1/4 Billie AMPS 247 mirtazapine, serotonin syndrome, liver masses

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Deanna & Billie

Member Since 2014
http://www.felinediabetes.com/FDMB/threads/12-20-billie-pmps-221.188352/#post-2092342

Hello all. Last time I checked in, I had some good news to share. This time, not so much. Billie went to an internist yesterday for a follow up ultrasound (last one was end of September). They found multiple masses in her liver. This is a significant change from September, when her liver looked more or less okay and the vet was thinking triaditis. So, I am fearing the worst. But, it's Billie, and she has overcome a lot. Waiting for bloodwork to come back today and then going from there.

The worst thing in the immediate present is that the internist prescribed mirtazapine, which sent poor Billie into serotonin syndrome. As I've been reading, I realize the dose (1/4 tablet) was too high for 7.5 lb Billie and am absolutely kicking myself for giving it to her. But I trusted the board certified internist and didn't question it until it was too late. About an hour after taking it last night, she started having head tremors, ataxia and issues with her back legs, fast respirations and fast heart rate. We rushed to the ER and were extremely lucky that the critical care specialist who knows Billie very well was there. She started her on cypro, 2mg every 4 hours for the next 3 days or until symptoms improve. She is doing better in some ways this morning - her respirations are getting closer to normal, she seems less dazed, and the tremors are less frequent. But she's restless and can't seem to get comfortable for long, and her back legs are still wobbly. As you can imagine, I feel terrible for her that she has to go through this on top of everything else.

On top of that, when we were at the ER, the critical care vet did a quick ultrasound and saw a couple things that were not mentioned in the radiologist's report, including a small amount of abdominal fluid, and something that might be a block or infection in her ureter. Not sure why those things weren't in the first ultrasound report, or if they somehow developed between her appointment at noon and her ER trip at 6.

Before the trip to the doctor yesterday, she seemed to be doing really well. So I'm wishing I hadn't brought her there at all. I know that's irrational, but I'm wondering if all the poking and prodding is doing more harm than good. But I wouldn't know about the liver masses if we hadn't gone in.

She is eating now, so that's something. And her BG stayed at a flat 180ish through all the chaos yesterday, so that's not too bad either.

Billie could use some vines right about now :(
 
Sending some heavy duty healing vines!

Sounds like Billie is one tough cookie!

These are for you.:bighug::bighug::bighug:

I have used the mirtazpine with Jones, there was the howling and stuff but no reactions like Billie had. Wow! The vets seem to like that over other appetite stims though. I have him in cypro now, more steady it seems.
 
I’m so sorry to read this but hoping for the best. All this could be infection. If a blockage what’s the plan? Was it a radiologist or regular vet that did it.? If not not a radiologist even though in the ER the results might not be what is suspected. Is cypro cyproheptadine? Or an antibiotic? That’s quite often to give it. Max and Tiffany got it twice a day. It can also make them agitated. Tiffany got the dose I was told which was 1/4 a 4 mg pill but for Max I knew more and found that he only needed a sliver. Prayers. :bighug:
 
Piling on the vines for Billie. These are for you:bighug::bighug::bighug:. I hope the blood work gives you answers.

If you can get mirtazapine in the transdermal form (for the ear) it's a slower absorption rate and much less chance of it turning into meowzapine.
 
Thank you all so, so much :bighug::bighug:. :bighug: I greatly appreciate the hugs and prayers and vines.

@tiffmaxee the cypro is cyproheptadine. The critical care vet said it will counteract the mirtazapine since it's a serotonin antagonist and should help her get over the serotonin syndrome, so that's what the frequent dosing is about for right now at least or until the mirtazapine clears. Hopefully, it's safe...

For the blockage/possible infection, both the IM and critical care vets decided to start her on Clavamox, so she has had one dose of that so far. Billie ended up with two ultrasounds yesterday...one by the radiologist who did not mention a blockage in the ureter or fluid in the abdomen. The second was by Billie's critical care specialist who took a quick look at the ER (and didn't even charge me for it...she's a saint). She saw the possible ureter blockage and abdominal fluid, as well as the scary liver and possible kidney issues.

@Wendy&Neko Thank you for letting me know there's a transdermal!! So good to know.

Still waiting for bloodwork results :nailbiting:
I unfortunately have to go to work but managed to arrange to work in the evening so that I could be with Billie, and DBF will be home two hours after I leave, so she'll at least have someone to watch her and offer her food pretty much all day.
 
Cyproheptadine does counteract mirt. I would never use mirt again after seratonin syndrome even in transdermal. Thank goodness you got Billie to the ER. That’s why I won’t use it again for any cat.
 
Home from work update...Billie is still not in great shape, but showing some signs of improvement. She is now able to lie down in more relaxed positions than yesterday or this morning. That's huge, I think, because it seemed like she just couldn't get comfortable and could only lie down in meatloaf for some reason. She's also eating well enough. She got really excited about some Fancy Feast. She's still having tremors and ataxia. The critical care vet we really like said to wait it out until the mirtazapine is out of her system and hope.

Her bloodwork came back from the IM vet. Liver values are elevated but actually less elevated than they were in November. Kidney values are normal. Red blood cell count, a little on the low end and something to keep an eye on.

The IM vet who I'm liking less by the hour also tried to tell us that mirtazapine can't cause serotonin syndrome and what we're seeing must be from something else. She is incorrect. I don't know how she can say that. This absolutely matches serotonin syndrome and mirtazapine absolutely can and did cause it, as determined by Billie's critical care specialist. I'm not sure what to make of the IM but I'm not a fan.

Thank you all for the vines!!! I think they are working!
 
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