Comparison of regular insulin infusion doses in critically ill diabetic cats: 29 cases (1999–2007)

Objective – To compare biochemical parameters, neurologic changes, length of hospital stay, and clinical improvement in 3 groups of cats with diabetic ketosis/diabetic ketoacidosis (DK/DKA) prescribed varied doses of regular insulin as a continuous rate of infusion (CRI). Design – Retrospective study. Setting – University teaching hospital. Animals – Twenty‐nine client‐owned cats with DK/DKA prescribed a regular insulin CRI. Interventions – Cats were grouped as follows: 7 cats each in Group 1 and 2, (prescribed 1.1 and 2.2 U/kg/d, respectively), and 15 cats in Group 3 (prescribed increasing doses as needed). Measurements and Main Results – None of the groups received the total prescribed dose of insulin. The mean actual dose administered/kg/d ranged from 0.30 (0.21) to 0.87 (0.32) U/kg/d in Groups 1, 2, and 3. There was no difference in mean minimum blood glucose (BG) per 4 hours or change in BG from baseline per 4 hours between Groups 1 and 2 (P=0.63, 0.50). There was no difference between groups regarding the time required to reach a BG ≤13.9 mmol/L (250 mg/dL), serum phosphorus or potassium concentrations relative to baseline values (P=0.53, 0.90), length of time until urine or serum ketones were no longer detected (P=0.73), the animal commenced eating (P=0.24), or length of hospital stay (P=0.63). Four of the cats had declining mentation during hospitalization; there were no relationships between osmolality at presentation, either prescribed or administered insulin dose, and mentation changes. Three of the 4 cats with declining mentation survived. Twenty‐seven of the 29 cats (93%) survived to discharge. Conclusions – In this study, prescribing the published canine dose (2.2 U/kg/d) of regular insulin to cats with DK/DKA does not appear to increase the frequency of adverse neurologic or biochemical sequelae compared with cats that are prescribed the published cat dose (1.1 U/kg/d). The use of a sliding scale for determination of infusion rates significantly reduces the amount of insulin cats receive in this setting. Determination of whether adverse sequelae would occur more frequently if cats with DK/DKA received the full insulin prescribed doses of 1.1, 2.2, or >2.2 U/kg/d is warranted. Further controlled studies are necessary to determine if higher doses of insulin are associated with beneficial effects on morbidity or mortality.     

A retrospective evaluation of lomustine (CeeNU) in 32 treatment naïve cats with intermediate to large cell gastrointestinal lymphoma (2006–2013)

Multi‐drug chemotherapy protocols for feline lymphoma have demonstrated variable efficacy and tolerability. In phase I trials, lomustine has demonstrated efficacy for cats with lymphoma though its use for treatment naïve feline intermediate/large cell gastrointestinal (GI) lymphoma remains unknown. This study evaluated the efficacy and tolerability of lomustine for the treatment of feline GI lymphoma. Thirty‐two cats with histologically or cytologically confirmed intermediate/large cell GI lymphoma were evaluated retrospectively. Factors assessed included clinical signs, hematologic/biochemical parameters and use of l ‐asparaginase at induction. A response rate of 50% (16/32), with median duration of response of 302 days (range 64–1450 days), was found. Median progression‐free interval was 132 days (range 31–1450 days), with overall median survival time of 108 days (range 4–1488 days). History of hyporexia, presence of anaemia and dose of lomustine were significantly associated with progression‐free survival. Overall, lomustine is a well‐tolerated and effective treatment for feline GI lymphoma.     

Chronic lymphocytic leukaemia in the cat: 18 cases (2000–2010)

There is little information regarding the presentation, biologic behaviour, treatment and prognosis in cats with chronic lymphocytic leukaemia (CLL), and further investigation is needed to characterize this disease in cats. The goal of this study was to describe the clinical presentation, response to treatment and prognosis of feline CLL. A multi‐institutional retrospective study of 18 cats diagnosed with CLL between 2000 and 2010 was performed. CLL was defined as the presence of a mature lymphocytosis (> 9000 lymphocytes µL^?1) and confirmation of an immunophenotypically monomorphic or clonal lymphoid population. Each patient was required to also have at least one of the two following criteria: (1) concurrent cytopenia of at least one cell line and/or (2) >15% mature lymphocytes in the bone marrow. Data on signalment, history, clinical signs, clinicopathologic features and response to treatment were reviewed. Median age of the cats at initial presentation was 12.5 years (range: 5–20 years). The most common presenting complaint was chronic weight loss, which was present in 8/18 (44%) cats. Sixteen of 18 (89%) cats were treated with chlorambucil and prednisolone; four of these cats also received vincristine. Two (11%) cats were treated with multi‐agent injectable chemotherapy (L‐CHOP, l ‐asparaginase, cyclophosphamide, doxorubicin, vincristine, prednisolone). Eighty‐eight percent of cats evaluable for response achieved a complete (nine cats) or partial (six cats) remission. Median overall remission was 15.7 months (range: 1.3–22.8 months). The median overall survival in the 17 cats with follow‐up data was 14.4 months (range: 0.9–25.3 months). Results of this study suggest that CLL affects older‐aged cats and responds favourably to treatment with oral chlorambucil and prednisolone.