Hepatic Lipidosis


Hepatic lipidosis (fatty liver disease) secondary to other serious illness

Question: Dear Dr. Richards,

My husband and I lost our beloved friend and companion, Max, on 01/05/01. I am trying to come to terms with his death and in doing this, I am trying to understand what happened to him.

My husband and I rescued Max from "death row" at an animal shelter when he was only a few weeks old in June 1993. He was scheduled to be put to sleep that day, and we adopted him. Max was a white, American Shorthair with a couple of gray patches. He was an indoor/outdoor cat. He seemed to be a healthy cat, a little large, but he had no health problems that we were aware of until a little over a year ago. He was having problems urinating, and after several trips to the vet, we learned that he was forming crystals and suffering from blockage. He was catheterized a couple of times, then we decided on the PU procedure. We understood this to be a "sex change" operation. We hoped that it would help his situation, but knew that he could still form the crystals later on. He weighed around 18 lbs at the time and needed to lose some weight.

In the summer of 2000 he had a hematoma on his right ear the size of a grape. It was lanced, stitched, and he was left with a "cauliflower" ear. (he didn t know it though) J

He did great after the surgery and all was well until 12/24/00. We had been out of town for a day and a half, and when we came home we noticed that he was a little lethargic. He was still eating a little, so we waited and took him to the vet on 12/26/00.

The vet said it sounded like he had a UTI, and gave us ClavaMox to give to Max, and brought him home. We were told to get a urine sample and bring it back to be analyzed. Max urinated that night, and we took the urine to the vet the following morning. He said there was a very high concentration of crystals in the urine, and we would need to start Max on the Hills Diet food to acidify the urine.

By the night of 12/29/00, Max was worse than we could imagine. He would only walk a couple of steps and then immediately lie down on his side. If we picked him up, he would meow loudly and begin to pant. We tried to feed him water by squirting some into his mouth with a syringe, but that only upset him more. We stayed up with him through the night. He threw up once, urinating on the bed as he lay there, unable to get up at first. Finally he got off of the bed and managed to walk a few shaky steps before lying down on his side and meowing painfully and panting for a few seconds.

We got Max to the vet when they opened that morning. He was in the laundry basket and would barely lift his head up. He is a white cat, and they could see yellow around his ears. His bilirubin was extremely high, around 7.4. His temp was 95. He was placed on a heating pad and covered with blankets. A Feline Leukemia test was negative. Blood work was done, and we were told the kidney and liver looked to be in the normal range. They gave him IV fluids and antibiotics, and he improved overnight. He would not eat though, and they had to force feed him. I visited Max at the vets on 01/02/01 and on 01/03/01, both times; he would eat a little bit. The vet thought that since he would eat for me, I could take him home and make sure that he ate. I was on vacation that week, and was grateful to have him home with me.

He was great when we brought him home. He would make periodic trips to the food dish, and would eat just a little at a time. I thought he was improving, but by Thursday, the 4th, he was becoming lethargic again. He ate that day (a few bites) and I did not see him eat again. By Friday the 5th, he had gone into a bathroom he hardly ever frequented to lie in a dark corner. I panicked and took him to the vet at 1:30. He brightened up a bit, and was walking around, nuzzling me, and was content in my lap. His temp was around 103. Weight 13 lbs. At this point he had lost about 2 or 3 lbs over the last two weeks. He received fluids, sub Q, and was sent back home with me in the hopes that he would eat that afternoon. I asked if I should try to force feed him myself, but was told that I didn t really want to start that, and that he needed to be feeling well enough to eat on his own.

I brought him home, and by 5:00 everything went wrong. I picked him up to see if I could get him to eat, and he was limp in my arms. I set him down, and he would not walk at all. My husband picked him up and took him to the litter box, but he just stepped out of it and tried to walk away. His back legs were wobbly, and he just lay down and began the painful meow again. We rushed him back to the vet, this time he would not even look around or pick his head up. The vet looked at him again, and just said that our options would be to start IV fluids again, and try to get an appointment for a liver biopsy the following Monday. I never really got a diagnosis until that point. He kept referring to a liver problem, the liver shutting down, and fatty liver disease, as possibilities. I told him that the other vet in the practice had done blood work the weekend before and I thought she had said the liver and kidneys appeared to be in the normal range. He seemed surprised by this and said they would do more blood work to see what was going on. We left Max there with the intention that he would be started on IV fluids, steroids, and antibiotics, and that hopefully it would jump start him back to feeling better, and then we would decide what to do from there.

An hour later, we got the call from the vet with Max s test results.

Anemia (paxel? Packed cell?) 9.7

Hemoglobin 3.1

ALT 224

Glucose 283.9

Platelets light

WBC 30,000

Bilirubin 2.94

He also said that his red blood cells were very low. He said that he felt that Max s organs were shutting down and that Max might not make it through the night.

We were devastated. The last thing that we wanted was for him to suffer anymore than he already had. It was our impression that he was indeed suffering, and I almost felt like this particular Doctor felt that liver biopsies and feeding tubes would not benefit Max, and would only prolong his discomfort.

We went back to the office to see him. He had been given a narcotic for pain and was a little out of it. He could not lift his head, and only lay there while we talked to him and petted him. I don t know any other way to say this, and it feels so dirty and disgusting, but we had him put to sleep that night. There are no words to describe what I feel right now. My husband and I don t have any children. To me, Max was my baby, and not knowing what was wrong with him is tormenting me.

This doctor was new to us, and I have to say that I am just not sure of the diagnosis or advice. I tried to ask questions, but I am still confused as to WHAT was wrong with him. What made him sick? I am left feeling like maybe the doctor just wasn t sure what to do. Now after visiting this site, I find that many people DO force feed their cats when they won t eat, and that it sometimes DOES help, and that feeding tubes sometimes DO help.

My questions are only for peace of mind. Max has a sister the same age that is a Siamese/calico mix, and I want to make sure I understand what happened to Max in case the same thing happens to her.

1.Is what happened to Max common or rare?

2.Why did he seem to get better when we brought him home, but then deteriorate so quickly?

3.Should I have been more aggressive in his treatment?

4.Were his last lab results listed above bad enough to indicate that he was seriously ill and might not make it through the night?

5.Did I do the right thing?

Thank you for reading my "book" I am sorry I couldn t condense it more for you.

Sincerely, Teresa

Answer: Teresa- I can not answer some of your questions with certainty, but I can try to tell you the possible problems and hopefully that will help some.

The lab work is suggestive of several problems but not conclusive for any of them. The high white blood cell count in combination with anemia makes immune mediated hemolytic anemia and anemia due to blood parasites somewhat likely. Feline leukemia virus infection also seems likely with this lab work and is not totally ruled out by a negative test, although the possibility that it was part of the problem is certainly lessened by the fact that it could not be found on testing. Feline immunodeficiency virus (FIV) is also a possible problem. The high blood sugar may indicate a problem with diabetes. It would be better to have several blood samples to compare blood sugar values, or perhaps the results of several urinalyses since cats can push their blood glucose to pretty high levels when they are stressed. Any rise in alananine transferase (ALT) in cats is considered to be significant and to warrant consideration of the potential for liver disease but it is hard to tell whether this would be a primary problem or a secondary one, considering the apparent lack of rise in ALT on blood work from the previous week.

Immune mediated hemolytic anemia is rare in cats. Anemia from blood parasites as significant as that seen in Max is unusual in cats. Anemia from feline leukemia virus is not unusual and would be very suspect except for the negative test. I think that I would tend to want to check his sister for feline leukemia, feline immunodeficiency virus and for blood parasites (Haemobartonella felis). These are the most likely things that might affect her, if Max was infected with one of them.

When pets have very low red blood cell counts, they can become lethargic and depressed very quickly. When red blood cell levels are as low as they were in Max, even a very small change can produce disastrous consequences. Cats frequently develop hepatic lipidosis (fatty liver disease) secondary to other serious illnesses. As this progresses it can cause serious deterioration in a cat's condition, as well. Probably some combination of these factors accounts for the rapid change in Max's condition.

I can not tell you if being more aggressive about diagnosis or treatment would have helped Max. It depends too much on what the problem actually was. If this was haemobartonellosis with secondary hepatic lipidosis then more aggressive therapy might have produced a better outcome. If this was the end stages of feline leukemia virus or feline immunodeficiency virus it may not have made any difference, or only a very short time difference, to pursue aggressive therapy.

I do think that most cats are better off if they are fed, even if this does involve implanting an esophageal feeding tube or stomach feeding tube. When these therapies don't work, it can seem as if the patient was overly burdened with invasive procedures in the last few days of life, but when they do work, which is probably more often, they provide the best hope for avoiding secondary complications like hepatic lipidosis. Many vets feel differently about this issue, though, probably due to bad outcomes of aggressive efforts and the bad feelings that sort of thing can cause.

A cat with an hematocrit (PCV) of 9.7 is in danger of dying at any time. So the lab work was suggestive of the possibility of imminent death. The overall situation was very bad at the time you decided to end Max's suffering. I think it was a reasonable decision and that you should not spend too much time second guessing yourself. It is always very difficult to have to make a decision to end a pet's life and there is always some room to look back and feel regret, either for waiting too long or because of worry that the decision was made too quickly. My experience in practice has been that almost all clients that are worried about these choices are the ones that made the right choices.

I hope that this helps some. If there are additional questions that come up as the result of this note, please feel free to ask them.

Mike Richards, DVM


Hepatic Lipidosis in Quarantine

Question: Dear Dr Mike,

I just wanted to start this mail by thanking you for the service you provide. Your site was an invaluable source of information when one of my cats was undergoing a very traumatic period.

I have one (hopefully quick) question regarding Hepatic Lipidosis.

As you will see from my cat's story, she is on the upswing of a long drawn out illness. She is doing great now and is back to her old self. My question is whether there is any specific after care for Hepatic Lipidosis. Are there things I should watch for or check? Things that I shouldn't feed her (I read somewhere that cats with liver problems shouldn't have fish - is this the case?)? Etc? Your input would be much appreciated as Hepatic Lipidosis is not a common disease in the UK and my vets have seemed not to know very much about it...

Anyway for your information here is the rest of Kila's story...

My cat Kila was diagnosised with Hepatic Lipidosis as a primary illness about 3 months ago. In her case, it was brought on by obesity, stress and questionable living surroundings. Six months ago we moved to the United Kingdom from Canada, and after much agonizing we decided to take our two babies with us. The first quarantine cattery they were in was a horrible place and after a couple months and cat that went from 13 pounds to 6 without any real medical care and refusal by the establishment to do any tests (I was well aware that my kitty was very sick), we yanked them out of the cattery and moved them to a wonderful (for a quarantine cattery) cattery called Cherry Trees International Quarantine Cattery. Within 24 hours the resident vet had called me asking permission to hospitalise Kila as apart from her weight loss and lack of appetite, she was also severely jaundiced. She spent 10 days in hospital on IV, while they ran the various tests. At one point (just in case this happens to someone else) they found a yellowish fluid build up in her chest - a tell tale sign of FIP - however in her case it was somehow (though they don't know why) a result of her liver problem. Finally the diagnosis came through as primary Hepatic Lipidosis. She spend a week or two being fed through a nasal tube, and finally after another week of hand force feeding, she picked up and began to eat on her own.

Best regards, Laurissa

Answer, Laurissa-

We have treated a number of cats in our practice for hepatic lipidosis at this time. So far, only one cat has had this condition more than once and she had two confirmed episodes and a third bout of problems that we really thought were due to hepatic lipidosis but which we did not run specific testing for. This seems to be the same experience that other veterinary hospitals are reporting -- hepatic lipidosis does not commonly recur in a cat who has suffered through this problem once. I do not know of any specific way to prevent it from happening again, except that it does help to keep cats from becoming obese, since obese cats are more prone to developing this problem if they go through a period of not eating, for any reason.

The liver probably is benefited by supplementation with essential fatty acids, especially those found in fish oils, so I don't see a reason to avoid fish in the diet, as long as it is part of a balanced diet.

There are a number of supplements to the diet that might be beneficial to the liver, including milk thistle, SAMe (Denosyl SD4 tm), essential fatty acids (3V Capsules tm, DermCaps tm, etc.) and ursodiol (Actigal Rx). It is probably not necessary to use any of these products in an effort to prevent hepatic lipidosis from happening again, but if you wish to be cautious about the possibility one or more of these supplements might be beneficial.

I'm glad that Kila recovered quickly. It is really hard to figure out how to advise people about moving pets to areas with long quarantine periods. It is reassuring that you were able to find a good quarantine facility but disturbing that it took two tries. I appreciate you passing on your experience with this.

Mike Richards, DVM


Hepatic lipidosis possible

Q: Hi,

I'm a subscriber to VetInfo. A friend is suffering a tragedy with her cat, Honey. She was very healthy when she suddenly lost her appetite and became sluggish. She appears to be dying. She is not an old cat. My friend, Teri, took her to the vet, but he has no idea what is happening.

Where can we begin with this?

Below is an excerpt from an email I received from her today:

P.S. Honey is doing very, very poorly. I'm not sure what to do. She doesn't move and is withering away to nothing. It is breaking my heart.

Thanks for any help you can provide.



A: Jim-

The number one problem to worry about with this history in a cat is hepatic lipidosis. This is a disorder that occurs most often as a secondary illness but often becomes more life threatening than the original illness that allowed it to happen.

Hepatic lipidosis occurs when a cat stops eating for any reason. This causes the cat's body to begin to use fat stores as fuel. Cats are inefficient users of fat (their livers are not good at transforming fat into energy). Because the cat doesn't utilize the fat well, it begins to accumulate in the liver cells, eventually interfering with their ability to function. Cats that have this condition will die, in most instances, without appropriate treatment.

Diagnosing hepatic lipidosis can be difficult using routine blood chemistry testing. Sometimes liver enzyme levels will not change despite this disease. Bile acid testing gives a better indication of the ability of the liver to function and liver biopsy is the best way to be certain of the diagnosis. A needle biopsy is usually sufficient to confirm this condition.

Cats with hepatic lipidosis often act like they want to eat, approach food and then turn away from it as if they are nauseous or just can't force themselves to eat. Some cats with this condition appear almost normal in activity and attitude while others are quite depressed.

The treatment is to force feed affected cats. Sometimes this can be accomplished by persistent owners using syringeable foods and a lot of effort. Most of the time it requires placement of a stomach tube and feeding through the tube for several weeks.

It is necessary, if possible, to figure out what the disease or disorder was that led to the hepatic lipidosis in the first place. We have seen it secondary to dental disease, kidney failure, diabetes, upper respiratory disease, eosinophilic granuloma complex of the oral tissues and many other conditions. We have even seen it infrequently in cats who just didn't have access to food because they were hiding in the attic or up a tree or something like that.

Other conditions that might lead to the symptoms you are seeing are chronic pancreatitis, cancer (in some cases), diabetes, kidney failure, other liver disease, feline leukemia virus, feline immunodeficiency virus, feline infectious peritonitis and blood parasite infection. Some of these things are also hard to find with routine lab work.

It sounds like your friend needs to take an aggressive approach to finding a diagnosis. If her vet has tested for these conditions and is unable to make a diagnosis it may be best to ask for referral to a veterinary teaching hospital (vet school) or to an internal medicine specialist or referral center.

I hope your friend is able to find an answer.

Mike Richards, DVM


Hepatic lipidosis

Q: I have just adopted a stray cat. To make a long story short, the cat was diagnosed with Hepatic Lipidosis. I have had the stomach tube put in On Aug. 10/98. Cleo came home from the vets Aug. 13. She started eating on her own Aug 20th. By August 24th, she was eating 3/4 cup by herself. I was still giving her 12 ML of a/d food to get her antibiotics in her but I had stopped giving her the anit nausea medication. I am hoping that by Sept 4th she can get the tube out. She will have been eating for over 10 days (my vet recommended that time frame). I don't know if this is an unusually short recovery period or not. From what I found on your site (very informative by the way) I might be too optimistic. Unfortunately I do not know the history of this cat but the vet suspects she is between 1 or 1 1/2 years old. Maybe this has helped. Maybe the amount of time and energy I have put into trying to save this cat has helped. I'm not sure I would follow this route again unless the animal had been with me for a little longer. Thanks for the info on your page. I am glad to hear of the 80% recovery rate.


A: Audrey-

There are lots of times when clients tell me that they are glad they did something (like total hip replacement or implanting a stomach tube) but they wouldn't do it again. It takes a lot of dedication to a pet to spend the money for major procedures or the amount of nursing care necessary for other illnesses. Sometimes trying one of these procedures is the only way to judge them and then it is too late if they are too much for someone to handle.

We see lots of variation in the time necessary to get a full recovery from hepatic lipidosis. We have had two cases confirmed by biopsy in which the cats recovered in very short time periods - one cat was willing to eat three days after we started treatment. We have had two cases that I remember in which it took months for the cats to decide to eat consistently, too. The most common recommendation I see is to wait at least 10 days after the cat is eating well before removing the tube, which agrees with your vet's plan.

Good luck with this. And congratulations on a job well done to everyone involved!

Mike Richards, DVM

Hepatic Lipidosis

Q: Well, I just finished reading all I could find on this disease. Your WEB SITE has been the most helpful at this very difficult time. I will reference it in the future to read all about cats and dogs. My cat, Sunny, was 14.5 lbs and a rather large cat. The vet never thought of him as obese, he was always a very active and playful cat. He started to be less hungry and less active, just after I had a temporary house guest (another cat). This cat had all it's shots and only visited our home for 4 days. I notice the lack of appetite but thought it wasn't anything to be too concerned about since he was still eating bites here and there. And he was drinking water as normal. Two weeks after the house guest kitty left, a friend of the family noticed that Sunny had really seemed to have lost a lot of weight. We took him in to be weighted. He was at 10.8 lbs. I was shocked to find out he had lost so much weight. The vet took some blood and were waiting on the results. I have started him on several medicines since the vet seems to think it is hepatic lipidosis, but might possibly be some other liver disease. I opted not to have the Biopsy done. The vet sent the blood off and all I know about it is PCV, CBC, FELV, FIV, FIA, FIP, and chem profile will be done. What is the doctor looking for? Currently, Sunny is still eating on his own, just very limited amounts--he ate 6.5 OZ of Science Diet A/D soft food during the night---I sat and spoon fed him and tried to encourage him to eat. He hasn't had any water for a day now. The medicines the Dr proscribed are: Amoxicillin , Flagyl, and Liquid Vitamins with his food. Is there anything the DR might be missing? All the literature I have read talks about the cat refusing to eat. Sunny will eat bits here and there. Is this just because this is the beginning of the disease, and the worst is yet to come? My Dr mentioned the feeding tube, but the cat is very active and bites when approached, thus Dr didn't think that was a good idea. Should I try to force water into him with a syringe? The Dr said it might become necessary to force feed him with the syringe. Any Ideas to make this less messy and bareable for Sunny? Any advice you might have would be comforting. What is the survival rate? Anything else I can do for the cat?

Thanks, Crystal

A: Crystal-

It is unusual, but possible, for hepatic lipidosis to occur as a primary disease. So your vet is looking for the underlying cause by testing for the types of diseases that don't always have obvious symptoms. I have to admit that I don't harp much on my clients about their pet's weights since many of the problems associated with overweight people don't occur in cats and dogs (like heart attacks). I probably should do more of this since hepatic lipidosis, diabetes and renal failure are all more likely in cats that are overweight. We have also seen this disease in small thin cats, so it isn't exclusively associated with obesity. Your cat may be a good weight for his size and just unlucky.

I really like to confirm this disease with fine needle aspirate biopsy. We have had very good luck getting confirmation through this technique and it poses minimal risk for the cat.

Many of my clients will not consider placing a stomach tube due to the problems with long term care associated with the tube. It is unquestionably the best approach to treating hepatic lipidosis, though. It is very very hard to hand feed adequate amounts of food in a cat that doesn't feel good. I have had several clients succeed in getting enough food into their cats to make them survive but I would estimate our success rate at about 30% using hand feeding. Survival rates of about 70 to 80% are reported with tube feeding.

I think a lot of cats with this condition will eat small amounts of food on an irregular basis. They just don't eat enough to stop the progress of the disease. It is really important to meet their caloric needs so that they stop trying to use body fat to support life.

Good luck with this. It takes a lot of effort to get a cat through this problem but it usually won't recur if you succeed.

Mike Richards, DVM

Good recovery after feeding with stomach tube.

Q: Dr Mike, you write: It is not uncommon for cats with hepatic lipidosis to vomit after feeding through a stomach tube is begun. There doesn't appear to be a clear consensus on medications to help with this condition but cimetidine (Tagamet Rx), cisapride (Propulsid Rx), metoclopramide (Reglan Rx), and other medications similar in effect to cimetidine are most often recommended.

Thanks for the info! My kitty was on cisapride for awhile but I don't think the anti nausea medicine really mattered too much. After a second stay in the hospital, he was put on Iams Recovery food on which he did well until the grainy-ness of the food actually popped the tube. The tube was replace and 20 minutes after I got him home from that stay, he started eating on his own and has been ever since (about 2 weeks). Things look pretty good finally. Joyce

A: Joyce- I am glad to hear that your cat is doing better. It is nice to get good reports from people.


Mike Richards, DVM

Hepatic Lipidosis

Q: Dr. M A friend of mine's cat was recently diagnosed w/ "Hepatic Lipidosis" . We understand this is something 2 do w/the liver. However, we would like more info, preferably details. What exactly is this disease, what causes it, is it treatable & if so in what ways, symtoms, info on treating this disease, etc. Any & all info would be greatly appreciated. ThankU in advance.

A: Hepatic lipidosis is literally fat infiltration into liver cells. When it is severe, it can cause severe problems, including death of affected cats.

Hepatic lipidosis occurs for any reason that forces a cat to begin to metabolize its own body fat rather than energy from food. As far as I know, this disorder probably does not occur as a primary problem. It is usually secondary to something else which causes the cat not to eat. It is more common in obese cats because they tend to metabolize fat more readily than thinner cats. Cats do not metabolize fat well. So the fat globules build up in a "backlog" in the cell, eventually making it unable to perform its normal functions at all.

There are many many things which will cause a cat not to eat for a several days. In many cases, the original cause of the not eating is gone when hepatic lipidosis becomes a problem. In other cases, it is necessary to find and correct the original problem in order to succeed in treating hepatic lipidosis.

The only successful treatment that I know of for this disease is to ensure that Barney ingests sufficient calories to make it unnecessary for him to metabolize fat. Cats with hepatic lipidosis do not usually feel like eating. Therefore, it is usually necessary to force feed them in some way. The most consistently successful approach is to implant a stomach tube through their body wall and feed them through the stomach tube. It make take several months to reach the point a cat will eat on its own again. Many people are reluctant to implant stomach tubes and try to force feed orally or use appetite stimulants. Sometimes this works. Usually when it doesn't work, the cat is much worse off and it may be too late to take the other approach.

This is a difficult disease for all family members. At present, the consensus of estimates seems to be that 70 to 80% of cats will recover from this condition if aggressively managed (i.e.-if they are fed adequate calories by whatever method it takes to get them in).

Be aggressive. It is Barney's best chance at recovery.

Mike Richards, DVM

More Hepatic Lipidosis

Q: Dr. Mike - I really enjoy your web page - lots of usefull information. Here is my question: We have 3 cats - a couple months ago, Jasper started sneezing a lot. We took him in to the vet and he was diagnosed with an upper respiratory infection. He was given a shot of pennicyllin (sorry about the spelling) and also Clavimox to be administerred at home. Our other 2 cats also caught it, so we just went and got more pills from the vet - no shots. Now Gizmo and Casper (the 2 that didn't get the shot) have developed Hepatic Lipidosis (fatty liver syndrome is what our vet calls it) - Jasper has shown no signs of this. Reading your information on this liver condition, the original cause of not eating is something else and ususally gone when this liver condition becomes a problem. Do you have any idea what the original cause could have been. Our vet wishes he knew what kind of bug our cats got, because it appears to be something else other than a "normal" respiratory infection. Gizmo seems to be doing much better and Casper was just diagnosed a few days ago - so we'll see....I'd appreciate any information that you could give me - Thanx!!!

A: The cause of hepatic lipidosis in most cats is the not eating -- it doesn't matter what made the cat not eat, just not eating for a sufficient period of time can lead to hepatic lipidosis. In some cats, this condition can develop in as little as three days of not eating. In others, starvation for extended periods won't lead to hepatic lipidosis. Overweight cats tend to have a lot more tendency to develop this problem but we have seen it in small thin cats, too. I do not know if any toxins, diseases or other problems can directly cause hepatic lipidosis but I can't recall hearing of any that do. It is weird to have two cats develop that problem in one household at the same time. I guess I'd want to review what happened and try to figure it out, too. Hopefully your vet will be able to.

Mike Richards, DVM

Avoiding Hepatic Lipidosis

Q: Dr. Mike, I recently lost my 3 yr. old cat to hepatic lipidosis. By the time the doctor gave him the stomach tube it was to late, I had to put him to sleep the next day. I have two other cats and I am wondering if they might end up with the same condition. Is there anything I can do to make sure this doesn't happen again?

A: The best thing you can do to avoid the possibility of hepatic lipidosis is to keep your cats at or near their ideal weight. This seems to be a much more common problem in cats who are overweight and suddenly experience a weight loss for any reason. It is also important to observe your cat's eating habits and to remember that even 3 or 4 days of not eating can lead to this condition. Any cat who is not eating should be examined by a veterinarian to determine the cause, if possible. Good health maintenance can limit the number of possible things that might lead to inappetance. Take care of your cat's teeth, keep their necessary vaccinations current and feed a good quality cat food.

If you cats do need to lose weight, work with your vet to design a good, safe, weight loss plan for your cats. It is possible to diet cats and not run into this problem, it just has to be done with a little more care than in some species.

It is pretty unlikely that you will face this problem again but I have seen two cases in the same household before, so it is not impossible.

Mike Richards, DVM

Appetite stimulation in cats

Sick cats often need to be stimulated to eat. It is very important that they maintain some caloric intake due to the nature of food metabolism in cats. There are a number of things that seem to help stimulate the appetite. For many cats, simply hand feeding an attractive food is adequate to stimulate appetite. Other cats respond to the owner petting them, sitting with them or talking to them by eating a little. Using canned foods instead of dry foods can be helpful. Warming food a little can make it more attractive to a cat.

Any medical conditions, such as dehydration or potassium deficits that exist should be corrected if possible. Pain relief medications may be helpful if there is any suspicion that a condition might be painful.

When these things fail, appetite stimulation may be necessary. There are a number of medications that have been shown to stimulate the appetite of cats. Diazepam (Valium), oxazepam (Serax), flurazepam (Dalmane) are three related compounds that are normally used as anti-anxiety medications. For some reason, used in smaller quantities these medications stimulate appetite. Oral pill forms will often work but if not, injectable diazepam can be more successful. The induction of appetite is very rapid, so the proper food must be on hand when the injection is given. If liver disease is suspected it may not be a good idea to use these medications. Periactin, an antihistamine, works to stimulate appetite in some cats, as well. If these medications do not work, it may be necessary to use corticosteroids or anabolic steroids. Due to the increase in side effects associated with steroids these should be the last resort in most cases.

If appetite stimulation fails, it is possible to force feed cats. The best way to accomplish this is usually a surgically implanted tube into the stomach. Most cats tolerate this much better than being syringe fed or tube fed orally in the quantities necessary to reverse some of the problems associated with inappetance, such as fatty infiltration of the liver (hepatic lipidosis).

Mike Richards, DVM


Michael Richards, D.V.M. co-owns a small animal general veterinary practice in rural tidewater Virginia. Dr. Richards graduated from Iowa State University's College of Veterinary Medicine in 1979, and has been in private practice ever since. Dr. Richards has been the director of the PetCare Forum...