Refeeding after starvation can lead to a range of fluid, electrolyte and hematologic shifts associated with metabolic abnormalities that is called "refeeding syndrome" in humans. Refeeding syndrome is not well documented in cats.

A prospective study was conducted on ill cats hospitalized in an internal medicine service who had inadequate food intake for more than three days and were refed with enteral feeding. The objective was to follow clinical and biological parameters known to be modified in refeeding syndrome during the first five days of enteral refeeding. An initial nutritional assessment was done for each cat. Sodium, phosphorus, potassium, ionized calcium, magnesium, glucose, insulin, albumin, haematocrit, creatine kinase, cardiac troponin I and serum amyloid A were evaluated at the time of feeding tube placement, and then after three and five days of refeeding. Physiological parameters were recorded twice a day. A daily weight was done. A nutritional plan based on the nutritional assessment was implemented for each cat.

From February 2015 to December 2015, 16 cats were recruited. Seven cats completed the study (stress precluded adequate blood sampling in six cats, one cat removed the feeding tube before day 5, two cats died). The seven cats were 9.3±3.8 years old. Six cats were anorectic from three to seven days, one cat was dysorexic for three months. Two cats with a hepatic lipidosis were considered at risk to develop a refeeding syndrome. One of them with a three-month history of dysorexia, icterus and marked emaciation at admission developed at day 3 of refeeding severe electrolyte shifts (marked hypokalaemia and hypomagnesaemia, moderate hypophosphatemia), aggravation of anaemia, acute elevation of creatine kinase activity and bilirubinemia concomitantly with respiratory distress, vomiting, muscle weakness and hypotension. He was strongly suspected of refeeding syndrome. None of the six other cats developed clinical signs or remarkable biological abnormalities potentially linked with refeeding. Glycaemia and insulinaemia were consistently higher on day 3 and 5 than on day 0 on all cats. Mild to moderate hypophosphatemia was documented in 4/6 cats, mild hypokalaemia in 2/6 cats and mild hypomagnesaemia in 1/6 cats.

In this pilot study, significant combined biological abnormalities suspected to be linked with refeeding were observed in 1/7 cats. A careful nutritional plan and an adequate electrolyte supplementation are critical to avoid refeeding complications. Strongly debilitated cats could be at risk to develop complications despite adequate precautions.

Disclosures

No disclosures to report.