Hepadic Lipidosis - Please Help!!!

[Kitty Mom]

My kitty (shyness) has been diagnosed with Hepatic lipidosis. I noticed on August 17th that the skin inside here ears was greenish yellow and rushed her to the emergency vet. Since then I spent 2 days force feeding every 3 hours along with daily vet visits for sub-q fluids and antibiotic but she was not getting enough food still so she had a esophageal feeding tube put in and feeding is going much better (1 can feline AD a day). I’m hoping someone out there can tell me….
At the emergency vet on the first day her blood panel came back with one of the numbers that should have been between 55 and 111 being at 500. After the 2 days of trying to force feed that number tested at 600, after 3 days of the feeding tube the number came back as 800. I am feeding 20-30 cc’s every 3 hours day and night (sleep deprivation and praying for understanding from my boss) which will be soooo worth it if she gets better. Has anyone with a success story had the numbers go up before they go down or is it to late???

[Traci]

First, ask your vet if you can increase each feeding session to 45-60 cc's per feeding, and reduce the time frequency to four times a day (morning, noon, late afternoon, evening). She could be enduring too much stress with the every three hour feeding schedule, plus if she is vomiting, the vomiting is prohibiting her nutritional intake, which is so critical at this point.

Ask your vet about giving sub-q fluids at home, they need to show you how, will provide you with the fluids, tubing and needles. It's easy to learn how, and probably necessary for your kitty in particular at this point.

Is she on antibiotics? If not, get her on them immediately (usually amoxicillin)....these can be given with her food via syringe.

Make absolutely certain you are flushing and administering the feeding tube with water before AND after each feeding schedule. This ensures that the tube is kept clear and viable, and also ensures additional hydration support.

What instructions did your vet give you? If he didn't give you explicit feeding instructions, a feeding schedule, antibiotics, fluid support instructions, etc, it's time to call him back right this moment and get your concerns met. If he's not instructing you at all, its time to see a NEW vet ASAP.

Hepatic lipidosis can be treated successfully, as long as it is treated aggressively, promptly, correctly, and that you are meeting her feeding requirements to the T. The number one concerns in treatment are nutritional support, fluids, and antibiotics. Also make sure that she is not suffering additional undue stress.

Again, call back your vet, ask about increasing the food amounts, feed four times a day, and if vomiting is a concern, ask for reglan (metoclopramide), sub-q fluid administration. What food are you using for the feedings, and are you mixing it with water?

[Kitty Mom]

My vet gave me a sheet with instructions and at first we were mixing the science diet A/D with water but we grandually changed it to just the food with a 5-10 cc flush of water afterward. I would love for her not to have to go to the vet everyday, she hates it. I am definatly going to see if I can do that stuff at home.
She has only vomited once and that was because she was in distress with constipation which has gotten better.

she is currently on an antibiotic the vet is giving her at the same time as her feedings, I don't know what it is but the vet said "it's very strong".

I have been feeding her every 3 hours because I thought the best bet would be to feed as often as possible so here stomach is never empty, but hadn't thought I could do it too much. The instruction sheet just said to administer 1 1/2 cans over a 24 hour period 6-8 times a day so I could increase the amount and decrese the frequency, I'm just worried for her stomach comfort.

Things seem to be going well exept for the numbers. She sleeps a lot and doesn't have much energy but she also gets up and moves around, is interested when I move my hand under the covers, and purrs fairly regularly.

[Traci]

If your vet gave you explicit instructions to feed 6-8 times, don't change that on my advice, just call him and ask if an increased amount and about 4 feedings per day would be more suitable to her. Do you know her weight? Perhaps he suggested more frequent feedings based on her weight.

I'm concerned with your feeding the food only through the tube....this can certainly clog the tube faster than anything (and if you push the syringe too hard to flush it, you could end up with a displaced tube, or gagging/vomiting/regurgitation, not good)....she also needs that additional fluid support with the flushing before and after. I usually recommend at least 2 cc's of water before feeding, and 2 cc's after feeding, sometimes 1 cc in between to keep the tube flushed. Hydration is a critical part of the recovery process, if she isn't getting enough fluids, dehydration is putting an added strain to her liver and it won't be able to regenerate itself fast enough.

Minimize any stress at all costs. If she is depressed, you need to inform your vet at once, he may suggest increasing her food amounts, he may suggest sub-q fluid administration at home, may change the antibiotic or any number of things. What you are looking for are signs of improvement each day, not progression of the disease. Her attitude should be more bright, alert and responsive, not seeking to hide, sleep all the time, etc. While in the first days after initial diagnosis, this could be expected, it's been 8 days since her ER visit, so you really should be seeing signs of improvement, slight as they may be.

At least call him and ask about increasing the amounts....

[Kitty Mom]

I will at least switch to 6 feedings a day instead of 8 (still inside instruction guidelines) until I can ask the vet about less.

I know the vet visits are stressing her out and I am probably stressing her out worse. I go in to see her at least once an hour because I'm worried but she startles because with not feeling well I think she feels vulnerable to be around the other cats and is afraid I'll let one in. I'm am going to work on giving her a little more peace.

The vet has been giving sub-Q liquids every morning and other than the feeding tube flush hasn't told me to do any more. Is it possible that the sub-q (or sometimes intravenous fluids) from the vet are enough?

also, my original question, do the enzyme numbers sometimes get worse before they get better?

[Traci]

Do you mean you are taking her to your vet every morning for sub-q fluids? (is he also charging you every time?) If so, ask him to show you how to do this so you can do it at home, it's relatively simple, and there is a post here in the forum that explains giving sub-q fluids in greater detail if you need help (we can look at that later). I have a feeling if you can do this at home, your kitty's stress level will be reduced by at least half. Just make sure he instructs you on how much to give each day.

If she is not severely or critically dehydrated, IV fluids probably are not necessary, and the hospitalization again would stress her to the max. Hopefully, she can be maintained on sub-q's only, at home.

Yes, the ALT can rise and get worse before it gets better, but ideally, you are looking for it to decease to at least 100-200 from this point onward, then you might be able to say she's in a safer zone, providing her liver is regenerating steadily, fluids are compensated and her nutritional needs are met strictly. Her labs should be retested at least once a week while the ALT is so high, when it reduces, you can then retest the labs every two weeks, at your vet's discretion. When her ALT decreases to around 50, you know her liver is regenerating and healing properly. (also depends on your vet's lab analyzer and reference ranges)

[Guest]

Traci,
Thank you soooo much!! Yes I have been bringing her into the vet everyday and this morning he told me that the he had gotten the wrong results yesterday (they were from the prior week) and her number was down to 425!!!!

I also changed her feeding times to every 4 hours instead of 3, and asked the vet about giving her the sub-q at home and I now have the IV bag with fluids, a bag of needles and some liquid antibiotic and Shy will only need to go in every 3 days or so.

And to top it off, I feed the other cats some tuna last night and brought in a spoonfull for her and once I left the room she ate it. so I ran to the store, got lots more tuna and a bunch of kitty food and put some fresh dry food out and the ate about a tablespoon of that overnight.

Thank you so much for you help. I'm going to go look at the detail instructions for sub-Q now!!!

[Guest]

I can't find the sub-q fluids instrutions?

[Mona]

I saw your post and found this, hope it helps you.

http://www.vetmed.wsu.edu/ClientED/cat_fluids.htm

You are doing wonderfully, keep up the good work. Your are a great kitty Mom!!

Mona, Chloe and Honeybun

[Traci]

I can't find the sub-q fluids instrutions?

First, I must warn you about canned tuna, this contains much too much fat for her condition at this point, please do NOT feed tuna right now. If she is interested in her normal dry food, that's fine, but you cannot rely on that slight interest for her sole recovery. You MUST continue the tube feeding until her labs are within normal range. Even then, the vet will not remove her feeding tube until at least 5-7 days after she is eating sufficiently on her own.

You can find detailed sub-q administration in this post:
Sub-q fluids administration