Abstract
Inappetence is a common presenting sign in cats, as well as a frequently noted complication during hospitalisation. Because it is common, the significance that the negative consequences of inappetence have on a patient, including impacts on immunity, healing and gut health – resulting in delayed recovery from illness and discharge from hospital – may not be fully recognised. If nutritional issues are not dealt with, this may undermine and reduce the efficacy of potentially complex or expensive surgery or medical interventions, and a cat’s wellbeing can also be negatively affected. As veterinary professionals, we should consider nutritional status to be the fifth vital assessment after temperature, pulse, respiration and pain assessment, so that we can identify cats in need of intervention. By taking a full nutritional history, calculating nutritional requirements, monitoring food intake and promptly intervening with appetite stimulants and tube feeding, as needed, we can improve the care of hospitalised cats and therefore optimise clinical outcomes.
There are many causes of inappetence in hospitalised cats beyond the underlying disease. Adverse effects of medication, for instance, perhaps simply due to administering multiple and/or bitter-tasting medications, in addition to the significant stress of being hospitalised, can have a negative effect on appetite. Pain, nausea, gastrointestinal dysmotility, dehydration and electrolyte abnormalities can also all contribute to reduced appetite and must be managed to encourage voluntary food intake. ‘Don’t wait!’ is the message: instead of hoping the patient will eat tomorrow, it is important to act today and improve patient outcomes. Any clinic hospitalising cats should be recording food intake and intervening promptly when any cat has a reduced appetite.
The 2022 ISFM Consensus Guidelines on Management of the Inappetent Hospitalised Cat were created to provide veterinary professionals with practical information on
the causes and consequences of malnutrition, when and how to intervene, how to reduce stress, the appropriate use of appetite stimulants, placement of feeding tubes and optimising tube feeding, and avoiding refeeding syndrome.
Minimising stress as much as possible, for example by allowing cats to adopt a comfortable position when being tube fed, is important in helping to optimise the clinical outcome. Image courtesy of Sam Taylor
To help clinics, a complete ‘toolkit’ for the guidelines includes printable dietary history and feeding tube record forms, videos on placement of naso-oesophageal/nasogastric and oesophagostomy tubes and, importantly for both caregivers and veterinary professionals, a video showing how to care for a cat with a feeding tube. Additionally, two caregiver guides cover inappetence and tube feeding. These accessible materials mean clinics can direct caregivers to reliable information when discharging a cat with a feeding tube in place. The aim is to provide veterinary professionals with the confidence to place feeding tubes, and caregivers with vital information on caring for cats with inappetence.
We hope these guidelines and additional materials will mean nutrition becomes the priority it should be for all hospitalised cats and their ongoing treatment, and that veterinary professionals and caregivers feel empowered to provide the nutrition such patients need.
Footnotes
Guidelines toolkit
The supplementary materials that make up the guidelines ‘toolkit’ are available at: bit.ly/inappetentcattoolkit. The two guides for caregivers are also available at 