stomachs TOY BREEDS What should diets have? Higher energy content More nutrient-dense matrix than for larger breeds High digestibility 8 2  Feed each dog separately when possible FEEDING Time-restricted method STRATEGIE Feed 1-3 timesworks daily well Feed with ad-lib S for 5-15 minutes consumption Method for dogs who overeat Serve calculated food Feed 2-3 times daily dose (one-half to one- third of daily volume) 8 3  OTHER FEEDING TIPS Follow feeding instructions on pet food label if dog maintains good wgt Utilize food dose calculators Utilize manufacturer’s technical information Feed maintenance pet food for the average house pet 1-7 years old Eliminate table food, or use in moderation Avoid feeding of animal bones Nylon bones and chew toys are safer substitutes for natural bones 8 4  Do provid Do provide fresh water e Do Do feed for control of calorie intake feed Do Do feed for ideal weight and body feed condition FEEDING Do provid Do provide consistent food DO’S e Do ritualiz Do ritualize time and place of feeding e Do use Do use life-stage feeding concepts Do Do feed treats with nutrient profile and feed caloric density considerations 8 5  Don’t Don’t provide stagnant or frozen water provide Don’t Don’t allow excess calorie consumption allow Don’t Don’t feed obesity-prone dogs on a free- feed choice basis Don’t Don’t rotate flavors or brands on frequent FEEDING rotate basis DON’TS Don’t Don’t make rapid transitions make Don’t Don’t use growth-lactation food for adult use maintenance Don’t Don’t supplement a balanced, high-quality supplem food ent Don’t Don’t allow competitive eating allow 8 6  Competiti ve eating Over- consumpti PROBLEMS A S S O C I AT E D WITH GROUP FEEDING on Anorexia 8 7  Bitch returns to regular body weight Expect food intake to rise rapidly by 50% the first week, and by 200%-400% by fourth week of lactation AFTER Free choice food should be available WHELPING Monitor water intake Perform frequent physical examinations 8 8  FEEDING DURING LACTATION Lactation markedly increases energy, protein, and mineral requirements Nutrient requirements greater than any other adult life stage Proper nutrient intake directly linked to successful milk production 8 9  OBESITY-PRONE ANIMALS Ratio of too much fat to lean tissue Contributing factors: Genetic background High-calorie diets and snacks Physical inactivity Endocrine or neuroendocrine disorders 9 0 Gonadectomy  Feeding programs Exercise strategies TREATING Educating clients on OBESITY health risks of obesity Routine weighing Body condition scoring 9 1  OTHER CAUSES OF OBESITY Declining lean body mass Declining activity level during normal aging processes Decreasing energy requirements in geriatrics Competitive eating Surgical neutering 9 2 GENETIC PREDISPOSITION 93  Coronary heart disease Type 2 diabetes and insulin resistance Hypertension HEALTH Pulmonary disorders RISKS OF OBESITY Liver, kidney, and gall bladder disease Colon, ovarian, endometrial neoplasia Musculoskeletal diseases including joint stress, hip dysplasia, and osteoarthritis Muscular injuries including cranial cruciate ligament rupture 9 4  Anesthetic risks Intolerant to exercise and heat OBESE PATIENTS Mortality is increased Linked with some endocrine diseases 9 5  Exami Visually examine subcutaneous fat ne deposits Palpita Palpate ribs, groin, and tail head te ASSESSME Obtain radiographs of abdomen and NT OF Obtain thorax OBESITY Measu Measure body composition by re weighing animal indirectly Utilize ideal weight tables for Utilize purebred animals 9 6  OBESITY TREATMENT Feed calorie-restricted, low-energy food Feed diet high in fiber Exercise Restriction of treats No human snack foods or commercial pet treats Teamwork between owner, veterinarian, and technician necessary 9 7  Toy and small- sized breeds 7 years Medium-sized AGES OF dogs GERIATRIC DOGS 6 years Large and giant breeds As early as 5 years 9 8  Reduced immune response Reduced digestive and renal function AGE - Reduced glucose tolerance A S S O C IATE D C H AN G E S IN Changed smell and taste DO GS perception Reduced lean body mass Reduced metabolic rate 9 9  Influenced by individual body condition Influenced by individual health history Maintenance of GERIATRIC optimal weight is ideal goal NUTRITION Senior diets are recommended Reduced protein Reduced phosphorus and sodium Increased fiber 1 0 0 10 1  H E A LT H Y O L D E R C AT S Limiting protein with normal renal and hepatic function can contribute to muscle loss Cats should not be fed a low-protein diet just because they are old 1 0 2  CATS Carnivorous predators Not “small dogs” Protein metabolism is unique 10 3  Have reduced carbohydrate metabolism Require higher percentage of protein FAC TOR S General I N FLU E N C IN G FE E DIN G O F requirements for C ATS food High-protein foods Low-carbohydrate foods Amino acids (e.g., taurine, arginine) B vitamins 1 0 4  Adequate colostrum immediately after birth is critical NEEDS OF Stable environment is ORPHANED important KITTENS May need assistance in urination and defecation 1 0 5  FEEDING OF ORPHANED KITTENS 1 0 6  KITTENS Weigh between 85 g and 120 g at birth Gain an average of approximately 100 g/week Caloric needs: 22-26 kcal/100 g of body weight for first 3 months of life Schedule feedings at least 4 times a day In general, male kittens grow faster than females 1 0 7  FORMULA FOR KITTENS Preparation should follow label instructions Initial feedings have less volume (but not less frequency) than directed by manufacturer Should be warmed to about 100° F (37.8° C) Feeding equipment must be cleaned immediately after use 1 0 8  FORMULA FEEDING OF KITTENS Increasing amounts of formula are given, based on weight gain and satiation Weaning generally ends at 7-9 weeks Growth-sustaining kitten foods are fed 2-3 times daily until 10 months of age 10 9  Do feed a consistent diet Employ a feeding FEEDING schedule to ADULT eliminate finicky CATS behavior and food aversion Most cat owners tend to feed ad- lib 1 1 0 111  HAIRBALL S Occur commonly in cats due to meticulous grooming habits Owners may observe periodic gagging, retching, and regurgitation or vomiting of hair and mucus Hairballs often tubular and usually do not contain food or bile 1 1 2  E NE R GY AND NU T R IE NT R E Q U I R E M E NT S DU R I NG F EL I NE PR EG NA NCY A ND L ACTAT I O N Must support both queen and offspring Requirements can be 3-4 times normal maintenance during peak lactation Ingesting larger amounts of food may not be feasible Queen uses stored body fat to support milk production in early part of lactation 1 1 3  Consid Consider overall health before diet er selection FEEDING Monitor food intake in association with GERIATRIC Monitor weight changes CATS Note Note water intake 1 1 4  No single food can meet needs of every cat Dietary modification can help to optimize health or modulate disease FEEDING OF Significant protein restriction not GERIATRIC recommended CATS Moderate protein restriction recommended if evidence of chronic renal failure Commercial diets available with balanced nutrient contents for optimizing geriatric health 1 1 5  FELINE OBESITY Common nutritional problem Obtain detailed dietary history Calculate amount of food offered during a calorie- restricted diet Encourage client to participate in weight reduction programs 1 1 6  Associated Not with recommen accumulati ded on of lipids in liver FASTING IN OBESE Can Mimics CATS become idiopathic pathologic feline al in 5-6 hepatic weeks lipidosis 1 1 7 Nutritional support often becomes the MOST essential element in the outcome of critical illness 11 8 11 9  Affects all body systems Affects mentation MALNOURISHMEN T IN THE C R I T I C A L PAT I E N T Exacerbates weakness and depression Speeds up the entire disease process 1 2 0  CRITICAL PAT I E N T S Metabolism accelerated to support healing Metabolism accelerated to resist infection Structural proteins consumed as source of energy 1 2 1  Recent weight loss of >10% Absent or poor food intake for more than 2 days IN D IC AT ION S Acute illness or injury FOR N UT R IT ION AL S U P P O RT Acute muscle wasting Heavy gastrointestinal or urinary system losses of protein or electrolytes 1 2 2  Hypoalbuminemia I N D I C AT I O N S F O R Body condition score SPECIFIC NUTRITIONAL under optimum value S U P P O RT of 3 Surgical intervention or hospital procedures that may result in a reduction of oral intake over 3-5 days 1 2 3  Critical illness = Hypermetabolic process NUTRITIONAL Body becomes reliant on C O N S I D E RAT I O N S FOR THE its protein stores to provide C R I T I C A L PAT I E N T gluconeogenesis Consequences Alternations in Loss of lean protein body mass homeostasis 1 2 4  Tachycardia Tachypnea CLINICAL SIGNS OF Hyperglycemia H Y P E R M E TA B O L I C S TAT E Eventual breakdown of skeletal muscle protein Mobilization of body fat 1 2 5  Evalua Evaluate respiratory effort te Evalua Evaluate lung sounds te MONITORING Monito Monitor vascular integrity r Monito Monitor serum protein and albumin r levels 1 2 6  Unexplained weakness Dull mentation Malnutrition C L I N IC AL Deterioration of respiratory S I G N S OF function P O OR Recumbent patient N U TR IT ION Decreased kidney function Decreased muscle function Weakened cardiac muscle 1 2 7  REFEEDING SYNDROME http://www.wisc onsinfederatedh s.org/feeding-sk inny-animals-he lpful-or-harmful. html 12 8 12 9