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My 8 year old Beans was recently diagnosed with hepatic lipidosis due to anorexia from stress (we just moved and she knew what the boxes meant - went on strike). I've had her home for a few days with an e-tube and I have a few questions about other peoples experiences with the recovery process....
Questions for other cat owners helping their feline through the beginnings of fatty liver disease: (Any additional tips/tricks with e-tube feeding or how I can better help her recovery are welcome!!!)
Diagnosis: Hepatic Lipidosis
Time of Presentation: Thursday 05/28/20 6pm
Amount of Recovery diet to be fed via syringe and frequency:
1. S-Adenosylmethionine Chewable 112.5mg (1/2 tablet) crushed with water every 24 hours 1 hour prior to feeding
2. L-Carnitine 250mg mixed into food daily
3. Taurine 500mg mixed into food daily
4. Metoclopramide 2mL every 8 hours for nausea
5. Amoxicillin 2.3mL every 12 hours with food
6. Gabapentin 1mL every 12 hours as needed for anxiety/pain
Here is a medicine/food log I've kept for the past 4 days Beans has been home
Pic 1: Going to ER vet 05/28/2020
Pic 2: First day home after 3 nights in ER 06/01/20
Pic 3: Late night feeding on the 3rd day she was home (first time she has laid on me in over 2 weeks!!!! Normally I can't get her off of me....)
Questions for other cat owners helping their feline through the beginnings of fatty liver disease: (Any additional tips/tricks with e-tube feeding or how I can better help her recovery are welcome!!!)
1. How long did you have to tube feed until your cat started to show signs of interest in their normal food again? Just interest - not eating it on their own.
2. How long did your cat slobber/smack their lips from nausea? Beans has been blowing spit bubbles consistently for the past week and while she has seemed to get better at home the last few days, she is still slobbering a lot and I'm not sure if that symptom should be lasting this long.
3. How did you heat up the slurry wet food mixture before dispensing it through your cats e-tube?
Everything I have found online only states to test it on your wrist prior to feeding (like you would a baby bottle) but I don't know how warm it should be and am afraid I'm serving it too cold.
Notes below are from the ER doc who treated Beans' illness (for context)Diagnosis: Hepatic Lipidosis
Time of Presentation: Thursday 05/28/20 6pm
- Beans, a 8 years old Female Spayed Domestic ShortHair, presented on Emergency for further evaluation of elevated liver values, and anorexia.
- Owner reports that patient vomited bile once Sunday morning (05/24) and Sunday night. She vomited yellow again Monday morning(05/25) and became uninterested in food that afternoon.
- Patient was taken to the RDVM on Tuesday and administered SQ fluids along with an anti nausea injection. Patient has not vomited since then but owner states that she has been hypersalivatory and has not eaten anything at all.
- Owner returned to the RDVM on 05/28 and CBC/Chemistry and abdominal radiographs were obtained, and patient was referred here for continued care.
- Abdominal ultrasound and liver aspirate were performed, providing a diagnosis of hepatic lipidosis. At this time an underlying medical reason for her condition has not been identified; we suspect her anxious personality and recent household move has been the trigger.
- Beans had an esophageal feeding tube (E-tube) placed on 5/29/2020. Unfortunately she vomited the end of the feeding tube the following morning, necessitating another quick anesthetic procedure to replace the tube with a new one. We have been slowly feeding Beans a conservative volume of food (Royal Canin Recovery), which is being escalated in volume at a slower rate than I usually administer with these patients. Beans has been able to tolerate these feedings with no additional vomiting.
- Therapy for Beans has also included the following: IV Unasyn, IV Cerenia (stopped after 2 days), IV ondansetron, metoclopramide via E-tube, IV pantoprazole, SQ vitamin K1, and supplements via E-tube (Denamarin, L-carnitine, and taurine). Once discharged from the hospital amoxicillin was to be continued via esophageal feeding tube. Gabapentin was initiated to try to reduce some of her anxiety in hospital.
- Recheck biochemistry panel on 6/1/2020 showed persistent degree of ALT elevation with ALP, GGT, an bilirubin increasing further. There may be progressive cholestasis occurring since we are slowly introducing nutrition to Beans. Brief recheck with ultrasound showed a diffusely hyperechoic liver and normal gall bladder, no effusion was noted.
- Owner was given instruction how to administer food and medications on 6/1/2020. She elected to take Beans home that evening to see if that could help reduce her anxiety in the hospital. Owners had unpacked their boxes, hoping their new home would be inviting for her.
Amount of Recovery diet to be fed via syringe and frequency:
For the first 24 hours, please offer 30 ml per feeding, doing 4 feedings per day if possible (120 ml per day). If 4 meals is difficult to administer, consider 3 meals per day, 40 ml each time. Increase by 10 - 20 ml per day every 1 - 2 days to a final volume of about 200 ml per day. We will adjust this as needed for her response.
Medications:1. S-Adenosylmethionine Chewable 112.5mg (1/2 tablet) crushed with water every 24 hours 1 hour prior to feeding
2. L-Carnitine 250mg mixed into food daily
3. Taurine 500mg mixed into food daily
4. Metoclopramide 2mL every 8 hours for nausea
5. Amoxicillin 2.3mL every 12 hours with food
6. Gabapentin 1mL every 12 hours as needed for anxiety/pain
Here is a medicine/food log I've kept for the past 4 days Beans has been home
Tuesday 6/2 | Wednesday 6/3 | Thursday 6/4 | Friday 6/5 | |
SAdenosylmethionine Chewable 112.5mg | 6:30a | 5:30a | 5:00a | 8:30a |
L-Carnitine 250mg | 7:30a | 8:30a | 8:30a | 9:30a |
Taurine 500mg | 7:30a | 8:30a | 8:30a | 9:30a |
Metoclopramide 2mL | 4:30a 12:30p 8:30p | 5:30a 12:30p 8:30p | 5:00a 1:00p 9:00p | 8:00a 4:00p 9:00p |
Amoxicillin 2.3mL | 4:30p | 8:30a 10:50p | 3:30p | 1:30p |
Gabapentin 1mL | 8:50a 8:50p | 11:15a - regurgitated it 5 min/decided not to continue | ||
Food | 15mL 7:30a 20mL 12:30p 30mL 4:30p 20mL 10:30p Total: 85mL | 40mL 8:30a 40mL 4:30p 40mL 10:50a Total: 120mL | 45mL 8:30a 45mL 3:30p 45mL 12:00a Total: 135mL | 15mL 9:30a 30mL 1:30p 15mL 4:30p 30mL 6:30p 30mL 11:00p 20mL 1:00a Total: 140mL |
Pic 1: Going to ER vet 05/28/2020
Pic 2: First day home after 3 nights in ER 06/01/20
Pic 3: Late night feeding on the 3rd day she was home (first time she has laid on me in over 2 weeks!!!! Normally I can't get her off of me....)