Metacam and my cat; overdose

[peterg2]

I moved to Montreal from Vancouver last year, having had wonderful
veterinary care from my 2 vets there and the Critical Care Group for
some 16 years.

3 weeks ago I brought my 11 year old female kitty in for a full panel
and a general check-up. One of the prime motivating forces was that the
night before while stroking her I found a small marble-size lump by her
right foreleg. Fortunately, it was not attached to bone and muscle and
was moveable. A fine needle aspirate showed very little and it was
decided to excise the lump at the same time that she had a dental
cleaning (2 weeks from then).

Then starts the whole debacle. The geriatric panel showed her serum
glucose at 16.8 mmol/L. This could well have been stress hyperglycemia
after the wait at the vet and the very rough way she was handled by the
vet tech. The vet then suggested a urinalysis would be conclusive but I
had doubts as if this was stress hypergylcemia to do a urinalysis the
next day would perhaps be pointless due to the glucose being dumped into
the urine 24 hours afterwards.

I suggested a fructosamine test and this came back normal. I wondered
then why it was I who had to suggest this.

Her Bun and Creatinine then were 25.21 and 1.56 respectively - US figures and 9 and 138 SI as we know it in Canada..

Surgery was set for 2 weeks then for excision of the lump and the teeth
cleaning.

I suppose I was remiss in not asking what drugs they would be using,
including NSAIDs. Ironically, a friend of mine had contacted me some 6
months earlier and had told me that her vet had prescribed Metacam for
her cat's condition. I then proceeded to warn her about the dangers of
this drug.

Well the surgery went fine but I was told that the vet tech got some
files mixed up and she was given the Metacam dosage for another animal.
She allegedly was given 0.4 mg/kg (she is 6.2 kgs) when she was supposed
to have received 0.2 mg. I really have no idea what dosage she was
actually given but this is what I was told. I do know that Boehringer,
the manufacturer of the drug have advised a 0.3 mg/kg one shot dosage
post or pre-surgery. I have read loads of peer-review studies on Metacam
and was frightened.

The error was supposedly discovered immediately and the cat was put on
iv fluids for 24 hours. Bun and Creatinine were then drawn 24 hours
later and they were low due to the IV fluids. Bun was 13.17 (due to
fluids) and creatinine was 1.22 US units and 4.7 108 SI units.

A week later, yesterday, bun and creatinine were tested and Bun was a
bit lower than it was 3 weeks ago at 22.41 (8 in SI units) but creatinine had gone up a
lot from the 1.56 to 1.92 (170 with the normal maximum range of 177). Normal range for the lab is 0.57 to 2.0

I am devastated - Forget about the lump, the biopsy of which I might get
today or early next week.

The vet when I phoned up last night said when I asked him how were the
results he said "She's fine!". To me that is not fine and after I got
the figures from him he said we should do another test in 2 weeks.

I really do not know what else to say. Any advice would be most
appreciated.

Hey, I have some good news regarding my other kitty.
Here is my original post 4 years ago on this:

http://groups.google.com/group/alt.m...hread/thread/a
73ce1d8ca4c0d98?
hl=en&q=idiopathic+hypercalcemia+peter+group:rec.p ets.cats.
*#da6aba922427264c

or using tinyurl:

http://tinyurl.com/6qe6rx

4 years ago I made a post to both rec.pets.cats.health+behav and
alt.med.veterinary about my cats idiopathic hypercalcemia. I tested
every which way and had ultrasounds and even exploratory surgery as
there was a a possibility of a parathyroid problem (which I hoped for).
I consulted twice with the Cornell Feline Health Center, had numerous
visits to the Critical Care Group in Vancouver (a specialized hospital)
and read every single peer reviewed journal on this. Nobody had a
solution. So once a year he was on prednisolone, I gave him IV fluids to
increase the volume and fed him Hill's X/D which is really low in
Calcium and he liked.

Then earlier this year while browsing I picked up anecdotal information
that Lactulose might create hypercalcemia. I knew from reading studies
that when lactulose is ingested with a meal it does increase calcium
absorption but that is why I gave lactulose at least 30 minutes before a
meal. But hypercalcemia? I was not sure.

This kitty I had adopted after he dragged himself to my door with a
broken pelvis some 10 years ago (he was a stray whom I fed whenever he
came by). From the beginning he was on lactulose - 5 ccs twice a day.

Anyhow, I read about Miralax aka Peg 3350 and substituted that for
lactulose and a month later I did a test. After about 40 elevated serum
calcium and ionised calcium tests this one came back normal and he was a
reborn kitty. So that is the good news this year.

Unfortunately, the bad news is all above with my girl.

Peter

[chico2]

Peter,I have no advice to give do not know anything about Metacam,but I am sorry this happend to your little girl:sad:
I am sure some of our cat-gurus will reply to you very soon.
It is difficult if you have to change vets,especially if you really trusted your old vet.maybe you should ask other pet-owners about another vet,that's how I found this wonderful new vet for my 3 kitties.
Good Luck with the little girl

[Love4himies]

Doesn't rustycat have some experience with Metacam in cats? I'll pm her with a link to this post.

[peterg2]

Thanks for the replies so far.

I suppose what I am looking for is some idea of whether any additional treatment can be given prior to her next bloodtest (which I am doing this Wednesday when she has her stitches removed from the lump excision operation).

Remember that IV fluids were given apparently immediately after the administration of the metacam dose (double what she was intended to receive and 1/3 higher than what the drug manufacturer recommends as a standard one-shot pre or post op dosage).

After 24 hours of this her bun and creatine were lower than what they normally were 3 weeks prior - Bun below normal and creatine 108 on a scale of 50 to 200. So I suppose then there would not have been a point to continuing IV fluids.

I suppose my question is, even though the cat is clinically fine and eating well, would administering sub-qs be of any value? I have given sub-qs for years to my boy when he had the idiopatic hypercalcemia and I do still have supplies of needles, lines and fluids. I do have however NaCl only which my girl might find quite tough as opposed to say Lactated Ringers.

My point is, assuming that this is a reversible acute insult, would sub-qs help or really do nothing at all supportive now.

Peter

[hazelrunpack]

You might want to PM Dr Lee--sounds like what you need is the advice of a vet.

Hmmmm...can you PM yet? Maybe not...

I'll send him the link

[sugarcatmom]

I think it would be tough for anyone to say what sort of damage, if any, might be possible from the Metacam overdose. I understand your concern but at this point I can't see subQ fluids being entirely necessary. What does she eat? If it's dry food, I would suggest switching to an all wet food diet since that's one of the best ways to keep kidneys in better health.

[peterg2]

Thanks once again for the replies.

Both the kitties have always been on a high quality canned diet with dry merely being a form of a snack representing no more than about 10-15% of caloric intake. I have also been watchful for years about phosphorus levels which some of the "boutique" brands seem to have excessive levels of (clearly using low quality meat meals with high levels of bones).

I also did not think sub-qs would really help and was just trying to think of something supportive of possible healing.

Peter

[RUSTYcat]

Originally Posted by peterg2

...She allegedly was given 0.4 mg/kg (she is 6.2 kgs) when she was supposed to have received 0.2 mg. I really have no idea what dosage she was actually given but this is what I was told. I do know that Boehringer, the manufacturer of the drug have advised a 0.3 mg/kg one shot dosage post or pre-surgery...

Love4himies- thanx for the heads-up!

Quite coincidently, I just finished reading peterg2's story on the Itchmo Metacam/Meloxicam thread. And, I read it on a blog somewhere else last night. Hats off to you, peterg2 for getting the word out there that this is NOT a drug to be taken lightly in cats!

The licensing approval for injectible Metacam in Canada is set at a dosage of .2mg/kg...MAXIMUM....so by those standards - and, if .4mg/kg is what was actually administered, then she received twice the allowable dosage:

"Cats
Single subcutaneous injection at a dosage of 0.2 mg/kg (0.04 mL/kg) before surgery. Give the lowest effective dose; giving a dose of 0.2 mg/kg is not always necessary. Do not exceed the recommended dose (see Contraindications and Cautions sections). The use of parenteral fluids during surgery should be considered to reduce the risk of renal toxicity when using NSAIDs perioperatively."

Note the recommendation (italicized red) that the cat receive IV fluids during the surgery. (Some Veterinarians will also keep the cat on IV for a period of time after surgery as well.)

One other point of interest on that reference page (the product insert):
"Concurrent Perioperative Therapy
Metacam® has been used in combination with the following anaesthetic protocols with no adverse events having been reported.
Cats
- Acepromazine, thiopentone and halothane
- Acepromazine, glycopyrrolate, propofol and isoflurane
Translation: The safety of Metacam in combination with other anaesthetic "combos" has not been established. So, IF other pre-anaesthetic/anaesthetic drugs were used...........

If I found myself in this situation, I'd go running towards the closest feline-only practice I could find - with a copy of that Vet's file in hand.

[peterg2]

Here is an update to my current situation. I do not know if I am going insane but here goes.

Today - I am still with the same vet for the moment until I can find another one whom I trust - I took my girl in for another Bun and Creatinine test as well as urine Specific Gravity which was not done last week. The figures came back this evening. Urine was 1.035 which is right on the edge of normal although it was not the first of the day which is normally the most concentrated.. The Bun was a bit lower than before but I don't think it is that important compared to Creatinine - Bun was 20.16 mg/dl US figures or 7.2 mmol/L as we use in Canada and Europe. so on the lower end of normal. Creatinine was essentially the same as last week -a very slight slight bit lower at 1.91 mg/dl US or 169 umol/L International, with the lab maximum being 2.00 mg/dl/177 umol/L

Here comes the kicker. I paid in full for her surgery etc etc when I picked her up after I heard about the metacam overdose. I never balked at this at all. I *assumed* that the bun and creatinine testing a week ago was for the account of the vet (he admits that they screwed up) and I assume it was. However the testing today which I wanted due to the high normal creatinine apparently was not supposed to be on the vet's account but my account and also the urine specific gravity.

I was floored. I said is there any charge for removing sutures and I was told no. I then said to the secretary that I assumed there was no charge for the bun and creatine and urinalysis and she said she did not know. The office manager said the same. One vet, not the owner said "this is not my practice so I cannot say but it would not seem right". The owner ummed and ahhed and said "the cat is normal but nothing will satisfy you....". He very reluctantly agreed to cancel today's bill for bun etc. He reiterated again that he is fully responsible for the overdose but this drug has shown in his practice to have very few problems.


Am I going nuts??

And here is another ringer. My boy has to have a couple of stitches removed around his tail next Monday. Should I say screw it with this vet practice (although the particular vet who gave him the stitches is really nice and I like him) and just take him somewhere else for that? It is a minor thing and will take 1 minute but I really have not found a decent vet yet to continue.

Peter

[Dr Lee]

Originally Posted by peterg2

The owner ummed and ahhed and said "the cat is normal but nothing will satisfy you....".

Peter,

I am glad that a Urine Specific gravity was done. It is very important. Has the vet performed a complete urinalysis? It might also prove useful.

I am glad that they took off the charges for you. I think the owner should be a bit more thankful to your understanding and willing to work through this unfortunate situation.

[peterg2]

Dear Dr Lee,

Thank you very much for replying. I actually wanted to have a full geriatric panel run and a urinalysis but with his blowing off my concerns I felt I was wasting my time.

I will take my cat to another vet in about 2-4 weeks to do a full panel and urinalysis. I ensured that this vet also uses the same laboratory - Idexx - so the results are directly comparable.

One of my vets in Vancouver (where I lived previously) actually suggested I might wish to contact the local veterinary board in my province and lodge a complaint as to the way the owner handled the post-overdose situation.

Peter

[chico2]

Peter,how is your kitty doing???

[peterg2]

Originally Posted by chico2

Peter,how is your kitty doing???

Hi chico2,

Clinically she appears fine but what is lurking in the months to come that concerns me. Will her creatinine stay within normal (her urine SG seems fine and bun is actually low end of normal)? That is why I am going to be testing her periodically.

[chico2]

I am glad she's doing ok,but regular testing sounds like a good idea.
My 13yr old boy has HyperT and is tested every 3 months,I've never felt comfortable giving my cats meds,but when they need it,they need it