shoot or no?

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Lilitiger2

Member Since 2023
Update: vet says no insulin until eating better. Asked about ondansetron. He's eaten a little kibble.

o Mr. Steven looks terrible this am and is not eating. First time in a very long time. Looked ok last night after subq fluids, got a cerenia injection. Had a poop. Ate a little over night but not much. This am before blood test and injection ..nothibg. BG 334.
Called ER vet (office same as his internal med vet) who said to hold off on insulin ?
He vomited 1x last night (hence, cerenia) but ate afterwards.
Worried about with holding, worried about giving and making things worse. Internal med 6 hours away, considering it
 
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Waiting for tech to talk to vet to "see if she was comfortable" giving him ondansatron. If I don't hear very shortly, I'll call them back and if that doesn't work, call my local vet and just beg. He needs it.

Yes, home testing and will continue.
Gave mirtazapine and he has now eaten a few (2?) Tbsp of his HP kibble. Vet said he could eat anything at this point so I even offered him the wet oncology food that he loves. Nope. Might try again with that now that he's had the Mirtaz.

Not syringe feeding (yet) how much does he need to eat before I do?
 
Dumb question...is zofran processed in the kidneys? I wonder if that's why vet is pausing (Steven has kidney issues)
 
Bobo had CKD and has been on ondansetron for years so no, that’s not a thing. ondansetron is a human med and I’ve filled it a human pharmacies before. If you have a doctor that would prescribe it, that would be an option too. You want the 4mg pills. What’s his weight? The dose is based on weight. Bobo is 15 pounds and he started with 1/2 a pill twice a day but is not on 1 pill x2 a day
 
Well, internal med vet said give insulin at 1145. He had eaten a little kibble. Agreed about ondansatron and wanted me to go to primary vet. We re there now. Hematocrit is 26...not quite transfusion range ((which he has had 1.5 years ago) but low. Running more chemistry. This vet thinks his dose .5 U once a day is not enough. Hope I don't get dueling vets.
Will do ondansatron injection then pick up pills. I'm sure they want to hospitalize but that will be a tough sell w me. A tough day (he did have a nice poop on the way over, tho, so...yay.
 
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Well more updates.
Primary vet thinks pancreatitis flare. Gave a buprenex shot and Steven seemed to feel better. Ate a bunch of kibble. Pancreatitis SHOULD have been on my radar,given how often he gets it, but we ll deer what bupe, cetenia, fluids and mirysz can do.
Ondansetron had some kind of interaction warning so will pick up tomorrow, after I see how he does.
 
I wasn't focused on what it was but for whatever reason while both regular vet and internal medicine vet prescribed zofran, it's not their first choice bc of whatever the interaction is? Also something about heart risk,,? I don't remember. He gets an EKg next week but I know there is concern about his heart. So, he's getting buprenex, which he seems to tolerate, cerenia, Mirtaz, and subq for the pancreatitis. And pred. And to make sure he's eating. I'm hoping he'll be back on his insulin schedule tomorrow
 
From Plumb's Veterinary Drug Handbook (11th ed, - not the most recent ed,):

Odansetron

Uses/Indications Used as an antiemetic when conventional antiemetics are ineffective, such as when administering cisplatin or for other causes of intractable vomiting. The use of ondansetron in cats is somewhat controversial and some state it should not be used in this species. (me: it does not say why)

Contraindications/Precautions/Warnings Ondansetron is contraindicated in patients hypersensitive to it or other agents in this class. Ondansetron may mask ileus or gastric distention; it should not be used in place of nasogastric suction. Use with caution in patients with hepatic dysfunction as half-life may be prolonged. Because ondansetron is potentially a neurotoxic substrate of P-glycoprotein, it should be used with caution in those herding breeds (e.g., Collies, Shelties, Australian shepherds, etc.) that may have the gene mutation that causes a nonfunctional protein.

Adverse Effects Ondansetron appears to be well tolerated. Constipation, extrapyramidal clinical signs, arrhythmias and hypotension are possible (incidence in humans <10%).

Drug Interactions/Laboratory Considerations None reported

Cats:
a) For intractable vomiting when other less expensive drugs are ineffective: 0.22 mg/kg (route not identified) 2 –3 times a day (Willard 1999)
b) As an anti-emetic for intractable vomiting: 0.1–0.15 mg/kg slow IV push q6 –12h as needed (Scherk 2003c) c) As an antiemetic for adjunctive treatment of severe pancrea
 
With a pancreatic flare he will need pain meds, antinausea meds, sub Q fluids and possibly an appetite stimulant, but only after an antinausea med has been given.
 
Most drugs interact with something, even if it's rare. Generally, if you Google interaction between Drug X and Drug Y it will turn up information. Drugs.com has an interaction checker as does Web MD and Medscape.
 
Yeah, i dont know exactly what the concern was but while both vets agreed w calling it in (,one did) neither was enthusiastic and wanted me to try something else first. The "something else" i guess was better pain management (buprenex).

And yes, thats the game plan for Steven's pancreatitis: fluids, buprenex (pain), mirtz (app stim and some anti nausea, NOT administered right with bupe) cerenia (anti emetic which tolerates well). And his well tolerated food. I will pick up the zofran so ill have it, as i said a former cancer kitty got it componded into a cocktail.

Sometimes, cats (mine) are hard to read. I wiyld have picked nausea as the issue yesterday, but, given his response, it seems like pain was more the factor. Ivjust want him confortable and eating so he can get his insulin.
 
Well two steps forward, 50 steps back. Apparently vet can't send any buprenex home, they have but I guess not now.

So, daily 80 mi drives five days a week for effective pain relief. I guess he ll just have to tough it out on the weekends...:(
 
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