Running head: CASE STUDY: TAURINE DEFICIENCY IN A CAT 1

Case Study: Taurine Deficiency in a Cat Fed a Vegetarian Diet

Sarra Lord

Tarleton State University

CASE STUDY: TAURINE DEFICIENCY IN A CAT 2

Case Study: Taurine Deficiency in a Cat Fed a Vegetarian Diet

Terra is a 6-year-old, intact female, Domestic Long Hair cat, presented by her owner for

difficulty seeing. The owner notes that Terra frequently misses when jumping from one couch

to another and that she no longer sits at the window to watch birds outside but instead just stares

at the walls. Terra is unspayed and has never been vaccinated. The owner reports that she

doesn’t believe very much in doctors or medicine and that she carefully controls what goes into

Terra. Terra is a strictly indoor cat and is fed a homemade vegetarian diet. The diet consists of

rice, leafy green vegetables, fruit and some mashed beans, soybeans and tofu with the addition of

some vegetable oil. The owner states that she fed Terra some meat when she was a growing

kitten but stopped once Terra reached adult size and weight.

Physical exam findings showed:

General appearance: Underweight and unkempt

Temperature: 100.7 F Rectal
Skin/Coat: Dry and dull
Eyes/fundic exam: dilated, slight response to light
Ears/otoscopic exam: normal
Oral cavity: moderate tartar on teeth, mild gingivitis, MM: pink; CRT: <2 sec
Musculoskeletal: ambulatory x 4
Cardiovascular: HR – 170 BPM, grade II systolic murmur, gallop rhythm
Gastrointestinal: normal abdominal palpation
Respiratory: RR: 40 bpm, lungs auscultate clear
Genitourinary: no abnormal findings
Nervous system: normal
Lymph nodes: No palpable lymphadenopathy (Rockett and Christensen, 2010)

Upon examination, Terra is alert and interested in her surroundings but appears to be

navigating by smell and touch rather than visually. She walked into the base of the examination

table when she was placed on the floor to examine her musculoskeletal system. Thoracic

auscultation revealed clear lungs sounds, but a grade II/IV systolic murmur with a distinct gallop

rhythm.
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While heart murmurs are common in cats with even apparently healthy cats showing

evidence of a grade I or II functional murmur as an incidental finding the addition of the gallop

rhythm was cause for concern (Collins, 2018). A gallop rhythm is an abnormal heart rhythm

defined as additional sounds heard during thoracic auscultation that resembles the sounds of a

horse galloping. A healthy heart has the familiar lub-dub sound as the heart valves close while

the extra sounds heard during a gallop rhythm indicate an abnormally rapid rate of ventricular

filling.

The combination of visual deficiency and heart murmur raised concerns about a taurine

deficiency. The owner questioned again about Terra’s diet, reiterated that she has always fed her

adult animals a vegetarian diet consisting of grains, fruits, and vegetables but no meat. The

owner commented that she also has a dog, Pogo. Pogo seems fine and is having no change in

visual acuity.

Terra is suspected to have taurine deficiency-induced dilated cardiomyopathy and retinal

degeneration due to her vegetarian diet. X-rays and an echocardiogram are recommended to

confirm this diagnosis. The owner agreed to a cardiac workup that included the imaging studies

and a blood panel. Blood was collected from the left jugular vein for a complete blood count and

a serum chemistry panel. Additional heparinized plasma was collected and frozen to send out for

a plasma taurine level. The in-house blood work revealed no abnormalities other than a mildly

elevated glucose level (200 mg/dL; normal range is 75 – 120 mg/dL) attributed to stress.

Another glucose level checked two hours later by ear stick was in the normal range (79 mg/dL).

The plasma taurine level came back from the laboratory at 15 nmol/mL; normal range is <50

nmol/mL.
CASE STUDY: TAURINE DEFICIENCY IN A CAT 4

The echocardiogram and the thoracic x-rays showed evidence of an enlarged heart with a

mildly thickened ventricular wall and a decreased fractional shortening measurement of 32%.

The average fractional shortening

measurement in the domestic cat is 41

+/- 7.3% (Pipers, Reef, and Hamlin,

1979).

Dilated cardiomyopathy due to

taurine deficiency is a relatively rare

Figure 1: Dilated Cardiomyopathy (Vetstream, 2018) finding these days. It was diagnosed

much more commonly in the era before it was discovered that most cases were due to dietary

insufficiency. In the late 1980’s, commercial pet food manufacturers started supplementing their

diets with additional taurine, and today it is

only diagnosed in cats who are fed

homemade diets that do not contain enough

meat or vegan diets that utilize soy protein

without supplemental taurine (Hines, 2018).

Vegetarian diets, particularly

unbalanced homemade vegetarian diets,

Figure 2: B-Mode Echocardiogram: Dilated
Cardiomyopathy (Kalumet, 2005)
generally have inadequate biologically

available levels of protein, fatty acids, vitamin A, folate, and essential amino acids. Unlike dogs,

cats are obligate carnivores. A cat requires a source of dietary taurine, contained in meat and

fish because its body cannot synthesize enough of this amino acid to meet its nutritional
CASE STUDY: TAURINE DEFICIENCY IN A CAT 5

requirements. A prolonged lack of taurine from an inadequate diet can lead to retinal

degeneration and dilated cardiomyopathy. “Taurine deficiency in cats is insidious because the

progressive retinal degeneration may go unnoticed until the damage is advanced and

irreversible” (Hayes, 1982). Without taurine, the

photoreceptors collapse and become

dysfunctional. Leading to cell death and loss of

cells eventually resulting in permanent

blindness. It is unknown but suspected that

Terra’s vision impairment would be permanent

even with a change in diet and supplemental Figure 3: Retinal Degeneration Taurine Deficiency (n.d)

taurine. Her vision will be assessed at each recheck visit determine if she is regaining sight.

Although the dog’s closest ancestor, the wolf, is also primarily carnivorous the dog was

domesticated approximately 33,000 years ago. During the domestication process as humans fed

the dog “table-scraps” which included many plant-based foods that are part of the omnivorous

human diet. As the domestic dog evolved away from the wolf, they gained “a superior ability to

metabolize carbohydrates and to subsist on a diet lower in protein” (Knight and Leitsberger,

2016). Cats have been considered domestic animals for only 10,000 years, and their role in

human society was notably different than that of the dog. The dog was selected as a helpmate

for its ability to assist in the hunt and to protect livestock and the homestead. The cat was

selected as a companion for its ability to keep the home and barn free of small vermin.

Many recipes published for homemade diets are not adequately nutritionally balanced.

Even with all the available nutritional information, it’s difficult to craft a diet by mixing random

ingredients. A properly balanced homemade food will contain a rotation of components and will
CASE STUDY: TAURINE DEFICIENCY IN A CAT 6

need supplementation with multiple vitamins and a calcium supplement. Even though the

supplements are necessary they can be expensive, so an owner may be inclined to leave them

out. Also, certain supplements can be dangerous if overdosed or if the wrong form is given. For

example, excess Vitamin A is toxic to the liver and can cause calcification of joints. To

compound this issue, cats require Vitamin A from an animal source as they can’t convert beta-

carotene (the Vitamin A precursor found in plants) into Vitamin A. Which means that a client

must be cautious when purchasing Vitamin A to be sure they are buying the correct form as

retinyl palmitate.

The veterinarian prefers that his clients feed their pets a commercially made pet food

because he knows that they have met AAFCO standards. AAFCO or the Association of

American Feed Control Officials has established the nutritional standards for complete and

balanced pet foods. Feed control officials in the state of manufacture and the FDA ensure that

companies that make pet food follow those dietary standards. For a product to meet an AAFCO

nutrient profile, it must contain every ingredient listed in the profile at the recommended level.

Commercial pet food labels are required to include a statement that they meet AAFCO

requirements or preferably that their food has gone through an AAFCO feeding trial. During a

feeding trial, the food is fed to a specified number of animals for a period sufficient to ensure

that they maintain weight and health. Therefore, the veterinarian is most comfortable with

recommending a commercial pet food such as Wellness, Innova or Acana that use biologically

appropriate ingredients in the proper proportions if the owner is looking for a holistic whole-food

type pet food.

The following instructions were given to Terra’s owner when she agreed to switch Terra

to commercial pet food. When changing from one diet to another, it should not be done abruptly
CASE STUDY: TAURINE DEFICIENCY IN A CAT 7

particularly in the feline patient. The first is that an abrupt dietary change may be upsetting to

the digestive tract resulting in diarrhea and potentially food aversion. Cats are creatures of habit

and may need to be coaxed to eat new food. We recommend that the two diets, old and new, be

mixed with no more than 25% of the offering being the new food. Continue that ratio for a week

before upping the new food to 50% for another week. The following week the new food ratio

can be increased to 75%, and then 100% the next week. If at any point, Terra stops consuming

her diet eagerly, it should be stepped down to the previous step, and the process continued more

slowly at Terra’s acceptance pace. It is very important that Terra is not allowed to go for a

prolonged period without eating as cats can start metabolizing fat which infiltrates the liver. This

condition is known as hepatic lipidosis, and it can result in liver failure and death if not caught

and treated.

Also, Ms. Hawthorne will need to keep watch over Terra for signs that her

cardiomyopathy is not improving. Dilated cardiomyopathy (DCM) is a disease in which the

heart becomes enlarged, and its contractile ability becomes impaired. A taurine deficient diet is

one of the most common contributors to the onset of feline DCM. The addition of taurine

supplementation and conversion to a commercial diet containing sufficient taurine should start to

reverse this condition although some of the heart damage may be permanent. Ms. Hawthorne

should keep a journal that records Terra’s activity level, appetite, and interest in her

surroundings. Especially note should be made of any coughing or labored breathing which may

indicate a worsening of her condition. Prognosis in taurine deficiency-induced myocardial failure

after taurine supplementation is excellent in cats that survive longer than two to three weeks

post-diagnosis (Kittleson and Kienle, 1988). Myocardial function generally normalizes over

three to five months. Taurine supplementation was prescribed at 250 mg PO q 12 hours

CASE STUDY: TAURINE DEFICIENCY IN A CAT 8

continued until the results of plasma analysis show that Terra’s plasma taurine levels have

normalized. A repeat echocardiogram and additional chest x-rays along with a plasma taurine

level are recommended in two to four months.

In conclusion, taurine deficiency induced myocardial disease with retinal degeneration

are conditions that have become much rarer since the advent of supplemental taurine being added

to all commercially produced pet food in the late 1980’s. These are now, unfortunately, diseases

of owner ignorance as they are only diagnosed in cats fed an inappropriate vegetarian diet or in

cats being fed dog food. Cats are not small dogs, and their nutritional needs are very different.

If caught early enough in the process it may be possible to reverse the damage to the heart, but

unfortunately, the visual impairment from the retinal degeneration is likely permanent. Client

education is the solution, and veterinary professionals should be prepared to discuss nutritional

requirements and offer recommendations to ensure that the pet is fed a species-appropriate diet

before they suffer a disease of malnutrition.

CASE STUDY: TAURINE DEFICIENCY IN A CAT 9

References

Collins, S. (2018). Heart disease in cats: Identifying and managing feline heart disease in

practice. Retrieved February 13, 2018, from https://veterinary-practice.com/article/heart-

disease-in-cats-identifying-and-managing-feline-heart-disease-in-practice

Hayes, K. (1982). Nutritional problems in cats: Taurine deficiency and Vitamin A excess. The

Canadian Veterinary Journal, 23(1), 2-5.

Hines, R. (2018). Cardiomyopathy in your cat: When your pet’s heart fails. Retrieved February

14, 2018, from http://www.2ndchance.info/cardiomyopathy-cat.htm

Kalumut (2005). Echocardiographic image of dilated cardiomyopathy [Digital photograph].

Retrieved from

https://upload.wikimedia.org/wikipedia/commons/1/11/Dilated_cardiomyopathy_B-

Mode.jpg

Kittleson, M., & Kienle, R. (1998). Small animal cardiovascular medicine. St. Louis, MO:

Mosby.

Knight, A., & Leitsberger, M. (2016). Vegetarian versus meat-based diets for companion

animals. Animals, 6(9), 57. https://doi.org/http://doi.org/10.3390/ani6090057

Retinal degeneration taurine deficiency [Digital image]. (n.d). Retrieved from

https://images.wagwalkingweb.com/media/articles/cat/taurine-deficiency/taurine-

deficiency.jpg?auto=compress&fit=max&ixlib=imgixjs-3.3.2&w=500

Rockett, J., & Christensen, C. (2010). Case studies in veterinary technology: A scenario-based

critical thinking approach. Heyburn. ID: Rockett House .

CASE STUDY: TAURINE DEFICIENCY IN A CAT 10

Vetstream (2018). Dilated cardiomyopathy [Digital image]. Retrieved from

https://www.vetstream.com/getmedia/bb9d2c16-dddb-427f-b2f7-

d42abf2d16f4/18_103397