Oops...

Re: Oops...

Claire Fisher — Sat, 22 Jun 2013 22:06:05 GMT

[quote user="CatherineThomas"]

I had someone who had given their puppy a 10kg dose of metacam because the first line of the label said 10ml metacam. He then called me in a panic saying that his 5kg puppy had had 10mls of metacam. This was when I was a new grad, I hadn't prescribed it but ever since I've always been really careful to explain the dosing system to everyone who is given a bottle of metacam.

[/quote]

We had this happen several times - even after showing people the syringe and the dose to give. We ended up changing the entry on the computer for the 10ml bottle to "Metacam - small" to avoid confusion!

Re: Oops...

Michael Woodhouse — Sat, 22 Jun 2013 21:54:02 GMT

[quote user="Christopher Saul"]Strictly speaking there aren't any non POM analgesics for dogs either (though in an OOH situation many people would advise giving paracetamol for dogs, and I haven't got a particular problem with this provided the owner is made aware of the cascade dilemma and you err on the conservative side with the dose, i.e. about 10mg/Kg. )[/quote]

Yes I do that if I judge that the animal can be made comfortable and there is something minor (bad ear, lame but weight-bearing etc).

Cats are so much better at hiding pain that if I was worried then I would see it. Unless they had loxicom for cats at home and had used it before in the same animal then no way.

I doubt you could titrate a dose down from an aspirin tablet suitable for a cat with suitable household equipment.

Re: Oops...

CatherineThomas — Sat, 22 Jun 2013 21:46:08 GMT

Re: Oops...

Utlendigur — Sat, 22 Jun 2013 20:46:31 GMT

[quote user="GrooveJet"]I've had a client tell me "this Metacam is useless..." Turned out she hadn't considered inverting the bottle, so was sucking 4kg-worth of air out of the bottle and spraying it over the cat's food. The stupidity of some people knows no bounds!

[/quote]

I had an OOH call late one night from someone looking after a friend's diabetic dog who was extremely irate that the bottle of insulin was "faulty" and demanding that I supply a new one NOW. I thought initially that she meant it was broken, or the dog was becoming unstable but eventually it transpired it was the same thing - she hadn't turned it upside down.

I'm always a bit wary of dispensing metacam/loxicom for post op analgesia unless I, or a nurse I trust (ie not the reception staff) can discharge the animal as we've had a few similar problems. I also always take the larger syringe out if it's not going to be used just in case someone confuses 4kg and 40kg.

Re: Oops...

Miriam Lodewyks — Sat, 22 Jun 2013 20:36:48 GMT

I've had a client tell me "this Metacam is useless..." Turned out she hadn't considered inverting the bottle, so was sucking 4kg-worth of air out of the bottle and spraying it over the cat's food. The stupidity of some people knows no bounds!

Re: Oops...

Dagmar Steele — Sat, 22 Jun 2013 20:15:57 GMT

I use a marker pen and draw a line up to where they are supposed to fill the syringe. Some people still manage to get it wrong.

Re: Oops...

Gillian Mostyn — Sat, 22 Jun 2013 20:11:07 GMT

A 'normal' syringe doesn't fit on the top of a metacam bottle - you have to use the one that they provide - and they are only marked up in 'kg'. Printing something else on the label would be likely to confuse the client.

Re: Oops...

Anthony Todd — Sat, 22 Jun 2013 20:08:25 GMT

Why don't you just print the actual dose in mls or whatever on the label? Seems obvious.

Re: Oops...

Clive Ansell — Sat, 22 Jun 2013 18:56:55 GMT

[quote user="Thomas Johnson"]

[quote user="Clive Ansell"]

I had one last year sometime where 100ml Metacam was dispensed with the label "Dose once daily for 18 Kg bodyweight". They requested more after a week as they were giving 18ml per day! fortunately the dog was fine. but the owner will always be brainless.

[/quote]

I always demonstrate dosing Metacam, but I have many clients who later say "I'm giving him 30ml", when they mean they're giving the dose for 30kg, I always question them carefully to make sure though!

[/quote]

These clients were shown in a competent manner how to dose to 18.0 Kg by an experienced RVN, but for reasons unknown they decided to use a standard syringe and measure 18.0ml ?

Re: Oops...

Thomas Johnson — Sat, 22 Jun 2013 16:33:46 GMT

[quote user="Clive Ansell"]

[/quote]

Re: Oops...

Anthony Todd — Sat, 22 Jun 2013 14:48:24 GMT

[quote user="Robin Grimmer"] "Dose once daily for 18 Kg bodyweight".[/quote]

That instruction would have confused me, I must admit....

Still, I've had an owner shake the cat instead of the ear prep. so I suppose I'm not in the clear either

Re: Oops...

Robin Grimmer — Sat, 22 Jun 2013 14:38:34 GMT

[quote user="Clive Ansell"]

[quote user="Anthony Todd"]

How, on earth. can an owner mistake half a ml for 2 ml and why would it be the vets fault??

You could understand "point zero five" for "point five" or point zero two for "point two" as many cases in humans will attest but "point five" [or half] for "two"???

[/quote]

Easily.

[/quote]

We had a similar case with Propalin where a dog was given 10x the dose it should have had. It was pretty poorly but made a full recovery. For liquid meds owners should always be shown how much to give.

Re: Oops...

Robin Grimmer — Sat, 22 Jun 2013 14:35:27 GMT

[quote user="Anthony Todd"]

[quote user="Christopher Saul"]I think that just about hits the nail on the head[/quote]

Are there any non-POM analgesics available for cats??

[/quote]

aspirin is the only one I can think of, but that's generally used for its thrombolytic properties rather than analgesia.

Any dose of paracetamol will kill a cat, ibuprofen is not recommended. Why didn't they ask to bring the cat in so it could have a jab of buprenorphine?

Re: Oops...

Christopher Saul — Sat, 22 Jun 2013 14:29:33 GMT

[quote user="Anthony Todd"]

[quote user="Christopher Saul"]I think that just about hits the nail on the head[/quote]

Are there any non-POM analgesics available for cats??

[/quote]

Strictly speaking there aren't any non POM analgesics for dogs either (though in an OOH situation many people would advise giving paracetamol for dogs, and I haven't got a particular problem with this provided the owner is made aware of the cascade dilemma and you err on the conservative side with the dose, i.e. about 10mg/Kg. ) To answer your question directly, I can't think of an occasion where I have ever advised a cat owner to use over the counter medications for their cat

Re: Oops...

Clive Ansell — Sat, 22 Jun 2013 14:11:35 GMT

[quote user="Anthony Todd"]

How, on earth. can an owner mistake half a ml for 2 ml and why would it be the vets fault??

You could understand "point zero five" for "point five" or point zero two for "point two" as many cases in humans will attest but "point five" [or half] for "two"???

[/quote]

Easily.

Re: Oops...

Anthony Todd — Sat, 22 Jun 2013 14:09:56 GMT

[quote user="Christopher Saul"]I think that just about hits the nail on the head[/quote]

Are there any non-POM analgesics available for cats??

Re: Oops...

Christopher Saul — Sat, 22 Jun 2013 13:52:23 GMT

[quote user="Stephen Courtney"]Again, compulsory CPD/ training rather than striking off is appropriate. Striking off should be considered a final sanction for incorrigible / intransigent incompetence, or for criminal behaviour.[/quote]

I think that just about hits the nail on the head

Re: Oops...

Anthony Todd — Sat, 22 Jun 2013 13:38:54 GMT

As an aside it appears that gastric signs occur at 4mg/Kg and kidney toxicity at 8mg/Kg, I wonder what does the cat had?

looks like the liquid is 20mg/ml so 2 ml ie 40mg would give toxic signs in a 10Kg cat and kill a 5kg cat.

Re: Oops...

Anthony Todd — Sat, 22 Jun 2013 13:30:33 GMT

[quote user="Stephen Courtney"]the issue is why, in this day and age, did a VS tell a client to give ibuprofen to a CAT . FFS.[/quote]

Fair point, but the emphasis was on the overdose, to be fair.

I wonder why she did? I think low dose aspirin is OK?? Just another reason always to offer to see the animal, after all you're well awake by then...

Re: Oops...

Stephen Courtney — Sat, 22 Jun 2013 13:25:44 GMT

[quote user="Anthony Todd"]

How, on earth. can an owner mistake half a ml for 2 ml and why would it be the vets fault??

You could understand "point zero five" for "point five" or point zero two for "point two" as many cases in humans will attest but "point five" [or half] for "two"???

[/quote]

Never assume client won't cock up. i always SHOW them exactly how much.

the issue is why, in this day and age, did a VS tell a client to give ibuprofen to a CAT . FFS.

Again, compulsory CPD/ training rather than striking off is appropriate. Striking off should be considered a final sanction for incorrigible / intransigent incompetence, or for criminal behaviour.

Re: Oops...

Anthony Todd — Sat, 22 Jun 2013 11:35:28 GMT

How, on earth. can an owner mistake half a ml for 2 ml and why would it be the vets fault??

You could understand "point zero five" for "point five" or point zero two for "point two" as many cases in humans will attest but "point five" [or half] for "two"???

Re: Oops...

Robin Grimmer — Sat, 22 Jun 2013 00:09:08 GMT

Yeah I guess you're right. But I think this case was worse than the Bedford ooh vet. This was incompetence.

Re: Oops...

Christopher Saul — Fri, 21 Jun 2013 23:44:47 GMT

[quote user="Robin Grimmer"]Now that's the sort of case which justifies being struck off.[/quote]

I think that's a little harsh even for this case; education /compulsory CPD/ redoing PDP or something first surely?

Re: Oops...

Robin Grimmer — Fri, 21 Jun 2013 23:35:25 GMT

Now that's the sort of case which justifies being struck off.

Re: Oops...

Michael Woodhouse — Fri, 21 Jun 2013 20:56:45 GMT

Oh dear.