Critical Care for Critical Patients: Parenteral Nutrition Formulation and Delivery in Third-Stage Starveling Phocids
IAAAM 2014
Greg F. Frankfurter1*+; Shawn P. Johnson1; Dorian Houser2; Frances M.D. Gulland1
1The Marine Mammal Center, Sausalito, CA, USA; 2National Marine Mammal Foundation, San Diego, CA, USA


Parenteral nutrition (PN) has been used effectively in a variety of veterinary patients1-3 as both the sole nutrient source (total parenteral nutrition - TPN) or as a partial nutrient source (peripheral parenteral nutrition - PPN). Parenteral nutrition is common in human medicine, most notably in neonatal critical care, where it is a standard procedure.4,5 While comorbidities and presenting problems may vary, the authors have observed that third-stage starvation in phocids - most notably Northern elephant seals (NES; Mirounga angustirostris) and Hawaiian monk seals (HMS; Monachus schauinslandi) - in a rehabilitation setting is associated with a poor prognosis. Force-feeding with fish and via gastric lavage has met with limited success in critically ill patients. These findings are consistent with recent findings that NES mount a glucogenic and insulogenic response to an amino acid challenge, but do not respond to glucose loading with either a significant insulin response or an increase in glucose disposal (DH pers. obs.). The objective of this project was to determine the efficacy of AminosynTM amino acid solution and Intralipid® lipid emulsion as an intravenous treatment of severe emaciation in NES. Previously, long-term maintenance of intravenous fluid therapy was confounded by animal movements resulting in displaced needles or kinked catheters. We were able to maintain IV access by placing a non-kinking catheter (Spirol 19-gauge open-end catheter, cut to 12 cm, BD Franklin Lakes, NJ, USA) inserted into the epidural sinus. The solutions were delivered using a portable syringe pump (AmbIT® continuous infusion pump, Summit Medical Products, Sandy, UT, USA) in a water-resistant case secured to the patient by a harness. This allowed for increased patient mobility. We hypothesize that this parenteral nutrition formula will be effective for stabilization and clinical improvement of stage 3, fasting-related emaciation in the NES. We will present results evaluating this hypothesis by comparing weight changes, albumin, glucose, and electrolyte profiles, and survival rates of treated animals versus a control group. Future analysis will include amino acid profiles, and serum insulin and glucagon concentrations and amino acid profiles. Due to the high rate of mortality in emaciated NES and HMS patients, this therapy could significantly improve care of critically ill seals.


The authors wish to thank the Coypu and Quadra foundations for financial support of this project.

* Presenting author
+ Student presenter

Literature Cited

1.  Lippert AC, Fulton RB, Parr AM. A retrospective study of the use of total parenteral nutrition in dogs and cats. Journal of Veterinary Internal Medicine. 1993;7:52–64.

2.  Peter JV, Moran JL, Phillips-Hughes J. A metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Critical Care Medicine. 2005;33:213–220.

3.  Clore E, Freeman L, Bedenice D, Buffington CT, Anderson DE. Retrospective evaluation of parenteral nutrition in alpacas: 22 cases (2002–2008). Journal of Veterinary Internal Medicine. 2011;25:598–604.

4.  Martin CR, Brown YF, Ehrenkranz RA, et al. Nutritional practices and growth velocity in the first month of life in extremely premature infants. Pediatrics. 2009;124:649–657.

5.  Seres D. UpToDate. In: Basow D, ed. UpToDate. UpToDate, Waltham, MA; 2013.


Speaker Information
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Greg F. Frankfurter
The Marine Mammal Center
Sausalito, CA, USA

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