Fallacies Regarding Feeding During Intensive Care

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"Nutrition is not a great problem. It is neither a priority nor an emergency compared with the other treatments and care protocols."

Nutritional support is not a substitute for emergency treatment to support the main vital functions. On the other hand, it must not be neglected. Status and nutritional requirements must be evaluated every day as part of a full examination of the cat during intensive care. Nutritional support must be part of the care protocol.

"The cat will be able to eat on its own in one or two days."

Time passes quickly in intensive care and the period the cat does not eat properly is always underestimated. Nutritional support takes time and may demand invasive procedures (e.g. esophagostomy or gastrostomy), which clinicians delay in the hopes that the cat will start eating again on its own. Anorexia is one of the most commonly observed clinical signs in intensive care units: treatment, anesthesia, surgery and the stress of hospitalization are all anorexigenic factors.

"Perfusion feeds the cat."

Although it does provide glucose, maintenance fluid therapy cannot be considered to be a form of nutritional support. While the aim is to correct blood volume, dehydration, and acid-base and electrolyte imbalances, its role is not to feed the cat. Only total or partial parenteral nutrition solutions administered in accordance with precise protocols can do this.

"If the cat does not want to eat, you can just initiate a parenteral nutrition protocol."

Parenteral nutrition is always tempting because it makes it possible to calculate precise intake with total certainty. Parenteral nutrition is not risk free, however, and it demands monitoring by qualified staff. Septic complications are especially common and the numerous required biological analyses are expensive.

"Hyperglycemia induced by parenteral nutrition is not a real problem. At least the cat receives the energy."

In humans, hyperglycemia is correlated with a negative prognostic outcome. In cats, it is correlated with the seriousness of the disease. There is a dearth of studies in this species for determining the influence of hyperglycemia on the prognosis and the necessity of controlling it with insulin therapy. The current recommendation is to avoid treatments that are likely to induce hyperglycemia.

"Cats fed through feeding tubes are not hungry. It’s not worth giving them anything else to eat."

On the contrary, it is important to offer food to cats fed through feeding tubes. It helps assess how interested they are in foods and whether they have their appetite back. It helps clinicians determine the best time to withdraw the feeding tube.

"Feeding tubes are very practical for administering drugs."

While tempting, it is inadvisable to administer drugs through a feeding tube. Turning drugs into powder can change their absorption and digestive tolerance. Also, the absorption of some drugs is changed by the composition of foods (depending on their fat content). Lastly, drugs may interact when administered at the same time.

"Parenteral solutions can correct electrolyte imbalances."

The aim of parenteral nutrition is to provide an intake of nutrients bypassing the digestive system, not to correct electrolyte imbalances, which should be done independently using traditional fluid therapy solutions.

It is however advisable to check the electrolyte content of common parenteral nutrition solutions. If they contain electrolytes, they can only be administered to animals with a normal electrolyte balance. Furthermore, the electrolyte balance must be monitored in these cats, to identify the appearance of any disruptions caused by the parenteral nutrition. If the cat’s electrolyte balance is disturbed, it is advisable to use parenteral nutrition solutions containing no electrolytes and to correct the patient’s electrolytes independently at the same time.