Page 1078 - Cote clinical veterinary advisor dogs and cats 4th

534 Inappropriate Elimination, Cat

and treatment plans are different. Cats with ○ Scoop litter multiple times daily. become more outgoing, the partial serotonin
periuria/perichezia may progress to more ○ Empty litter entirely, including recyclable agonist buspirone 0.5-1 mg/kg PO q 24h ×
VetBooks.ir Differential Diagnosis ○ Wash, rinse, and dry the litter box at least clients should monitor carefully because the
multi-cat litters, two to three times per
60 days minimum can be used. However,
anxious responses.
week (more often if more cats).
newly confident cat may engage in social
weekly.
• Feline lower urinary tract signs/disease
interactions that result in a physical fight.
• Bacterial cystitis ○ Avoid liners and scented litters. • If animals are added to the household,
• Urethral obstruction ○ If they must be used, ensure covered litter clients should expect social upheaval and
• Diabetes mellitus boxes have good ventilation. be prepared to restart analysis of interaction
• Cognitive dysfunction • Use good odor elimination (e.g., Anti-Icky- and behavior.
• Hyperthyroidism Poo [AIP]) on all substrates where urine or • Attention should be paid to the victimized
• Lower motor neuron disease feces has been inappropriately deposited. cat before the other cats.
• Enteritis/colitis • Pheromonal analog products have been • Outdoor or visitor cats should be kept to a
• Parasitemia suggested for use to calm animals, but they minimum or excluded.
may make some animals more reactive. • If all else fails, consider allowing the cat to
Initial Database Studies of efficacy are poorly designed be an indoor/outdoor cat.
• To rule out medical problems and before initi- and involve medication; medication for
ating medications: CBC, serum biochemistry underlying anxiety is likely more effective Possible Complications
profile, urinalysis, thyroid profile (if > 6 years than pheromones. • BZDs: hyperexcitability (less rare), severe
old), urine culture (urination issue), fecal • Identify and redress potential stressors or con- hepatotoxicity (more rare), potential
flotation and direct smear (defecation issue) flicts in the household. The most common abuse by clients. Diazepam uses the
• Detailed history regarding toileting is of these may be relationships between cats N-desmethyldiazepam metabolic pathway;
essential: number, type, and placement of in the household. Intercat aggression is a N-desmethyldiazepam has a long T 1/2 in cats
litter boxes; type of litter offered; surfaces/ serious concern if and is highly sedative.
textures used for inappropriate elimination ○ One cat is avoiding one or more other • Cats treated with monoamine oxidase inhibi-
cats tors (some flea and tick collars) should not
Advanced or Confirmatory Testing ○ One cat consistently leaves the room or be treated with TCAs or SSRIs.
Client observations are essential. Videotaping, a preferred resting spot when other cat(s)
including interactions between cats in a multi- enter Recommended Monitoring
cat household, can be extremely informative. ○ One cat does not eat or drink in the If on medications, exam and laboratory tests
This is especially useful if the client is unable presence of the others q 6-12 months
to determine which cat is eliminating inap- ○ One cat often hides
propriately and/or is unable to understand social ○ One cat is hyperreactive to noise or tactile PROGNOSIS & OUTCOME
interactions and dynamics between the cats. stimuli
• If any of the previous conditions are iden- • Changes in hygiene and/or social manage-
TREATMENT tified, clients should separate cats when ment can resolve concerns for most cats.
they are unsupervised. The more timid cat • Without treatment, the prognosis is guarded.
Treatment Overview should have free range; the more aggressive Inappropriate elimination is the single most
Treatment goals: cat should be confined in a space that is common reason cats in North America are
• Identify preferred locations/substrates (no not highly contested/desirable (e.g., not the euthanized or relinquished. Many shelters
litter, shredded paper towels, washable fabric, client’s bedroom or the kitchen). consider cats that have litter box issues
disposable vegetation)/box types/numbers/ • If anxiety and aggression are involved, unadoptable and euthanize them.
sizes/locations, and deploy. Appropriate benzodiazepines (BZDs), gabapentinoids, • Prognosis is improved by early diagnosis,
and reliable use of intended substrates and tricyclic antidepressants (TCAs), or selective comprehensive treatment, attentive client
locations for elimination when the problem serotonin reuptake inhibitors (SSRIs) may monitoring, and open communication
is preference/aversion be useful. between clinician and client.
• Identification and management of concurrent ○ TCAs: amitriptyline or nortriptyline 0.5-1
behavioral disorders (e.g., social factors involved mg/kg PO q 12-24h × 30 days minimum); PEARLS & CONSIDERATIONS
in intercat aggression) that can contribute to clomipramine 0.5 mg/kg PO q 24h × 60
elimination change when the above fail. days minimum Comments
○ SSRIs: fluoxetine or paroxetine 0.5 mg/ In the absence of meeting the cat’s needs,
Acute and Chronic Treatment kg PO q 24h × 60 days minimum attempts to constrain the cat to eliminate in
• Identify previously preferred substrates (types ○ Gabapentinoids: gabapentin 3-5 mg/kg places, on substrates, or in modes preferred by
of litter or atypical substrates [rags, shredded PO q 12-24h × 30 days minimum the client will likely result in a worsening of
paper, no litter]) and locations, and replicate ○ BZDs: diazepam or oxazepam 0.2-0.4 mg/ the problem and potentially create an anxiety
or use these. kg PO q 12-24h × 30 days minimum, disorder from an original hygiene/basic needs
• Ensure there is at least one more litter box alprazolam 0.01-0.025 mg/kg PO q situation.
than the number of cats. 12-24h or as needed q 4-5h for panic
• Ensure the litter boxes are at least 1.5 cat ○ BZDs are helpful primarily in behavior Prevention
body lengths long (including tail). This is modification programs involving food • It is essential to ask clients about inap-
larger than virtually all commercially available reward (e.g., teaching cats to tolerate each propriate elimination at every veterinary
litter boxes for cats, but research indicates other). visit. Clients may not mention occasional
this is the preferred size. ○ TCAs and SSRIs can be extremely useful inappropriate elimination, when correc-
• Identify locations where the cat spends the in helping overcome aversions and address- tion is most easily accomplished. Allowed
most time, and place boxes accordingly. ing anxiety involved in marking behaviors to go untreated, the problem is likely to
• Litter box hygiene must be meticulous and and intercat aggression. worsen. On average, owners allow 2 years
lifelong. Ensure that clients are complying • If the toileting issue is associated with of occasional issues before the situation is
with an appropriate cleaning regimen: intercat aggression and the victim needs to considered untenable.

www.ExpertConsult.com