The Effect of Orally Administered Ranitidine and Once‐Daily or Twice‐Daily Orally Administered Omeprazole on Intragastric pH in Cats

Background

Gastric acid suppressants frequently are used in cats with acid‐related gastric disorders. However, it is not known if these drugs effectively increase intragastric pH in cats.

Objectives

To examine the effects of PO administered ranitidine and omeprazole on intragastric pH in cats and to compare the efficacy of once‐daily versus twice‐daily dosage regimens for omeprazole.

Animals

Eight domestic shorthair cats.

Methods

Using a randomized 4‐way cross‐over design, cats were given enteric‐coated omeprazole granules (1.1–1.3 mg/kg q24h and q12h), ranitidine (1.5–2.3 mg/kg q12h), and placebo. Intragastric pH was monitored continuously for 96 hours using the Bravo^™ system¹, starting on day 4 of treatment, followed by a median washout period of 12 days. Mean percentage of time pH was ≥3 and ≥4 was compared among groups using repeated measures ANOVA.

Results

Mean ± SD percentage of time intragastric pH was ≥3 and ≥4 was 67.0 ± 24.0% and 54.6 ± 26.4% for twice‐daily omeprazole, 24.4 ± 22.8% and 16.8 ± 19.3% for once‐daily omeprazole, 16.5 ± 9.0% and 9.6 ± 5.9% for ranitidine, and 9.4 ± 8.0% and 7.0 ± 6.6% for placebo administration. Twice‐daily omeprazole treatment significantly increased intragastric pH, whereas pH after once‐daily omeprazole and ranitidine treatments did not differ from that of placebo‐treated cats.

Conclusion and Clinical Importance

Only twice‐daily PO administered omeprazole significantly suppressed gastric acidity in healthy cats, whereas once‐daily omeprazole and standard dosages of ranitidine were not effective acid suppressants in cats.     

Efficacy of Intravenous Administration of Combined Acid Suppressants in Healthy Dogs

Background

Short‐term intravenous co‐administration of famotidine and pantoprazole is used by some veterinarians to treat gastrointestinal bleeding in critically ill dogs. However, clinical studies have not evaluated the efficacy of combination acid suppressant treatment in dogs.

Hypothesis/Objectives

To compare the effect of intravenous co‐administration of famotidine and pantoprazole to monotherapy with pantoprazole on intragastric pH in dogs. We hypothesized that single agent pantoprazole would be more effective than combination with famotidine.

Animals

Twelve healthy adult colony dogs.

Methods

Randomized, 2‐way crossover design. All dogs received placebo (0.9% saline) for 24 hours followed by 1.0 mg/kg IV q12h pantoprazole or combination treatment with famotidine and pantoprazole for 3 consecutive days. Intragastric pH monitoring was used to continuously record intragastric pH for 96 hours beginning on day 0 of treatment. Mean percentage time (MPT) that intragastric pH was ≥3 and ≥4 were compared between groups using ANOVA with a posthoc Tukey‐Kramer test (α = 0.017).

Results

The MPT ± standard deviation intragastric pH was greater than ≥3 and 4 were 79 ± 17% and 68 ± 17% for pantoprazole and 74 ± 19% and 64 ± 23% for combination treatment, respectively. There were no significant differences in MPT intragastric pH was ≥3 and 4 between groups. Pantoprazole administered alone achieved pH goals established for humans with acid‐related disorders.

Conclusions and Clinical Importance

These results suggest that short‐term combination treatment with famotidine and pantoprazole is not superior to pantoprazole alone for increasing intragastric pH in dogs.     

3株牛乳源乳酸菌安全性初步评价

通过小鼠的7d急性毒性实验及30 d喂养实验,对源自牛乳中的3株肠球菌LQ-R-16-1、FC-3-7、FC-3-2进行安全性初步评价.分别对清洁级昆明小白鼠进行7d及30d连续灌胃不同剂量的肠球菌LQ-R-16-1、FC-3-7、FC-3-2,实验期间观察小鼠体征变化、计算日增体质量,最后通过大体解剖,观察脏器变化、脏器细菌易位情况并称质量计算脏器指数,脏器细菌易位情况.结果表明:7d急性毒性实验及30d喂养实验中各实验组小鼠日增体质量、脏器指数与对照组之间无显著性差异(P＞0.05),30 d喂养实验结束后未发现脏器之间有细菌易位现象.初步表明,肠球菌LQ-R-16-1、FC-3-7、FC-3-2安全,无毒副作用.     

Evaluation of a Novel Real-Time Continuous Glucose-Monitoring System for Use in Cats

Background: The Guardian REAL‐Time is a continuous glucose‐monitoring system (CGMS) recently developed to provide instantaneous interstitial glucose concentrations; the system does not require a monitor being fixed to the animal. Hypothesis: The CGMS provides accurate and reproducible real‐time readings of glucose concentration in cats. Animals: Thirty‐two diabetic cats, 2 cats with suspected insulinoma, and 5 healthy cats. Methods: Prospective, observational study. CGMS accuracy was compared with a reference glucose meter at normal, high, and low blood glucose concentrations using error grid analysis. Reading variability of 2 simultaneously used CGMS was determined in diabetic cats by calculating correlation and percentage of concordance of paired data at different glycemic ranges. The time interval between increasing glycemia and a rise in interstitial fluid glucose measured by the CGMS was assessed in healthy cats receiving glucose IV; the time point of maximal increase in interstitial glucose concentrations was calculated. Results: The CGMS was 100, 96.1, and 91.0% accurate at normal, high, and low blood glucose concentrations. Measurements deviated from reference by ?12.7 ± 70.5 mg/dL at normal, ?12.1 ± 141.5 mg/dL at high, and ?1.9 ± 40.9 mg/dL at low glucose concentrations. Overall, paired CGMS readings correlated significantly (r= 0.95, P < .0001) and concordance was 95.7%. The median delay after IV administration of glucose to an increase in interstitial glucose was 11.4 minutes (range: 8.8–19.7 minutes). Conclusions and Clinical Importance: Although some readings substantially deviated from reference values, the CGMS yields reproducible results, is clinically accurate in cats with hyperglycemia and euglycemia, and is slightly less accurate if blood glucose concentrations are low. Rapidly increasing interstitial glucose after a glycemic rise suggests that the CGMS is suitable for real‐time measurement under clinical conditions.     

Treatment of Ionized Hypercalcemia in 12 Cats (2006–2008) Using PO‐Administered Alendronate

Background

Long‐term treatment of cats with ionized hypercalcemia using alendronate has not been evaluated.

Hypothesis/Objectives

Alendronate is well tolerated in treatment of ionized hypercalcemia in cats.

Animals

A total of 12 cats with ionized hypercalcemia.

Methods

Prospective study of 12 cats with ionized hypercalcemia of idiopathic origin was identified by telephone and email communication with a convenience sample of consulting veterinarians. Cats were treated with alendronate at a dose of 5–20 mg per feline PO q7d. Serum ionized calcium concentration (iCa) was measured before beginning treatment with alendronate, and after 1, 3, and 6 months of treatment. Alendronate dosage was adjusted according to iCa. Evaluation included physical examination, CBC, biochemistry profile, and diagnostic imaging. The owners and referring veterinarians were questioned about any observed adverse effects. The Wilcoxon matched‐pairs signed rank test was used to compare baseline iCa to iCa at different time periods.

Results

Alendronate treatment resulted in a decrease in iCa in all 12 cats. The median percentage change in iCa was −13.2%, −15.9%, and −18.1% (range, −29.6 to +7.6; −30.5 to −1.9; −45.8 to +1.5%) at the 1, 3, and 6 month time points, respectively. Baseline iCa was significantly different from 1 month (P = .0042), 3 months (P = .0005), and 6 months (P = .0015). No adverse effects were reported for any of the cats.

Conclusions and Clinical Importance

Alendronate was well tolerated and decreased iCa in most cats for the 6‐month period of observation.     

Computed Tomographic Angiography of the Pancreas in Cats with Chronic Diabetes Mellitus Compared to Normal Cats

Background

Diabetes mellitus (DM) is a common endocrinopathy in cats. No known diagnostic test or patient characteristic at the time of diagnosis can predict likely disease course, unlike in people in whom computed tomographic angiography (CTA) is used. No published data exist regarding the CTA appearance of the pancreas in cats with DM, and thus, it is unknown what if any CTA variables should be further assessed for associations with pancreatic endocrine function.

Hypothesis/Objectives

A significant difference in pancreatic attenuation, volume, and size will be identified between normal cats and those with chronic DM on CTA.

Animals

Ten healthy control cats and 15 cats with naturally occurring DM present for >12 months.

Methods

Prospective cross‐sectional study comparing pancreatic attenuation, enhancement pattern, size, volume, pancreatic volume‐to‐body weight ratio (V:BW), pancreatic arterial: portal phase ratio (A:P), time‐to‐arterial enhancement, and time‐to‐peak portal enhancement on CTA between sedated healthy control cats and those with chronic DM.

Results

The pancreas in cats with chronic DM was significantly larger, had higher volume, higher V:BW, and shorter time‐to‐peak portal enhancement on CTA when compared to normal cats.

Conclusions and Clinical Importance

Peak portal enhancement time, pancreatic size, pancreatic volume, and V:BW can be used to differentiate normal sedated cats from those with chronic DM by CTA. These variables warrant further investigation to identify possible associations with endocrine function.     

Evaluation of Environmental, Nutritional, and Host Factors in Cats with Hyperthyroidism

The pathologic changes associated with hyperthyroidism (adenomatous hyperplasia, adenoma of the thyroid gland) have been well characterized in cats, but the pathogenesis of these changes remains unclear. In this research, we undertook a case-control study to search for potential risk factors for this disease. Owners of 379 hyperthyroid and 351 control cats were questioned about their cats' exposure to potential risk factors including breed, demographic factors, medical history, indoor environment, chemicals applied to the cat and environment, and diet. The association between these hypothesized risk factors and outcome of disease was evaluated by conditional logistic regression. Two genetically related cat breeds (ie, Siamese and Himalayan) were found to have diminished risk of developing hyperthyroidism. Cats that used litter had higher risk of developing hyperthyroidism than those that did not. Use of topical ectoparasite preparations was associated with increased risk of developing hyperthyroidism. Compared with cats that did not eat canned food, those that ate commercially prepared canned food had an approximate 2-fold increase in risk of disease. When these 4 variables (breed, use of cat litter, consumption of canned cat food, and use of topical ectoparasite preparations) from the univariate analysis were selected for further study as candidate risk factors and analyzed by multivariate conditional logistic regression, a persistent protective effect of breed (ie, Siamese or Himalayan) was found. In addition, results suggested a 2- to 3-fold increase in risk of developing hyperthyroidism among cats eating a diet composed mostly of canned cat food and a 3-fold increase in risk among those using cat litter. In contrast, the use of commercial flea products did not retain a strong association. The results of this study indicate that further research into dietary and other potentially important environmental factors (eg, cat litter) is warranted.     

A Review of the Studies Using Buprenorphine in Cats

Pain management is a crucial component of feline medicine and surgery. This review critically evaluates studies using buprenorphine in cats and highlights the clinical application of the opioid in this species. The pharmacokinetic‐pharmacodynamic (PK‐PD) modeling of IV buprenorphine has been best described by a combined effect compartmental/receptor association‐dissociation model with negative hysteresis. Therefore, plasma concentrations of the drug are not correlated with analgesia, and clinicians should not expect to observe pain relief immediately after drug administration. In addition, a ceiling effect has not been demonstrated after administration of clinical doses of buprenorphine in cats; dosages of up to 0.04 mg/kg have been reported. The route of administration influences the onset, duration, and magnitude of antinociception and analgesia when using this drug in cats. At clinical dosages, the SC route of administration does not appear to provide adequate antinociception and analgesia whereas the buccal route has produced inconsistent results. Intravenous or IM administration at a dosage of 0.02–0.04 mg/kg is the preferred for treatment of pain in the acute setting. A literature search found 14 clinical trials evaluating buprenorphine sedation, analgesia, or both in cats. There were 22 original research studies reporting the antinociceptive effects of buprenorphine by means of thermal threshold, mechanical threshold, or both, minimal alveolar concentration, or PK‐PD. Individual variability in response to buprenorphine administration has been reported, indicating that buprenorphine may not provide sufficient analgesia in some cats. Pain assessment is important when evaluating the efficacy of buprenorphine and determining whether additional analgesic treatment is needed.     

Ultrasonographic Evaluation of the Muscularis Propria in Cats with Diffuse Small Intestinal Lymphoma or Inflammatory Bowel Disease

Background: An ultrasonographic pattern of thickened muscularis propria in the small intestine and lymphadenopathy have been associated with gastrointestinal lymphoma and inflammatory bowel disease (IBD) in cats. Objectives: To investigate the association of these imaging biomarkers with IBD and lymphoma in cats. Animals: One hundred and forty‐two cats with a histologic diagnosis of normal small intestine (SI) (n = 56), lymphoma (n = 62), or IBD (n = 24). Methods: Retrospective case review. Pathology records from 1998–2006 were searched for cats with a diagnosis of normal, IBD, or lymphoma, an ultrasonographic examination <28 days before surgery, and without ultrasonographic evidence of a mass. Multinomial regression analysis was used to determine the association of imaging biomarkers with disease status. Results: Cats with thickening of the muscularis propria detected by ultrasonographic examination were more likely to have lymphoma compared with normal SI cats (odds ratio [OR] = 4.0, 95% confidence interval [95% CI] 1.2–13.1, P= .021) and those with IBD (OR = 18.8, 95% CI 2.2–162.7, P= .008). Histologic samples of cats with muscularis propria thickening were more likely to have disease infiltrates in both the mucosal and submucosal layers (OR = 8.1, 95% CI 1.7–38.4, P= .008) than cats with normal SI. Cats with ultrasonographic evidence of lymphadenopathy were more likely to have a diagnosis of lymphoma (OR = 44.9, 95% CI 5.1–393.0, P= .001) or IBD (OR = 10.8, 95% CI 1.1–106.3, P= .041) than normal SI. Fifty‐six of 62 cats had confirmed or presumptive diagnosis of diffuse T‐cell lymphoma. Conclusions and Clinical Relevance: Older cats with muscularis layer thickening are more likely to have T‐cell lymphoma than IBD. The ultrasonographic pattern is associated with histologic infiltrates in the mucosal and submucosal layers of small intestine. Lymphadenopathy is associated with lymphoma or IBD.     

Effect of Feeding an Iodine‐Restricted Diet in Cats with Spontaneous Hyperthyroidism

Background

Exclusive feeding of an iodine‐restricted diet has been proposed as a method for controlling clinical manifestations of hyperthyroidism in hyperthyroid cats.

Objectives

To determine the effect of feeding an iodine‐restricted diet on TT4 concentrations and clinical signs in cats with spontaneous hyperthyroidism.

Animals

Forty‐nine client‐owned cats with spontaneous hyperthyroidism.

Methods

Retrospective case series. Hyperthyroid cats were exclusively fed a commercially available iodine‐restricted diet. Clinical response was assessed by change in weight and heart rate and serum TT4, blood urea nitrogen (BUN), and creatinine concentrations at various times during dietary management (21–60 days, 60–180 days).

Results

Serum TT4 normalized in 20/48 cats (42%) and 39/47 cats (83%) at 21–60 days and 61–180 days, respectively. Cats in which the TT4 concentrations were still above reference range at 21–60 days had a significantly higher starting TT4 than those that normalized their TT4 levels during the same time period (P = .038). Body weight did not significantly increase (P = .34) nor heart rate decrease (P = .64) during the study. There was a significant decrease in serum creatinine (P = .028). Cats in the low reference range for serum TT4 concentrations did not have a significant increase in body weight (P = .41) nor creatinine (P = .54) when compared to those with high reference range.

Conclusions and Clinical Importance

Restricted‐iodine diets were effective at maintaining serum TT4 concentrations within reference ranges for a majority of cats with spontaneous hyperthyroidism over 1 year, although not all clinical signs of hyperthyroidism improved.     

Antithrombotic Effect of Enoxaparin in Clinically Healthy Cats: A Venous Stasis Model

Background: Systemic arterial thromboembolic events are a serious complication of cardiac disease in cats.
Objectives: To determine if enoxaparin induces an antithrombotic effect in cats at a dosage of 1 mg/kg SC q12h and if this antithrombotic effect is predicted by anti-Xa activity.
Animals: Fourteen clinically healthy cats were divided into 3 groups: control (4 cats), treated and assessed at 4 hours (5 cats), and treated and assessed at 12 hours (5 cats).
Methods: A venous stasis model was used and the extent of thrombus formation estimated by measuring thrombus weight and accretion of ¹²⁵I-fibrinogen. Plasma anti-Xa activity was measured in treated cats.
Results: There was a significant reduction in thrombus formation in the 4 h group compared with control (median weight, 0.000 versus 0.565 mg/mm, P < .01; median %¹²⁵I-fibrinogen accretion, 0.0 versus 42.0%, P < .01). There was a reduction in thrombus formation in the 12 h group (median weight, 0.006 mg/mm, P = .09; median %¹²⁵I-fibrinogen accretion, 3.83%, P = .09) but this reduction was not significant. The median percent thrombus inhibition for treated cats was 100.0% at 4 hours and 91.4% at 12 hours. Plasma anti-Xa activity was not significantly correlated with thrombus formation.
Conclusions and Clinical Importance: This pilot study demonstrates that enoxaparin, when administered at a dosage of 1 mg/kg SC q12h, produces an antithrombotic effect in a venous statsis model in clinically healthy cats. Furthermore, this study demonstrates that anti-Xa activity is a poor predictor of enoxaparin's antithrombotic effect.