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Dr. B.
Dr. B., Board Certified Veterinarian
Category: Vet
Satisfied Customers: 18305
Experience:  General practice veterinary surgeon with extensive experience in a wide range of species.
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Smudge has been on metacalm for almost six months; no side

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Smudge has been on metacalm for almost six months; no side effects to date. Vomited this morning, brown no food particles, at around five a.m. repeated vomiting since, probably 3-4 times, every time she drinks; only water. Please advise.
Submitted: 3 years ago.
Category: Vet
Expert:  Dr. B. replied 3 years ago.

Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you with your wee one today.

 

Can you tell me if the vomit looked brown coffee grounds or just brown material?

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

Does Smudge have any belly tenderness?

Any black feces?

Are you just seeing clear vomit now, when she vomits after drinking?
Customer: replied 3 years ago.

Sort of brown metallic. Gums not very pink, pale. doesn't sam to have tenderness. she hasn't poo'd since yesterday a.m. - was quite dark brown and a little loose. The vomit is just clear and immediately after drinking. She hash' drunk anything since about 9.30 since she last vomited... pretty much immediate after drinking. Am trying her with ice cubes but she's not interested. Obviously main immediate concern is she does not get dehydrated. Remains pretty alert but clearly not her best.


 

Customer: replied 3 years ago.

Sorry, P.S. No discernible tenderness around belly

Expert:  Dr. B. replied 3 years ago.

Thank you Mary,

First, I must say that the significance of her vomit's appearance is difficult to interpret. The reason I asked about whether it appeared like brown clots of material (and if she had had any black feces) is because that would be an indication of bleeding in the stomach. So, if you think it did look like brown bits in the vomit, the feces were uncharacteristically dark, or if her gums are very pale, then I would say that we'd have to be concerned about a potential issue with her Metacam and we'd want to consider having her seen urgently to limit the situation for her.

 

Now usually if a cat has been on Metacam for this length of time, we would not expect to see an adverse GI reaction. That said, we cannot rule out an other triggers for vomiting that has affected the stomach such that the Metacam is now causing issue. Just to explain why Metacam (or any NSAID, even in people) can affect the stomach, this arises because NSAIDs have a side effect of lowering stomach mucus production. And if she has an empty stomach and vomiting for any reason and then also has less protective mucus present, we can see an increased risk of the stomach acid traumatizing the stomach (which could give her more GI upset and risk a stomach ulcer). So, no matter the trigger for her vomiting and even if we weren't seeing those potential signs of a stomach bleed, we'd need to discontinue the Metacam at least until this is settled.

 

Now as I noted, the Metacam may only be a side issue and as I am sure you can appreciate, when a elderly cat starts to vomit, this is a vague clinical sign that can occur with a range of conditions. In regards XXXXX XXXXX could trigger her vomiting, we have to consider bacterial gastroenteritis, viral infection, parasitic infestations, pancreatitis, metabolic disease, organ troubles (ie kidney, liver), dietary indiscretion, and/or toxin or foreign material ingestion (the last ones hopefully less likely at her age). Just to note, if Smudge cannot even keep water down, this is often a sign that nausea is severe. In these cases we often will need to start with treatment via injection from the vet first to settle her stomach to give our home treatments a chance to work.

 

Now if we were to try to orally address these issues, we could consider protecting the stomach and allaying the GI upset with an antacid. Antacids can reduce nausea and also are able to lower stomach acid pH (so its not so erosive on the compromised stomach). There are a number of antacids that are available over the counter and pet friendly that can help settle his stomach. I would advise only treating with one, but the two I tend to recommend are Pepcid (More Info/ Dose) or Zantac (More Info/Dose). These are usually given 20 minutes before food (to allow absorption) and of course you want to double check with your vet if your kitty has a pre-existing condition or is on any medications. This all said, if she cannot keep water down, we do have to be aware that oral medication may be difficult to use with her. Therefore, you can try this but if she cannot keep the antacid down, then it would be a sign that we’d need her vet to start her on injectable treatment to settle her stomach first.

Otherwise, if she can keep the antacid down then after 20-30 minutes, you can try her with a light diet. Examples of this would be boiled chicken, boiled white fish, scrambled egg (made with water not milk) or meat baby food (do avoid the ones with garlic powder in the ingredients). When offering this, just give a tablespoon at a time, let it settle for 30 minutes, and if she doesn't vomit then she can have another spoonful and so on.

On top off all of this, you do need to keep an eye on her water intake (especially if she isn’t able to keep anything down). You are right to be concerned about dehydration, since older cats just don't have the body reserves they once did. In her case, I woudl advise you to consider checking her hydration status at this point. To do so and 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 Smudge 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.

In regards XXXXX XXXXX 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), you can encourage her to drink by 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. Since she is vomiting, we would of course not want to force any fluids (since we'd likely make her vomit more, which would be counter productive).

Overall, in Smudge’s situation, we do have to appreciate that her vomiting could be related to the Metacam but it may be that something else unrelated is brewing. Therefore, we do want to stop her Metacam in the face of the vomiting and consider antacids to protect the stomach. But further to this, we need to address the vomiting in general, pinpoint the cause, and address it appropriately. Therefore, you can try her with an antacid and the above to start. That said, if she cannot keep water down then we do have to be aware that her nausea is severe and home treatment alone may not be enough. So, if you try the antacid and she cannot keep it down, then that would be our cue to follow up with the vet. And I would be keen to have her seen since you have noted paling of her gums, and there is a risk that this could be digested blood in her feces and vomit. If you did have her seen, the vet will be able to examine her, assess her hydration, and have a feel of her belly to rule out any sinister lumps, bumps and anything abnormal. Depending on their exam findings, they will be able administer anti-vomiting medications by injection to help settle her stomach, gastroprotectants to protect the stomach, alternative pain relief (ie bupenorphine) if she needs it, and antibiotics if necessary to help get her back on track.

Finally, just to note in case you were keen to have her seen today, I do want to note 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. Even if they are not open, then will have either an answering service or answering machine 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 you can check the RCVS Register (HERE) to find your local Vets Now (LINK) who are open all nights/weekends. In any case, since she is pale and we are concerned about a bleed, 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! : )
Dr. B., Board Certified Veterinarian
Category: Vet
Satisfied Customers: 18305
Experience: General practice veterinary surgeon with extensive experience in a wide range of species.
Dr. B. and 2 other Vet Specialists are ready to help you
Customer: replied 3 years ago.

Except Smudge is a dog, so does that change anything?

Expert:  Dr. B. replied 3 years ago.


Oh Mary, I do apologize for having called your Smudge a cat. Embarassed (My own Smudge is a kitty, so my brain just made that leap automatically when I was typing to you about the worry of stomach ulcers). Anyway, no matter her species our concerns are just the same for her. It would be the same even if Smudge were a person with these signs. The only difference I would say is that appreciating stomach pain via palpation will be harder in a dog since their stomachs are usually too far tucked up under the rib cage for us to get a proper feel. So, for her, I'd not completely trust a lack of belly tenderness here.

So, even as a dog, our concerns and worries here are just the same (only the doses of antacid will be different but that is weight dependent anyway) and I would use the above for approaching this situation.

Take care,
Dr. B.

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