Content continues after advertisement

Findings & Prognosis for Refeeding Syndrome in Cats

Janine M. Calabro, DVM, DACVECC, Friendship Hospital for Animals, Washington, D.C.

Sign in to Print/View PDF

In the literature

Cook S, Whitby E, Elias N, Hall G, Chan DL. Retrospective evaluation of refeeding syndrome in cats: 11 cases (2013-2019). J Feline Med Surg. 2021;23(10):883-891.


FROM THE PAGE...

Refeeding syndrome in cats is a complex condition characterized by multiple metabolic derangements (including hypophosphatemia, hypokalemia, and hypomagnesemia) that develops after reintroduction of nutrition following prolonged starvation or malnourishment.

This study used medical records from 4 referral hospitals to describe clinicopathologic findings, management, and outcome in 11 cats that developed refeeding syndrome after having been missing. Inclusion criteria included presence of a refeeding syndrome risk factor (eg, emaciation or severe weight loss following presumed starvation); hypophosphatemia or a maximum drop in phosphorous of ≥30% after refeeding; hypokalemia, hypoglycemia, and/or hyperglycemia; and treatment based on clinical diagnosis of refeeding syndrome. Data on clinicopathologic findings, blood product administration, nutritional plans, evidence of organ dysfunction, length of hospitalization, and outcomes were collected.

Cats had been missing for a median of 6 weeks (range, 3-104 weeks; n = 11), and mean percentage weight loss was 46% ± 7% (n = 8). Hypokalemia, hypoglycemia, hyperglycemia, and elevations in bilirubin and ALT were common. Organ and cardiovascular dysfunctions were documented in all cats; hypotension was noted in 6 cats. GI dysfunction, most often inappetence after initial feeding, developed in all cats. New or progressive neurologic deficits after refeeding were seen in 8 cats. All cats developed anemia, with 7 cats requiring transfusion therapy, and 6 cats developed acute kidney injury (AKI). All cats ate initially after presentation, and 4 cats ate voluntarily throughout hospitalization.

Eight cats survived to discharge; 1 cat died, and 2 cats were euthanized. Surviving cats were hospitalized for a mean of 14 ± 4 days. Maximum bilirubin concentration was significantly higher in nonsurvivors, and AKI was significantly associated with nonsurvival. ALT concentration and magnitude of decrease in phosphorous were not associated with outcome.

...TO THE PATIENT

Key pearls to put into practice:

1

Refeeding syndrome is an uncommon clinical condition that may develop following realimentation after prolonged starvation or malnutrition. A variety of clinicopathologic changes are possible, but  hypophosphatemia, hypokalemia, and altered glucose homeostasis are most common in cats.

2

Cardiovascular, neurologic, and GI dysfunction may be common in cats with refeeding syndrome, and patients may develop anemia that requires transfusion therapy. Increased bilirubin and AKI appear to be associated with nonsurvival.

3

Good prognosis is possible, but prolonged and intensive care may be required.

Suggested Reading & Author Information

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.

Material from Clinician's Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.

Podcasts

Clinician's Brief:
The Podcast
Listen as host Alyssa Watson, DVM, talks with the authors of your favorite Clinician’s Brief articles. Dig deeper and explore the conversations behind the content here.
Clinician's Brief provides relevant diagnostic and treatment information for small animal practitioners. It has been ranked the #1 most essential publication by small animal veterinarians for 9 years.*

*2007-2017 PERQ and Essential Media Studies

© 2022 Educational Concepts, L.L.C. dba Brief Media ™ All Rights Reserved. Terms & Conditions | DMCA Copyright | Privacy Policy | Acceptable Use Policy