Visiting Veterinarian : It's Motrin, not a munchie
Honey is a 12-year-old cat. Recently, her owner started giving her a little handful of kitty treats every morning. Honey loves those tasty brown morsels so when, early Friday, she spotted several similar round objects that had fallen on the floor, Honey promptly tried to eat them up. A family member swiftly intervened, but not before Honey swallowed one 200 mg ibuprofen tablet.
"How long ago?" was my first question when I quickly returned her owner's call via the emergency answering service.
"Six fifty-four," she replied. I glanced at the clock. Five minutes ago. Good for her for knowing to call immediately. There are times we appreciate clients waiting until regular office hours to talk with us, but when a pet ingests something potentially toxic, the sooner you contact a veterinarian the better. In some cases, by inducing vomiting, we can purge the offending substance from the pet's system before it causes serious trouble.
Other times, vomiting can be dangerous and is contraindicated, as with caustic substances or sharp objects. Some toxins have specific antidotes where time is of the essence. Other toxicities require aggressive supportive care even when there are no visible symptoms. You need professional advice to know how to handle each individual situation.
So how much trouble could Honey be in? After all, it was just one tablet. Ibuprofen, commonly known by the brand names Advil and Motrin, is a non-steroidal anti-inflammatory drug or NSAID, in the same group as aspirin.
In the past, ibuprofen has occasionally been prescribed therapeutically in dogs. The recommended dose is one tablet for an 88-pound dog, but even at this dose, there is risk of serious side effects, such as gastric ulcers and even perforation. At higher doses, ibuprofen can cause anorexia, nausea, abdominal pain, vomiting, lethargy, diarrhea, bloody stool, incoordination, excessive drinking, and urination. In very large amounts, we're talking seizures, kidney failure, coma, and death. There are many safer NSAIDs for routine use for dogs.
What about Honey? Well, remember a single tablet treats an 88-pound dog. Honey weighs a mere 11. To make things worse, because of their unique metabolism, cats are twice as sensitive to ibuprofen as dogs. A cat is not a dog. "This could be very serious," I told Honey's mom.
If we had been dealing with a dog, this would be a no-brainer. I would have the owner feed a dose of hydrogen peroxide mixed in milk. Peroxide irritates the stomach, making dogs barf. But a cat is not a dog. In cats, oral hydrogen peroxide can be intensely damaging to the stomach. There are multiple reported cases of kitties dying from gastric hemorrhage and perforation after being given peroxide to induce vomiting. Although these cases are rare, they always make me weigh the odds carefully before going this route.
What about that stuff the veterinarian gave Fido when he ate chocolate chips, you ask? That's apomorphine. Some doctors give it by injection. I prefer instilling a bit into the lower eyelid where it is absorbed through the mucous membranes. The patient almost invariably vomits within minutes.
But a cat is not a dog. Apomorphine rarely works with cats and can actually cause a kind of psychosis. As I pulled up treatment recommendations for ibuprofen toxicity on my computer, I scanned some newer methods for trying to induce vomiting in cats.
"Let's check in with Animal Poison Control," I suggested. "At this dose of ibuprofen, I'm not sure it's worth the risk to use peroxide, and I can ask them about these other techniques for making cats upchuck. In the meantime, head over to my office, because she's going to need other emergency care."
Ten minutes later, Honey was here, wondering what all the fuss was about those funny kitty treats. "The toxicologist agreed that at this dose our main concern is gastrointestinal irritation," I reported. "She says we're better off not inducing vomiting, but because of her age, to get baseline blood tests to evaluate kidney function."
In cats, 400 milligrams of ibuprofen can potentially cause kidney failure. Honey only ate half that amount, but because she is a senior citizen, it made sense to check for any pre-existing kidney dysfunction that might increase her risk. If her kidneys were at all compromised, then it would be prudent to give several days of intravenous fluid therapy to help her body metabolize and excrete the drug.
As her tests were running, we gently syringe-fed Honey activated charcoal slurry. This would bind any ibuprofen remaining in her stomach and prevent it from being absorbed into her system. Honey was a phenomenally good girl, patiently swallowing the thick black goop.
"Her kidneys are fine, so she can go home with oral medications, " I said when the lab work was done. "This is sucralfate, an anti-ulcer agent that reacts with stomach acid to form a pasty substance which binds directly to any irritated areas of the stomach lining, forming a barrier that protects from further damage."
I also advised famotidine, commonly known as Pepcid, to reduce gastric acid production, further protecting Honey's delicate stomach.
"These treatments need to be done in a specific way and specific order," I elaborated. "Sucralfate works best given in a liquid form on an empty stomach, to maximize coating the stomach lining. It also needs a slightly acidic environment to work well, so should be given at least an hour before the antacid."
Animal Poison Control advised two weeks of medication. I demonstrated how to dissolve and administer the sucralfate and mapped out a daily treatment and feeding schedule to meet all these requirements.
Honey's mom worried that her recent habit of offering treats is what caused the cat to mistake the ibuprofen for something yummy. But she shouldn't feel guilty. Her quick response was exactly right. The prognosis is good.
And Honey, she says all is forgiven — but can she have her real kitty treats now?