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Dr. B.
Dr. B., Cat Veterinarian
Category: Cat
Satisfied Customers: 19586
Experience:  I am a small animal veterinarian with a special interest in cats and am happy to discuss any questions you have.
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My cat was started on slow release Carbimazole 14 days ago

Resolved Question:

My cat was started on slow release Carbimazole 14 days ago for overactive thyroid. In last few days is virtually eating and drinking nothing and just wants to sleep, does not even want to go out. Is this normal or should I retur to vet. My vet did not want to see her again for 21 days. Any advice appreciated.
***** *****
Submitted: 1 year ago.
Category: Cat
Expert:  Dr. B. replied 1 year ago.

Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you today. I do apologize that your question was not answered before. Different experts come online at various times; I just came online, read about your wee one’s situation, and wanted to help.

Again I do apologize that my colleagues could not aid you sooner. If you would still like assistance, can you tell me:

Has she had any vomiting, retching, gagging, gulping, or lip licking?

Are her gums nice and pink (not white/pale)? Moist or sticky?

If you press on her belly, does she have any tensing, tenderness, discomfort, or pain?
Customer: replied 1 year ago.

No vomiting but her gums do look quite pale also no abdominal tenderness. Just wants left alone and the minute you try to disturb her quite tetchy. Hope this helps.

Expert:  Dr. B. replied 1 year ago.
Thank you Karen,

Do you think they are paler then when she was at the vets?

Did they mention any anemia on her blood work?
Does she have any other health issues (ie kidney disease)?
Expert:  Dr. B. replied 1 year ago.
Hi again,

While I am waiting for hear back from you, I do want to start giving you my thoughts on Cheeky. First, it is not uncommon to see lethargy, vomiting, diarrhoea, appetite and weight loss with this medication in sensitive animals. That said, we would not call it normal or something we'd just allow if you know what I mean. Therefore, if she has reacted to the medication in this manner (or we possibly have a secondary infection and the new medication is a red herring), we need to be proactive here with Cheeky.

Therefore, with all of this in mind, I do think we need to tread with care. First, if she is pale and has just had bloods, it is worth checking to see if she has an obvious anaemia on those bloods +/- any inflammatory or kidney issues (since we can see anaemia secondary to these). Otherwise, I would note that anaemia can cause weakness, withdrawal, and cats often seem lethargic and not right. As it progresses, we can see more severe signs associated with their not being able to get enough oxygen to their cells (ie depression, breathing elevation, collapse).

Otherwise, as I noted, while we can see these signs, we need to address them for her. Therefore, you may want to consider stopping it for the weekend until you can speak to her vet. If she is still off colour once you do so, you may need to start some supportive care. To start, to address any nausea (a common reason for cats to go off their food), we can consider treating with an antacid. There are a number of antacids that are available over the counter and pet friendly. I would advise only treating with one, but the ones I tend to recommend are Calcium carbonate (60-120 mg per cat every 12 hours, Pepcid (More Info/Dose) or Zantac (More Info/Dose). This medication of course shouldn’t be given without consulting your vet if she does have any pre-existing conditions or is on any other medications. Ideally, it should be given about 30 minutes before food to easy her upset stomach.

As well, you will want to try and see if you can get her eating (as I know you have been). Favourite foods are allowed or you can tempt her with a light/easily digestible diet. Examples of this would be boiled chicken, scrambled eggs (made with water and not milk), meat baby food (do avoid the ones with garlic powder in the ingredients) or there are also veterinary prescription diets that can be used here (ie Hill’s I/D or Royal Canin’s sensitivity.)

Further to this, if tempting doesn’t work, then we do have to consider initiating syringe feeds to get some proper food into her. In that case, you may want to try Hill's A/D (LINK) or Royal Canin Recovery (LINK) from your local vet. These are critical care diets that is comes as a soft, palatable pate. Both are alorically dense, so a little goes a long way nutrition-wise and this could just help get some more calories into her even if we can’t get a huge volume of food in. As well, for syringing food, you can use the animal version of Ensure (balanced for animals dietary requirements) called Clinicare Canine/Feline Liquid Diet (LINK). It is actually by the same people who make Ensure, but is formulated to meet out pet's dietary needs. Your vet should be able to order it for you but it is available without a prescription. They also make one specifically for older cats with kidney troubles, and this could be an alternative for an older cat. And in a pinch we can even use kitten wet food (as its more nutrition per bite and can be watered down for syringing if she won't eat it herself) This way it would a means of getting food, staving off hepatic lipidosis, and buying you time to uncover the reason for her anorexia and lethargy.

On top off all of this, you do need to keep an eye on her hydration if she won't drink. To check her hydration status to make sure she is not becoming dehydrated there are a few things we can test at home. One is whether the eyes appear sunken, if the gums are tacky instead of wet/moist, and whether she has a "skin tent" when you lift the skin. To see how to check these parameters for dehydration, you can find a wee video on this HERE. ( They use a big dog but it makes it easier to see and the principles are exactly the same) If you are seeing any signs of dehydration already, then you do want to have your kitty seen by her vet before this gets out of control for her.

In regards ***** ***** you can do to help stave off dehydration at home (though do note that if she is already then she will likely need more the oral rehydration), encourage her to drink but offering fresh water or even low-sodium chicken broth. As well, wet foods (as mentioned above) are 35% water, so getting her to eat will help us deal with water intake as well. If she isn't amenable to drinking, you may wish to offer unflavored pedialyte via syringe feeding. While we cannot do this if they are vomiting, it may be an option for this situation. A typical maintenance rate for hydration in an animal 48mls per kilogram of her body weight a day. If you do give syringe pedialyte, this should obviously be divided up into multiple offerings through the day rather then all at once. This value will give you the total she needs for the day and is a good starting point to give you an idea of her daily requirement. If she does vomits if you give pedialyte, I would discontinue this as a therapy. (since we don’t want her vomiting because of our intervention).

Overall, I am concerned that her signs may be triggered by her new medication or potentially related to an opportunistic infection. And as she is feeling so off, we can start the above supportive care but also need to consider stopping her medication in the short term until you can speak to her vet on Monday. If need be, you can also have them treat her symptomatically via injection to settle her stomach +/- start antibiotics and appetite stimulating medication. And if this medication does not agree with her, then we may need to consider an alternative formulation or drug to keep her thyroid disease stable.

Finally, just to note in case you were keen to have her seen today, some veterinary practices in our country have Sunday office hours. As well, I wanted to mention that most veterinary practices here do have contingency plans for emergency care for their patients even when they are not open. Therefore, it is worth ringing the practice. If they are open, you can get him seen today. If they aren't, then they will likely have a message to direct you on how to contact their out of hours service. And if you don't have a vet you can find one local to you, you can check the RCVS Register (HERE) to find your local Vets Now (LINK) who are open all nights/weekends. In any case, if you wanted to get her checked out sooner then there are options to have her seen today too.

I hope this information is helpful.

If you need any additional information, do not hesitate to ask!

All the best,

Dr. B.

-----------------------------------------------------------------------------------------------------------------

If you have any other questions, please ask me – I’ll be happy to respond. Please remember to rate my service once you have all the information you need. Thank you and hope to see you again soon! : )

Customer: replied 1 year ago.

Thank you so much for all your help and advice. I did take Cheeky to the emergency vet and she has been admitted. She has had preliminary blood tests which rule out renal failure and is currently being given an IV and will stay in vet overnight. They will review her in the morning but early signs show she may now have gone too far the other way and may now be under active. I will let you know outcome. Thank you again.

karen

Expert:  Dr. B. replied 1 year ago.
You are very welcome, Karen.

I am glad to see that you did have her seen and that her vet has put her onto an IV to help rehydrate her. Hopefully, they won't find anything amiss with her kidneys, but we do always have to be wary of kidney issues at this age...especially when thyroid disease can mask its presence. In any case, supportive care will help reduce the circulating volume of the medication if it is our trigger and also flush out any kidney toxins if present. And hopefully once that is taking effect, she will start to feel better and start eating for you.

Please do let me know how she gets on,
Dr. B.
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Experience: I am a small animal veterinarian with a special interest in cats and am happy to discuss any questions you have.
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