scott@vtx-cpd.com
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Replying to Raquel M. 14/04/2022 - 14:09
Hello.
The probiotic question is a great one.
Depending on the type of probiotic, antibiotics will absolutely have an effect on the bacterial load. It seems there is more and more support for using probiotics with antibiotics:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3601687/pdf/JFP-62-148.pdf
Hope that helps.
Scott 🙂
Replying to Raquel M. 12/04/2022 - 22:44
Hello.
Thank you again for these brilliant questions. We will definitely chat more about this decision making in the feeding tube lecture. The use of appetite stimulants is very case dependant and feeding tubes will be more appropriate in some cases.
It is important to remember that anorexia is a symptom of disease and not a disease itself and, as such, the primary medical treatment should be aimed at addressing the causes of food refusal. For animals with reduced but not absent
food intakes, those where the duration of anorexia is expected to be less than one week, or for those whose owners are reluctant to place an indwelling feeding tube, short‐term use (i.e., less than one week) of appetite stimulants can be considered. In animals that experience persistent anorexia for more than three days despite medical management of the underlying disease state or those requiring longer‐term nutritional support (i.e., expected anorexia for more than one week), placement of an indwelling feeding tube should be considered.Hope that helps.
Scott 🙂
Replying to konstantinos C. 26/04/2022 - 15:07
Hello.
It is a good question. Honestly, if there is a histopathological diagnosis of hepatitis or enteritis, I would often continue longer with 2mg/kg. It all depends on clinical response too. Once symptoms were better controlled, I would always consider a dose reduction.
Scott 🙂
Hello.
Thank you again for your question. I found the following quite helpful (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4810896/):
The exact mechanism of hypocalcaemia in acute pancreatitis is unknown. Mechanism of hypocalcaemia during early stage (within 1st week) is different from hypocalcaemia developing in late phase of the disease. Several mechanisms proposed for hypocalcaemia seen in early phase are autodigestion of mesenteric fat by pancreatic enzymes and release of free fatty acids, which form calcium salts, transient hypoparathyroidism, and hypomagnesaemia.
Later stages of pancreatitis are frequently complicated by sepsis, which becomes an important contributor to hypocalcaemia. Mechanism of hypocalcaemia in sepsis is not clear. Whitted et al. proposed that increased circulating catecholamines in sepsis cause a shift of circulating calcium into the intracellular compartment leading to relative hypocalcaemia. This causes increased PTH secretion by negative feedback loop leading to further increase in intracellular calcium overload, oxidative stress, and cell death. Hypomagnesaemia-induced impaired PTH secretion and action, relative PTH deficiency, and Vitamin D deficiency, etc., are some of the other plausible causes.
Hope that helps.
Scott 🙂
Hello.
Thank you again for the great questions. Some clinicians feel that prednisolone should only be used in cats that are not hyperglycaemic and only at anti-inflammatory dosages (ie, 0.5-1.0 mg/kg PO q24h on a tapering schedule)
I would tend to use immunosuppressive dosages of prednisolone (eg, 2.0 mg/kg q12h for 5 days and then 1.0 mg/kg q12h for 6 weeks with a decreasing dosing schedule after that time) with close monitoring (ie, clinical re-evaluation and measurement of fPLI after 2-3 weeks).
If hyperglycaemia develops, or is pre-existing, I would consider the use of cyclosporine (5 mg/kg q24h for 6 weeks) with close monitoring (ie, clinical re-evaluation and measurement fPLI after 2-3 weeks).
In cats treated with either prednisolone or cyclosporine in which clinical signs have not improved and pancreatic lipase has not decreased, discontinuation of treatment should be considered. In cats that show a clinical response, continuation of treatment is indicated.
I hope that helps.
Scott 🙂
Hello.
I hope you are well. This is a great question. I would say that we do not have evidence for the routine use of pancreatic enzyme supplementation in cases of acute or chronic pancreatitis. As you mention, I would be keeping an eye out for the development of EPI.
It seems like the data is also mixed in human medicine, but there may be some benefit:
https://gut.bmj.com/content/66/8/1354.1
Hope that helps.
Scott 🙂
Hello.
I hope you are safe and well. Thank you for your question.
The dosage of ILE used varied between the cases and was not always recorded. However, in most cases
standard protocols were followed and included an intravenous bolus of 1.5 ml/kg of a 20% ILE, followed by a
constant rate infusion CRI of 0.25-0.5 ml/kg/min for 30-60 minutes, which was repeated as necessary.Reported dose ranges in the literature include boluses of 1.5 ml/kg-2.0 ml/kg over 2-15 minutes, then as a CRI
0.06 ml/kg/min to 0.5 ml/kg/min for multiple hours (Gwaltney-Brant, 2012). No maximum daily dose has been
determined in veterinary patients (Kuo et al., 2013).I would repeat/continue treatment if clinical signs persisted.
I hope that helps.
Scott 🙂
Replying to Hannah B. 25/04/2022 - 13:31
Hello.
Lovely to hear from you. NAC is usually given as a 10% solution diluted 1 to 2 with saline as an IV bolus over 20 minutes through a 0.25 micron non-pyrogenic in-line filter at a dosage of 140 mg/kg initially followed by dosages of 70 mg/kg q 8-12 h.
I would use this type of filter if possible.
Let me look in to where we get them from!
Scott 🙂
Hello Amanda.
Hope you are well. Campylobacter can indeed be tricky. I would often not treat.
The majority of cases are uncomplicated, self-limiting and resolve with supportive therapy. Because isolation of Campylobacter does not confirm causation, treatment may not be warranted. Antibiotics may further disrupt intestinal microflora. However, in animals that are immunocompromised, febrile, or with evidence of hemorrhagic diarrhoea, antimicrobial treatment may be indicated. The drugs of choice are the macrolides (erythromycin at 10 to 15 mg/kg q 8 h) or fluoroquinolones (enrofloxacin at 10 mg/kg q 24 h). Fluoroquinolones are not used initially due to their high rate of mutational resistance and obviously I would avoid enrofloxacin in cats completely. You could consider marbofloxacin. The macrolides such as erythromycin (10-20 mg/kg q 8 h for 7 days, despite possible gastrointestinal side-effects) or azithromycin (5-10 mg/kg q 24 h for 7 days) are the drugs of choice.
I would only treat if all else fails!
Scott 🙂
Replying to Raquel M. 25/04/2022 - 03:49
Hello Raquel.
Thank you so much again for your questions. I have heard of this higher dose, but I must admit I don’t use it routinely. I will ask some anaesthesia pals too and see what their thoughts are.
I would agree about not using buprenorphine longer term. I would normally use for not more than 7 days at a time.
Hope that helps.
Scott 🙂
Hello.
Thank you so much for your question.
Oral transmucosal buprenorphine is used off-licence for postoperative pain and “flare ups” of pain in patients with chronically painful conditions. It appears to be efficacious in cats, with varying reports of effectiveness (Robertson et al, 2005; Giordano et al, 2010). The original pharmacokinetic paper indicated 0.02mg/kg buprenorphine administered oral transmucosally produced similar, if not better, analgesia than when administered IV or SC, but a later paper suggested IV produced more profound analgesia. The difference may be due to the type of stimulus and the dose of the drug used. The formulation of the buprenorphine appears to affect how well the patient tolerates medication, with single use vials being tolerated well compared to buprenorphine from multi-use vials (Bortolami et al, 2012).
The IV formulation can be used orally. The vials tend to be better tolerated orally compared to the multi dose bottles as there is not the same preservative.
I tend to use it at the 0.02-0.03mg/kg TID when using orally. I have indeed heard of people using at higher doses. This is not something I would normally use long term, but it could be considered in some patients. As I said, this would be a drug I would use for flare ups or in the more acute phases of disease. I would normally use for no longer than a week at a time.
Hope that helps.
Scott 🙂
This is a brilliant question.
I did not mention these products during the pancreatitis webinars as it is not something I use routinely… however, I am wondering if I should. There is basically very little evidence, but it makes perfect sense.
There is some rationale to consider antioxidant therapy in patients with pancreatitis. Vitamins C and E, silybin, S-Adenosylmethionine (SAMe), and omega-3 fatty acids could be prescribed. Veterinary products, Marin™ (vitamin E and silybin), Denosyl® (SAMe), and Denamarin® (SAMe and silybin), manufactured by Nutramax Laboratories, Inc., are available.
Would be interested to see if others use these sorts of products in these cases.
Scott 🙂
Hello.
It really depends. Coccidia generally are considered to be minor pathogens in dogs and cats, causing disease in young or immunosuppressed patients, but Giardia infection can be clinically significant. The trichomonads (Tritrichomonas foetus, Pentatrichomonas hominis, Balantidium coli and Entamoeba histolytica) are colonic inhabitants.
Did they give any more information on what they could be? Can you share the report?
Scott 🙂
Replying to Emma Holt 08/04/2022 - 17:24
Hey.
Prednisolone seems to to be the main part of treatment in these cases. This case was treated with 2mg/kg/day of prednisolone.
There is an uncertain role of bacteria in these cases and many are also treated with antibiotics. The biggest case series in these cases is here:
https://pubmed.ncbi.nlm.nih.gov/25896239/
I think FISH staining is a useful addition in these cases if possible.
Some cases also undergo some sort of debulking surgery.
This cat did very well with steroids alone!
Scott 🙂
Replying to Nathalie Cunha 08/04/2022 - 16:55
Hello again!
We chatted a bit about this at the live Q&A too… I hope that helped!
Scott 🙂
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