Clinicians should engage in shared decision-making with patients and caregivers about nutrition support in palliative and end-of-life care. ![]() Nutrition support therapy does not improve quality of life in patients with dementia. Patients receiving nutrition support therapy should be monitored for complications, including refeeding syndrome. Family physicians can use the Mifflin-St Jeor equation to calculate the resting metabolic rate, and they should consult with a registered dietitian nutritionist to determine total energy needs and select a nutritional formula. Parenteral nutrition has an increased risk of complications and should be administered only when enteral nutrition is contraindicated. When nutrition support therapy is required, enteral nutrition is preferred for a patient with a functioning gastrointestinal tract, even in patients who are critically ill. Family physicians should work with registered dietitian nutritionists to complete a comprehensive nutritional assessment for patients with acute or chronic conditions that put them at risk of malnutrition. The evidence for when to use nutrition support therapy is inconsistent and based mostly on low-quality studies. Family physicians can provide nutrition support therapy to patients at risk of malnutrition when it would improve quality of life. JVECC 23:58-62, 2013.Nutrition support therapy is the delivery of formulated enteral or parenteral nutrients to restore nutritional status. SourceIvermectin-induced blindness treated with intravenous lipid therapy in a dog. Consultation with an animal poison control center is always recommended to determine which toxin may be removed with ILE infusion and the current dosage recommendations. It may be used as an alternative intervention to avoid ventilator support for toxicity-related respiratory failure. Lipid rescue should not be considered unless conventional and antidote therapies have failed. This study discussed an important point about ILE, in that it may not have the same positive effects in dogs having extreme sensitivity to ivermectin (ie, those with a homozygous mutation in the ABCB1-1D). It is inexpensive and has yet to show significant adverse effects with recommended doses. Possible adverse effects of IV lipid therapy include pancreatitis, fat emboli, phlebitis, and hypersensitivity reactions.ĬommentaryIV lipid emulsion (ILE) therapy, or lipid rescue, has become popular in veterinary medicine for the treatment of many lipid-soluble toxins (eg, local anesthetics), macrocyclic lactones (eg, ivermectin), and other drug toxicities. IV lipid therapy may work via a lipid sink, in which lipophilic ivermectin is sequestered into plasma lipids, effectively removing it from the CNS. The mechanism for ivermectin-induced blindness is not fully understood, but that ERG readings were not completely extinguished at initial examination suggests the retina is not the only location affected blindness could relate to cranial nerves II and III, as well as cortical involvement. ![]() Rechecks 9 and 11 months later revealed normal neurologic reflexes in both eyes and improved, but still abnormal, ERG readings. ![]() Within 30 minutes, slight PLRs and dazzle reflex returned the dog was sighted enough to navigate obstacles by the end of the infusion (~1.5 hours after treatment initiation). Approximately 3.5 hours after signs were noted, treatment was initiated using a 20% IV intralipid emulsion. The dog’s serum was positive for ivermectin. Electroretinography (ERG) results were below normal. Fundic changes were noted, including linear areas of retinal edema. Examination by a veterinary ophthalmologist revealed an absent direct and consensual pupillary light response (PLR), menace response, and dazzle reflexes in either eye. An 11-year-old spayed Jack Russell terrier presented on emergency for acute onset blindness following possible ivermectin ingestion.
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