NM05 - Acute Dietary Choline Chloride Toxicity in Cats: A Case Series Report

Abstract: Background

Choline, an essential nutrient for cats, is a precursor of phosphatidylcholine, acetylcholine, and betaine. The Association of American Feed Control Officials (AAFCO) and the National Research Council (NRC) dietary recommendations for adult cats’ are 2,400 mg/kg and 2,550 mg/kg choline dry matter (DM) respectively without suggested maximums. The European Food Safety Authority (ESFA) previously deemed it virtually non-toxic.

Objective

This case series describes the signalment, presentations, laboratory changes and outcomes of cats with choline chloride toxicity.

Animals

Medical records from 19 adult pet cats with confirmed exposure to recalled canned cat food.

Methods

Record reviews from January 1, 2020 - January 15, 2021, report signalment, examinations, treatment, and outcomes. Data analysis was performed with JMP^®, Version 16. SAS Institute Inc., Cary, NC, 1989–2021.

Results

Signalment: 9 neutered males, 7 ovariohysterectomized females, 3 unreported; weight (mean; SD): 5.0; +/- 1.5 kg; ages 1-12 years old.

Observations: tachycardia (100%), vomiting (95%), ataxia (58%), fishy odor (47%), tachypnea (42%), ptyalism (42%), inappetence (26%), lethargy (21%), diarrhea (21%), abdominal pain (21%), tremors (10%) and mydriasis (5%). Onset occurred 2 - 96 hours post-exposure; duration 12 hours to 5 days (excluding death/euthanized). Biochemical abnormalities: table 1. Radiographs: (n=4) gas-distended intestines. Food analysis: 66,157-164,010 mg/kg choline DM.

Treatments: supportive IV fluids, heat, oxygen, antiemetics, hepato-protectants, antibiotics, neurotransmitter inhibitors, muscle relaxants and enemas.

Outcomes: 15/19 recovered within 5 days. 4 died/euthanized within 24 hrs.

Conclusions and Clinical Importance

Recognizing choline and probable acetylcholine toxicity may improve treatment and outcomes. Choline’s safe limit < 66,000 ppm DM.