Page 285 - Problem-Based Feline Medicine

16 – THE CAT WITH ACUTE DEPRESSION, ANOREXIA OR DEHYDRATION 277

Acetaminophen (paracetamol) poisoning. The remainder of therapy is largely supportive.
● Probing for a history of ingestion, and careful
Fluid therapy to correct dehydration and hypotension.
observation for appearance of brown mucous
● If crystalloid solutions are insufficient, or pul-
membranes, and facial and paw edema, will
monary or peripheral edema is present, colloid
establish the diagnosis.
solutions should be considered (e.g. plasma, dex-
Anticoagulant rodenticide poisoning. trans, hetastarch, pentastarch).
● A careful search for subcutaneous or internal
Nutritional support.
bleeding will help establish that a bleeding disorder
● The optimal approach is not known. The tendency
is present. Clotting times are likely to be normal to
to withhold food based on treatment of acute pan-
minimally elevated in acute pancreatitis, and
creatitis in dogs is tempered by the overlap between
markedly prolonged in rodenticide poisoning. Note
acute and chronic pancreatitis in cats, the presence
that markedly prolonged clotting times and vitamin K
and risk of hepatic lipidosis in cats, the observation
deficiency have been recognized in chronic pancre-
that most cats are not vomiting, and the observation
atitis.
that feeding does not appear to aggravate pancreati-
Snake bite envenomation. tis in cats.
● A high index of suspicion should be maintained for ● Cats that are willing to eat should be fed. Food
cats at risk because of geographical location and should be withheld for 2–3 days for cats that are
season. For North American snakes with cytotox- vomiting. For anorexic cats that are not vomiting,
ins, a thorough physical examination should reveal an appetite stimulant may also be considered –
a bite wound; there may be associated tissue necro- these include cyproheptidine (may cause unusual
sis. For Australian snakes, acute onset of weakness behavior), intravenous diazepam and oral oxazepam
and depression are early findings. Dilated pupils at standard doses.
with slow or absent papillary light reflexes, ataxia ● Parenteral nutrition may be used if available,
and elevated creatine kinase concentration or evi- especially for cats that are vomiting.
dence of a bleeding tendency are frequent findings. ● If exploratory laparotomy is used to make a diagno-
Paresis may progress to flaccid paralysis. sis, a jejunal feeding tube should be placed. This
is best placed as a jejunostomy tube. Transpyloric
Trauma.
tubes may also be used, either threaded through a
● Subtle external signs of trauma include car grease
gastrostomy tube, or as a nasojejunostomy tube, but
on the fur, shorn nails, dried blood around the exter-
preliminary experience is that such tubes tend to
nal nares, blood seen on otoscopic examination,
back out into the stomach.
small scleral hemorrhages and lacerations on the
● If laparotomy is not performed, a gastrostomy or
ventral surface of the tongue.
esophagostomy tube may be placed once the cat
The above differential diagnoses are applicable to cats has stopped vomiting. Endoscopic placement of a
with acute onset of signs. Other than liver diseases, most transpyloric tube is difficult.
of the above differential diagnoses will not be applicable ● If it is desired to avoid anesthesia, a nasoesophageal
to cats with pancreatitis with a longer duration of clini- tube should be used.
cal signs and weight loss. For cats with pancreatitis and ● The optimal diet is not known. Low-protein, low-
subacute or chronic signs, the primary differential fat and high-carbohydrate diets are recommended
diagnoses are neoplasia, chronic renal failure, and for dogs, but may not be appropriate for cats,
inflammatory bowel disease. Concurrent diabetes mel- especially if there is concurrent diabetes melli-
litus may confuse the clinical picture. See The Thin, tus, and may not be sufficiently calorie-dense.
Inappetent Cat (page 355). Another problem is that the fat content on an
energy basis is not provided for many foods.
A food with a moderate fat content is a reason-
Treatment
able initial choice, which includes most commer-
Address the inciting cause if one is identified. cial cat foods.