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Inappetence and Anorexia in Cat and Dog

Inappetence and anorexia in cat and dog

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Introduction

 

  • Inappetence means reduced appetite.
  • Anorexia means complete lack of eating.
  • Both are common signs but don't specifically point to a disease.
  • They might indicate nausea.
  • Inappetence is not the same as being picky about food.
  • Small breed dogs often have picky appetites.

Differential Diagnosis

 

  • Inability to smell food, e.g. cat flu
  • Pyrexia
  • Pain
  • Dental disease
  • Gastrointestinal disease, especially foreign bodies, intestinal neoplasia, severe gastroenteritis, intussusception
  • Renal failure
  • Hepatic disorders
  • Pancreatitis
  • Heart failure
  • Anaemia
  • Neoplastic disease
  • Metabolic abnormalities, e.g. hypokalaemia,
    hypercalcaemia, hypoadrenocorticism

Diagnostic Approach

 

  • Obtain a detailed history including duration of reduced appetite, percentage of normal daily intake eaten, weight loss, and drinking habits.
  • Perform a thorough physical examination, evaluating all body systems.
  • Pay special attention to the abdomen for any masses.
  • Assess body condition score, hydration status, and signs of underlying disorders.
  • The diagnostic approach depends on whether specific signs of illness are present.
  • If there are no specific clinical signs and inappropriate diet is ruled out, a blood sample should be taken for haematology and biochemistry.
  • Biochemistry should cover urea, creatinine, albumin, globulin, liver enzymes, dynamic bile acids, sodium, potassium, calcium, phosphorus, and glucose.
  • Urinalysis, including specific gravity, dipstick examination, and sediment examination, can be helpful, especially if azotaemia is detected in serum biochemical testing, aiding in distinguishing between pre-renal and renal azotaemia.
  • If haematology, biochemistry, and urinalysis results are normal, survey radiographs of the abdomen and chest are recommended.

Treatment

 

  • Identify and treat the underlying cause to restore appetite.
  • Offer small meals of warmed, palatable food like boiled chicken or fish during recovery.
  • Hand-feeding can be helpful, but avoid force-feeding to prevent food aversion.
  • Some pets, particularly cats, may not eat while hospitalized, possibly requiring early discharge decisions.

What to do if animal not responding to treatment ?

 

  • Complete anorexia for more than three days in cats, or five days in dogs, requires urgent intervention.
  • Hospitalization and supportive care are necessary, especially in cats to prevent hepatic lipidosis.
  • IV fluids may be needed to treat dehydration and provide maintenance fluid requirements.
  • Address any additional problems such as hypokalemia as appropriate.
  • Nutritional support should primarily be through the enteral route, allowing absorption via the gastrointestinal tract.
  • Calculate daily caloric requirements for hospitalized dogs and cats using the formula: (30 × body weight in kg) + 70.

 

  • If the patient continues to be anorexic, tube-feeding is recommended.
  • Naso-esophageal tubes are well-tolerated and relatively easy to place, suitable for short-term nutrition in non-vomiting patients without esophageal disease.
  • Patients can still eat voluntarily with these tubes.
  • Syringe feeding may be tolerated by some patients but should only be done by competent individuals due to the risk of aspiration.
  • Syringe feeding should be discontinued if the patient appears to resent the procedure.

 

  • Appetite stimulants may be beneficial and include intravenous diazepam for cats, or oral cyproheptadine or mirtazapine for dogs or cats.
  • Suspected nausea can be treated with maropitant or metoclopramide.
  • Vitamin B12 supplementation might be considered, especially in patients with low B12 concentrations due to gastrointestinal disease.
  • Corticosteroids should not be used empirically as appetite stimulants. They should be reserved for patients with identified corticosteroid-responsive diseases or for palliative treatment in very sick patients if further investigations/treatments are declined by owners.

 

  • Parenteral nutrition (IV route) is suitable for only a small number of patients with severely compromised intestinal function and is not typically done in general practice.
  • Isotonic glucose-containing IV fluids and amino acid supplements provide only a small portion of daily caloric needs and should not replace adequate enteral nutrition.
  • If the patient fails to eat after treating an identified underlying cause, clinicians should search for additional causes.
  • Repeat physical examination to ensure specific clinical signs haven't been overlooked or developed.
  • Re-evaluate blood test results and radiographs to ensure nothing has been missed.
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