Page 1140 - Small Animal Clinical Nutrition 5th Edition

1186 Small Animal Clinical Nutrition

(approximately 5%) was evident based on abnormal skin turgor and tacky mucous membranes.
Results of a complete blood count were consistent with a stress leukogram and mild microcytic normochromic anemia. Results
VetBooks.ir of a serum biochemistry profile included hyperbilirubinemia, elevated liver enzyme activities, mild hyperglycemia, hypoproteine-

mia, hypoalbuminemia and mild hypokalemia (Table 1). Urinalysis results were normal except for marked bilirubinuria. A blood
coagulation profile revealed slightly prolonged prothrombin time (13.4 seconds, normal 8.5 to 10.5 seconds). Vitamin K therapy
1
was started (phytonadione, 5 mg/kg body weight, subcutaneously, q12h).
Ultrasonographic evaluation of the liver revealed hepatomegaly with a diffuse increase in echogenicity and no evidence of intra-
hepatic masses. Hepatic tissue was obtained by ultrasonographic-guided needle biopsy.The hepatic tissue was brown, soft and float-
ed in 10% formalin. Cytologic evaluation revealed an increased number of bile casts, increased amount of bilirubin within hepato-
cytes and all hepatocytes contained vacuoles filled with lipid.These findings were interpreted as hepatocyte lipid accumulation and
cholestasis. Bacterial culture of a portion of the liver biopsy specimen was negative. A diagnosis of feline hepatic lipidosis was made.

Assess the Food and Feeding Method
Historically, since the cat was neutered at nine months of age, it had been slightly overweight (BCS 4/5).Therefore, for several years
the cat had been fed a dry commercial specialty brand food with a reduced caloric density (Science Diet Feline Maintenance
a
Light ). The food was offered free choice. The exact amount of food consumed by the cat over the last month was unknown but
markedly less than normal. A 4-lb bag of food usually lasted a month, but the owners had not purchased a new bag within the last
two months. During the past week, the referring veterinarian had been giving vitamin-B supplements and force-feeding an
a
unknown amount of a commercial recovery food (Prescription Diet a/d Canine/Feline ) per os. The cat was still vomiting three to
four times per day.
Questions
1. Outline an appropriate fluid and feeding plan (food, amount and method of administration) for this cat.
2. What other medical therapy may be appropriate for cats with idiopathic hepatic lipidosis?
3. How should the patient’s response to therapy be monitored?
Answers and Discussion
1. Severe dehydration and electrolyte and acid-base disturbances should be corrected with appropriate parenteral fluid therapy before
initiating the feeding plan. The single most effective means of treating feline patients with hepatic lipidosis is providing fluid and
nutritional support with assisted feeding. This is most easily accomplished using liquid foods administered through a nasoe-
sophageal tube or homogenized/blended foods administered by esophagostomy or gastrostomy tube (Chapter 25).These tubes are
well tolerated by cats and help ensure adequate caloric intake and, if necessary, owners can continue feeding the cat at home. A
variety of commercial liquid and blended enteral products have been used successfully in patients with hepatic lipidosis.
Energy requirements, and therefore the daily amount of food, should be calculated to meet the resting energy requirement
(RER) for the cat’s current body weight. The amount of food should be divided into multiple small feedings (four to six meals
daily). Most cats can initially tolerate at least 30-ml bolus feedings and can be given 50- to 80-ml meals after a few days of refeed-
ing. However, vomiting cats, especially those that have not eaten for weeks, may not tolerate bolus feedings initially, but will tol-
erate continuous rate infusion of a liquid food.
Vitamin K therapy should be used in cats with abnormal coagulation tests. Some clinical investigators have advocated L-carni-
1
tine supplementation for improving recovery based on results in experimental models of feline hepatic lipidosis. At the present time
there are no clinical studies demonstrating the effectiveness of L-carnitine supplementation in cats with naturally occurring disease.
2. Vomiting is a common complication of enteral feeding in cats and can be managed with antiemetic drugs given 15 to 30 min-
utes before each feeding. Cats with hepatic lipidosis rarely develop hepatic encephalopathy. If they do, lactulose, enemas and oral
antibiotics may also be needed. Cats that do not eat voluntarily may be given appetite stimulants.
3. The amount of food given each day should be carefully recorded to ensure that an appropriate caloric intake is being achieved.
Complications of tube feeding should be monitored. These include epiphora (nasoesophageal tubes), displacement of the tube,
vomiting, diarrhea and infection at the site of tube placement. Decreasing icterus, serum bilirubin concentrations, liver enzyme
activities and improved activity and mental attitude mark clinical improvement in the hospital. Long-term weight gain, improved
body condition and a return of normal appetite indicate improvement. In general, one to three weeks of assisted feeding are nec-
essary, but some patients may require three to seven months of tube feeding. Many patients can be managed at home until nor-
mal appetite returns. At home, food and water should be readily available and offered before each tube feeding. Decreasing the
amount fed or discontinuing the number of daily tube feedings is recommended when the cat begins to show interest in food
again. The feeding tube may be removed when the cat voluntarily consumes an amount equal to its RER for two to three con-
secutive days.