By Lisa Provost
Hepatic lipidosis is one of the most common causes of liver failure in a cat and stems from the basic feline design. Cats evolved as predators of small birds and rodents, eating multiple small meals throughout the day. Their physiology is geared towards a completely carnivorous diet and with the predisposition that cats live lean and never have the opportunity to develop extensive fat stores.
This all changed when cats became domesticated. The modern house cat has every opportunity to become overweight and while this may not spell immediate disaster, it can be a recipe for serious illness on so many levels. If a cat becomes ill for any reason and stops eating, their liver may become infiltrated with fat, and fail. Normally, in starvation, fat is moved from the body’s storage depots to the liver for processing into lipoproteins. But the feline liver was never intended to handle huge amounts of mobilized fat. Complications can also arise from the high dietary protein requirement that is unique to cats; protein malnutrition develops very quickly when a cat doesn’t eat. Cats that are especially weak may have electrolyte imbalances and/or vitamin deficiencies from their liver disease. It can take anywhere from 36-48 hours for a cat to develop fatty liver disease if they’ve stopped eating and/or are eating very little calories in one day. If this happens, get them to the vet immediately for examination and testing. If you can’t get to the vet right away, please begin syringe feeding until you can.
If your cat has liver disease, IBD, pancreatitis, chronic kidney disease (CKD) or any other health issue please don’t fast your cat unless it’s under the guidance of your vet for certain blood tests. And even then a lot of times the acid produced by their systems is incredibly nauseating and fasting for longer than 12 hours can be a problem. If that’s the case, speak to your vet about it. But do not follow websites that tell you its okay to fast your sick kitty for 24 hours to cleanse their systems. You are putting your cat’s already fragile state in danger. Especially with liver inflammation and fatty liver disease, fasting is the last thing you want to do; it can be fatal.
There are obvious, visible signs of liver problems; one being jaundice. A cat’s normal skin color is pink. But when a cat’s liver is compromised, the skin on their ear flaps, lips and gums usually are the first places to change color and become yellow. Severe jaundice is visually present on their undersides, stomachs, eyes, paws, etc. If your cat has seemed ill, depressed, isn’t eating properly and develops a yellowish color anywhere on its skin or eyes, and/or develops a fever, please bring your cat to a vet immediately. If liver disease is present, there is no time to waste. A biochemical profile must be done, and usually antibiotics are administered via a slow, continuous, IV drip of fluids. Your cat may have to be hospitalized for a few days depending on the severity of the jaundice and what the profile indicates. There are also other forms of liver disease such as cholangiohepatitis and cholangitis but regardless, the signs of liver inflammation and/or liver failure are the same and so is the urgency of testing and treatment.
The good news is that with proper food and support, the liver can often be restored to normal function: liver damage is not necessarily permanent, and the liver can heal. But getting the full daily caloric need into your cat is the main, most important step you can take to get your kitty through this. If you cannot hand feed or assist feed your cat into eating all the food needed daily, please talk to your vet about a feeding tube. Food – the right amount of food – is critical, and feeding tubes save lives. Don’t be scared if your cat needs a feeding tube inserted. This is vital to the healing process and will help with feeding the proper calories and nutritional intake for awhile (weeks, maybe months, depending on how sick they are). Feeding tubes are a valuable tool in healing the liver and do not cause any pain to your pet. In fact, some grow to love the feedings.
In hindsight there are many things I wished I’d done differently for Alex. It all seemed so fast with her I hardly had any time to wrap my head around what was happening. First, I would have immediately put her on Denosyl or Denamarin at the very first sign of an inflamed liver and got her enzyme levels down before it had gotten out of hand. By waiting to start this treatment, almost six months later, the damage was already done. Hepatic lipidosis was already present and it was too much stress on her body to try and turn things around at that point. Her liver had affected her pancreas and she was producing too much bile. The professional advice was to give her liver as much of a rest as possible and let it heal itself, but in her case it did absolutely no good. By the time I started any vitamins, Omega oils, diet changes, all natural therapies, (all under my vet’s guidance), the disease was well underway and at an advanced stage. Of course there’s no way to know for sure if any of that would have curbed her disease or could have given her the advantage to fight it better, we’ll never know. I just know that if I had it to do all over again, I would not hesitate for a single day to start that particular treatment.
I would have also gone with my gut and given her Actigall (ursodiol) instead of trying other medications that just made things worse. The steroids cranked up her liver inflammation instead of bringing it down, the antibiotics did the same, so none of it worked. In fact, all it did was put her into seizures, which she’d never had before. As I stated on her medical history page, Alex had a seizure once she was put on Flagyl. I didn’t know this is at the time but when a cat has liver disease, there is a danger of seizures. Not in every cat’s case, but it can happen. And that seizure is what pushed her over the edge to become severely jaundiced and cause her liver to start failing. Flagyl can cause neurotoxicity in some cats. There’s a big difference of opinions on this medication. In many cases (such as SIBO, small bacterial overgrowth), it’s needed to be given long term as there are hardly any choices for antibiotics that work in this area. But Pfizer states in their literature that it was never intended to be given long term and that it can in fact cause neurotoxicity of the liver. I think my poor girl’s system was in such a mess it couldn’t handle it. It seemed that no matter what we gave her, she had a negative reaction to it. This is a drug that needs to be monitored closely if you’re going to give it. I do agree that many do need it and do well on it. But just know complications can happen and if they do, call the vet immediately.
A high ammonia level can also cause seizures and can happen with severe liver disease. This may be why Alex was so sensitive to the Flagyl, she may have had a high ammonia level and was already close to the seizure threshold. A high ammonia level isn’t something that shows up on any chemical profile, it has to be specifically ordered and if the level is high, it can be overcome with intensive treatment. I don’t know for sure if Alex’s levels were high but because she became severely jaundiced within hours of the seizure and had to receive IV fluids, antibiotics and partial hospitalization, this may very well be the case. I do know that during the very first day of treatment she started recovering immediately and was doing very well.
To my vet’s credit, a week before Alex died I talked with her about giving Alex Actigall and the final decision was left up to me. But at the time, Alex had been on Denosyl for awhile, had a good appetite and her coloring looked 98% better than it had before. Her opinion was that she didn’t really need it and because Alex had so many terrible reactions to medications she was leery of giving her anything else. I just didn’t know what to do, so I chose not to give it to her. Neither my vet or myself had any way of knowing she’d suddenly develop an infection a week later and be gone so quickly. But if I had it to do again, I’d have given her the ursodiol much, much earlier when her liver inflammation was first diagnosed.
Ursodeoxycholic acid (ursodiol) is a choleretic. It improves the flow of bile through the tiny ducts into the gall bladder and from the gall bladder into the intestine. By doing this, it facilitates the removal of toxic bile acids (as well as other toxins excreted in bile) from the body. Ursodeoxycholic acid also appears to have beneficial effects in normalizing immune reactions in the liver and may be useful in the treatment of cirrhosis and chronic active hepatitis. If your cat is on ursodiol, you should supplement with 250-500mg taurine per day due to increased urinary losses of taurine. There’s a possibility that chronic use of Ursodiol in cats may deplete the body of taurine.
Bile is a fluid used to excrete toxins as well as to prepare fat for absorption into our bodies. Some bile acids are simply lost in the intestine and eliminated in stool and some are reabsorbed, or recycled, for reuse by the liver. If more bile acids are required than were reabsorbed, then the liver has to produce more. If the liver is failing, reabsorbed bile acids are not captured by the liver for reuse. Instead they’re passed through the liver and into the body’s circulation.
I also would have started her immediately on B12 injections from the moment she lost her appetite. What I believe now is that B12 is a MUST with all of these GI and intestinal disease. It’s water-soluble and can greatly increase absorption of nutrients and hunger levels without the use of appetite stimulants in many cases.
Don’t forget that any and all medications, including all natural supplements and herbs, have to be filtered and processed through the liver. In fact, there are some medications that require that the vet monitor and check the liver enzymes periodically as it can do some slight damage or push it to work too hard. All of that can have an exhausting effect, even if there isn’t currently any enlargement or inflammation. Whenever one organ in the body has inflammation or disease present, it almost always puts an added strain on the surrounding organs and/or other organs that rely on it to function.
One feeds off of the other and if the liver is over-working, the pancreas will start to overwork, the kidneys, the intestines, the bowels, etc. Always keep in mind the chain of reaction that’s going on inside of the body. The same goes for other diseases that are present before lipidosis, such as kidney or renal disease, pancreatitis, inflammatory bowel disease, etc. These diseases will in turn put strain on a properly functioning liver and cause strain to filter out the toxins being produced from these other organs.
These are all teaching moments and my goal is to teach you to educate yourself, educate your vet, bring new ideas to the table about your cat’s treatment and above all, listen to that little voice in your head and heart when it’s telling you something is, or isn’t right. Be your pet’s advocate and learn as much as you can. I hope that my experiences and research can help you make better choices for your cat if need be.
Some materials used in this article were written and provided by: Dr. Wendy C. Brooks, DVM, DipABVP
Feline Liver Disease:
Flagyl ( Metronidazole)