Page 442 - Problem-Based Feline Medicine

434 PART 7 SICK CAT WITH SPECIFIC SIGNS

Fluid therapy may be required to correct dehydration, Clinical signs
acid–base imbalances and electrolyte abnormalities
Most cats become lethargic, ataxic and anorectic
occurring from vomiting.
within 96 hours following ingestion.
Specific antidotal therapy.
Jaundice is common and occurs during the first 11 days
● N-acetylcysteine (Mucomyst, Mead Johnson &
of illness.
Co.) helps to neutralize toxic intermediates.
– Administer a loading dose of 140 mg/kg orally,
followed by doses of 70 mg/kg every 4–6 hours Diagnosis
for upto 3 days.
History of recent drug exposure.
● Ascorbic acid is used in combination with N-
acetylcysteine. Unexplained and rapid increase in liver biochemical
– Its use is controversial. It works slowly and is parameters.
used as adjunctive therapy. ● Profound increases in ALT, AST and total bilirubin
– Give 30 mg/kg q 6 h PO for seven or more treat- are present.
ments. ● Hypoglycemia/hypocholesterolemia indicates severe
● Cimetidine inhibits hepatic production of toxic hepatic insufficiency.
intermediates. ● Abnormal coagulation tests (OSPT, APTT) suggest
– Give 5 mg/kg q 8 h PO or parenterally for 3 days disseminated intravascular coagulation.
minimum.
Death occurs from acute hepatic failure.
Blood transfusions and oxygen therapy should be given ● Histologic review of tissue specimens reveals pro-
as needed. found hepatocellular necrosis.

Prognosis Differential diagnosis
The prognosis is guarded and is highly dependent on A history of diazepam administration associated with
severity of intoxication and time lapse prior to treatment. fulminate hepatic failure make most other diseases
unlikely.
Prevention
Treatment
Avoid drug overdosage.
Supportive care as dictated by the patient.
Store medication safely away from pets.
Fluid therapy for hydration maintenance.
● Add dextrose to combat hypoglycemia.
DIAZEPAM INTOXICATION Meet nutritional needs to facilitated hepatic regeneration.
● Total parenteral nutrition or nasoesophageal
Classical signs catheter feeding.
● Lethargy, ataxia and anorexia < 3–4 days Plasma transfusions to replace consumed coagulation
post-ingestion. factors.
● Jaundice commonly observed.
Prognosis
Poor: cats presented in an obtunded condition warrant a
Pathogenesis
grave prognosis.
Idiosyncratic hepatotoxicity is suspected. The dosage
causing toxicity may range from 1 mg once daily to 2.5 Prevention
mg twice daily.
Evaluate baseline ALT and AST activities in cats prior
Prior sensitization to diazepam is not required. to initiating daily oral treatment with diazepam.