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Gave to much ivermectin, cat, acting drunk falling down, No…

Customer Question
Gave to much ivermectin ...

Gave to much ivermectin

Veterinarian's Assistant: What sort of animal are we talking about?

Cat

Veterinarian's Assistant: OK. I'll do all I can to help. What is wrong with the cat?

Acting drunk falling down

Veterinarian's Assistant: Did the cat have a fall?

No to much wormer

Veterinarian's Assistant: What is the cat's name and age?

Gus . one year

Submitted: 11 months ago.Category: Cat Veterinary
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Answered in 35 minutes by:
9/10/2017
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 11 months ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 35,561
Experience: University of California at Davis graduate veterinarian with 45 years of experience.
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You're speaking with Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 11 months ago

I'm sorry to hear of this with Gus. Regretfully, there's no specific antidote to ivermectin toxicosis. These patients are treated intensively in a hospital setting. Please see synopsis of treatment below:

First manage critical CNS abnormalities (seizures, coma). If signs are mild or absent, treatment consists of inducing vomiting (within 2 hours of ingestion) and/or giving activated charcoal (within 8-12 hours of ingestion). Consider using IV lipid-emulsion therapy for severe toxicoses.

Acute General Treatment

Manage seizures
Diazepam (0.25-2 mg/kg IV) or midazolam (0.1-0.5 mg/kg IV), PRN
Gas anesthetics, propofol if diazepam ineffective
Methocarbamol for tremors (50-100 mg/kg IV PRN, typically q 4-8h; or 8-12 mg/kg/h continuous rate infusion [CRI])
Avoid barbiturates because of residual CNS depression.
Minimize sensory stimuli.
Manage comatose animals:
Maintain airway, assist respiration as needed.
Thermoregulation essential
Atropine (0.01-0.02 mg/kg IV) for excessive bradycardia
Frequent turning to prevent decubital ulcers
Urinary catheter and hygiene to avoid urine scald
Physostigmine
Duration of action 30-90 minutes (may allow time for feeding animal). Does not shorten recovery time.
Decontamination of patients
Emesis Not recommended if clinical signs are already apparent (risk of aspiration) as is the case at this time.
Gastric lavage
For large ingestions
Activated charcoal (ivermectin is mainly excreted in feces):
Initial dosage: 1-4 g/kg PO or labeled dosage of commercial product within 12 hours of exposure. Repeat administration q 8-12h in animals showing overt signs.
Subsequent doses: half of initial dosage to avoid osmotic fluid shifts and hypernatremia; monitor serum sodium.
Intravenous lipid-emulsion therapy: Intralipid 20% (dogs/cats):
1.5 mL/kg IV over 10-15 minutes, followed by 15 mL/kg IV CRI over 30-60 minutes. Repeat both slow bolus and CRI at 4h and 8h for total 3 doses. Monitor for lipemia before repeating doses. If evidence of lipemia, withhold until serum clears.
Intralipid may bind lipophilic medications like ivermectins, making them unavailable. Efficacy and safety in dogs is under investigation. Consider using when other treatment methods are not working.
Monitor for pancreatitis.
Nursing care:
Frequent turning
Prevent urine scald.
Thermoregulation
Nutrition/Diet

Tube feeding may be needed for recumbent/comatose animals for several days.

Drug Interactions

Avoid drugs that may contribute to CNS depression (e.g., barbiturates).
Concurrent use of spinosad and ivermectin can aggravate signs of ivermectin toxicosis.
Possible Complications

Decubital ulcers
Aspiration of activated charcoal or food
Retinopathy has been reported in two dogs.
Recommended Monitoring

Respiration
Body temperature
Heart rate
Fluid/electrolyte balance
Prognosis & Outcome

No specific antidote
Prognosis depends on dose, individual sensitivity, and provision of good nursing care/treatment. Most animals recover with good supportive/nursing care.
Animals surviving > 24 hours have reasonable prognosis. Supportive care may be necessary for days or weeks.

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Customer reply replied 11 months ago
Dr Mike, We are passed the 24 hour period. He is better but eyes are still dialated . Walking better eating and drinking.
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 11 months ago

Thank goodness. He appears to have bit the bullet. Blindness, if present, if usually reversible in a few days. Thank you for the good update. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

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Customer reply replied 11 months ago
sleeping alot and no seizures. Seems to be coherent to surroundings. Eyes and balance seem to still be the issue?
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 11 months ago

That's consistent with ivermectin toxicosis. Expected neurologic signs are mydriasis (wide open pupils) +/- blindness, central nervous system depression, ataxia ("drunken sailor"), disorientation, tremors, and seizures. Animals surviving for more than 24 hours have a reasonable prognosis but supportive care may be necessary for days or weeks.

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Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 11 months ago
Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Michael Salkin
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