Nasogastric tube feeding in cats with suspected acute pancreatitis: 55 cases (2001–2006)

Abstract

Objective -To evaluate the complications and outcome associated with different nasogastric tube (NGT) feeding techniques in cats with suspected acute pancreatitis. Design -Descriptive retrospective case series Setting -Small animal emergency and referral hospital Animals -The patient database (2001)(2002)(2003)(2004)(2005)(2006) was searched for cats with suspected acute pancreatitis that received NGT liquid enteral feeding within 72 hours of admission and ! 12 hours during hospitalization. Measurements and Main Results -Signalment, history, clinical signs, laboratory data and abdominal ultrasonographic examinations were used for suspected diagnosis. Cats were grouped based upon whether they received bolus feeding or continuous rate infusion (CRI) of a liquid diet via the NGT, and whether or not administration of an intravenous amino acid and carbohydrate solution occurred prior to NGT feeding (AAS and non-AAS group, respectively). Fifty-five cats were included. For all cats, NGT feeding was initiated at a mean of 33.5 AE 15.0 hours and the target caloric intake (1.2 X {(30 X BW [kg]) +70}) was reached at 58.0 AE 28.4 hours from presentation. There was a significantly longer time from admission to the initiation of NGT feeding in the 34/55 cats in the AAS group vs. the 21/55 cats in the non-AAS group (P = 0.009). The 8 bolus-fed cats took longer to reach target caloric intake vs. the 47 CRI-fed cats (P = 0.002). Complications associated with NGT feeding for all cats included: mechanical problems (13%), diarrhea (25%), vomiting following NGT placement (20%) and vomiting following NGT feeding (13%). Mean time to discharge for all cats occurred after 78.6 AE 29.5 hours with an overall weight gain of 0.08 AE 0.52 kg. Fifty cats survived 28 days post-discharge. Conclusions -NGT feeding in this group of cats with suspected acute pancreatitis was well tolerated, and associated with a low incidence of diarrhea, vomiting, and mechanical complications.

Management of the anorexic cat

“…The most frequently reported adverse effects with the use of nasal feeding tubes in cats with pancreatitis as reported by Klaus and others (2009) were diarrhoea, vomiting (after tube placement and after feeding) and mechanical problems. Signs of local irritation, such as sneezing and nasal discharge, are also seen.…”

“…The use of a constant rate infusion will overcome the requirement for frequent bolus feeding, but these patients need to be monitored throughout the delivery of such an infusion. A study by Klaus and others (2009) demonstrated a that the target calorie provision was reached sooner with constant rate infusion feeding than bolus feeding in cats. More recently however, a study by Campbell and others (2010) comparing intermittent to continuous feeding found no difference in the percentage of nutrients delivered or the rate of complications.…”

Pancreatitis

“…The most common clinical signs in cats with pancreatitis do not specifically indicate gastrointestinal disease and include complete or partial anorexia (63-97%) and lethargy (28-100%) (Hill & Van Winkle 1993;Gerhardt et al 2001;Saunders et al 2002;Ferreri et al 2003;Forman et al 2004;Klaus et al 2009). Other clinical signs include vomiting (35-76%), weight loss (20-61%), and diarrhea (11-33%) (Hill & Van Winkle 1993;Gerhardt et al 2001;Saunders et al 2002;Ferreri et al 2003;Forman et al 2004;Klaus et al 2009).…”

“…Also, in cats, episodes of vomiting may have occurred days or weeks before presentation and may thus not be reported by the owner (John R. August, personal communication, 2008). The most common physical examination findings include dehydration (33-96%), pallor (30%), and icterus (16-24%) (Hill & Van Winkle 1993;Gerhardt et al 2001;Saunders et al 2002;Ferreri et al 2003;Forman et al 2004;Klaus et al 2009). Tachypnea and/or dyspnea, hypothermia or fever, tachycardia, signs of abdominal pain, and a palpable abdominal mass may also be noted (Macy 1989;Hill & Van Winkle 1993;Simpson et al 1994;Steiner & Williams 1999;Ferreri et al 2003).…”

“…Results of the complete blood count, serum biochemistry profile, and urinalysis are nonspecific and thus of limited usefulness for the diagnosis of pancreatitis in dogs and cats (Akol et al 1993;Hill & Van Winkle 1993;Hess et al 1998;Kimmel et al 2001;Simpson et al 2001;Ferreri et al 2003;Klaus et al 2009;Weatherton & Streeter 2009). However, these tests should always be performed in animals with suspected pancreatitis because they are useful for the diagnosis or exclusion of other diseases, and give important information about the general condition of the animal.…”