scott@vtx-cpd.com

Replying to Jeanette Tungesvik 26/11/2021 - 16:37

Hello.

Really interesting question and really challenging cases. I am glad the cat is doing well. Is this the only medication the cat is currently on? Is the cat urinating normally?

There are various different drug combinations that can be used, including diazepam, prazosin, bethanechol, a combination of diazepam and prazosin, or a combination of diazepam, prazosin and bethanechol.

I generally find diazepam is not necessary. I tend to use a combination of bethanechol and prazosin. Regarding the phenoxybenzamine; I would probably reduce this gradually. Reducing to once daily for a week and then every other day. I think it is worth weaning but impossible to know if this might be needed long term without trying.

Hope that helps.

Scott 🙂

Replying to Louise Groot 29/11/2021 - 15:11

This is a really great question Louise.

I am afraid there is not a straightforward answer! In veterinary medicine, colloids are indicated primarily for bolus intravascular volume support. Much of the decision making will be based on the individual case and what is available:

1. In hypovolaemic cases I would typically use a combination of isotonic crystalloids, hypertonic saline and blood products (if appropriate).

2. In cases where hypotension is the biggest issue I would use isotonic crystalloids, hypertonic saline and blood products when appropriate and consider vasopressors if this was not effective.

3. Cases where colloid support can be most tricky is cases with severe hypoalbuminaemia. Right now due to concerns about cost, safety, and availability of albumin products, synthetic colloids (HES) are used extensively for resuscitation and improvement of colloid oncotic pressure (COP) in veterinary medicine. Colloid CRIs have been used historically for improvement of COP, but the possible risk of increased side effects with cumulative doses and lack of improvement in outcome data from human studies indicate this practice should be further examined. Also, no large-scale human study has found a significant outcome advantage in patients given any colloid (natural or synthetic) over balanced isotonic crystalloids alone. As with any drug, the risks versus benefits of colloids should be carefully considered and their use titrated as needed for each individual patient. The lowest possible dose of HES should be used for the shortest period of time to minimize potentially underrecognized adverse effects in our veterinary patients. Further studies are needed to see if the use of natural albumin products such as canine serum albumin is superior to crystalloids alone in improving outcomes in veterinary patients.

Ultimately, I would be using them in cases where other options had been exhausted as far as supporting blood pressure and COP.

Hope that helps. Happy to chat through this more at Q&A too.

Scott 🙂

Replying to elaine elder 29/11/2021 - 19:38

Hey Elaine.

It is a really good question! We also used to use Oxyglobin during my residency. It went off the market and has not made any attempt to come back, so this is really not an option now.

Xenotransfusion is definitely a great option in the true emergency while you sort out getting actual cat blood by whatever means!

Scott 🙂

Replying to Zoe McGarry 19/11/2021 - 12:05

Hey Zoe.

Hope you are well.

I have started a whole new thread regarding the feline blood bank.

Would love to hear your thoughts.

Scott 🙂

Replying to Lesley M. 22/11/2021 - 22:09

Hey Lesley.

Hope you are well. I totally understand your concerns. We were having this exact debate last week at work. We are not currently able to have a feline blood bank in the UK due to RCVS concerns and regulations within this country, but it is OK for us to import this blood from another country.

The donation scheme in Portugal is very well set up. The donors are client-owned cats and cats. Most of the cast are brought in by owners just as we do in UK for dogs. The facility itself is excellent and the blood is all screened appropriately. I have even had colleagues that have even visited!

I would love to hear your thoughts!

Scott 🙂

Replying to Nichola C. 25/11/2021 - 21:23

Hello.

Hope you are OK. Blood pressure is definitely an important part of the monitoring in shock patients. It is best used as part of many other parameters that are important to keep an eye on too.

The treatment of shock can be distilled down to the idea of improving oxygen delivery as soon as possible; there is a narrow therapeutic window before cellular energetics become deranged and cannot be reversed. The goal is to normalize blood pressure, central venous pressure, and the physical parameters of heart rate, pulse quality, capillary refill time, mentation and urine output.

Systemic hypotension is defined as a systolic arterial blood pressure < 80 mm Hg and/or MAP < 60 mm Hg in either dogs or cats. Normal Arterial Blood Pressure Values in Adult Dogs & Cats BLOOD PRESSURE VALUES DOGS CATS Systolic arterial pressure 90 to 140 mm Hg 80 to 140 mm Hg Diastolic arterial pressure 50 to 80 mm Hg 55 to 75 mm Hg Mean arterial pressure 60 to 100 mm Hg 60 to 100 mm Hg I would ultimately be aiming for a mean pressure of 80mmHg when resuscitating with fluids. Hope that helps. Scott 🙂

Replying to emily a. 23/11/2021 - 23:11

Hello Emily.

I hope you are safe and well. Following on from Andy’s message, I am sorry about any confusion regarding these lessons.

I hope you are enjoying the course.

Let me know if you have any other questions.

Scott 🙂