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15 year old cat with kidney disease and hyperthyroidism was…

15 year old cat...

15 year old cat with kidney disease and hyperthyroidism was given mirtazipine on Saturday as an appetite stimulant. He was being to refuse most appropriate foods and has wasting away so quickly, the vet decided it was worth the risk. Within 30 minutes of the 3.75 mg dose, Salem could barely stand. Would face-plant into the floor and his movements became very disorganized. 4 days later, he hasn't snapped out of it. He can't eat because he can't swallow without difficulty... I keep hoping he will clear, but by that time, he might starve or develop encephalopathy... Is it worth continuing sub-q fluids and hoping, or should I let him go. He's so confused and miserable. So are we...Btw, he doesn't look jaundiced. Tonight he ate some ground, boiled chicken in broth ( bad for kidneys but at this point, who cares?) He drank a lot of broth...

Veterinarian's Assistant: I'll do all I can to help. The Expert will know if the cat will be able to digest that. What is the cat's name?

SALEM

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about SALEM?

I'm just concerned that the ataxia is here to stay and I'm just prolonging the inevitable... I have an appt tomorrow to euthanize, but he ate... do now I'm conflicted.

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Answered in 7 hours by:
12/7/2017
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 33,761
Experience: University of California at Davis graduate veterinarian with 45 years of experience.
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I'm sorry that your question wasn't answered in a timely manner. Please let me know if you still need help. May I have an update on Salem, please?

He was given twice the recommended dose of 1.88 mg (practically, 1/4 of a 7.5 mg tablet). The median half-life at his dose and in cats with chronic kidney disease is a bit over 15 hours and so adverse effects could conceivably last for over 30 hours. Because they've persisted for over 144 hours, we have to assume that his kidneys haven't been able to excrete the drug. Regretfully, trhere are no studies that tell us how long Salem will be symptomatic or if he can ever recover.

Pragmatically speaking, if he continues to eat and drink, albeit ataxic, you can continue to monitor him and hope for the best. Yes, subcutaneous fluids are essential at this time as they can only encourage urine production and excretion of the mirtazapine.

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 33,761
Experience: University of California at Davis graduate veterinarian with 45 years of experience.
Verified
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Thank you for your kind accept. I appreciate it. 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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Dr. Michael Salkin
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
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Satisfied Customers: 33,761
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Experience: University of California at Davis graduate veterinarian with 45 years of experience.

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