UNDERSTANDING PET FOOD

Appetite Management in Hospitalized Dogs and Cats

AUTHOR NAME, CREDENTIALS AND AFFILIATION: 

Adesola Odunayo 

DVM, MS, DACVECC 

University of Florida 

Gainesville, Florida, USA 

Q. Why is malnutrition important to consider for hospitalized patients? 

A. Appetite is the manifestation of hunger and is the body’s normal response during periods of decreased energy intake.¹ Hyporexia or anorexia is a maladaptive response resulting in a reduction or absence of food intake despite inadequate consumption of energy and might lead to malnutrition if untreated.¹ Hospitalized patients are at risk for malnutrition as acute (and chronic) illness can impact nutritional intake and appetite.² Malnutrition has been correlated with morbidity and mortality, increased length of hospital stay, and increased medical costs.^2–4 In one study, dogs and cats were more likely to be discharged from the hospital when they achieved nutritional goals closer to their resting energy requirements.⁴ 

Recognition and treatment of malnutrition should be prioritized in hospitalized dogs and cats. Thus, nutritional interventions should be considered when a patient has been anorexic or hyporexic for three or more days or if anorexia is expected to last for at least that period (e.g., an animal with severe acute pancreatitis who is hospitalized for treatment).¹ It is important to note that many hospitalized patients are hyporexic or anorexic at home prior to hospitalization, and this should be accounted for when evaluating the patient’s risk of malnutrition. 

Q. What interventions can be implemented in anorexic or hyporexic hospitalized patients? 

A. Strategies to consider to increase voluntary food intake in hospitalized patients include clinical and nutritional interventions. An important first step to getting a patient to eat is to treat the underlying disease causing a poor appetite. An appropriate diagnostic plan should be implemented and abnormalities surrounding volume status, hydration, nausea, infection, pain, and acid-base/electrolyte abnormalities should be corrected as soon as they are identified. Once interventions have been made to address the underlying disease, specific nutritional interventions should be carried out to encourage voluntary consumption of food. 

Q. What are examples of nutritional interventions? 

A. 

• Remove any uneaten food from kennel/cage after about 20 minutes 
• Avoid feeding around times of unpleasant procedures 
• Try different texture food (dry kibble and different textures of canned food, etc.) to improve acceptance 
• Remove barriers to eating (such as Elizabethan collars) 
• Heat up the food before offering (can be really helpful for cats) 
• Hand feed the patient 
• Feed in a quiet location 
• Feed the patient outside when the weather is nice (especially true for dogs) 
• Have the pet owner bring in the patient’s favorite food 
• Have the pet owner visit and feed the patient 

Q. How much food should hospitalized patients receive at first? 

A. When initiating feeding in hospitalized patients, it is generally recommended to start with about 25% of the patient’s resting energy requirement (RER) for current weight, and then gradually work up to 100% of the patient’s RER over approximately four days. The time will be dependent on how well the dog or cat eats and the patient’s tolerance to feeding. Resting energy requirements in kcal/day is equal to 70 x (body weight in kg)^0.75, and current weight should be used for hospitalized patients. 

Q. If initial clinical and nutritional interventions are not successful, what other strategies can be implemented?  

A. Pharmacologic agents that stimulate appetite may be considered if addressing the primary underlying disease and providing nutrition-specific interventions fail to promote voluntary food intake. The use of appetite stimulants as the primary or sole means of increasing food intake is not recommended.¹ Appetite stimulants that may be considered may include but are not limited to cyproheptadine, mirtazapine, and capromorelin. It is important to note that the efficacy of appetite stimulants may be unpredictable, and they may not increase food intake to a level that meets the patient’s target energy requirements.¹ 

For patients with prolonged anorexia or more severe disease, a feeding tube is indicated as a means to provide enteral nutrition. Nasogastric or nasoesophageal tubes are easy to place, inexpensive, and do not require general anesthesia. Esophagostomy or gastrostomy tubes may also be considered although both are more suited for long-term assisted feeding and require general anesthesia. Parenteral nutrition may also be considered in animals who may not tolerate enteral feeding (irretractable vomiting or regurgitation or patients with neurologic disorders like a compromised gag reflex).