Contraindication of frusemide

RE: Contraindication of frusemide

David Mills — Thu, 05 Jan 2017 23:17:59 GMT

[quote user="shanley barber"]

Hello all, I've just been reading this thread, and got a report back from an 18 year old diabetic cat that i sent for an echo, as I found an arrhythmia on general PE. The echo reports mild LA enlargement (18 mm max) and a small mitral regurg jet. Thyroid 26 ng/ml, diabetes relatively well controlled, no episodes of collapse or weakness. Electrolytes not checked, but small blood profile relatively unremarkable. When I saw the cat, his heart rhythym was irregulary irregular, but apparently was normal during the scan.

So, do I treat this cat? I suspect i need to check blood pressure first, but would an ace-i be indicated to expand blood volume?

Thanks.

[/quote]

I'd do an ecg as minimum. If it's got AF it's a sudden death waiting to happen.

RE: Contraindication of frusemide

Kate Richardson — Wed, 04 Jan 2017 18:39:51 GMT

Personally, if the cat is assymptomatic with respect to the heart, then no I wouldn't, other than considering anti-thrombotic medication, but I agree with your idea of checking BP first.

RE: Contraindication of frusemide

shanley barber — Wed, 04 Jan 2017 18:27:46 GMT

So, do I treat this cat? I suspect i need to check blood pressure first, but would an ace-i be indicated to expand blood volume?

Thanks.

RE: Contraindication of frusemide

Kate Richardson — Mon, 19 Dec 2016 18:07:49 GMT

Word of caution. damping down hair with spirit is fine, but don't then put the cat into a small oxygen cage/chamber without decent ventilation- the intense smell will definitely worsen any dyspnoea. An experience I will not be repeating Rinse it off well.

RE: Contraindication of frusemide

Sarah Keir — Mon, 19 Dec 2016 17:33:53 GMT

I checking for fluid (and usually left atrial size too) by just dosing the fur in loads of spirit then rubbing in some ultrasound gel with the cat in sternal or standing/walking/whatever it wants to do. Further echocardiology is reserved for when the patient is not critical.

RE: Contraindication of frusemide

mariette asselbergs — Thu, 15 Dec 2016 17:03:57 GMT

[quote user="Beats"]

[quote user="mariette asselbergs"]ultrasound is really my very first quick check before tapping in a dyspneic cat. It is stressless [/quote]

do you clip first?

[/quote]

I do just the little bit for the probe (we have good quiet clippers) and the advantage is that you then have already a clean area to stick the needle in.

Mariette

RE: Contraindication of frusemide

Anthony Todd — Tue, 13 Dec 2016 19:25:51 GMT

[quote user="Mike Martin"]Hope my experience helps a little.[/quote]

More than a little !

No chance of a nice picture for the dinovets please.

PS SG with a refractometer of the fluid, (if not pus) gives a lot of info too [forgot that]

RE: Contraindication of frusemide

Mike Martin — Tue, 13 Dec 2016 17:05:36 GMT

Interesting discussion and I like hearing the experience of busy vets who have seen a lot too. I agree with much with everyone!

I'm not aware of a contraindication for using frusemide and steroids together.

I do see a few cases a year of cats being tipped into heart failure following steroids (either long acting inj or chronic oral). I presume these cats had underlying structural heart disease and also borderline failure cases anyway.

So there might be an argument for using frusemide as a precaution when you also give steroids to a cat with dyspnoea.

I rarely see or hear of cases of pneumothorax following blind chest taps - but I do come across the occasional one - I'm surprised it is not a more frequent complication. Prior to doing a chest tap in a blue and dyspnoeic cat I prefer to cage rest them for 30 minutes + O2. Let them calm down a little. Usually the car journey to the clinic tips them into being blue - I think. I prefer to at least do a quick ultrasound check for the pleural fluid - both to check there is fluid and also to check the best place to insert my needle.

Hope my experience helps a little.

RE: Contraindication of frusemide

Anthony Todd — Tue, 13 Dec 2016 16:07:44 GMT

[quote user="Sarah Keir"]

I was told yesterday by a reliable source that blood samples in cats used to be not infrequently taken directly from the heart!

[/quote]

Phew, makes me feel better.... [bit unnerving feeling the syringe and needle beating with the heart....]

RE: Contraindication of frusemide

Sarah Keir — Tue, 13 Dec 2016 14:41:09 GMT

I was told yesterday by a reliable source that blood samples in cats used to be not infrequently taken directly from the heart!

RE: Contraindication of frusemide

Anthony Todd — Mon, 12 Dec 2016 23:57:22 GMT

[quote user="Anthony Todd"]An ultrasound would be good but they hadn't been invented back in the day[/quote]

Love to see a good demo. picture please.

RE: Contraindication of frusemide

Anthony Todd — Mon, 12 Dec 2016 17:45:42 GMT

[quote user="Beats"]do you clip first?[/quote]

I never did for fear of sudden death. [of the cat] Some are really that anoxic, and any stress can be fatal!!

An ultrasound would be good but they hadn't been invented back in the day.... and time is of the essence in these cases so delay for referral can be fatal.

Never had nose bleed either, but I may just have been lucky. A dinovet today said he had one or two which just aspirated air on the tap, but without any subsequent problem....

We decided to try and insert the needle on expiration, which I'd never thought of before.

I've had an obvious haemothorax which made me sit up a bit, thinking I was in the heart, and have hit the heart muscle too [the needle and syringe pulses] but with no apparent after effects.

We both agreed a tap had saved many cyanotic cats.

RE: Contraindication of frusemide

Beats — Mon, 12 Dec 2016 12:37:42 GMT

[quote user="mariette asselbergs"]ultrasound is really my very first quick check before tapping in a dyspneic cat. It is stressless [/quote]

do you clip first?

RE: Contraindication of frusemide

mariette asselbergs — Mon, 12 Dec 2016 11:42:07 GMT

If it is mainly edema, then furosemide (plus cat calmly in oxygen box) will work fast and progressively cause improvement. If there is free fluid then frusemide is not enough in my experience and a tap is necessary. I have always leaned to the idea that a quick tap just to see if there was fluid could do no harm (as Anthony says), but in my last cat which came in very dyspneic and with a known life long heart murmur, the ultrasound showed some free fluid, and the tap just produced very little fluid and then blood, and she started sneezing blood!!! Very luckily, frusemide and vetmedin and oxygen overnight helped her through this lungbleed on top of edema! Now I am more aware that a tap when there is not a chest full of fluid is not entirely benign! And ultrasound is really my very first quick check before tapping in a dyspneic cat. It is stressless and quick and clear: fluid or not. My obvious mistake was to want to tap fluid when there was only little amount.

Mariette

RE: Contraindication of frusemide

Beats — Sun, 11 Dec 2016 21:35:48 GMT

What is rough expected time to repeat dyspnoea in cat presenting with pulmonary edema or hydrothorax due to left-sided congestive heart failure after treatment with furosemide?

RE: Contraindication of frusemide

Anthony Todd — Sun, 11 Dec 2016 19:49:45 GMT

Come on, anonymous one-starrer, refute, comment or argue about what I've said 'cos I, and other dinovets, have probably saved more blue cats than you've booked for Xrays, including leg fractures, let alone saved from terminal cyanosis, as the radiographers try to restrain them in dorsal recumbency......

RE: Contraindication of frusemide

Anthony Todd — Sun, 11 Dec 2016 19:18:39 GMT

[quote user="Sarah Keir"]It was actually an unusual cat - it had purely pulmonary oedema so the xray 'confused' the OOH vet.[/quote]

So a quick, easy, and safe chest tap would have eliminated all that "confusion" should have narrowed the diagnostic possibilities to the lungs themselves.

Ps how was the pulmonary oedema, diagnosed post Xray? how did the cat do?

RE: Contraindication of frusemide

Sarah Keir — Sun, 11 Dec 2016 08:25:03 GMT

It was actually an unusual cat - it had purely pulmonary oedema so the xray 'confused' the OOH vet.

RE: Contraindication of frusemide

Anthony Todd — Sat, 10 Dec 2016 15:53:35 GMT

[quote user="Stephanie Fursland"]so I don't know if it was the steroids or the frusemide (or neither) that did the trick...[/quote]

It's very frustrating. although I should be used to it by now, that even when steroids are the obvious and sensible drug to be used, they still don't get any credit at all.

But see below with cats.

The review of trials found that systemic (oral or intravenous) corticosteroids reduce the need for people with asthma attacks to stay in hospital, with few adverse effects.

from

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2009, Issue 4 http://www.thecochranelibrary.com

from the first link Google gave me.

With cats though, IMHO, pyothorax, or some fluid in the chest cavity is usually the cause with any acute dyspnoea, so a tap should be done ASAP IMHO, and without a dangerous GA or Xray.

RE: Contraindication of frusemide

Anthony Todd — Sat, 10 Dec 2016 15:10:41 GMT

[quote user="Kate Richardson"]Thinking pyothorax for example, corticosteroids and frusemide might not be the best option for initial treatment if the cat is septic and dehydrated. [/quote]

I always did a chest tap in the consult with these, 'cos most of them used to have fluid, usually pus in the chest. Got them on my favourite AB through the same needle. [and sent a sample off for culture that night]

See I did do lab.tests and only used steroids when needed, just check back Kate!

RE: Contraindication of frusemide

Anthony Todd — Sat, 10 Dec 2016 15:06:33 GMT

"and why would steroids cause heart failure?" just before I asked the same question!!

[]Don't you just hate it when someone cites a reference which just totally nails it!

I've been right through it too, and it doesn't seem as if they were on excessive dosages or long duration either?

My only comment is that, as the steroid king of the world, I can't say I've had any sequel, apart from a considerable improvement in the presenting condition, following Dmed or any steroid.

Certainly nothing as obvious or severe as the cases described.

RE: Contraindication of frusemide

Stephanie Wellings — Sat, 10 Dec 2016 10:51:17 GMT

I have used dex and frusemide together before in that situation, sometimes you just have to cover the most likely causes - even if it might not be ideal, if you think it will keep them alive long enough to then deal with any side effects it has to be worth a try?

One particularly memorable one was a cat who came in so dyspnoeic we couldn't even exam properly or attempt thoracocentesis, but after the drugs and an hour in the oxygen tent was right as rain (did need ivft to correct the dehydration, but no other obvious issues were caused by the treatment). Very frustratingly though we never found the source of the dyspnoea - owner declined further investigations but it has never recurred - so I don't know if it was the steroids or the frusemide (or neither) that did the trick...

RE: Contraindication of frusemide

Kate Richardson — Sat, 10 Dec 2016 02:50:04 GMT

Corticosteroids are not a drug I'm scared of using in the slightest, and I will often use them where others have been too cautious/'scared' to but as with any drug, one has to be aware of the potential negative effects and weigh these up against the benefits. I agree they are an incredibly useful drug and very high up my list of drugs I couldn't live without

just waiting for Anthony to come along now and give his usual repetitive spiel about roids, so I will probably disappear from this conversation if that happens

RE: Contraindication of frusemide

mariette asselbergs — Sat, 10 Dec 2016 00:43:32 GMT

I used to work in a hospital where one of the user practices sent us regularly overnight bulldogs with BOAS, pre- and after surgery. They sort of specialised in this. When I got an acutely blue suffocating Bulldog in one day in a small branch of the hospital practice, I did the intubation then phoned them for advise, and they said steroids and furosemide iv. Since then I use them together as first aid in BOAD dogs in crisis.

(I know that is not immediately comparable to cats).

Being old, I remember the sixties and seventies when steroids were the wonder drugs and used for almost all sick animals because they always made them feel better and helped their appetite, a bit like today's NSAIDs really. At the time we even had drug bottles which had mixtures of antibiotics, steroids and vitamin A in them, just one injection needed. A bit like resflor these days....?

I got weaned of the use of steroids in Africa, where a shot of steroid could bring a clinical flare up of otherwise perfectly tolerated blood parasites like babesiosis.

These days I rarely dare to reach for the steroid bottle.

But then, the medics seem to have no such fears. They gave me a shot of IV dexamethason pre-op as antiemetic, on two occasions the last years, and they add a few days of dexamethason to anti-nausea medication (their version of maropitant and ondansetron) because the addition of steroids enhances their effectivity. It certainly works fine, and haven't got diabetis or heart failure yet....

Mariette

RE: Contraindication of frusemide

Kate Richardson — Fri, 09 Dec 2016 19:29:16 GMT

ps I have seen both cats and dogs with decompensated heart failure following corticosteroid administration, albeit for an unrelated condition, so it does happen