Severe muscle fasciculations and tremor in a cat with hypochloraemic metabolic alkalosis secondary to duodenal obstruction.

CASE SUMMARY: An 18-month-old, female spayed, Australian Mist cat presented with a 24 h history of muscle tremors and inappetence progressing to collapse with generalised muscle fasciculations. The cat was diagnosed with a hypochloraemic metabolic alkalosis due to a duodenal foreign body found to be a trichobezoar at coeliotomy. The cat made a complete recovery after enterotomy to remove the trichobezoar, with cessation of neuromuscular clinical signs and normalisation of its electrolyte and acid-base imbalances. RELEVANCE AND NOVEL INFORMATION: Muscle fasciculations and tremors in cats can be caused by intoxications, metabolic derangements, encephalomyelitis, feline hyperaesthesia syndrome and cerebellar diseases. The presenting clinical signs of severe muscle fasciculations and tremors have not previously been reported in association with an intestinal obstruction in the cat.

Cutpoints for screening blood glucose concentrations in healthy senior cats.

Objectives The objectives of this study were to determine the reference interval for screening blood glucose in senior cats, to apply this to a population of obese senior cats, to compare screening and fasting blood glucose, to assess whether screening blood glucose is predicted by breed, body weight, body condition score (BCS), behaviour score, fasting blood glucose and/or recent carbohydrate intake and to assess its robustness to changes in methodology. Methods The study included a total of 120 clinically healthy client-owned cats aged 8 years and older of varying breeds and BCSs. Blood glucose was measured at the beginning of the consultation from an ear/paw sample using a portable glucose meter calibrated for cats, and again after physical examination from a jugular sample. Fasting blood glucose was measured after overnight hospitalisation and fasting for 18-24 h. Results The reference interval upper limit for screening blood glucose was 189 mg/dl (10.5 mmol/l). Mean screening blood glucose was greater than mean fasting glucose. Breed, body weight, BCS, behaviour score, fasting blood glucose concentration and amount of carbohydrate consumed 2-24 h before sampling collectively explained only a small proportion of the variability in screening blood glucose. Conclusions and relevance Screening blood glucose measurement represents a simple test, and cats with values from 117-189 mg/dl (6.5-10.5 mmol/l) should be retested several hours later. Cats with initial screening blood glucose >189 mg/dl (10.5 mmol/l), or a second screening blood glucose >116 mg/dl (6.4 mmol/l) several hours after the first, should have fasting glucose and glucose tolerance measured after overnight hospitalisation.

Intramuscular glargine with or without concurrent subcutaneous administration for treatment of feline diabetic ketoacidosis.

OBJECTIVE: To describe treatment response and outcome in 15 cats with diabetic ketoacidosis (DKA) initially stabilized with glargine administered intramuscularly (IM) with or without subcutaneous (SC) glargine. MATERIALS AND METHODS: Fifteen cats diagnosed with DKA were initially administered IM glargine (1-2 U) and in most cats (12/15 cats) this was combined with SC glargine (1-3 U). This was followed by intermittent IM glargine as required at intervals of 2 or more hours (range 2-22 h) and SC glargine (1-2 U) every 12 hours. KEY FINDINGS: All 15 cats survived and were discharged from hospital (median 4 d; range 2-5 d) and one-third (5/15) of cats subsequently achieved remission (median time 20 d; range 15-29 d). Complications included hypokalemia and hypophosphatemia, which were likely the result of DKA therapy rather than glargine treatment specifically. SIGNIFICANCE: This study demonstrates that glargine administered IM is an effective treatment for DKA in cats, and may provide an alternative to regular insulin. The same vial used for initial treatment of DKA can then be used for subsequent management with SC glargine injections. Future prospective randomized controlled trials evaluating clinical outcomes in cats with DKA using different types and routes of administration of insulin are warranted. A prospective randomized controlled trial is required to compare outcomes for IM and IV administration of glargine and regular insulin in DKA cats with or without SC glargine.

Focal pulmonary granuloma caused by Cladophialophora bantiana in a domestic short haired cat.

Following a 4-week history of coughing, a 12-year-old cat with a history of insulin-dependent diabetes mellitus was diagnosed with a pulmonary granuloma caused by Cladophialophora bantiana. Thoracic radiographs revealed consolidation of the right caudal lung lobe and cytology confirmed the presence of mycotic pneumonia. Results of clinical investigations showed no evidence of extra-pulmonary infection. A thoracotomy and lung lobe resection was performed. Histological examination of the mass revealed black pigmented fungal hyphae and pyogranulomatous inflammation. Cultures inoculated with portions of these tissues yielded a dark walled fungus consistent with an etiologic agent of phaeohyphomycosis and DNA sequencing confirmed the presence of Cladophialophora bantiana. The cat was treated with itraconazole for 4 weeks post-operatively and then with posaconazole for 7 months but was euthanized 13 months after initial diagnosis due to a hepatocellular carcinoma. On post-mortem examination there was no evidence of recurrent fungal infection. This is the first report of localized pulmonary C. bantiana infection in a cat.

Insulin glargine has a long duration of effect following administration either once daily or twice daily in divided doses in healthy cats.

The pharmacological effects of glargine administered once or twice daily were compared in six healthy cats. A two-way crossover study was performed with insulin and glucose concentrations measured following subcutaneous administration of glargine once daily (0.5 U/kg) or twice daily (0.25 U/kg, repeated after 12h). Nadir glucose concentration and mean daily glucose concentration did not differ significantly following insulin administration once daily or twice daily in divided doses. Time to reach last glucose nadir differed, with longer intervals occurring following twice daily dosing. Blood glucose failed to return to baseline concentration by 24h in three of six cats in each treatment group. Insulin variables were not significantly different following once or twice daily dosing. This study in healthy cats demonstrates that glargine has a long duration of action with carry-over effects to the next day likely, regardless of dosing regimen. A study in diabetic cats is required to determine the best dosing regimen.

Long-term safety, efficacy and palatability of oral meloxicam at 0.01-0.03 mg/kg for treatment of osteoarthritic pain in cats.

Osteoarthritis is a chronic, painful condition that is now recognised as affecting a large proportion of cats. Non-steroidal anti-inflammatory drugs (NSAIDs) have proven efficacy in dogs and humans but there are limited published data on the use of NSAIDs in the long-term management of this condition in cats. This prospective study aimed to assess the long-term safety and palatability of oral meloxicam and its efficacy in treating osteoarthritic pain in cats when given at a dose of 0.01-0.03 mg/kg once daily. Forty cats diagnosed with osteoarthritis completed the trial with a mean treatment duration of 5.8 months. Gastrointestinal upset in 2/46 (4%) cats was the only adverse effect noted. No deleterious effect on renal function was detected in cats studied. Owners subjectively assessed treatment efficacy as good or excellent in 34/40 (85%) of cases. The results of this study showed oral meloxicam to be safe and palatable long-term treatment for osteoarthritis in cats when given with food at a dose of 0.01-0.03 mg/kg.

Diabetes mellitus in cats.

Feline diabetes is a multifactorial disease with genetic and environmental factors, including diet, excess body weight, and physical inactivity, involved in its pathogenesis. Although type 2 diabetes is most common in cats, most cats are insulin-dependent at the time of diagnosis. If good glycemic control can be achieved early after diagnosis, a substantial proportion of diabetic cats go into clinical remission. Diabetic remission may be facilitated by using a low-carbohydrate-high-protein diet combined with a long-acting insulin, such as glargine, administered twice daily. Rather than just controlling clinical signs, these new treatment modalities make curing feline diabetes a realistic goal for practitioners.