Acute vomiting in cats: rational treatment selection

Abstract

Practical relevance: The control of nausea and vomiting in cats is important in order to prevent the development of food aversion, anorexia (with its associated complications of weight loss and dehydration), and hepatic lipidosis.

Clinical challenges: There are several antiemetic drugs that are clinically effective in cats. Making a rational choice from the available options requires knowledge of the likely cause of the vomiting, and the mechanisms of action and side effects of each drug. For example, a drug such as prochlorperazine, which can cause sedation, may be a useful first-line choice in a hospitalized cat that requires mild sedation to be handled, but would be undesirable in a critically ill cat.

Audience: For companion animal and feline practitioners, the vomiting cat is a common presentation.

Evidence base: The guidance provided in this review draws on the findings of clinical trials in humans, experimental studies in cats, some clinical trials in cats, and clinical experience.

Fig 1

In cats, metoclopramide is a prokinetic drug, but it may not have direct central antiemetic effects. The dosage should be reduced (eg, by 50% or more) for cats in renal failure. Tremors are a possible side effect, especially in combination with phenothiazine antiemetics

Fig 2

This radiograph of a 2-year-old female spayed cat, which presented with a 3-week history of vomiting and inappetence, shows linear foreign bodies in the stomach. Multiple hair elastics were removed by endoscopy, and the cat recovered uneventfully. Courtesy of the Section of Radiology, University of Wisconsin-Madison, School of Veterinary Medicine

Fig 3

Esophagitis, such as that caused by clindamycin capsules in this 12-year-old male neutered Persian (a), may initially manifest as vomiting and then progress to regurgitation. Esophagitis should be treated aggressively to prevent progression to esophageal stricture, as occurred in this case (b). The cat was treated successfully with balloon dilation of the esophageal stricture, and was discharged on a short course of famotidine and sucralfate treatment