Case 8

Because of concerns regarding coagulopathy in Misou's case, you begin parenteral supplementation with vitamin K (0.5 to 1 mg/kg subcutaneously b.i.d.) for four doses. Vitamin K supplementation is especially important in malnourished patients before an esophagostomy or a gastrostomy tube is placed or any liver aspirates or biopsy samples are obtained.

Some research suggests that cats with hepatic lipidosis have vitamin B12 insufficiency, so supplementation in these cases can also be part of the treatment plan. You begin Misou's treatment with a subcutaneous injection of 250 µg of B12 to be given once a week for six weeks.

Providing these patients with an oral feeding option depends on how you think the pet is doing. If the cat is nauseated and drooling or if there is any vomiting, avoid offering food. The concern is that cats may develop a food aversion response, which will further complicate return to a normal feeding schedule. If the patient doesn't want to eat voluntarily, don't force the issue.

The next day (day 2 of hospitalization), Misou has started nasoesophageal feedings successfully. The owners agree to abdominal ultrasonographic and thoracic radiographic examinations to look for an underlying problem such as neoplasia, fungal or granulomatous lesions, intestinal wall structural changes, enlarged abdominal lymph nodes, and pancreatic disease. Because Misou is allowed to go outdoors, infectious causes of illness and hepatic disease should be considered such as protozoal or fungal infections. Ultrasound-guided fine-needle aspiration of her liver is planned.

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