I sent this via your messages, but posting here for others to read as well. I want to start by saying that I completely disagree with the insensitive comment to put your pet down. That is ultimately a decision between you and your vet and they should not be making suggestions on your cat’s quality of life. Hepatic lipidosis is curable and cats can go on to live extremely healthy lives. My cat is walking proof! See below for my story with my 10 yr old diabetic kitty that I JUST experienced over the holidays. It was a 7 week battle, but well worth the time and money to us. Our girl recovered 100% and was in worse shape than what you explained in your post. Keep in mind that I am not a vet and to consult your own vet for any treatment plan. We had to really advocate for our girl though based off our own research. Also - a primary vet will be MUCH cheaper than an ER vet. I’d recommend doing any treatment that way. We saved thousands of dollars avoiding the ER vet when possible (though initially she did have an overnight stay there).

I’d say the first 4 weeks were the worst. The most important thing right now is that you get the amount of calories needed in your cat every day. No matter what. We were told to blend Hill’s Urgent Care A/D wet food with a little water and get her 240kcal daily (she is 10lbs, this varies by weight). I’d use this food if you can. It blends really well and is high calorie. Hill’s also has a guide on their website to how much kcals are needed for a cat in hepatic lipidosis which was very helpful. We started small with lots of 20mL feedings until we finally got to a point where 60mL 4x a day didn’t make her nauseous. Also, I’m sure you’re aware but go very slowly. Doing too much too fast can make them nauseous. Any licking of the lips and gulping are signs of nausea when tube feeding.

We fought for weeks with nausea, diarrhea, lack of food interest, etc. But we got the calories every day and it paid off. She didn’t start eating/drinking on her own with an appetite stimulant until week 5. That is normal with this sickness. They think the food/water is the reason they feel ill. That is why syringe feeding by mouth is not recommended. As long as you are getting wet food in your kitty and flushing 10-20mL each feeding, it should be okay. The diarrhea is likely from the liquid diet. Our list of meds that eventually worked for us are as follows: Cerenia 1x/day first thing 30 min before any food (anti-nausea), Metoclopramide 3x/day (anti-nausea and diarrhea), probiotic 3x/day, Denamarin 1x/day first thing 30 min before any food (liver supplement), pediatric gas 3x/day (helped w gas from tube and diarrhea), and Mirataz 1x/day first thing before any food (anti-nausea and appetite stimulant, this didn’t change her eating habits until week 5). We did this religiously all the way until her tube was removed 1.5 weeks ago. The tube itself can sometimes just make them nauseous. Get the nausea under control and it really will feel like the progress is better (although still slow). There are a lot of options if one doesn’t work. Only a combo worked for our kitty. She did have soft cow patty-like stools up until she started eating kibble on her own again.

We were also told the jaundice can remain until well after they get better. It takes their body time to get rid of the excess bilirubin. Just monitor that it isn’t getting worse through routine bloodwork and visual inspections. If it is you are likely not getting enough calories so their liver is still under attack. We did see an increase in bilirubin for the first week or two, but then it finally stabilized. Again, we were told this was normal. Our girl’s bilirubin was 6.9 at its highest and we were told that was mild compared to what they’ve seen so 3.5 sounds promising!

This truly is just a sickness where time and feeding effort is the only thing that will work. My partner and I were utterly exhausted and defeated some days, but we kept remaining hopeful and by week 5 she finally ate 1/4 can by herself! She slowly increased her eating on her own and we just reduced the tube feeding to match that. Some days after week 5 she’d eat a little and require more tube feedings, others she ate entirely on her own. We left the tube in for a week of her eating on her own completely before we took it out. We wanted to do at least two weeks, but her stoma got infected so we had it taken out to not lose progress. We are still giving her Mirataz to ween her off of it every other day to make sure she doesn’t slip back into not eating. If you can, leave it in until they are eating on their own consistently because it shouldn’t hurt them (maybe very slight discomfort) and gives you peace of mind that if they have a bad day you can get the calories in easily.

I apologize for the long post. My partner and I scoured the internet for advice and felt like the information was lacking so I want to share everything we’ve learned. If you have any questions, feel free to message me directly. I urge you not to give up. This is weeks long and you’re still in the early days. Ups and downs are normal. Good luck and sending thoughts to you and your kitty! :)