Patients with tetanus provide a challenge when considering nutritional support as they are commonly dysphagic and at increased risk of aspiration pneumonia. Additionally, improvement of clinical signs can take up to 2 weeks. Little information is available on optimal nutritional support for dogs with tetanus. Current recommendations are to provide critically ill patients with their resting energy requirements (RER). Illness factors are no longer applied except in certain circumstances e.g., severe burns. It has been suggested that patients with tetanus have increased energy requirements due to increased muscle activity and therefore may require greater than RER to maintain body weight.

Hospital records were searched from January 2000-January 2007 for cases of tetanus. Cases were reviewed for details of nutritional support and the following data recorded. Type of nutritional support (enteral vs parenteral), type of feeding tube (if enteral nutrition), duration of nutritional support, time to initiation, complications associated with nutritional support, maximum factor applied to RER and weight change (%).

During the study period 16 cases of tetanus were identified. Thirteen cases had nutritional intervention during their hospitalisation period. Twelve had enteral nutrition and one had parenteral nutrition. Of the cases that had enteral nutrition, 8/12 had a PEG tube placed, 2 had an oesophageal tube placed and one each had a naso-oesophageal and nasogastric tube.

Median time to initiation of nutritional support was 2 days (range 1-3) and nutritional support was maintained for a median of 10 days (range 2-17). Reasons for cessation of nutritional support included adequate oral intake (10 cases) and regurgitation associated with a hiatal hernia in 1 case.

Resting energy requirements (RER) were retrospectively calculated and a comparison made to actual energy supplied. Patients were fed a median of 1.4 RER (range 0.7-2.6). Median % body weight change was -5 (range -19 to +5).

Complications pertinent to nutritional support included aspiration pneumonia in 3 dogs and hiatal hernia in one dog. Both these conditions have been previously reported complications of tetanus. Two dogs died during hospitalisation. Weight loss was encountered in most patients despite feeding more than RER.

In patients with tetanus where increased metabolic demands are suspected, caloric requirements seem to exceed calculated RER and this should be considered when managing these patients. In these cases frequent reassessment of nutritional status is critical to prevent weight loss.