Veterinary Medicine - November 2008 - (Page DM11)

Twedt: Even though it is off-label, I often use maropitant in cats and have been very pleased with the results. Metoclopramide is a dopamine antagonist and inhibits vomiting by blocking the CNS dopamine receptors in the chemoreceptor trigger zone (CRTZ). It is probably not a very good antiemetic in cats because they are reported to have few CNS dopamine receptors in the CRTZ. Side effects can also occur at high doses as it causes CNS excitement from dopamine antagonism. fentanyl levels for pain control in cats, the protocol that I have used is to administer another analgesic such as buprenorphine IV at the time the fentanyl patch is placed. I then monitor the cat to see if additional pain medication is required. Twedt: That is also my protocol. If I diagnose an animal with acute pancreatitis, even if the patient does not show signs of pain, I begin pain management. I have been surprised by how many patients improve clinically with the only difference being pain management. Robertson: Do we have any alternatives to opiates? Fluid, colloid, and plasma therapy Robertson: Do you use fluid therapy in cases of acute pancreatitis? Williams: Yes, uid therapy is very important. Robertson: Beyond crystalloid therapy for hydration and to restore electrolyte and acid-base balance, do you routinely use colloid therapy in these cats? Steiner: No, not for serious pain. Nothing is as effective in my opinion. Twedt: People with chronic pancreatitis usually have pancreas-associated pain. For cats that have vomiting are-ups, rather than just putting them on antiemetics, maybe we should also provide more pain control because we know pain will trigger vomiting. For some of those patients that have are-ups and “The fPLI, now the Spec fPL, is an emerging gold standard for pancreatic inﬂammation.” — Dr. David Williams Forman: I don’t routinely use it, but if the cat is extremely depressed and hypotensive, I’ll use it for blood pressure support and to better perfuse the pancreas. Robertson: What about plasma therapy? vomiting episodes associated with chronic pancreatitis, I prescribe buprenorphine for the owners to administer sublingually at home. Nutritional support Forman: It depends on the case. If a concurrent coagulopathy exists, I’ll use plasma therapy. Twedt: I don’t have plasma readily available for cats as I do for dogs. I use colloids if I think I need to improve oncotic pressure. The most important thing is to ensure that there is adequate perfusion of the pancreas. Robertson: Beyond uid therapy, pain control, and antiemetic therapy, what are your recommendations for nutritional support for a cat with acute pancreatitis? The historical recommendation of nothing per os (NPO) for animals with pancreatitis is no longer accepted. Steiner: If the gastrointestinal tract works, use it. Williams: If they are vomiting, give an antiemetic so that they keep the food down. Pain management Robertson: What analgesics do you routinely use in cats for pain control? Forman: I prefer buprenorphine. Robertson: Fentanyl transdermal patches have become popular as an adjunctive therapy for pain relief because they provide a longer duration of analgesia. Since it takes at least six hours to achieve adequate Twedt: Sometimes they don’t eat because of the nausea or pain. If you can control the pain and nausea, they might start to eat. Anorexic cats are prone to also develop hepatic lipidosis. If I have a cat that hasn’t had adequate nutrition for three or more days, I often put in a nasogastric or some other feeding tube to begin nutritional support. We have been very happy with esophageal feeding tubes for enteric nutritional support. If we were ever to 11

Table of Contents Feed for the Digital Edition of Veterinary Medicine - November 2008

Veterinary Medicine - November 2008 Contents Leading Off Editors' Guest Just Ask the Expert Letters Practice Makes Perfect Clinical Exposures Practice Matters Idea Exchange Author Guidelines A Challenging Case: Esophageal Leiomyoma in a Dog Osteoarthritis in Cats: What We Now Know About Recognition and Treatment Product Preview CE Form/Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - November 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.