A 5-year-old, spayed female domestic shorthair was missing for 49 days. Although not proven, it was presumed that she had been trapped for the entire time in the garage, where she was ultimately found. At a wellness checkup 4 months earlier she had weighed 5.9 kg. Her current weight was 2.7 kg-a 46% reduction. Rectal temperature was 90º F; heart rate was 30 beats per minute. Emergency treatment included warmed lactated Ringer's solution, atropine, and endotracheal intubation with intermittent positive-pressure ventilation. Warm fluid peritoneal dialysis was performed to increase body temperature. Once spontaneous ventilation returned and the heart rate increased to 114 beats per minute, the cat was extubated. Numerous complications occurred during the management of the cat, similar to those reported in humans. Clinical signs of thiamine deficiency (marked neck ventroflexion) were present, and thiamine supplementation was given. Other complications were hypokalemia and hypomagnesemia when the cat was fed; these complications were managed by feeding a lower-carbohydrate, lipid-containing solution, thereby decreasing insulin release and reducing electrolyte abnormalities. Hyperglycemia was noted on days 3 and 7 but was not considered to warrant treatment. The cat was discharged 15 days after presentation. At 6-month follow-up, body weight had increased to 5.6 kg. The only reported problems were mild cerebellar compromise with occasional loss of balance when climbing stairs or jumping.

COMMENTARY: Although this case is dramatic, it is a good reminder of the problems that can be encountered when refeeding patients that have been starved, either accidentally or intentionally. Careful monitoring of these patients for complications, with the attendant supportive care for any that do arise, is necessary.

Management of prolonged food deprivation, hypothermia, and refeeding syndrome in a cat. Armitage-Chan EA, O'Toole T, Chan DL. J VET EMERG CRIT CARE 16:S34-S41, 2006.