Page 809 - Cote clinical veterinary advisor dogs and cats 4th

Gastroenteritis: Acute, Nonspecific 383

ASSOCIATED DISORDERS • Urinalysis: nonspecific; if dehydrated, Drug Interactions
concentrated urine specific gravity expected.
In severe cases: dehydration, hypokalemia, • Fecal evaluation (centrifuged flotation and • Maropitant is protein bound and may affect
VetBooks.ir Clinical Presentation • Radiographs: generally unremarkable; ileus drugs such as nonsteroidal antiinflammatories Diseases and Disorders
metabolism of other highly protein-bound
metabolic acidosis
saline preparation): no pathogens noted
and anticonvulsants.
HISTORY, CHIEF COMPLAINT
may be apparent
• Acute onset of vomiting and/or diarrhea • ± Pancreatic lipase immunoreactivity (if • Metoclopramide interacts with numerous
drugs; avoid concurrent use of sedatives,
○ Vomitus may contain food or foreign high-risk breed, other risk factors): within tranquilizers, and narcotics.
material. normal range
○ Diarrhea may be accompanied by mucus, • ± Fecal ELISA for parvovirus (if young and/ Possible Complications
urgency, and tenesmus. or questionable vaccination status): negative • Esophagitis may be prevented by acid-
• Anorexia, lethargy, and mild abdominal • ± Fecal antigen test for Giardia: negative reducing drugs.
discomfort may be noted. • ± Serum cortisol: > 2 mcg/dL (>55 nmol/L) • Aspiration pneumonia is more likely in
• Owner may report recent dietary indiscretion. expected and excludes hypoadrenocorticism depressed or sedated patients.
• Intussusception is uncommon but more likely
PHYSICAL EXAM FINDINGS TREATMENT in young dogs.
• Normal vital parameters (temperature, heart
rate, respiratory rate, pulse quality, blood Treatment Overview Recommended Monitoring
pressure) in most cases Provide supportive care; select appropriate • Hydration status
• Possible dehydration in more severe cases therapies based on physical exam and clinical • Temperature, pulse, respiratory rate
• Mild nonlocalized abdominal discomfort evaluation. If animal is not improved within 48 • Volume of fluid losses
may be noted. hours, additional diagnostic testing is indicated.
• Mucoid stool may be noted on rectal exam. PROGNOSIS & OUTCOME
Acute General Treatment
Etiology and Pathophysiology • Small quantities of water or an oral electro- Prognosis is excellent. This disorder usually
• Specific cause is often not determined. lyte solution may be offered if vomiting is resolves within 48 hours of onset.
• Vomiting is likely due to direct gastric infrequent.
irritation or dysmotility. • Subcutaneous crystalloids may be used PEARLS & CONSIDERATIONS
• Diarrhea is likely due to irritation, dysmotil- for small animals with mild hydration
ity, or dysregulation of normal intestinal deficits. Comments
microbial populations. • Intravenous fluids are required if patient is • Animals with marked dehydration, hypo-
• Diagnosis is usually based on history, absence moderately dehydrated or hypovolemic. volemia, depression, melena, substantial
of an identifiable cause of gastrointestinal • Antiemetics should be administered, provided hematemesis, or overt abdominal pain require
(GI) signs, and prompt response to sup- GI obstruction has been ruled out. prompt diagnostic evaluation and treatment
portive therapy. ○ Maropitant 1 mg/kg SQ q 24h or 2 mg/ (often including hospitalization).
• Often associated with dietary indiscretion kg PO q 24h is an effective first choice • GI obstruction should be excluded (e.g.,
(e.g., ingestion of garbage, nontoxic plants, (dogs > 8 weeks old; cats > 16 weeks abdominal radiographs) before administra-
spoiled food) old). tion of antiemetics.
○ Metoclopramide 0.2-0.5 mg/kg SQ or
DIAGNOSIS PO q 6-8h must be given frequently or Prevention
provided as a constant-rate infusion of Prevent access to garbage or spoiled food.
Diagnostic Overview 1-2 mg/kg/day.
This is a diagnosis of exclusion; pursue other dif- • Gastric acid–reducing drugs may reduce the Technician Tips
ferentials as appropriate. If clinical signs persist risk of esophagitis and are always appropriate • Encourage food intake by warming and
for more than 48 hours, further diagnostic if hematemesis is noted. offering frequently (p. 1199).
testing is strongly indicated. ○ Omeprazole 0.7-1.5 mg/kg PO q 12h • Maropitant SQ may be painful; chilling the
○ Pantoprazole 0.7-1 mg/kg slow IV q 24h injectable formulation may reduce patient
Differential Diagnosis • Protectants/adsorbents provide little clinical discomfort.
Other causes of vomiting and diarrhea (pp. benefit. Products containing salicylate should
1213 and 1293) be avoided in cats. Client Education
• Infection: parasitic, bacterial, viral, protozoal • Opiate antidiarrheals (e.g., loperamide) • Signs should resolve within 48 hours. Further
• GI obstruction decrease GI motility and secretion and should veterinary care should be sought if vomiting
• Drug or toxin ingestion be used with caution in dogs because they or diarrhea persists.
• Systemic disease (e.g., pancreatitis, acute may cause constipation and depression (avoid • Neonates, geriatric animals, and those with
hepatic injury, kidney disease, hypoadre- in cats). pre-existing disorders are more prone to
nocorticism) • Antibiotics are not indicated and may dehydration and may need more aggressive
contribute to intestinal dysbiosis. fluid support.
Initial Database • Probiotics +/− prebiotics are unlikely to
• Extensive diagnostics usually are unnecessary significantly hasten recovery. SUGGESTED READING
if physical exam and hydration status are Gallagher A: Vomiting and regurgitation. In Ettinger
unremarkable. Nutrition/Diet SJ, et al, editors: Textbook of veterinary internal
• CBC: stress leukogram is expected in canine Food should be provided as soon as the patient medicine, ed 8, St. Louis, 2017, Saunders, pp
patients; erythrocytosis may be noted if the is interested in eating. Easily digestible diets 158-164.
patient is dehydrated. (e.g., boiled white rice with cottage cheese or AUTHOR: Audrey K. Cook, BVM&S, DACVIM,
• Serum biochemistry profile: hypokalemia low-fat turkey breast, commercially available DECVIM, DABVP
common; metabolic acidosis common; highly digestible enteric diets) may be beneficial EDITOR: Rance K. Sellon, DVM, PhD, DACVIM
mild azotemia may be evident if patient is in vomiting patients because gastric emptying
substantially dehydrated. times are shorter.

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