vomiting/neutropenia

Re: vomiting/neutropenia

Tedders — Tue, 15 Feb 2011 20:20:29 GMT

Hi in a 6 month old cat with vomiting going on for a few days I would consider ex lapping it and being done with it as it may well have eaten something soft. Not sure how the pyrexia fits with that unless there's some localised peritonitis. Be interesting to get an update.

Re: vomiting/neutropenia

Richard Fox — Tue, 15 Feb 2011 19:15:07 GMT

Yup - as said above - common things are common - pancreatitis or a septic focus would be high on my list of differentials. As the cat pyrexic then neutropenia is likely consumptive and thus any left shift? Again full CBC and smear exam will help. I think Chris's comments are spot on

I hope the cat is not fat as it may go into 2ndry fatty liver?

Re: vomiting/neutropenia

Lucie Allcutt — Sun, 13 Feb 2011 13:06:38 GMT

[quote user="Rob Davis"]

I'm sure I remember being told at a lecture at BSAVA congress a couple of years ago that metoclopramide was not a very effective anti-emetic in cats. I think it was something to do with cats not having the same dopamine receptors, but I can't remember the details. Has anyone else been told this?

[/quote]

I've also read/been told that metoclopramide isn't as effective in cats as an anti-emetic...but it has its uses as a prokinetic in gastric emptying issues or esophageal issues. I would use maropitant or ondansetron as first-line anti-emetics in kitties.

Metoclopramide is also contraindicated in pancreatitis in cats (vasoconstriction of vessels in the pancreas leading to more ischemia) AND it can cause them to become manic/highly agitated/aggressive - as I've unfortunately had first hand experience with in my own cat.

Re: vomiting/neutropenia

Christopher Saul — Sat, 12 Feb 2011 11:19:59 GMT

Just to add one or two musings here.......

I've just re-read the initial post; the abdominal radiographs were unremarkable, but the cat is still vomitting 2 days later???

I would agree you need to aleviate this cat's vomiting, but before comencing anti-emetic treatment I would want to completely eliminate obstruction (by say a radiolucent foreign body); perhaps a repeat radiograph? Ultrasound can be also useful for this to assess GI motility, also I find it more sensitive than radiography for detection of free abdominal fluid.

Re: pancreatitis, I would request an fPLI if everything else comes back negative. Of course ultrasound could help assess the pancreas too....

regarding the panleukopenia in a vaccinated cat, the vaccine of course makes it far less likely, but no vaccine is ever 100% effective; I think to diagnose this you're looking at PCR, though a high antibody titre would be suggestive and might be cheaper to run, to be honest I'd ring your lab and ask their advice on this point.

Re: vomiting/neutropenia

Rob Davis — Sat, 12 Feb 2011 10:52:13 GMT

[quote user="Louise Alexander"]With regards to his vomitting, in the recent Hills webinar on feline liver disease by Danielle Gunn-Moore, Danielle seems to be a big fan of metoclopramide for vomitting in cats, I've copied the dose from the lecture notes:[/quote]

Re: vomiting/neutropenia

Louise6732 — Sat, 12 Feb 2011 10:28:31 GMT

With regards to his vomitting, in the recent Hills webinar on feline liver disease by Danielle Gunn-Moore, Danielle seems to be a big fan of metoclopramide for vomitting in cats, I've copied the dose from the lecture notes:

Metoclopramide

(anti-emetic + pro-kinetic: 0.2-1.0 mg/kg PO, SC, q8h, ½ h before food, or 1-2 mg/kg q24h as constant rate infusion)

Not a diagnosis but might make him feel a bit better if not V+ all the time!

Louise

Re: vomiting/neutropenia

Christopher Saul — Sat, 12 Feb 2011 10:17:08 GMT

In general terms (going back to first principles here) neutropenia will be caused by -A) overwhelming demand for neutrophils eg sepsis, B) reduced bone marrow production or C) defective neutrophil maturation.

When I'm presented with a neutopenic patient, before thinking about going into bone marrow, I generally try to investigate/rule out possible reasons for overwhelming demand.....................

Have you sent a smear to an outside lab?? I would always get a full CBC including smear evaluation by a specialist pathologist at an external lab: generally speaking sepsis will result in some degenerate changes and/or left shift. Also, it's interesting to see if the other cell lineages are affected (eg platelets).

As another part of such investigations, I would generally do imaging to look for a septic focus including survey radiography ( I see you've already done this ) and ultrasound, I'd prob also throw in a full urinalysis for good measure in case of pyelonephtis. If a patient is not eating for a few days, I would think about placement of some sort of feeding tube also, but only after vomiting has resolved of course.

It will certainly be interesting to see the results of the FIV testing; I would imagine if positive this could explain alot of things. Bristol I believe offer a quantitative PCR if you're not sure.........

Hope this helps

Chris