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Clinical examination
Temperature: 38.1C.
Pulse: 120 per minute.
Respiration: 36 per minute.
The cat was moderately dehydrated and the nose was slightly
dry. In addition to the third eyelids protruding, the pupils were
also dilated and had no pupillary
light reflex. Menace and palpebral
reflexes were intact, ophthalmic
examination revealed no abnormalities and vision was deemed
normal. The conjunctiva were
mildly hyperaemic.
Other mucous membranes
were a normal colour, and CRT
was two seconds. A Schirmer
tear test (STT) revealed reduced
VICKI BROWN
Hiatal disorder.
Oesophageal neoplasia.
Oesophageal diverticulum.
Constipation and
faecal tenesmus
Dietary: foreign
material in faeces.
Obstruction: extraluminal
perirectal/perianal tumour, peril
From
Depression
GI tract disease as primary
cause for example, leading to
systemic infection.
Systemic disease with secondary GI disease for example,
dysautonomia.
l
Investigation
Initially, blood haematology and
biochemistry were performed
(Table 1). This revealed haemoconcentration and hyperproteinaemia, which reflected the
patients dehydration. FeLV and
FIV tests were negative and a
blood smear was unremarkable.
rr
gUrr
Result
High/
low
Normal value
Units
Haemaglobin
Haematocrit
18
0.56
H
H
8-15
0.24-0.45
G/dl
L/l
MCHC
32
30-36
G/dl
16.5
5-18
x109/l
Neutrophils
10.2
3-14
x109/l
Lymphocytes
6.3
1.5-7
x109/l
Eosinophils
<1.0
x109/l
Monocytes
<0.5
x109/l
Platelets
434
175-500
x109/l
ALKP
135
0-193
IU
ALT
67
0-100
IU
Urea
6.6
5-12.85
Mmol/l
Creatinine
80
71-212
Umol/l
Glucose
5.8
3-8.06
Mmol/l
Total protein
88
57-89
G/l
Albumin
42
29-39
G/l
Globulin
46
24-44
G/l
Cholesterol
3.2
1.68-5.81
Mmol/l
Amylase
891
456-1,376
IU
Total bilirubin
0-9
Umol/l
Calcium
2.4
2.03-2.9
Mmol/l
Phosphate
1.9
1.0-2.42
Mmol/l
Sodium
138
135-155
Mmol/l
Potassium
5.0
3.3-5.5
Mmol/l
VT38.08 master.indd 18
29/2/08 10:49:22
CLINICAL FELINE 19
Treatment
The patient was given intravenous
Hartmanns solution (Aquapharm
number 11, Animalcare) at a rate
of 10ml/kg/hour for two hours.
The drip rate was then slowed
to 4ml/kg/hour. Hypromellose
0.3 per cent (non-proprietary)
eye drops were given every two
hours. Pilocarpine one per cent
(non-proprietary) eye drops
were given every eight hours
to aid oronasal and lacrimal
secretion.
A dose of 3mg metoclopramide hydrochloride (Emequell,
Pfizer) was given by intravenous infusion to improve gastric emptying. A liquid paraffin enema was administered.
Follow-up
Regular small meals per os were
offered from a raised platform
from the third day of treatment.
Regurgitation was significantly
reduced with the aid of cisapride,
although not entirely eliminated.
The cat was discharged
on cisapride, pilocarpine and
hypromellose (as above). Two
weeks later the cat was doing
well and gaining weight. Constipation was present intermittently
and the owner was provided
back to
PUrrrrr
Membrana nictitans
response to 1:10,000
adrenaline solution
Feline
dysautonomia
Miosis within
12 minutes
Retraction
Control
No response
No response
Discussion
Feline dysautonomia is a disease
of domestic cats characterised
by extensive degeneration of
the autonomic nervous system
(Cave, 2003). Within a few days,
clinical signs develop, characterised by regurgitation, constipation, dilated pupils (which are
unresponsive to light) prolapsed
third eyelids and reduced tear
secretion (Sharp et al, 1984).
Feline dysautonomia was first
reported in 1982 in the UK but
has now also been seen sporadically in the US, other European
countries, New Zealand and the
United Arab Emirates (Sharp et
al, 1984). Feline dysautonomia
appears to be one of a group of
primary dysautonomias affecting
dogs, hares, rabbits and horses.
These diseases have very similar
pathophysiology. To date, the
causes of this group of diseases
remains unknown (Cave, 2003).
Although differential diagnoses
are few in cats with multiple
cardinal clinical signs, definitive
diagnosis requires histopathological examination of autonomic ganglia at postmortem.
It is not known how sensitive
and specific the clinical scoring
system for antemortem diagnosis is (Table 3). Ideally, thoracic
radiology should be performed
with the cat conscious as sedation and anaesthesia can cause
megaoesophagus. However,
adequate restraint of the patient
in the conscious state was not
possible in this case.
As the aetiology of feline dysautonomia is unknown, treatment is symptomatic. Pilocarpine
is an autonomic stimulant; poten-
Score
Patient
Constipation
Proprioceptive deficits
Anal reflexia
... comINg
SooN
Key
VT38.08 master.indd 19
Score
Clinical grade
Clinical diagnosis
1-4
Inconclusive
5-8
Probable
9-12
Positive
13-16
Positive
29/2/08 10:49:51