Veterinary Medicine - February 2008 - (Page MV4) MANAGING VOMITING Dr. Albert E. Jergens days after chemotherapy. The best example is cisplatin. Some of those dogs will have delayed vomiting that may have more of a peripherial a erent input. Leib: Let’s look at diabetes mellitus and central vomiting mechanisms. Twedt: With ketosis, acidosis, and electrolyte abnormalities, we’re looking at the chemoreceptor trigger zone. So it’s centrally acting. “Sometimes it’s tough to pinpoint the trigger.” Simpson: O ering advice on premedicating animals for travel is a challenge. Is the owner going to leave the pet alone? How anxious will the pet get? Is it at risk for overheating? Do we use sedatives vs. antiemetics? Motion sickness is di cult to medicate e ectively. Twedt: The trend has been to tranquilize, but that may not be the best approach. Leib: Dr. Simpson, you mentioned intravenous drug treatment in the intensive care unit and frequent vomiting. Could you make some general comments on the mechanisms that cause vomiting? Simpson: I presume it’s through the chemoreceptor trigger zone. I consider it a potential cause when the animal’s vomiting corresponds with the administration of an intravenous medication, especially if the intravenous medication is administered rapidly. Leib: So slowing down the rate of administration will decrease the vomiting frequency? Simpson: Yes. 4 Jergens: We also see numerous medication-induced vomiting cases in my practice. We have a lot of oncology cases, and vomiting may be attributable to the use of cancer chemotherapeutic drugs. And I also have observed rapid infusions of intravenous antibiotics stimulating vomiting. Leib: Do certain antibiotics cause vomiting more frequently? Twedt: Penicillins and cephalosporins given intravenously and erythromycin orally. Jergens: I might argue that I see it more with oral antimicrobials than the intravenous medications. Tetracyclines come readily to mind. Leib: Do you see vomiting after plasma transfusions as well? Twedt: Yes, I have seen animals vomit when given blood or plasma too quickly. Slowing down the infusion rate solves the problem. As far as chemotherapy-associated vomiting, we tend to see two types: an immediate response, which is probably through the chemoreceptor trigger zone, and a more delayed e ect four or ve Simpson: Dogs with diabetic ketoacidosis usually have other complications, such as pancreatitis, that may be associated with vomiting. If you look at the University of Pennsylvania studies, pancreatitis was diagnosed in about 40% of dogs with diabetic ketoacidosis.1 Twedt: So it could also be peripheral associated with pancreatitis. Jergens: Over the past year, I’ve treated several schnauzers with diabetes mellitus and concurrent Cushing’s disease. They may have pancreatitis as well. So you have these animals with multiple endocrinopathies that are vomiting, and sometimes it’s tough to pinpoint the trigger. Twedt: Many of those schnauzers are hyperlipidemic. That may even play a role in gastrointestinal tract ischemia. Leib: What about parvovirus— are the mechanisms of vomiting straightforward? Twedt: Parvovirus isn’t all that straightforward. As we know, vomiting is a common complication of parvovirus infection, and it is one of the big problems we deal with at our hospital. I certainly think the gastrointestinal in ammation
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