Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Martin Atkinson — Thu, 30 Jul 2015 10:52:17 GMT

[quote user="Kate Richardson"]but we now have 2mg tablets (Summit) and often use 1/2 a tablet.[/quote] We also have these, makes life a lot easier. If I was listening properly Sarah Caney suggested at BSAVA that you could give 2mg daily. I found that dose for my old cat makes him go a bit mental so tend to give him 1mg. Periactin is also back in circulation now although that tends to make him go a bit mental as well.

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Kate Richardson — Thu, 30 Jul 2015 09:16:54 GMT

[quote user="David Mills"]

Ranitidine according to studies needs to be used at 4mg/kg at least to change stomach pH. At 2mg/kg it is no better than placebo. Omeprazole needs about 7d to reach maximal effect. Best given in evening as proton pumps manufactured during the overnight fast.

Agree re metoclop - next to useless in cats, they have minimal dopamine recpetors. In fact, it's pretty crap in dogs too. Most hospitalised cats given metoclop don't vomit because of environmental stressors, not because they've had metoclop. In some vomting studies doens't perform any better than saline!

[/quote]

That's interesting, thanks David- one of my colleagues is obsessed with using ranitidine and omeprazole in just about any patient that vomits once! I will pass this info on.

I tend to use metoclopramide more for promoting motility than as an anti-emetic, and clinically it seems to help, but maybe they just improve on their own?

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Kate Richardson — Thu, 30 Jul 2015 09:14:06 GMT

[quote user="David Mills"]Mirtazapine was discussed at congress this year. Some work been done on daily doing of cats with CRF and significant increase in appetite and reduction in vomiting. Apparently acts as a quite potent anti-emetic as well as app stimulant so may be an option when used q24h. Dose is higher than formulary, I think quarter of a tablet daily. Have used it since, and does anecdotally seem to help. Not going to solve all problems but may be alternative. [/quote]

Can be used daily as David says in renal patients, every other day in liver cases, but the info I have suggests lower doses are as effective and less risk of neurological side effects- we used to use the 15mg tablets, 1/4 q 3 days, then we went to 1/8 of a tablet, but we now have 2mg tablets (Summit) and often use 1/2 a tablet.

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Kara Gibson — Thu, 30 Jul 2015 07:57:35 GMT

Thanks for the tips guys, didn't know about cerenia IV. Her Hct has stabilised at 15% and is starting to regenerate a bit so we will see how it goes.

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

David Mills — Thu, 30 Jul 2015 00:22:11 GMT

Mirtazapine was discussed at congress this year. Some work been done on daily doing of cats with CRF and significant increase in appetite and reduction in vomiting. Apparently acts as a quite potent anti-emetic as well as app stimulant so may be an option when used q24h. Dose is higher than formulary, I think quarter of a tablet daily. Have used it since, and does anecdotally seem to help. Not going to solve all problems but may be alternative.

Cerenia is now licensed IV or SQ. Great anti-emetic in cats, and refirgerating does make a difference to SQ inj, good evidence is out there for perusal which trumps anecdote.

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Rob Loxley — Wed, 29 Jul 2015 19:43:59 GMT

[quote user="Martin Atkinson"]keeping the Cerenia in the fridge as it is then (allegedly) less painful on injection[/quote]

I do find such allegations to be true

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Lucy Fleming — Wed, 29 Jul 2015 16:16:46 GMT

We all spot different things in these threads!

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Martin Atkinson — Wed, 29 Jul 2015 16:08:37 GMT

[quote user="Lucy Fleming"]I believe it is already on IV fluids,[/quote]Good point. Doh!

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Lucy Fleming — Wed, 29 Jul 2015 16:04:25 GMT

I believe it is already on IV fluids, so has IV access ready, otherwise yes, I would agree!

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Martin Atkinson — Wed, 29 Jul 2015 15:34:52 GMT

I presume folk are keeping the Cerenia in the fridge as it is then (allegedly) less painful on injection. What I have a problem getting my head round is how a cat that is so adverse to SC injections is going to tolerate being held and a vein being raised for IV. Surely that is more stressful than grabbing its scruff and injecting 0.5ml?!

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

vanessab — Wed, 29 Jul 2015 10:57:35 GMT

we use 1mg/kg diluted and slow IV (haven't noted any adverse reactions), might be worthwhile considering an alternative to ranitidine? (have used ondasetron for anorexic patients where ranitidine having no apparent effect)

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Hannah Wynne Richards — Wed, 29 Jul 2015 10:12:19 GMT

Anthony I'd forgotten that - too far back in the thread.

Wynne

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

grumpyoldman — Tue, 28 Jul 2015 18:32:44 GMT

[quote user="Anthony Dennison"]Acute Kidney Injury - used rather than ARF (Acute Renal Failure).[/quote]

It pops up on VIN and at cpd , not sure why ,about every 15 years quite a few things change their names, I think its just to make you feel old.

One of my nurses had a cat like this ,with what turned out to be very persistent ionised hypercalcaemia, Idiopathic, the total calcium was pretty unremarkable too ,I thought it was toast ,but 18 months down the line its still ticking over and seems happy,

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Anthony Dennison — Tue, 28 Jul 2015 17:51:30 GMT

[quote user="Hannah Wynne Richards"]

I can't find anything posted about the cat not tolerating it s/c - and it has a feline licence! I still can't work out why anyone would apologise for stating maropitant rather than metoclopramide.

Wynne

[/quote]

Wynne, the cat is averse to all s/c injections, just maropitant.

I said sorry because I was apologising for pointing out that metoclop isn't very effective in cats and that the OP would be better giving s/c maropitant, which probably isn't going to be fun.

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Hannah Wynne Richards — Tue, 28 Jul 2015 17:38:34 GMT

I can't find anything posted about the cat not tolerating it s/c - and it has a feline licence! I still can't work out why anyone would apologise for stating maropitant rather than metoclopramide.

Wynne

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

nikki — Tue, 28 Jul 2015 17:11:39 GMT

I was told by a feline medicine specialist that maropitant was ok to give IV in cats - ok, going off licence but better than not giving it at all if it won't tolerate it SC.

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Hannah Wynne Richards — Tue, 28 Jul 2015 10:53:51 GMT

Anthony You're definitely suffering from ASMD (or SAD)

Wynne

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Martin Atkinson — Tue, 28 Jul 2015 10:50:16 GMT

I am a great fan of EPO in CKD cats but the sudden drop in HCT is more suggestive of internal bleed or haemolysis. Another look to see if the anaemia is regenerative would be a good idea and what was its BUN you just said it wasn't particularly azotaemic? I wouldn't worry to much about a mild hyponatremia in an old cat I often find its a couple of points below normal and am not concerned so long as the K is normal.

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Kara Gibson — Tue, 28 Jul 2015 10:35:13 GMT

Thank you for all your helpful suggestions - I will check her urine again. Blood smear is on the list too!

Actually today her creatinine is down to 323 (71-212) but really her pancreas looked quite abnormal on ultrasound and I think this is driving her current symptoms predominantly. Luckily I do have access to erythropoeitin and as we anticipated issues with regeneration we started her on it yesterday!

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Andrew Kent — Tue, 28 Jul 2015 10:10:24 GMT

Hi Kara,

My priority in these cases is to look for correctable causes of the acute deterioration - so as Kate says a urinalysis to exclude UTI/pyelonephritis and an ultrasound of the urinary tract to look for ureteral obstruction or other obstructive diseases.

Have you examined a blood smear to make sure there is no evidence of haemolysis or other blood disorders?

This cats renal disease may well make its ability to regenerate quite limited so if you can get hold of erythropoietin or darbepoetin then that is likely to be beneficial.

Andy

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Anthony Dennison — Tue, 28 Jul 2015 09:56:07 GMT

[quote user="Hannah Wynne Richards"]What's AKI?[/quote]

Acute Kidney Injury - used rather than ARF (Acute Renal Failure).

Then of course, there's always the possibility of AOCKI (Acute On Chronic Kidney Injury)

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Hannah Wynne Richards — Tue, 28 Jul 2015 09:37:21 GMT

What's to apologise about in saying that maropitant is better than metoclopramide?

What's AKI?

Wynne

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Anthony Dennison — Tue, 28 Jul 2015 09:03:18 GMT

[quote user="Kara Gibson"]I have started her on metoclopramide injs iv as she is very reactive to subcut injections so we are reluctant to give her maropitant![/quote]

Cats don't respond to one-off injections of metoclopramide as dogs as they don't have as many dopamine receptors; a CRI is more effective, but maropitant is better still. Sorry!

[quote user="Braden Collins"] I have rarely found cats responding once creatinine over 600.[/quote]

Depends on the case - if it's an AKI, creatinine shoots up and then comes back down. My receptionist's cat had a creatinine of 850 at one point, at last check it was back down to 232

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Kara Gibson — Tue, 28 Jul 2015 08:14:21 GMT

Thanks for the replies!

Her Hct after being on fluids for 4days was 28% and then 3d later had dropped to 15% so I don't think it is all dehydration.

I did not measure aldosterone levels, we don't have a lab offering it in Hong Kong but repeated checks of her BP at home (she is too stressy to get an accurate reading here) are normal.

Today she seems more uncomfortable on palpation and even when doing the ultrasound, I have started a morphine/ketamine CRI to try and address her pain as buprenorphine doesn't seem to be touching it today.

We have check for a UTI and there is none.

I have started her on metoclopramide injs iv as she is very reactive to subcut injections so we are reluctant to give her maropitant!

I know that her prognosis is poor but my nurse really wants us to try so we will monitor carefully over the next 24-48hrs.

RE: Cat with chronic renal failure, pancreatitis and sudden drop in haematocrit

Kate Richardson — Tue, 28 Jul 2015 08:07:30 GMT

hi Kara

what was her hct before this recent deterioration? may have been falsely elevated to 28% due to dehydration.

Did you measure aldosterone levels or just ultrasound? And what is bp?

how is the cat in herself other than inappetant?

have you checked for a urinary tract infection?

You can increase the mirtazipine to every other day and I would also give maropitant as I tend to assume there is nausea, but don't let your judgement be clouded by the fact it's a nurses cat.