Cat Drooling Excessively and Refusing to Eat

[Neco]

Hello,

My cat fell sick two days ago. Thursday evening, she looked a bit unhappy but still accepted food. Friday morning she had a fever, so my housemate administered a small oral dose of analgesic/antipyretic, 1 cc of liquid Vermidon, previously recommended by our vet. I woke up yesterday, and saw that my cat had thrown up the dose. (There has been excessive drooling ever since.) So, I took her to our vet immediately. The vet administered injections and prescribed an oral antibiotic (Largopen, amoxicillin.) She didn't accept any food yesterday, only some water, and when we tried to give her the antibiotic, she didn't close her mouth and all of it dribbled on the floor. She seems to have difficulty swallowing. Since she didn't get any better, my housemate took the cat to the vet this morning. She was administered an antibiotic injection, then offered her favourite food. She ate some, so we were happy, but then she threw up again. What to do? Tomorrow is Sunday, which means that most veterinary clinics are closed in my country. The cat looks weary but not altogether lethargic. She can walk normally. What worries me the most is her refusal/inability to eat, and the excessive drooling.

Note: I just read that paracetamol, the ingredient of Vermidon, is poisonous to cats! I immediately checked my cat for the symptoms of parasetamol poisoning, but there are no jaundiced eyes, no blue tongue, no swellings either. 1 cc contains 32 mg active parasetamol, which seems to be below toxic dose for our cat. But we actually used Vermidon once before, again in a small dose, to wondrous effect. Why would or veterinary prescribe this drug if it's poisonous cats? Or am I to seek the cause of the symptoms elsewhere?

[Traci]

Actually, this is an EMERGENCY, and you need to get your kitty to an emergency vet or a much more educated and trained vet RIGHT NOW!

Paracetamol is the equivalent to acetaminophen (Tylenol and many other brands) and those are extremely toxic to cats! A 1 cc dose for a cat could be lethal, since there is NO safe dose for cats!! Emergency treatment is paramount!

The drooling could be a result of fever activity or diseased teeth, pain, tongue/throat/esophagus problems, or a number of other issues, only a complete exam, bloodwork, urinalysis can determine exactly what might be going on and how to treat most effectively.

At this moment in time, get your kitty to an ER vet RIGHT NOW, immediately, no time to spare, go now! Tell the new, more experienced vet, that your previous vet gave paracetamol, the exact dose and when (and the other medications given, including all the injections), that kitty has been vomiting, lethargic, anorexic, etc. I strongly advise you get immediate bloodwork done, a complete urinalysis, and ask the vet if he would treat this AS IF acetaminophen toxicity (worry about the anorexia after you've addressed this toxicity), meaning specific medications and IV fluid therapy. The longer treatment is delayed, the worse the outcome could be.

Here is a link for treating acetaminophen toxicity, hopefully the new vet will already know what to do, and administer emergency treatment ASASP - otherwise show this link to him, and especially to the previous vet after kitty is treated.

http://www.addl.purdue.edu/newsletters/ ... acet.shtml

Signs of acetaminophen toxicity in cats:

Brownish-gray gums
Labored breathing
Swollen face, neck and limbs
Hypothermia (low body temperature)
Uncoordinated gait
Coma
Jaundice

I suspect the reason your vet gave paracetamol, was for several reasons: possible non-availability of safe and proper drugs for cats, not educated in it's toxicity to cats, and perhaps suspected that the dose would help reduce the fever and/or any pain associated, but whatever his reasoning, it was SO WRONG!!

[Neco]

It's almost midnight here, I am looking for a 24-hours healthcare centre right now...

Your link says the toxicity level is 50-100 mg/kg. Luckily, the dose my housemate administered was a lot lower than this level, and LUCKILY, my kitty threw up soon after. (trying to be optimistic!)

Thanks for the advice..

[Traci]

That is only a reported toxic dose, please remember, the dose makes the poison. Your kitty's age, otherwise health status, her weight especially, all must be taken into account in determining any toxic dose. The bottom line is that ANY dose of paracetamol/acetaminophen is toxic to cats to any degree (i.e., liver toxicity, oxygen delivery deficit, hemolytic and heinz body anemia, potential for lethal outcome within hours to just a few days)

This is why I strongly suggest getting her to a qualified emergency vet or university vet RIGHT NOW for detoxification, fluid therapy, blood and urine tests. They may not have a lab to detect acetaminophen, but a human lab could test kitty's urine or blood sample.

Also, you have to remember there's an underlying health condition going on yet undetected (not eating, vomiting, fever, drooling, lethargic), that still needs to be addressed, but the most important thing right now is detecting the risk of acetaminophen toxicity and treating that immediately.

In your first post, you said your vet "previously recommended" the dose of Virmidon, what do you mean? That you had it at home and had used it for a prior condition months or years before? Or that it was prescribed by the vet, you picked it up at his clinic for later administration of the med? If the former, one NEVER ever gives medication to a pet without explicit advice from the vet, because that medication could be expired, non-effective, or contraindicated for the undiagnosed condition.

If the latter, it is good practice to never prescribe any such medication at all, but equally as important to get the actual weight of the pet before prescribing anything. Ideally, an exam and testing should have been done before prescribing anything. (mainly bloodwork and urinalysis). You didn't mention if that was done, but knowing a cat was given paracetamol when the cat was clearly not feeling well, then given additional meds without testing, then all of this right before a weekend was NOT good practice nor good thinking on the part of your vet. (not your fault, just ranting on the vet)

[Neco]

I've taken my kitty to a veterinary clinic now. She'll be staying there tonight. We discussed her excessive drooling, lethargy, and loss of appetite. I also mentioned the paracetamol incident. The clinic said either poisoning or some renal complication was the reason. She'll receive anti-toxicity therapy tonight, as well as intravenous therapy, and if her condition doesn't improve, there will be additional blood tests.

Or that it was prescribed by the vet, you picked it up at his clinic for later administration of the med?

Well, my kitty was sick a few months ago, and the same vet prescribed Vermidon for the complication. I bought a bottle from the apothecary and administered the dose (1 cc, twice per day) orally. It seemed to work wonders in just two days, and she got better quickly. Two days ago, we noticed that she was getting sick again. Yesterday morning, my housemate decided to administer the same drug, in the same dosage, while I was asleep, seeing that the kitty had a fever. (Drooling had begun before she took Vermidon.) When I woke up, I found that she had thrown up the medication. I was worried so I took her to the vet for the first time. I mentioned what happened to the vet, and he administered two injections (Meloxicam and Synulox). There was no improvement, so this morning my housemate took her to the same vet again. She was administered another antibiotic injection. There was still no improvement, so I took her to the other clinic, where she'll be staying tonight.

Thanks for the advice.

Edit: Quote tags

[Traci]

I've taken my kitty to a veterinary clinic now. She'll be staying there tonight. We discussed her excessive drooling, lethargy, and loss of appetite. I also mentioned the paracetamol incident. The clinic said either poisoning or some renal complication was the reason. She'll receive anti-toxicity therapy tonight, as well as intravenous therapy, and if her condition doesn't improve, there will be additional blood tests.

Glad to hear she's getting treatment, do you trust this vet to know what they're doing? What were the comments on the prior-prescribed paracetamol and Friday's paracetamol dose?

I would not wait to see if "the condition improves". Bloodwork and urinalysis testing is crucial at this point to rule out toxicity, and would also help determine why she is having the symptoms that she is. Bloodwork is generally the only tool available to detect hidden illnesses in cats when exams can't detect anything. Being that she is on IV fluids now, after the course of IV's, bloodwork can be done immediately. Unless her condition worsens, in which, bloodwork should be done IMMEDIATELY.

If she's an older cat, bloodwork can detect kidney disease, heart disease, liver disease, gastrointestinal disease, diabetes, etc etc etc. You cannot detect any of these illnesses without bloodwork.

Well, my kitty was sick a few months ago, and the same vet prescribed Vermidon for the complication.

Sick with what? Was bloodwork or other tests done at that time? After your kitty is hopefully and successfully treated from this incident, please inform that vet that paracetamol is toxic to cats. You might just end up saving the life or lives of other cats.

Since the vet had access to meloxicam, there was absolutely NO reason to even give paracetamol. Meloxicam works as both a pain reliever as well as helps reduce inflammation. The fact he gave both says volumes about his lack of education or skills.

I bought a bottle from the apothecary and administered the dose (1 cc, twice per day) orally.

Then, by all accounts, you gave upwards of 64 mg/kg a day, which is beyond any reported toxic dose. Hopefully, you know now this is a serious problem!

By apothecary, do you mean a human drugstore or general store, but the vet did not mix it up and give it to you directly? If this is the case, one NEVER ever uses human medications to give to pets, ever. The strengths and doses are much too dangerous for animals. Most importantly, many medications cannot be metabolized by the liver in cats, that's why we are especially careful and judicious when giving medications to cats.

At the dose you mention, 1 cc twice a day, that's EXTREMELY TOXIC, and could very well have already affected her kidneys and liver, I'm surprised she didn't get deathly ill after you gave that to her. How much exactly, did you end up giving her at that time? The concentration may have been diluted, but the point is, paracetamol is toxic in ANY dose. Please, never ever give this to a pet again.

my housemate ecided to administer the same drug, in the same dosage, while I was asleep, seeing that the kitty had a fever.

Please inform your housemate NEVER to give any medications to your cat, without first consulting your vet. If the cat belongs to you, then your housemate has no business giving medications at all. Now that you know that paracetamol is toxic to cats, please inform your housemate of the same. One must not ever give human pain relievers of any kind to cats, ever.

When I woke up, I found that she had thrown up the medication.

Do you know how much time passed between the time she was given the paracetamol and the time you found out? Vomiting doesn't mean she vomited it all out of her system. It enters the bloodstream very rapidly and very little is actually excreted in the urine. It is actually non-metabolized by the liver, which is why it is toxic. As the link I provided explains, activated charcoal and inducing vomiting in an emergency clinical setting is better because the charcoal acts as a buffer and absorbant, to help absorb the toxins and prevent further damage to vital organs.

I mentioned what happened to the vet, and he administered two injections (Meloxicam and Synulox). There was no improvement, so this morning my housemate took her to the same vet again. She was administered another antibiotic injection. There was still no improvement, so I took her to the other clinic, where she'll be staying tonight.

This is where your vet failed again. Knowing kitty already had paracetamol in her system, and THEN gave her meloxicam?! Meloxicam is an NSAID, which is also toxic to some degree in cats. Meloxicam must be dosed very specifically in cats, it is usually reserved for pain (like oral or surgical pain), and it is only dosed once as an injection (as a very low dose). Oral doses can be given thereafter, but very short-term. It also depends on your country's veterinary guidelines and restrictions, because subsequent oral doses in cats is not without potentially serious side effects - any use beyond the first injectable dose is done off-label (which means you would not be compensated for damages from the manufacturer). The manufacturer doesn't even approve oral doses in cats because they haven't done any long-term studies of effects. Only one injectable dose is actually approved by the manufacturer for cats.

Ultimately, your vet should never have given any pain reliever at any time without first having determined why kitty is sick. A urinalysis, bloodwork, complete exam should have been done to at least have some clue what was wrong and how to treat.

Likewise, giving multiple injections of an antibiotic is not good practice unless you're treating a very severe health case (like burns or systemic infections)

If bloodwork is to be done in the next coming days, I have to say, I would not be surprised to learn if your kitty has kidney or liver damage from the previous administration(s) and Friday's additional administration of paracetamol. Please understand I am not blaming you, I'm wondering how competent your vet is. Hopefully, the paracetamol was diluted enough to have caused little damage, but you need to be certain, and that is via bloodwork and urinalysis. Address testing to find out why she has been sick, when she has recovered from this incident, or, get bloodwork done now to detect anything that could benefit from treatment now.

Lastly, please always discard all medications when the course of illness is resolved. Never keep old medications, throw them out immediately. They not only can lose effectiveness, but they can spoil, cause gastrointestinal effects etc, and in this case, obviously toxic potential.

I'm keeping your kitty in my thoughts and prayers for a successful recovery, please post updates, I'm very worried about her.

[Cleo]

Whoa! Please keep us posted. Sending prayers and healing thoughts to your kitty.

[Neco]

Glad to hear she's getting treatment, do you trust this vet to know what they're doing?

I think so, yes. I am very tired right now, and the IV will end early in the morning. If the anti-toxicity therapy works, I'll retrieve my cat. Otherwise she'll be staying in the clinic until she improves. I think I'll opt for the blood tests either way.

While I was petting her, before taking her to the clinic, I noticed that her belly and paws felt cold. I was deadly afraid that she was about to develop hypothermia. Her body temperature turned out to be normal at the clinic, but at he lowest limit. Her care unit has a heating pad, so I hope she'll be warm and comfy. She was conscious the whole time and screamed a lot, but she was also quite lethargic.

Was bloodwork or other tests done at that time?

He physically examined the cat and took her temperature, as far as I can remember.

How much exactly, did you end up giving her at that time?

I don't remember exactly. I remember administering it at least twice. I am certain, however, that she did not receive more than 4 cc total. She is two years and a half old, and weighs three kilograms. That means paracetamol toxicity level for her should be 150 mg, according to the link you've posted, though I understand that smaller doses would have detrimental effects as well. Vermidon did have a visible positive effect back then, so it did not occur to me that paracetamol might be toxic.

By apothecary, do you mean a human drugstore or general store, but the vet did not mix it up and give it to you directly?

As far as I know, there are no separate apothecaries for pets here. Drugs are not sold in general stores either, only in apothecaries. We were asked to purchase the Vermidon for infants, which I assume is more diluted. The bottle says that every mL in the solution has 32 mg of paracetamol as active ingredient.

Please inform your housemate NEVER to give any medications to your cat, without first consulting your vet. If the cat belongs to you, then your housemate has no business giving medications at all.

Well, we're kind of taking care of the cat together, though I was the one to adopt her initially. I am not angry at him because I know he was doing it out of good will, but yes, he did the wrong thing. I wouldn't have done the same.

Do you know how much time passed between the time she was given the paracetamol and the time you found out? Vomiting doesn't mean she vomited it all out of her system.

I cannot be sure. I saw the stains when I woke up, a few hours after my housemate administered the medication. The stains were already drying by that time.

Meloxicam must be dosed very specifically in cats, it is usually reserved for pain (like oral or surgical pain), and it is only dosed once as an injection (as a very low dose). Oral doses can be given thereafter, but very short-term.

Meloxicam was not administered orally. He injected 0,2 cc Meloxicam and 0,3 cc Synulox, according to the health certificate.

Thanks for all your help.

[Traci]

But, no NSAIDS should have been given when the vet already knew that paracetamol was given. The lesser of the two evils would be the metacam, since it was relatively a small dose, and dosed only once. (in the US, this is marketed as metacam, in your country, it is meloxicam, it's virtually the same thing as long as the dosing formulation is the same).

For what it's worth, 1 ml is equivalent to 1 cc.
For every 1 cc you gave her, she got 32 mg paracetamol.
You gave paracetamol 32 mg/ml at least twice, and possibly 4 times. That's approximately 64-128 mg, the first time she was sick. Then the vet gave it to her again this week. Therein lies the problem. IF, in fact, the bottle's content was stating correctly that each ml contained 32 mg. The vet should never ever have recommended it, prescribed it, administered it. No matter the dose, it can cause kidney and liver damage, if fatal hemolytic anemia doesn't occur first.

Kitty is relatively young, and hopefully will recover. However, you still have to find out what caused the initial anorexia, drooling, vomiting, etc. It could have been something relatively mild and self-limiting, but it could also have been fever activity, diseased tooth or absess, heat and severe dehydration, or something more serious etc. This still needs to be investigated. Please also discuss with the vet any potential connection to the first time she was sick about a month ago, and determine if treatment failed then and the condition resurfaced now, or if this is unrelated.

The IV's will help any dehydration and any high temperature. Not sure what meds the vet is giving during hospitalization, but he may want to attempt to feed small amounts in the morning to see if she can keep it down. If she can keep it down over the course of a few hours, then bloodwork should be considered, primarily to monitor toxicity and to monitor kidney and liver function. Bloodwork can also help narrow down why she is sick, regardless of the wrong meds given.

Because we don't know the home environment, please check your home for any signs she could have gotten into something, like plants, toxic insects or spiders, bad or rancid food, baits or poison for rodents, make sure you don't give her people-food or snacks, keep all human medications and preps sealed and completely out of reach to her, etc. Look for signs of any leaves or plants nibbled or tipped over, any signs of wrappers or packages ripped or torn, use your best judgment, you know your home best and what to look for.

Again, please don't feel I'm berating you, I certainly am not, and feel for you and your kitty, your vet seems unskilled in small animal medicine, particularly cats, and just hope you can in the future, find a more qualified, educated vet who understands the many contraindications of many medicines in cats. I know that in some countries, vet's often use large animal medications and their doses on small animals, it's wrong, and so risky. I also know that sometimes, access to a great vet can be difficult. Hope this new one takes excellent care of your kitty.

Please post an update when you know more. We're thinking of your kitty, and sending good thoughts for a rapid recovery, please hang in there!!

[Neco]

Whoa! Please keep us posted. Sending prayers and healing thoughts to your kitty.

Thank you.