Managing inappetence, nausea, and vomiting is a common concern for cats with chronic kidney disease (CKD). These symptoms can significantly impact their quality of life and overall well-being. Here's how to approach these issues effectively.
Nausea and Vomiting in CKD Cats
Nausea and vomiting in cats with CKD are often related to the buildup of toxins in the bloodstream that affect the brain's chemoreceptor trigger zone. This can lead to reduced appetite, which is a major worry for pet owners and can contribute to malnutrition.
Signs of nausea:
Loss of Appetite: A nauseated cat may show disinterest in food or refuse to eat altogether. They may also behave as if they are hungry and then appear to change their mind once they see or smell food.
Fussy Appetite: They may only want to eat their favourites, or freshly opened tins of food.
Excessive Drooling: Hypersalivation or drooling is a common sign of nausea in cats.
Licking, Lip-Smacking and Swallowing: Cats may repeatedly lick or smack their lips or swallow more frequently when feeling nauseated.
Vocalisation: Some cats may meow excessively or make unusual sounds when feeling sick.
Lethargy: A nauseated cat may appear tired, less active, or show a lack of interest in their surroundings.
Behavioral Changes: Cats might hide, show less interest in interacting with people or other animals, or appear restless.
It's important to note that these signs can vary from cat to cat, and some may be more subtle than others.
Anti-emetic Treatment:
Medications like maropitant (Cerenia) and ondansetron can help control nausea and vomiting. These drugs target the brain's vomiting centers, providing relief from nausea. A study found that maropitant, given orally for two weeks, significantly reduced vomiting in CKD cats, while mirtazapine, another helpful medication, increased both appetite and weight (1).
Appetite Stimulants:
Reduced appetite can lead to dangerous weight loss and malnutrition in CKD cats. Managing appetite is crucial for maintaining energy and strength. Mirtazapine, which also acts as an appetite stimulant, has been found to be effective in increasing food intake. This can help CKD cats maintain a healthier weight and receive the necessary nutrients.
It is also very fortuantely that the molecular composition of this drug makes it an ideal candidate for transdermal application (i.e. is absorbed via the skin). This easy method of drug administration is ideal for nauseated cats that may resent oral administration. Please see a demonstration of this in the video below:
Managing Underlying Factors
Addressing underlying issues that contribute to nausea and appetite loss is key. Dehydration, hypokalaemia (low potassium), and acidosis (a blood pH imbalance) should be carefully monitored. Ensuring these factors are managed through proper hydration, potassium supplementation, or bicarbonate therapy can improve the cat’s overall condition and support better appetite.
Feeding Support
In some cases, when cats remain too nauseous or weak to eat enough on their own, a feeding tube (such as an oesophagostomy tube) may be used to ensure they receive adequate nutrition and hydration. Feeding tubes are often helpful in long-term management, allowing the cat to recover strength and maintain energy.
Take a moment to read our other blog posts about other important management aspects of CKD:
Reference:
Quimby, J. M., Brock, W. T., Moses, K., Bolotin, D., & Patricelli, K. (2015). Chronic use of maropitant for the management of vomiting and inappetence in cats with chronic kidney disease: a blinded, placebo-controlled clinical trial. Journal of Feline Medicine and Surgery, 17(8), 692-697.