Page 289 - WSAVA2018
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M. Scherk1
1Dip ABVP (Feline Practice), Vancouver, Canada
Inappetence and anorexia are common problems in feline patients. Inadequate nutrient intake is, at best, detrimental and interferes with healing. At worst, it is life- threatening. Cats have only a limited ability to conserve body protein; this can result in negative nitrogen balance, protein: calorie malnutrition and deterioration of protective mechanisms impacting immunity, red cell hemoglobin content, muscle mass as well as the ability to repair tissues. Additionally, cats have limited storage of many other nutrients as well as a restricted ability to down-regulate numerous metabolic processes. Their design is best suited to eating multiple small meals per day, high in protein, and moderate in fat. Inappetence and anorexia should be dealt with promptly and adequately.
Meeting the patient’s nutritional needs is not a substitute for localizing the cause for this inappetence. It is, however, necessary and allows time to identify the cause. Providing nutrients may be the most challenging part of any therapeutic regimen, and recovery or attaining the best possible QOL in cats may depend on our ability to ensure optimal nutrition.
The first question that must be answered is: why has this cat stopped eating? Is it because of a loss in appetite or some other reason? Nausea may be of neurologic origin (e.g., vestibular disease or irritation of the chemoreceptor trigger zone or the vomiting center by inflammation, neoplasia or chemicals including metabolites or drugs).
It may be a result of dehydration or may originate with GI inflammation for any reason (e.g., ileus, colitis, upper intestinal or gastric disease). However, decreased food intake may be due to other factors, such as dysphagia, pain (e.g., oral, dental, GI, multisystemic, etc.), dislike of the diet (e.g., boredom, altered palatability, spoilage), aversion, fear (e.g., environmental changes including those in the social demographics).
Nutritional support should be considered for the severely malnourished cat (20% weight loss, body condition score 1-2/9) or moderately malnourished (a 10% weight loss, BCS 3-4/9) who also have catabolic disease. Some cats will benefit from early intervention even at normal weight and condition if they suffer from advanced renal disease, hepatopathy, protein losing GI or glomerular disease, pancreatitis or bile duct obstruction.
Inappetent cats, and those not ingesting adequate protein, shift into a catabolic state. They are at risk for hepatic lipidosis, especially if ill and possibly at a
greater risk if previously obese. Lipidosis is a disease of dysfunctional lipoprotein metabolism; it is important to calculate the daily caloric and protein requirements as part of the therapeutic plan. [Calories: 50 kcal/
kg ideal BW/day; 4.5 g protein/kg ideal BW/day]. The diet needs to be balanced for energy (protein, fat, +/- carbohydrates), vitamins and minerals. It needs to be palatable taking the following four factors into account: texture, aroma, taste, and consistency. Bowls should
be wide and flat to avoid interfering with whiskers. The environment should be non-threatening, so a hospital setting is especially off-putting. Feline facial pheromone may be beneficial to reduce stress.
Rehydration and correction of electrolyte imbalances are important but oft overlooked goals in the correction of inappetence and anorexia. Anti-emetics have a place if the cat is vomiting. In gastric-origin nausea, agents such as H2 antagonists, gastroprotectants, proton pump inhibitors or prostaglandin E agonists may be beneficial depending on the cause of the gastric upset.
Appetite stimulants including cyproheptadine (1 mg/
cat PO BID), mirtazapine (1-2mg/cat PO q48h) may help jump-start a cat’s appetite, but keep track of total calories consumed. If a cat is eating but not enough, supportive feeding (assisted syringe feeding or tube feeding) must be considered. A cat eating small amounts of baby food will not meet his caloric needs until he eats 2-3 jars/
day. Meat baby food is not balanced, but is sufficient
for several weeks. There are several diets specifically designed for the assisted feeding of cats (Royal Canin Recovery, Hill’s a/d, Purina PVD CN, Eukanuba Maximum Calorie), liquid balanced enteral diets for cats (Clinicare, Rebound) Additionally, we can make a slurry from any canned food; blend with a liquid feline diet rather than water to minimize loss of calories.
There are several options for assisted feeding each with advantages and disadvantages. In general, the author starts with syringe assisted feeding until the cat is stable enough to allow the brief anaesthetic required for the placement of an esophageal tube. With concurrent
liver disease, give three doses of Vitamin K1 (1.0 mg/
kg q12h SC) prior to tube placement, biopsies or any other procedure that might result in bleeding. Placement of esophageal tubes is discussed elsewhere. The instrumentation for this procedure is very basic requiring only the following: 14-16 Fr red rubber feeding tube/ urinary catheter, Carmalt or other long curved forceps,
a scalpel blade, suture and bandaging materials and a multiple use injection port (prn adaptor).
Calculating how much to feed requires that you know the patient’s current weight as well as their healthy weight and the caloric densities (kcal/ml) of the diet you are intending to use (see Table 1). Use 50 kcal/kg as a rough guide to determine calories needed. Start by feeding 1/3-1/2 of the calories needed for the current, inappetant
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