Page 318 - Problem-Based Feline Medicine

310 PART 6 CAT WITH WEIGHT LOSS OR CHRONIC ILLNESS

months and maintain on every other day doses, if include vitamin E (50–200 IU/cat/day PO),
needed. Use of budesonide (1 mg/cat PO q 24 hours) vitamin A (1000–5000 IU/cat/day PO), vitamin C
instead of prednisolone may help to reduce sys- (50–80 mg/kg/day PO), zinc (7.5 mg/cat/day PO), and
temic signs of corticosteroid administration. N-acetyl glucosamine (125–1500 mg/cat/day PO).
● Other immunosuppressive agents may be consid-
ered. While they all have potential side effects and Prognosis
warrant regular monitoring chlorambucil (2–5
The prognosis depends on the nature and severity of the
2
mg/m PO up to once every 48 h) is often very
GI infiltration, and the presence of concurrent and/or
well tolerated. Other less favorable options
associated disease, such as pancreatitis or cholangio-
2
include cyclophosphamide (50 mg/m PO up to
hepatitis. In general, the prognosis for control is rea-
four times a week), cyclosporine (0.5–8.5 mg/kg
sonably good, but the condition cannot be cured, and
every 12–24 hours, indefinitely) or, in the cases of
many cats will need treatment for the rest of their life.
colonic disease, sulfasalazine (10–20 mg/kg/day
PO for 7–10 days). Prevention
Supportive therapies are often recommended. Since it is not known what triggers IBD to develop, it is
However, few have been assessed using controlled not currently possible to prevent its onset.
studies in cats.
● Tylosin may be effective for its antibiotic actions as
DIABETES MELLITUS**
well as other, as yet undefined, effects (5–20 mg/kg
every 6–12 hours PO).
Classical signs
● Motility modifiers may give short-term palliative
relief in cases of very watery diarrhea (loperamide ● Usually seen in older, obese, neutered
0.04–0.2 mg/kg every 8–12 hours PO). male cats, and Burmese cats may be over-
● Metoclopramide may be useful for its anti-emetic represented.
and prokinetic effects (0.2–0.5 mg/kg PO up to four ● History of polyuria, polydipsia and
times a day, being given just prior to feeding, or as polyphagia.
a constant IV infusion 1–2 mg/kg over 24 hours). ● Possible initial weight gain, followed by
● Cisapride is a good prokinetic, but it is now more weight loss.
difficult to obtain (0.3–1.0 mg/kg every 8–12 hours
PO). Pathogenesis
● Cobalamin and folate may be needed as they are
Diabetes results from a variety of mechanisms that
often reduced by malabsorption (cobalamin
cause an absolute or relative lack of insulin.
125–250 μg/week SC or IM for 6–8 weeks then q
2–4 weeks [50–100 μg/cat/day PO]; folate 0.5–1.0 Classification of diabetes in cats is best made by cause,
mg/cat/day PO for 1 month). rather than whether or not they require exogenous
● Vitamin K1 is often required because fat malab- insulin.
sorption results in poor absorption of fat-soluble
Type 1 diabetes, previously called juvenile-onset dia-
vitamins like vitamin K, and this can result in
betes, is due to immune-mediated destruction of pan-
abnormal hemostasis (0.5 mg/kg/day SC for 3–4
creatic islet beta cells. It appears to be very rare in cats.
days, then once weekly).
● Glutamine may be given as an energy source for Type 2 diabetes results from impaired insulin secre-
the GI mucosal cells (250–5000 mg/cat/day PO, tion, and peripheral resistance to the action of insulin.
indefinitely). Hyperglycemia results from decreased glucose uptake
● Lactobacillus acidophilus may be given as a probi- in tissues and increased hepatic glucose production.
otic to help restore intestinal flora (50–500 M Many cats with diabetes appear to have type 2 diabetes.
organisms/cat/day PO until feces return to normal). ● This is often associated with accumulation of islet-
● Various nutritional supplements may be given for specific amyloid polypeptide (IAPP), which
their potential anti-inflammatory properties. These occurs in aggregates around pancreatic islets. While