Jerome Olitin

Case Study Thiamine Deficiency in Cat

Introduction:
Thiamine, or vitamin B1, is a water-soluble vitamin that is required for carbohydrate metabolism.1 With a
deficiency in this vitamin, normal energy metabolism is interrupted and the alternative anaerobic
metabolism is stimulated which is detrimental to the brain.

Case:
Tilly, a 10-year-old spayed female domestic short hair cat, was referred to Animal Specialty Group on
12/13/2016 for evaluation and treatment for being unable to walk. Tilly was suddenly found earlier that
day with all limbs splayed out and seeming to drag herself around by her front legs and crying out as if in
pain. She was assessed quickly by her primary care veterinarian where bloodwork showed some mild
liver enzyme evaluation and spinal and thoracic x-rays were unremarkable.

Examination:
Tilly’s general physical examination was largely unremarkable aside from an increased body condition
score of 7/9. Tilly’s neurologic examination revealed a positional vertical nystagmus (up and down
abnormal eye movement), bilateral, wide, head excursions, a dull to inappropriate mentation, and
severe vestibular ataxia with no ability to stand up right. These signs all pointed to a bilateral central
vestibular (brain) neurologic problem.

Diagnostics:
As Tilly came in with recent full lab work and clear chest x-rays, Tilly was put under general anesthesia
for a Brain MRI and spinal tap. Her brain MRI revealed symmetric T2 signal changes in the geniculate
nuclei, caudal colliculi, and periaqueductal tissues. No masses or brain herniation was seen. Prior to
anesthetic recovery Tilly had a spinal tap performed which ruled out any active inflammatory brain
disease (encephalitis). Tilly the had blood submitted for a thiamine blood level, still pending, and a
metabolic panel (organic aciduria screen) that was negative.
Jerome Olitin

Diagnosis:
Tilly was diagnosed with presumptive thiamine deficiency encephalopathy based on her characteristic
clinical signs and brain MRI findings.

Treatment:
Tilly was treated with supportive care and IV fluid therapy while hospitalized and started on twice daily
subcutaneous injections of supplemental 100mg thiamine. She was also transitioned from a fish-based
diet to a non-grain free, non-fish based cat food.

Discussion:
Cats, which are carnivores, require thiamine from the diet as they cannot appropriately synthesis or
store this vitamin. Common causes include recent diet change to a grain free, fish based (especially raw),
highly heated foods, or foods that have not been properly stored. Primary gastrointestinal diseases that
prevents the body from absorbing thiamine will also lead to clinical signs. Cats are more prone to
thiamine deficiency than dogs, but both companion animal species can develop this disease.5 Clinical
signs of deficiency can vary and can be very mild, but neurologic deficits often include vestibular
(balance system) signs, visual deficits, mydriatic (large) and non-responsive pupils, trouble walking as
well as seizures.

Recovery:
Tilly showed marked improvement within 5 days and at her recheck examination she was up and
walking around almost normally. She has been transitioned to an oral suspension of the thiamine
supplementation and has persisted in her improvements. She may with time be able to be weaned of
this supplementation since she is on a new, non-fish based, food, or may require life-long
supplementation due to mild underlying malabsorptive issues. Repeat MRI images will show resolution
of the originally identified lesion but is not always preformed due to cost and the need for a subsequent
general anesthesia.