Page 483 - Small Animal Clinical Nutrition 5th Edition

Parenteral-Assisted Feeding 497

because the cat was eating well, there was no concern about continuing PN. On Day 22, the necrotic portion of the cat’s tail was
removed using local ring-block anesthesia. The patient continued to improve and was discharged from the hospital on Day 25. At
VetBooks.ir the time of discharge, the cat weighed 3.2 kg and had a hematocrit of 19%. The cat continued to do well at home. At two weeks
after discharge it weighed 3.4 kg, was still thin (BCS 2/5) but no longer cachectic and had a hematocrit of 22% with a corrected
reticulocyte count of 6.2%. One year later on a routine annual examination, the cat weighed 4.1 kg (BCS 3/5), had a normal PCV
with no reticulocytes and was reportedly doing very well.

Endnotes
a. Albon. Pfizer Animal Health, Exton, PA, USA.
b. Ralston Purina Co., St. Louis, MO, USA.
c. Baytril. Bayer Animal Health, Shawnee, KS, USA.
d. Amoxi-Tabs. Pfizer Animal Health, Exton, PA, USA.
e. Periactin. Merck and Company, Inc., Rahway, NJ, USA.
f. Hill’s Pet Nutrition, Inc., Topeka, KS, USA.

Bibliography
Godfrey DR, Anderson RM. Cold agglutinin disease in a cat. Journal of Small Animal Practice 1994; 35: 267-270.
Lippert AC, Fulton RB, Parr AM. A retrospective study of the use of total parenteral nutrition in dogs and cats. Journal of
Veterinary Internal Medicine 1993; 7: 52-64.

CASE 26-3

Combined Parenteral and Enteral Feeding in a Cat
Donna Raditic, DVM
MSPCA Angell Animal Medical Center
Boston, Massachusetts, USA
Patient Assessment
A five-year-old, neutered male, domestic shorthair cat was presented for anorexia and weight loss.The patient lived in a large mul-
tiple-cat household and had been missing for one week.The owners found the cat and thought it had lost weight, but couldn’t coax
the cat to eat. On physical examination, the cat was lethargic, dehydrated with a body weight of 4.5 kg and a body condition score
of 2/5. The cat had excessive skin folds, which supported the owner’s report of recent weight loss. The cat was icteric with palpa-
ble liver enlargement. All cats in the household were fed a dry grocery brand cat food fed free choice.
Results of a complete blood count included a regenerative anemia; Bartonella was detected on a blood smear.The patient also had
elevated liver enzyme activities, increased blood urea nitrogen values and hypoalbuminemia. Serum electrolytes were within normal
limits.
The patient was stabilized with an intravenous bolus of crystalloid solution followed by appropriate fluid management, antibi-
otics and antiemetics. Although therapy stabilized the cat’s laboratory values, the patient continued to vomit bilious fluid through-
out the day and evening. Plans included radiography, ultrasonography and liver biopsy.
Abdominal ultrasonography showed hepatic enlargement. An ultrasound-guided liver biopsy was performed. Histopathology
revealed neutrophilic and lipid infiltrates. A diagnosis of hepatic lipidosis with Bartonella infection was made.
Because the patient’s vomiting was unresponsive to antiemetics, a parenteral solution of Aminosyn II (a parenteral nutrition [PN]
admixture containing 3.5% amino acids and 5% dextrose solution) was started. The PN was given at a rate of 20 ml per hour and
supplied 144 kcal/day. The patient became more alert and seemed to be responding positively to PN feeding.
Two days later the cat was sedated for placement of an esophagotomy tube for possible home care. Feeding instructions were
a
given early afternoon, to start a continuous rate infusion of a monomeric solution that contained 1.3 kcal/ml. This solution was
given at a rate of 5 ml/hour, providing the cat with 156 kcal/day (653 kJ/day). PN and supportive care were continued. The next
day the cat was unresponsive, febrile, more anemic and had increased liver enzyme activities. An electrolyte panel was performed
(Table 1).