Page 668 - Problem-Based Feline Medicine

660 PART 9 CAT WITH SIGNS OF GASTROINTESTINAL TRACT DISEASE

and shock-like signs (e.g. rapid, weak pulses, prostra- days. BAL toxicity may occur (e.g. vomiting, tremors
tion, subnormal body temperature and collapse). or convulsions), which will require cessation of the
drug.
Chronic, low-grade exposure to arsenic may be
impossible to detect clinically, as anorexia is the only DMSA (dimercepto succinic acid) is often used in chil-
consistent sign. dren, because it is less toxic than BAL, but its effec-
tiveness in cats has not been evaluated.
Diagnosis If the cat is in acute, oliguric or anuric renal failure,
dialysis may be necessary.
Historical information of exposure to heavy metals is
a very important means of getting the diagnosis, how-
ever, such information is not always known.
ANTRAL PYLORIC
The hemogram and serum chemistry profile will be HYPERTROPHY/STENOSIS
unremarkable when the cat presents with signs of gas-
trointestinal disturbance. Classical signs
Arsenic poisoning also causes hepatocellular necro- ● Vomiting is the primary sign, and usually is
sis, which will be evidenced by elevations in serum ala- observed several hours after eating.
nine aminotransferase and alkaline phosphatase ● Projectile vomiting will be observed if the
enzymes. Other abnormalities may include elevations pylorus is obstructed.
in bilirubin, bile acid values and decreases in albumin
(end stage). See main reference on page 694 for details of The Cat
With Signs of Chronic Vomiting.
Nephrotoxicity associated with arsenic poisoning is
also associated with isosthenuria, azotemia and eventu-
ally oliguria/anuria. Clinical signs
Definitive diagnosis is made by measurement of Vomiting is the most common sign. In adult cats, the
arsenic concentrations in urine (acute), kidney, liver, vomiting occurs as a chronic problem, but in kittens
vomitus or hair (chronic). may occur as acute vomiting in a kitten that is just
beginning to consume solid foods.
Differential diagnosis In congenital pyloric stenosis, the kittens begin to
vomit shortly after they are started on solid food.
Other heavy metal toxicoses (e.g. lead), ingestion of
caustic agents, or ingestion of poisonous plants should Acquired pyloric hypertrophy in adult cats has a
be considered. more variable presentation, but is usually associated
with intermittent vomiting of digested food several
Acute renal failure due to other infectious or metabolic
hours after consumption.
causes may mimic arsenical nephrotoxicity.
If the pylorus is completely obstructed the vomiting
may be projectile.
Treatment
Chronic intermittent vomiting and gastric distention
The first step is to remove the source of arsenic if pos-
may lead to gastroesophageal reflux or esophagitis
sible. If the toxin has been ingested, lavage the stom-
which may be associated with regurgitation or inappe-
ach and administer activated charcoal to minimize
tence and the resulting weight loss.
further absorption of the agent from the GI tract.
Promote excretion of the toxin from the body by
Diagnosis
starting fluid diuresis and administration of BAL
(British anti-Lewisite, dimercaptol) at a dose of 2.5–5 History and signalment are suggestive of a gastric emp-
mg/kg in oil, IM, q 4 h for 2 days, then q 12 h up to 10 tying disturbance.