Page 1141 - Small Animal Clinical Nutrition 5th Edition

Hepatobiliary Disease 1187

Progress Notes
An intravenous catheter and nasoesophageal tube were placed the day of hospital admission.The cat was given fluid and nutrition-
VetBooks.ir al therapy concurrently with vitamin K therapy as diagnostic procedures were performed. Because the cat was still vomiting three
1
b
to four times per day, a liquid food (CliniCare Feline containing 1 kcal [4.2 kJ]/ml) was given by continuous rate infusion. The
cat’s RER was 163 kcal (682 kJ)/day [70(3.1) ]. Fluid requirements were 200 ml/day (3.1 x 60 ml/kg body weight + 5% + ongo-
0.75
ing losses). Therefore, the cat initially received 163 ml of liquid food via nasoesophageal tube and 37 ml of Plasmalyte A (with 30
mEq KCl/l), intravenously per day. Dehydration and hypokalemia were corrected, and vomiting ceased by Day 2 of hospitalization.
The cat tolerated the continuous rate infusion given by nasoesophageal tube, and its prothrombin time returned to within normal
limits after four treatments with vitamin K .
1
A gastrostomy tube (G-tube) was placed on Day 3 of hospitalization.Twelve hours after the tube was placed, the cat began receiv-
ing 30-ml bolus feedings of a blended commercial veterinary recovery food (Prescription Diet a/d Canine/Feline) (2 cans plus 50
ml water = 1 kcal/ml). The cat had no problems with the G-tube or the blended food and was discharged to the owners’ care on
a
Day 4 with instructions to offer the cat food (Science Diet Feline Maintenance ) first and, if the cat did not voluntarily eat, to then
feed 55 ml of the blended recovery food followed by a 12-ml water flush, three times daily. This feeding regimen provided the cat
with 165 kcal (690 kJ) and 200 ml of water daily.
The owners returned with the cat 11 days later.The G-tube was in place, body weight was 3.3 kg and the cat was more alert with
less intense icterus. A complete blood count showed no evidence of anemia. The serum biochemistry profile revealed normo-
glycemia, increased serum total protein and albumin concen-
trations and decreased serum total bilirubin concentration.
Table 1. Laboratory data from a domestic shorthair cat with icterus.
The liver enzyme activities had almost returned to normal
(Table 1). The cat was still not eating spontaneously; there- Parameters Day 1 Day 15 Reference
values
c
fore, an appetite stimulant (cyproheptadine ) was prescribed
Packed cell volume (%) 27.5 31.7 30-45
(2 mg per os, twice daily).The cat continued to receive 80 ml Hemoglobin (g/dl) 9.2 10 10-15
of the blended food twice daily via the G-tube.The cat began Glucose (mg/dl) 150 89 70-110
Total protein (g/dl) 5.9 7.2 6.5-7.7
eating the adult maintenance-type food spontaneously after
Albumin (g/dl) 2.2 2.4 2.5-4.0
four days of receiving the appetite stimulant.The G-tube was Alanine aminotransferase (IU/l) 264 80 10-33
removed three days after the cat began eating voluntarily and Alkaline phosphatase (IU/l) 110 45 14-43
the recommendation was made to continue feeding the main-
tenance-type food free choice until the cat achieved an ideal BCS (3/5) and body weight (approximately 5.0 kg). The owners were
instructed to monitor the cat’s appetite, body weight and body condition closely and, after the cat had achieved an optimal BCS,
to change the feeding method from free choice to meal feeding a specific quantity of food (approximately one-fourth cup, twice
daily) to maintain optimal body weight and condition.
Endnotes
a. Hill’s Pet Nutrition Inc.,Topeka, KS, USA.These foods are available as Science Diet Light Adult Feline and Science Diet Adult
Feline.
b. Abbott Laboratories, North Chicago, IL, USA.
c. Periactin. Merck & Company, Inc., Rahway, NJ, USA.

Bibliography
Center SA, Crawford MA, Guida L, et al. A retrospective study of 77 cats with severe hepatic lipidosis: 1975-1990. Journal of
Veterinary Internal Medicine 1993; 7: 349-359.
Center SA. Hepatic lipidosis. In: Guilford WG, Center SA, Strombeck DR, et al, eds. Strombeck’s Small Animal Gastroenter-
ology, 3rd ed. Philadelphia, PA: WB Saunders Co, 1996; 766-782.