Page 979 - Problem-Based Feline Medicine

44 – THE CAT WITH GENERALIZED WEAKNESS 971

● For severe pain use methadone (0.2–0.4 mg/kg IM Prognosis worsens if shock signs (hypotension) do not
q 4–6 h), or morphine (0.1 mg/kg IM q 2–6 h respond to resuscitation within a few hours.
or 0.12 mg/kg/h CRI) with or without diazepam
Severe hypothermia (T < 35˚C), or neutropenia (neu-
(0.2 mg/kg IV).
9
trophil count < 1.0 × 10 /L) are poor prognostic signs.
1
Hypoglycemia is treated with 2 ⁄2–5% dextrose added to
IV fluids and/or boluses of dextrose at 0.25–0.50 g/kg
FELINE IMMUNODEFICIENCY VIRUS
increments.
MYOPATHY
Hyperglycemia is treated with low doses of regular
insulin IV as CRI of 40–60 mU/kg/h. Classical signs
Hyperkalemia is treated by adding 2 g potassium ● Subclinical myopathy evident on muscle
(26.8 mmol) per IL fluids, with a maximum CRI of biopsy.
0.5 mEq/kg/h.
See main reference on page 339 for details (The Thin,
Hypocalcemia. If not giving blood products, use lac-
Inappetent Cat).
tated Ringer’s solution (Hartmann’s) as the IV fluid, and
give a slow IV bolus of calcium gluconate (20 mg/kg).
Clinical signs
Hypomagnesemia. Administer Plasma-Lyte 148
which is compatible with blood. A subclinical myopathy has been shown to occur in
experimentally infected FIV cats.
Antimicrobial therapy. Early identification of the most
likely pathogen is advantageous. Use antibiotic combi-
nations (≥ two antimicrobials is now routine) to gain Diagnosis
synergy, spectrum and reduced emergence of resistance.
A presumptive diagnosis is based on evidence of a sub-
● Acceptable combinations while awaiting culture
clinical myopathy in a FIV positive cat where other
results include:
potential causes of myopathy have been excluded.
– Ampicillin (20–50 mg/kg q 6 h), gentamicin
(6 mg/kg q 24 h) and metronidazole (20–40 mg/ Some cats had elevated CK levels and changes on
kg q 24 h). EMG evaluation.
– Cephazolin (20–40 mg/kg q 8 h), gentamicin
Muscle biopsies may show inflammatory changes.
(6 mg/kg q 24 h) and metronidazole (20–40 mg/
● Predominant histologic characteristics were perivas-
kg q 24 h).
cular and pericapillary lymphocytic infiltration and
– Enrofloxacin (5–11 mg/kg q 24 h), metronida-
myofiber necrosis, phagocytosis and regeneration.
zole (20–40 mg/kg q 24 h).
OR
– Ticarcillin/clavulanate (30–50 mg/kg q 8 h) ± CIGUATOXIN INTOXICATION
gentamicin (6 mg/kg q 24 h)
OR Classical signs
– Enrofloxacin (5–11 mg/kg q 24 h)
● Signs begin within 3–6 hours of ingestion
– Ampicillin, cephazolin, or ticarcillin/clavulanate
of a toxic meal of reef fish.
as above.
● Hindleg paresis and vomiting are the most
– CAUTION: do not use gentamicin if there are
prominent.
signs of renal dysfunction. Enrofloxacin has been
● Cardiovascular shock and/or respiratory
associated with blindness which is often irre-
distress may precede coma and death
versible.
within 24 hours of ingestion.
Prognosis
Pathogenesis
Prognosis is guarded to poor, and a successful out-
come relies on early intervention, and detection and Ciguatoxin is the main toxin that accumulates in the
elimination of the site of infection. flesh and viscera of large carnivorous species of fish