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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 30376
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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We have a 6 year old female about 8 pounds. She just when

Customer Question

We have a 6 year old female about 8 pounds. She just when through a bit of trauma when someone abandon a 6 week old kitten in our yard and we took him in. The older cat Punkin hid under the bed and pretty much stop eating, had dry heaves pretty consistently. So we moved her box, food , etc. into the bedroom with her and kept the kitten separated (kitten went to vet and has clean bill of health). It's been three weeks since we got the kitten. But now Punkin hasn't pooped in over 6 days (last Friday Xrays showed no stool in her colon, no foreign objects, organs normal) she just wasn't eating. prescribed valium and a medication for nausea. Valium just made her a zombie. Took her to ER Saturday night. Blood work at ER ago was normal. They gave her fluids and prescribed mirtazapine for appetitie. 1/4 of a 7.5 mm TABLET every 24 hours. She did seem to be a bit better before the medication took affect.
We started boarding the kitten today. Now Punkin is moving around the house a bit more but is acting like she can't see or focus, zombie and makes weird mewing sounds when we come near her or touch her. It's a distress sound like leave me alone. I'm just wonder if she could have a huge hairball that she can't get in or out. Whatever is wrong affects her appetite and gives her dry heaves. I'm looking for advice on what a vet would suggest doing next. She is eating a little dry food now and I'm force feeding her wet food (but not much), she is drinking water. Could the zombieism and mewing and not being able to focus (no eye contact) be from that mirtazapine?
My husband has been disabled for 8 years and Punkin has been his companion it's important that we get her well.
She forms urine crystals other than that she seemed in good health before the kitten arrived - but I don't want to overlook something that could be wrong blaming the appearance of the kitten.
It's complicated but there must be a next step for punkin. Stop the meds and see? Take her to get her stomach scoped?
Thank you,
Kathy Sheppard
Submitted: 2 years ago.
Category: Cat Veterinary
Customer: replied 2 years ago.
I have to make a decision soon - no answer to my question yet. How long will it take????
Expert:  Dr. Michael Salkin replied 2 years ago.

I'm sorry that your question wasn't answered in a timely manner, Kathy. Mirtazapine appears to be well tolerated in cats. Besides the desirable side effect of appetite stimulation, other currently reported side effects in animals include drowsiness/sedation, vocalization, increased affection, hypotension, and tachycardia (increased heart rate). Be that as it may, I recommend stopping its administration (or any currently administered drug) when such symptoms are occurring. If she didn't normalize once the mirtazapine were stopped, my next diagnostic of choice would be an abdominal ultrasound - an imaging modality more sensitive in evaluating the abdomen of cats - particularly in evaluating the gastrointestinal tract.

Can you upload a copy of her test results to our conversation? I understand that you might not have a copy of the results at home but the ER or her regular vet should be able to give you one which you could scan into your computer and give me the link or you can photograph the page(s) and upload the images by using the paperclip icon in the toolbar above your message box (if you can see such an icon) or by using an external app such as or

Customer: replied 2 years ago.
I'll try to get results sent. Can you tell me how long it might be for the affects of the mirtazapine to wear off? Last dose was about noon yesterday. Thank you.
Expert:  Dr. Michael Salkin replied 2 years ago.

It's a rather long-lasting drug in cats allowing every other day dosing and so I would expect the effects to persist for up to 48 hours. Please continue our conversation if you wish.

Customer: replied 2 years ago.
One more question. What would/could the ultra sound reveal?
Expert:  Dr. Michael Salkin replied 2 years ago.

We're primarily interested in detecting the inflammation associated with inflammatory bowel disease (IBD) and neoplasia (lymphoma, adenocarcinoma) in the GI tract and ultrasound can "see" areas not well-represented in blood work - the GI tract, spleen, and non-major organ areas inside the abdomen.