Page 174 - Cote clinical veterinary advisor dogs and cats 4th

68 Anorexia

Differential Diagnosis ○ Enteral feeding is indicated for animals Nutrition/Diet
Inability to eat (pseudoanorexia): with sufficient GI function that are able • Use a conservative energy estimate to avoid
VetBooks.ir ○ Dental disease ○ Parenteral feeding is reserved for patients using the RER without “illness factors” is
overfeeding critically ill patients. Calculation
to hold food down without vomiting.
• Painful apprehension or mastication
with severe GI dysfunction or uncontrol-
preferred. This energy estimate can be
○ Mandibular fractures
○ Oral or retrobulbar neoplasia/foreign
lable vomiting.
to lose weight (p. 1077).
bodies • Nutritional support is key in the management increased by 25% if the patient continues
○ Masticatory myositis and polymyositis of critically ill patients. Protein and calorie • Individualized nutritional assessment is
• Oropharyngeal dysphagia malnutrition leads to decreased immune important to identify factors that can affect
○ Oropharyngeal mass competence and delayed healing. the nutritional plan.
○ Cricopharyngeal achalasia • Cats have a higher protein requirement than
○ Inflammatory myopathies, peripheral dogs and become protein malnourished Possible Complications
neuropathies, neoplasia quickly when anorexic. • The pharmacokinetics and side effects of
• Trigeminal neuritis • Overconditioned cats are at risk for hepatic pharmacologic appetite stimulants must be
○ Painful swallowing (odynophagia) and lipidosis when anorexic for any reason for considered.
esophageal disorders more than a few days. • Overfeeding can lead to hyperglycemia
○ Difficulty reaching food (e.g., arthritis, (parenteral) or regurgitation, vomiting, and
neuromuscular disease) Acute General Treatment diarrhea.
• Maintain fluid and electrolyte balances; • Refeeding syndrome is possible after pro-
Initial Database isotonic crystalloid fluids with potassium longed anorexia.
• Pseudoanorexia: observation of the animal supplementation, as deemed necessary.
eating and drinking. If suspect pseudo- • Address pain, if present. Recommended Monitoring
anorexia • Judicious use of antiemetic drugs in animals Monitor body weight, albumin, triglycerides,
○ Complete oropharyngeal exam under with nausea or vomiting electrolytes. and glucose. In patients with enteral
anesthesia (pp. 1125 and 1140). ○ Maropitant citrate 1 mg/kg SQ q 24h feeding, the stoma should be cleaned periodi-
○ Neurologic examination (p. 1136) IV over 1-2 minutes. Acts at the emetic cally. Catheters used for parenteral nutrition
○ Dental radiographs or a head CT scan center as a neurokinin-1 receptor antago- should be monitored regularly to detect
may be necessary to further evaluate the nist. Can be continued at 2 mg/kg PO if problems early (e.g., vasculitis, malposition).
oronasal cavity. necessary.
○ Thoracic radiographs and endoscopy ○ Ondansetron 0.5-1 mg/kg IV q 12h (dog), PROGNOSIS & OUTCOME
(p. 1098) to evaluate obstructions and 0.1-1 mg/kg IV, IM (cat); 5-HT3 receptor
esophagitis antagonist Loss of appetite is a symptom, and prognosis
○ Fluoroscopic studies are required to assess ○ Metoclopramide 0.2-0.5 mg/kg IM, SQ, depends on the underlying disease.
pharyngeal and esophageal function and or IV constant rate infusion at a rate
motility. of 0.01-0.09 mg/kg/h. It has antiemetic PEARLS & CONSIDERATIONS
• True anorexia properties and improves gastric motility.
○ History and examination may provide • Pharmacologic appetite stimulation is not Comments
explanation without need for further always appropriate, such as in critically ill • Treatment of nausea and pain, if present,
investigation. For example, a young cat or severely malnourished patients. are crucial to regain appetite.
recently obtained from a shelter presenting ○ Mirtazapine 1.88 mg/CAT PO q 24h (q • Prolonged anorexia/hyporexia is distressing
with fever, oral ulcers, and ocular and nasal 48h in cats with chronic kidney disease) to pet owners; they may opt for euthanasia
discharge is likely inappetent due to viral and 3.75-30 mg/DOG (depending on dog sooner than necessary if the pet does not
upper respiratory infection and may not size) PO q 24h; tetracyclic antidepressant, willingly eat.
require further testing. serotonin receptor antagonist • Early enteral nutrition in dogs with critical
○ CBC, serum chemistry profile, and uri- ○ Capromorelin 3 mg/kg PO q 24h in dogs; illness has a positive impact on survival.
nalysis often clarify the reason for anorexia selective ghrelin receptor agonist However, overfeeding can lead to severe
(e.g., azotemia, ketoacidotic diabetes ○ Cyproheptadine 1-4 mg/CAT PO q 8-24h metabolic and GI complications and is associ-
mellitus, hepatopathy). in cats; serotonin antagonist ated with the development of hyperglycemia.
○ Abdominal imaging studies are often • Nutritional support therapy • Pharmacologic appetite stimulation is not
useful (e.g., rule out GI obstruction, ○ Provide a palatable food; warming the recommended in critically ill patients and
abdominal mass effect, echogenic changes food may be helpful (p. 1199). is generally not effective.
in and around the pancreas suggestive of ○ Enteral nutrition by nasoesophageal, • Cats (and dogs) will not eat if they are
pancreatitis). esophagostomy, or gastrostomy tube can unable to smell food. Anosmia can cause
maintain intestinal structure and function anorexia.
Advanced or Confirmatory Testing (pp. 1106, 1107, and 1109).
Additional testing is based on results of initial ○ Parenteral nutrition is reserved for patients Technician Tips
investigations. that cannot tolerate enteral nutrition • Creating a comfortable environment increases
(p. 1148). the likelihood of a patient eating. Increasing
TREATMENT ○ Nutritional support can prevent further the palatability of the meal offered can be
loss of lean body tissue in the acute stages achieved by feeding a diet with a higher
Treatment Overview of illness. moisture or increased content of fat and
The most important aspect of treatment is to protein. Adding a sweet flavor can increase
identify and address the underlying cause for Chronic Treatment palatability of food for dogs but not cats.
inappetence. The objective is to provide necessary nutrients • Food aversion can occur readily in cats when
• Assisted feeding is often recommended when and calories until the patient consumes an eating or the smell of food is associated with
nutritional intake is less than resting energy adequate amount of food. Esophagostomy and being nauseous or painful. Avoid leaving
0.75
requirements (RER) = 70 (body weigh kg ) gastrostomy tubes can be used for extended food in the cage of nauseous or painful
for 3-5 days. periods of time. cats.
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