Use of paracetamol in 10 yo Lurcher with CKD

RE: Use of paracetamol in 10 yo Lurcher with CKD

mariette asselbergs — Tue, 30 Aug 2016 14:25:48 GMT

The iv dose of paracetamol for dogs is 10 mg/kg, but the oral dose is 25-35 mg/kg because it is only 40% bio-available; e.g. 400mg pardaleV one tablet for a 20 kg dog TID. Obviously if the lower dose works then that is fine, but don't be afraid to increase the dose!

(From my BSAVA Cert SAECC anaesthesia and analgesia forum)

Mariette

RE: Use of paracetamol in 10 yo Lurcher with CKD

Rob Loxley — Sat, 27 Aug 2016 22:50:06 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]The only complication I ever saw from a cysto was a vet who tried to perform it on a blocked cat, conscious and ruptured the bladder [/quote]

Any more on this, although I've heard about a similar incident. because I thought a cystocentesis, by lowering the forward pressure in a blocked cat, might be a help, although I've never done it ever.

[/quote]

I have cysto'd (with care) blocked cats that need relief where passing a catheter has been a nightmare, and also where it does seem to have helped with passing a catheter (?bladder less full so less straining and urethral muscle spasm?).

With care as I can imagine how you could use the bevelled end of a hypodermic needle to lacerate the bladder and cause leakage.

RE: Use of paracetamol in 10 yo Lurcher with CKD

Robin Grimmer — Sat, 27 Aug 2016 14:54:24 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]The only complication I ever saw from a cysto was a vet who tried to perform it on a blocked cat, conscious and ruptured the bladder [/quote]

[/quote]

I used to do it with blocked cats, but only under ga and never had any problems, but I've stopped doing it now. Always been able to unblock without cysto first, just need patience and lots of flushing.

Maybe we should start a tangent?

RE: Use of paracetamol in 10 yo Lurcher with CKD

Anthony Todd — Sat, 27 Aug 2016 14:15:41 GMT

[quote user="Robin Grimmer"]The only complication I ever saw from a cysto was a vet who tried to perform it on a blocked cat, conscious and ruptured the bladder [/quote]

RE: Use of paracetamol in 10 yo Lurcher with CKD

Robin Grimmer — Sat, 27 Aug 2016 13:08:31 GMT

Cystocentesis in cats anyway is a simple procedure and rarely requires sedation. All you need is a reasonably full bladder, and not too fat. Certainly much better tolerated than trying to express.

The only complication I ever saw from a cysto was a vet who tried to perform it on a blocked cat, conscious and ruptured the bladder

RE: Use of paracetamol in 10 yo Lurcher with CKD

Hannah Wynne Richards — Sat, 27 Aug 2016 12:13:33 GMT

No one has explained why doctors consider a mid-stream sample adequate for culture and sensitivity

Wynne

RE: Use of paracetamol in 10 yo Lurcher with CKD

Anthony Todd — Sat, 27 Aug 2016 10:37:45 GMT

Acute staphylococcal peritonitis following cystocentesis in a dog (case report)

from

http://www.vetcontact.com/en/art.php?a=124

I do hope, under the new era of "informed consent"m the owner of the thread dog was informed of the possible risks.....

Still waiting for some advantages to the patient, the diagnosis, the treatment or the owner of a cystocentesis in the thread dog.

RE: Use of paracetamol in 10 yo Lurcher with CKD

Anthony Todd — Fri, 26 Aug 2016 23:47:57 GMT

[quote user="Michael Woodhouse"]Creatinine is (generally) predictably produced so it is used as a means of quantifying proteinuria, correcting for urine concentration.[/quote]

Yeah but this animal is azotemic with a low USG so would have a raised creatinine anyway, I would have thought, so the values will be skewed??

RE: Use of paracetamol in 10 yo Lurcher with CKD

Anthony Todd — Fri, 26 Aug 2016 16:49:28 GMT

[quote user="Aisling McGrath"]I might as well find out how truly proteinuric it is? [/quote]

Assessment and Management of Proteinuria in Dogs and Cats: 2004 ACVIM Forum Consensus Statement (Small Animal)

http://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2005.tb02713.x/epdf

This is a very comprehensive 8 page recommendation which does recommend cystocentesis as the first of 7 steps in the diagnostic process.

Step 1. To exclude ‘‘extra-urinary postrenal,’’ evaluate urine obtained by cystocentesis.

I wonder if the extra definition gained from cystocentesis is somewhat academic and whether it would influence the diagnosis and treatment enough to make it worthwhile, when compared to a mid-stream urine sample.

Wouldn't "proteinuric" be enough?

It seems to be OK for people.

RE: Use of paracetamol in 10 yo Lurcher with CKD

Aisling McGrath — Fri, 26 Aug 2016 14:43:19 GMT

Just on this point "But is the result going to change anything significantly ie diagnosis, treatment or prognosis, which was my question?"

When it comes to cats, it is going to change my treatment, because if the cat has proteinuria, then I am going to treat that with Semintra, in the hope of improving the cats quality and quantity of life. Because Semintra can control the proteinuria, and also secondarily, help with any blood pressure issues the cat may have.

Most of my CKD cases are cats, in this dog, I want to do a culture anyway, because UTI's are common in animals with CKD (dogs and cats), and as the dog is 2+ protein on dipstick, I might as well find out how truly proteinuric it is?

RE: Use of paracetamol in 10 yo Lurcher with CKD

Anthony Todd — Fri, 26 Aug 2016 11:57:24 GMT

[quote user="Michael Woodhouse"]Creatinine is (generally) predictably produced so it is used as a means of quantifying proteinuria, correcting for urine concentration.[/quote]

But is the result going to change anything significantly ie diagnosis, treatment or prognosis, which was my question?

Sounds like a procedure of little extra benefit, as opposed to a midstream conventional urine sample and exam.

A dinovet [nearly] has just told me of a similar serious sequel to cytocentesis and I remember a paper detailing a number of complications.

RE: Use of paracetamol in 10 yo Lurcher with CKD

Michael Woodhouse — Fri, 26 Aug 2016 00:28:24 GMT

[quote user="Anthony Todd"]Don't you get the "C" from the blood anyway, and is the "P" going to change anything?????????????[/quote]

Creatinine is (generally) predictably produced so it is used as a means of quantifying proteinuria, correcting for urine concentration.

RE: Use of paracetamol in 10 yo Lurcher with CKD

Anthony Todd — Fri, 26 Aug 2016 00:15:38 GMT

[quote user="Aisling McGrath"]

So have I been doing this wrong all along, doing cystos on all my CKD cats when I need a UPC measurement???????? :s

[/quote]

Don't you get the "C" from the blood anyway, and is the "P" going to change anything?????????????

RE: Use of paracetamol in 10 yo Lurcher with CKD

Anthony Todd — Fri, 26 Aug 2016 00:05:52 GMT

[quote user="Aisling McGrath"]We plan to do a cysto next week [/quote]

J Am Vet Med Assoc. 2009 Aug 1;235(3):288-91. doi: 10.2460/javma.235.3.288.

Massive transfusion and surgical management of iatrogenic aortic laceration associated with cystocentesis in a dog

The risk of this might put me off, particularly as the information gained, judging by the history, isn't likely to be vital.

RE: Use of paracetamol in 10 yo Lurcher with CKD

Michael Woodhouse — Thu, 25 Aug 2016 19:45:04 GMT

I'd be happy keeping the dog on the Metacam.

I'd be happy swapping to paracetamol (care with the suspensions as there is a move to sugar free products, many of which contain xylitol).

I'd be happy reducing the meloxicam and adding in low dose paracetamol (10mg/kg).

I'm also quite happy collecting a clean free catch sample for urine culture and sensitivity.

I'm also happy squeezing cats bladders for either C&S or UPCR. It is rare I would need to do a cysto.

RE: Use of paracetamol in 10 yo Lurcher with CKD

Judith Archbold — Thu, 25 Aug 2016 19:26:56 GMT

I swapped a 12 year old Golden Retriever onto paracetomol @ 10mg/kg bid recently ( about 3 months ago) as she had been on meloxicam for a couple of years for OA. on a routine renal blood check the UREA had crept-up. But her faeces were also darker, although no occult blood? I was suspicious the urea was possibly a reflection of an intestinal bleed so we stopped the NSAID.

faeces returned to normal ( owned happy for no further tests with respect to this) and at a check three weeks later renal / liver enzymes normal.

Anyway, my point is the dog is doing very well on paracetomol. In fact the owner feels she is more mobile and content on this drug at only once daily dosing than she was on the meloxicam.

i know paracetomol is a valuable drug to not forget in the treatment of OA but I'm still cautious when using it longterm. However the dog is happy so I'll just monitor her enzymes.

RE: Use of paracetamol in 10 yo Lurcher with CKD

Rob Loxley — Thu, 25 Aug 2016 18:41:50 GMT

[quote user="Matt Hilary"]My understanding was that a free catch sample is fine for UPCR provided inactive sediment/no gross haematuria[/quote]

Mine too

RE: Use of paracetamol in 10 yo Lurcher with CKD

Matt Hilary — Thu, 25 Aug 2016 18:17:52 GMT

My understanding was that a free catch sample is fine for UPCR provided inactive sediment/no gross haematuria. Cysto needed for C&S.

Microscopic haematuria from cystocentesis will not interfere.

RE: Use of paracetamol in 10 yo Lurcher with CKD

Clive Ansell — Thu, 25 Aug 2016 17:27:33 GMT

[quote user="Hannah Wynne Richards"]

Well. either our approach is wrong, or doctors are.

We can't both be right

[/quote]

No.

Not right or wrong necessarily, just different approaches

I guess humans are more easy to catheterise too than some of our patients.

In humans cystoscopy is used a lot more too I believe.

RE: Use of paracetamol in 10 yo Lurcher with CKD

Clive Ansell — Thu, 25 Aug 2016 17:21:07 GMT

[quote user="Hannah Wynne Richards"]Yes, but my point is the veterinary profession is now routinely doing an invasive procedure that carries some risk, whilst the medical profession seem able to avoid doing this. Why the difference in attitude?[/quote]

Fair point, but it is minimally and no more invasive than a I/m or I/v injection, abdominocentesis or an fna. Most patients tolerate it well without any sedation.

Is there any evidence that cystocentesis carries an unacceptable risk of complication?

RE: Use of paracetamol in 10 yo Lurcher with CKD

Hannah Wynne Richards — Thu, 25 Aug 2016 17:19:59 GMT

Well. either our approach is wrong, or doctors are.

We can't both be right.

Wynne

RE: Use of paracetamol in 10 yo Lurcher with CKD

Clive Ansell — Thu, 25 Aug 2016 17:17:19 GMT

[quote user="Aisling McGrath"]I was under the impression that in order for the UPC to be valid, that it must be a cysto sample, otherwise you have "protein" from the rest of the urinary tract that would give you a falsely high value???[/quote]

And of course a sterile sample for C&S.

RE: Use of paracetamol in 10 yo Lurcher with CKD

Aisling McGrath — Thu, 25 Aug 2016 17:17:09 GMT

So have I been doing this wrong all along, doing cystos on all my CKD cats when I need a UPC measurement???????? :s

RE: Use of paracetamol in 10 yo Lurcher with CKD

Hannah Wynne Richards — Thu, 25 Aug 2016 17:16:10 GMT

Yes, but my point is the veterinary profession is now routinely doing an invasive procedure that carries some risk, whilst the medical profession seem able to avoid doing this. Why the difference in attitude?

Clive You could give the owner a sample pot, with instructions to catch an early morning mid-stream sample

Wynne

RE: Use of paracetamol in 10 yo Lurcher with CKD

Clive Ansell — Thu, 25 Aug 2016 17:15:53 GMT

[quote user="Hannah Wynne Richards"]

Do doctors routinely do cystos, or do they just ask the patients to produce a sample?

Wynne

[/quote]

Yep. I'd give this Lurcher a sample pot, point her in the direction of a cubicle and request a midstream sample.