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Thursday, June 27, 2013

About Liver Failure In Cats

Pablo passed away in his sleep suddenly this morning.

Through him we have learnt wealth of knowledge about liver failure, and in his memory here is a summary of information on liver failure in cats and the care required.

Liver disease symptoms:
Jaundice (yellowing of the eyes, urine, skin most visible on ears)
Ascites or bloated stomach that is the accumulation of fluid
Weak and lethargic
No appetite
Underweight
Vomitting and diarrhoea
Drooling
Enlarged liver felt upon touch
Pain in abdomen
Excessive water drinking
Cat leaning head against wall as if having headache
Confusion, seizures
Coma

(Pablo had symptoms 1-5)

The most common cause of liver failure is hepatic lipidosis, a condition unique to cats. Other causes include poisoning via chemicals such as insecticides, acetaminophen (human medication toxic to cats), xylitol (artificial sweetener toxic to cats), medication overdose.

Hepatic lipidosis has many causes itself. One is when a cat goes without food for more than 2 days due to excessive vomitting, anorexia or neglect. Other feline illnesses also can cause hepatic lipidosis: hyperthyroidism, diabetes, urinary tract  infection, obesity, even cat flu'. About 15-20% of cases have no obvious cause.

In layman terms, when the liver fails, the body cannot metabolise proteins into the essential amino acids, and it also cannot detoxify. This means that a cat with liver failure will require supplementation of amino acids, antioxidants and essential vitamins and minerals it would get with a healthy liver that can obtain from food.

Treatment:
Fluid therapy through IV drip or subcutaneous injection
Feeding tube if cat does not eat on own
Supplements

If cat survives the first 4 days, 85% go on to recovery. Recovery may take 2 to 3 months of intensive home care. If cat also has pancreatitis, prognosis is poor.

Home care:
The only medication usually prescribed for liver failure is Onipural. The other is actually a supplement known as Zentonil. Both require veterinarian prescription.

Food must be free of carbohydrates, high in protein, low in fat, supplemented with essential vitamins and minerals. Feedings should be throughout day instead of just one meal a day. It should be wet food not dry food. If the cat has neurological signs such as seizures and confusion, ammonia production in the body must be reduced through lowered protein or renal diets from vets.

Appetite stimulant such as cyproheptadine (obtained from vet) will help a cat already able to eat on own.

If cat has gastric ulcers, the vet should also prescribe gastric medication such as ranitidine.

If the cat also has seizures or confusion, antibiotics such as metronidazole may be prescribed.

Essential vitamin supplements required include vitamin B, C and E. No specific doses of vitamin B and C available; use a pet vitamin or give half the stated dosage on human grade supplements. Vitamin E is advised at 10IU per kg of body weight per day.

Amino acid supplements required (suggested dosages based on available literature):
Taurine 250-500mg
Carnitine 250-500mg
Arginine 2.5g

Antioxidant supplements required (suggested dosages based on available literature):
SAMe (S-Adenosyl-Methionine) 20mg/kg of body weight
NAC (N-acetylcysteine) 70-140mg/kg of body weight

Herbal supplements (dosage is half the stated dosage on human grade products or as prescribed by vet):
Milk thistle - improves liver function
Dandelion root - detox function
Burdock root - detox function, diuretic
Slippery elm bark - for cats who present vomitting symptom

We find that digestive supplements are also useful:
Probiotics
Digestive enzymes - especially helpful if cat also has pancreatitis

Neurological supplements:
St John's Wort - improved mood and calming effect
Skullcap - improvement on confusion or seizures, calming effect

We get all our supplements from iherb.com (if you also need them, get USD5-10 off your first purchase from the site by using our discount code AVA985). Feed them mixed in food or make into a suspension and syringe feed. All herbal supplements need to be administered 3 hours before or after pharmaceuticals to prevent counteraction. If taste is repulsive to cat, reduce dosage.

Thank you Pablo for giving us all this knowledge. We miss you already. Wish we could have done more for you.



Sources: 
1. Plumb's Veterinary Drug Handbook 7th Edition 2011, Donald C. Plumb
2. Cat Owner's Home Veterinary Handbook 3rd Edition 2008, Eldredge et al

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