Page 691 - Problem-Based Feline Medicine

31 – THE CAT WITH SIGNS OF CHRONIC VOMITING 683

Differential diagnosis Most epidemiologic studies do not incriminate pet
contact with human infection, and only contact with
Chronic gastritis due to other causes such as hepatic
commercially reared cats has been shown to have any
disease, pancreatitis, chronic renal failure or IBD may
potential for risk, suggesting the possibility of a reverse
result in a similar clinical presentation.
zoonotic infection.
Treatment HYPERCALCEMIA* (MALIGNANCY,
There have been various treatment regimens recom- CHOLECALCIFEROL TOXICITY,
mended for cats with Helicobacter infection, but none CHRONIC RENAL FAILURE,
have been well substantiated. HYPERPARATHYROIDISM, IDIOPATHIC
HYPERCALCEMIA)
The triple therapy regimen has been the mainstay of
treatment for Helicobacter infection. This is bismuth
Classical signs
(0.5–2 ml/kg PO q 4–6 h), metronidazole (62.5 mg PO
q 24 h), and amoxicillin (15–20 mg/kg PO q 12 h). This ● Signs vary with the cause of
regimen with the addition of famotidine (0.5–1.0 mg/kg hypercalcemia.
PO q 24 h) has been recommended in refractory or ● Anorexia, vomiting and weight loss are
severe cases. typical.
● Polyuria and polydipsia are late signs, due
Famotidine (0.5–1 mg/kg PO q 24 h), ranitidine (1–2
to renal failure.
mg/kg PO q 12 h), or omeprazole (0.5–1.0 mg/kg PO q
● Muscle weakness or tremors may occur
24 h), in addition to antibiotic therapy have more
acutely.
recently been recommended.
Other antibiotics that may be used include tetracycline See main reference on page 245 (The Cat With
(22 mg/kg PO q 8 h), clarithromycin (7.5 mg/kg PO q Polyuria and Polydipsia) for details.
12 h), or azithromycin (5 mg/kg PO q 24–48 h).
Pepto-bismol can be used (1 ml/kg PO q 24 h) to con-
trol gastritis due to Helicobacter infection, but salicy- Clinical signs
late toxicity has occasionally been observed in
Vomiting may be due to the disease causing the
individual cats.
increased serum calcium or to the direct effects of ele-
The duration of treatment for infected cats has also vated calcium stimulating vomiting receptors both
not been well substantiated, but 14–28 days has been peripherally or centrally.
the standard recommendation.
The signs are dependent upon the cause of hyper-
calcemia, which can be due to the presence of
malignancy, ingestion of cholecalciferol-containing
Prevention
rodenticides, endocrinopathies (primarily primary
Unknown, but careful attention to cleanliness of endo- hyperparathyroidism) or idiopathic.
scopes and dental equipment is advised.
Signs associated with large elevations in serum calcium
include anorexia, vomiting, muscle weakness, polyuria
and polydipsia, shaking/tremors and weight loss.
Public health
Hypercalcemia has also been associated with the devel-
H. felis and H. heilmannii both are capable of coloniza-
opment of calcium-containing nephroliths or uroliths,
tion of humans and cats, but are not particularly patho-
which may cause signs of renal or bladder dysfunction.
genic. H. pylori has not been isolated reliably from pet
cats, so the zoonotic potential of Helicobacter in pet Generally, in cats, hypercalcemia is rare, but if pres-
cats as a cause of human gastritis (a significant prob- ent is most commonly caused by renal failure or is
lem) has not been shown. secondary to malignancy. In some cats, the cause cannot