Page 928 - Small Animal Clinical Nutrition 5th Edition

960 Small Animal Clinical Nutrition

patients with metabolic acidosis or hypokalemia. In addition,
Table 46-23. Tips for increasing water consumption in cats. struvite dissolution foods with increased amounts of sodium
VetBooks.ir Food may not be ideal for patients with concomitant conditions
Feed moist food
Add small amount of water to moist food including chronic kidney disease, hypertension or congestive
Add warm water to dry food heart failure.
Divide daily food amount into several smaller meals
Add flavor enhancers to food Assess and Determine the Feeding Method
Low-sodium chicken or beef broth
Clam juice Cats with suspected struvite uroliths (usually <7 years of age,
Tuna juice (low sodium) often with alkaline urinary pH, struvite crystalluria and/or
Water radiopaque uroliths) can usually be transitioned to a dissolu-
Use fresh, clean water at all times (change at least once daily)
Try water from different sources tion food over a seven-day period. The method of feeding
Tap water influences urinary pH values throughout the day and there-
Filtered water fore may affect the success of the struvite dissolution protocol.
Bottled water
Distilled water When fed free choice, most cats will eat small amounts every
Place ice cubes in water or provide cold water few hours, resulting in a smaller but more prolonged alkaline
Offer frozen cubes of water mixed with low-sodium tuna juice, tide than with meal feeding (Figure 46-18) (Taton et al,
etc.
Containers 1984). The smaller alkaline urinary pH excursions observed
Use non-reflective bowls for food and water with free-choice feeding may improve dissolution of struvite
Use wide bowl so whiskers do not touch sides uroliths and thus may be the preferred method of feeding.
Ensure ideal location of water and food bowls
Quiet, draft-free environment (avoid noisy appliances, However, this has not been confirmed. Also, dry foods are
near vents) most likely to be fed free-choice; nevertheless, feeding moist
In areas where cats can escape if needed food is preferred for dissolution of struvite uroliths and man-
Not in same area as litter boxes
On different levels of multi-floor house aging most other types of uroliths and FIC.
Provide access to other sources of water If a UTI has been diagnosed, an appropriate antimicrobial
Water fountains with circulating water drug should be administered for two to four weeks beyond
Dripping faucet
removal or radiographic disappearance of uroliths. Although
most cats do not have UTI, infection with urease-producing
organisms may cause struvite uroliths in some cases and other
bacteria may cause UTI secondary to uroliths in others.

Reassessment
During the time a dissolution food is being fed, cats should be
reevaluated every two to four weeks. A thorough nutritional
history should be collected, including amounts of all foods and
supplements given; this is especially helpful when uroliths do
not decrease in size as expected. Urinalysis is indicated to eval-
uate urinary pH and examine urine sediment for presence of
abnormalities (e.g., crystalluria, pyuria). When interpreting pH
of a spot or random urine sample, consider when the sample
was collected relative to the time of eating. Samples obtained
early in the morning, before food is offered, tend to be more
acidic, whereas samples obtained within several hours of eating
tend to be more alkaline (because of the postprandial alkaline
tide). When evaluating effects of a food change on urinary pH,
standardize the time of collection relative to the time of eating.
For most accurate results, urinary pH should be measured using
a pH meter. Urine culture should be done in cats with UTI to
confirm the absence of infection during treatment with antimi-
crobial drugs and one week after completion of treatment to
Figure 46-18. Mean urinary pH of cats fed a commercial food either
free choice (i.e., ad libitum) or once daily. Note how once daily feed- confirm eradication of UTI. Abdominal radiographs should be
ing results in a significant increase in urinary pH (i.e., postprandial taken to evaluate number and size of uroliths compared with
alkaline tide). (Adapted from Taton DF, Hamar D, Lewis LD. previous results. Nutritional management should be continued
Evaluation of ammonium chloride as a urinary acidifier in the cat. for one month beyond radiographic evidence of urolith(s) dis-
Journal of the American Veterinary Medical Association 1984; 184:
433-436.) solution. If uroliths do not dissolve completely or decrease in
size after two months of feeding a dissolution food exclusively,
a different treatment (urolith removal) should be considered.