Monday, October 10, 2011

Daily Water and Fluid Requirements and Needs for Hyperthyroid Cats

Hyperthyroid cat drinking water
in his condo at the Hypurrcat spa
Drinking a healthy amount of water is vital to a cat’s health. Although water is certainly important for clinically normal cats, it is absolutely essential in maintaining and restoring health in sick cats, and that certainly includes cats with hyperthyroidism.

Everything your cat does uses energy, and water plays a critical role in the body's metabolic processes, which regulate all the body's functions (1,2). This is especially true in hyperthyroid cats, in which the metabolic rate is increased, body temperature tends to be elevated, and increased moisture loss through the respiratory and gastrointestinal routes are common.

Many hyperthyroid cats are mildly to moderately dehydrated. Keeping a hyperthyroid cat well hydrated helps ensure that adequate oxygen and vital nutrients will reach all the tissues of the body — this allows the cat to metabolize its nutrients and sustain or restore normal body function. Maintaining adequate hydration also helps absorb the excess body heat typically generated by hyperthyroid cats because of their “revved up” metabolic state (3-5).

The Potential for Dehydration is High in Older, Geriatric Cats

As cats age, they develop a number of important changes in water metabolism that can predispose them to dehydration. First of all, even healthy geriatric cats have higher water losses than younger cats, possibly due to reduced urine concentrating ability even without obvious evidence of overt kidney disease (6,7). In addition, the poor thirst reflect, already present in the younger cat (1,7,8), worsens as the cat ages; again, this reduced sensitivity to thirst commonly leads to a state of chronic dehydration in the geriatric cat.

The potential for dehydration will be exacerbated in cats with concurrent diseases that cause increased thirst (polydipsia) and urination (polyuria), such as diabetes mellitus, chronic kidney disease, or hyperthyroidism. Senior cats may benefit from increased water content via feeding canned foods, ensuring access to fresh water, or flavoring the water (see Water and Hydration Recommendations for Hyperthyroid Cats, below). Older cats do not cope well with changes in daily routine, so any changes to food and water should be made gradually.

Hyperthyroid Cats Commonly Have Increased Thirst and Urination

Thyroid hormones have a diuretic action, an effect that was reported in cats almost 70 years ago (9). In accord with those experimental findings, increased thirst (polydipsia) and urination (polyuria) are frequent clini­cal signs observed in hyper­thyroidism, occurring in over half of affected cats (3-5). Because of that effect, hyperthyroidism (along with kidney disease and diabetes) is one of the three major rule-outs for a cat presenting with increased thirst and urination. Although concurrent primary kidney disease con­tributes to polyuria and polydipsia in up to a third of cats with hyperthyroidism (5), these signs also occur in many cats with­out any evidence for kidney disease.

The precise cause of these signs in hyperthyroid cats without any kidney disease is not always clear. However, the hyperthy­roid state may impair urine con­centrating ability by increas­ing total blood flow to the kidneys, thereby decreasing the solute concentrations in the inner part of the kidney (i.e., the renal medulla). This renal “medullary washout” may cause polyuria with secondary poly­dipsia (5, 10). In other words, these cats drink more to compensate for the increased amounts of water lost through their kidneys.

Alternately, in cats with normal renal con­centrating ability, a central nervous system disturbance caused by hyperthyroidism may produce a “compulsive” primary polydip­sia (3-5,10,11). In other words, these cats develop a compulsive need to drink more water, and the increased urination occurs as a secondary response to the large volumes of water consumed. In these hyperthyroid cats, increased thirst and urination will normalize within a few weeks after successful of treatment of hyperthy­roidism.

In addition, it has been suggested that diseases that promote polyuria and a dilute urine (such as hyperthyroidism, diabetes, or renal disease) predispose to urinary tract infections (12,13). In one study, over 20 percent of cats with untreated hyperthyroidism has a positive urine culture, diagnostic for a urinary tract infection (13). If this infection would spread to the kidneys, pyelonephritis and subsequent renal failure could result (10).

As we discussed in my last post on Daily Water Requirements and Needs for Cats, cats have failed to evolve a strong "thirst reflex" like that of dogs and humans. This inherited weakness of the cat's thirst drive to respond to changes in his or her state of hydration must be considered in the hyperthyroid cat. We must work to ensure that an adequate hydration status is maintained on a daily basis in these cats.

Water and Hydration Recommendations for Hyperthyroid Cats

An important aging change in cats is reduced sensitivity to thirst, resulting in an increased risk of dehydration even in cats with seemingly normal renal function. As animals go, cats require less water than many others, and we often have a difficult time getting cats to drink as much as we would like. Cats with certain health problems, especially those with hyperthyroidism, need to drink more water than an average cat.

But how can we get a hyperthyroid cat to drink more water?
Here are a few hints:
  • Place more bowls of fresh water located in different areas of the house —Providing cats with more than one bowl of water in different locations around the house or apartment will encourage the cat to stop and take a sip from each one. I normally recommend at least to three bowls in various locations throughout a cat’s living space.
  • Provide larger water bowls —Another way to encourage cats to drink more water is to provide larger water bowls, such as ones designed for dogs, to prevent the cat`s whiskers from touching the sides when drinking. Filling the water level all the way to the top also helps prevent the whiskers from touching the sides of the bowl. A cat’s whiskers are very sensitive; whiskers touching the sides of the bowl can be very irritating for the cats.
  • Keep water bowls clean — By nature, cat will not drink stagnant or dirty water. Standing water tends to get warm and stale and can harbor bacteria, dust, and insects. To prevent this problem, it’s important to wash the bowl daily and provide fresh, clean water. In addition, use of stainless steel or ceramic bowls is best, as plastic bowls may lock in bacteria and odors.
  • Provide running water — Running water is naturally enticing to some cats. Some cats that refuse to drink out of a water bowl will drink water from a slowly running faucet or a “fountain bowl,” which can provide your cat with running water 24 hours a day. Make sure that the cats are drinking out of the fountain before removing other water bowls.
  • Flavor the water or add ice cubes — Adding a little water from a can of water-packed tuna to the bowl of water provides extra flavor to the water, which may entice some cats to drink. Flavoring water with chicken broth is another useful means to convince cats to drink more. Adding ice cubes or chips to the water as a treat will also help in some cats.
  • Feed canned food — Canned food has a lot of moisture, so it will provide your cat with much more water than feeding dry food. See my last post on Daily Water Requirements and Needs for Cats for more information about how to calculate the amount of water that the food contains.
  • Add water to the food— In some cats, 3 to 4 teaspoons of warm water can be added to the canned or dry food to provide more water. However, some cats do not like food with added water and may refuse to eat it, so this approach must be individualized.
  • Filtered or spring water — Some cats prefer filtered or spring water over tap water. However, distilled water is never a good choice, as it may actually flush needed minerals out of the cat’s body. I do not advocate the use of bottled water because of the environmental consequences of the plastic bottles as waste (14), as well as the chemical plasticizers known to leach from the plastic bottles. In addition, it’s important to realize that there is no way to know if the bottled water you buy is really pure and natural, or if it’s just processed and packaged tap water. 

Bottom Line: Water and Hyperthyroid Cats

Since up to a third of hyperthyroid cats have concurrent kidney disease, and up to 20 percent have concurrent urinary tract infections, keeping our hyperthyroid cats well hydrated is of utmost importance. Feeding a canned diet containing 70 to 80 percent moisture together with plenty of fresh water freely available helps guarantee control of water balance in both normal cats and cats with hyperthyroidism.

Again, water serves as the hub of all chemical processes in the body. Ensuring and maintaining proper hydration plays a key role in treatment of all cats with hyperthyroidism.

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  2. Kohn CW, DiBartola SP. Composition and distribution of body fluids in dogs and cats. In: DiBartola SP, ed. Fluid therapy in small animal practice. Philadelphia: WB Saunders Co, 1992;1–34. 
  3. Peterson ME, Kintzer PP, Cavanagh PG, et al. Feline hyperthyroidism: pretreatment clinical and laboratory evaluation of 131 cases. Journal of the American Veterinary Medical Association 1981;183:103-110. 
  4. Broussard JD, Peterson ME, Fox PR. Changes in clinical and laboratory findings in cats with hyperthyroidism from 1983 to 1993. Journal of the American Veterinary Medical Association 1995;206:302-305. 
  5. Mooney CT, Peterson ME: Feline hyperthyroidism, In: Mooney C.T., Peterson M.E. (eds), Manual of Canine and Feline Endocrinology (Fourth Ed), Quedgeley, Gloucester, British Small Animal Veterinary Association, 2012; in press. 
  6. Pérez-Camargo G. Feline decline in key physiological reserves: implication for mortality. Proceedings of the Nestlé Purina Companion Animal Nutrition Summit: Focus on Gerontology. St. Louis, MO. 2010, pp. 6-13. 
  7. Little S. Managing the senior cat. In: Little, S. (ed), The Cat: Clinical Medicine and Management. Philadelphia, Elsevier Saunders, in press. 
  8. National Research Council. Feeding behavior of dogs and cats. In: Nutritional Requirements of Dogs and Cats. National Academies Press, Washington, D.C. 2006; pp 22-27. 
  9. Radcliffe CE: Observations on the relationship of the thyroid to the polyuria of experimental diabetes insipidus. Endocrinology 1943;32:415-421. 
  10. Nichols R, Peterson ME: Investigation of polyuria and polydipsia, In: Mooney C.T., Peterson M.E. (eds), Manual of Canine and Feline Endocrinology (Fourth Ed), Quedgeley, Gloucester, British Small Animal Veterinary Association, in press.
  11. Evered DC, Hayter CJ, Surveyor I. Primary polydipsia in thyrotoxicosis. Metabolism 1972;21:393-404. 
  12. Mayer-Roenne B, Goldstein RE, Erb HN: Urinary tract infections in cats with hyperthyroidism, diabetes mellitus and chronic kidney disease. J Feline Med Surg 2007;9:124-132. 
  13. Bailiff NT, Westropp JL, Nelosn RW, et al. Evaluation of urine specific gravity and urine sediment as risk factors for urinary tract infections in cats. Veterinary Clinical Pathology 2008;37:317–322.
  14. Is Bottled Water Better?  

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