C.S.I Bangalow: Spiked Custard?

One of three companion cats at a local nursing home, 1 year-old, Puddles was much loved by staff and residents. He was rushed to hospital after a Friday night on the tiles, with profuse vomiting and diarrhoea. Twelve hours earlier he was playful, and hungrily devoured his usual supper with the residents; now he was depressed and unable to walk.  What could have caused such a rapid deterioration?

Delirious and disorientated, with pupils constricted and third eyelids up, Puddles looked F.O.I. (fully-out-of-it). His limited responsiveness to stimuli could have been a direct effect of a mystery toxin on the brain, or secondary to the effects of all that vomiting on blood glucose, hydration and blood salts.

Heart rate was 120bpm, pulse weak, and his gums and tongue had a distinct purple hue – reflecting cardiovascular complications, shock, or possibly paracetamol  poisoning (yes, Panadol is toxic to cats). Irrespective of cause, it wasn’t reason for optimism.

Puddles looked even more unwell when placed on paws and encouraged to walk. Too weak to support his own bodyweight, his limb muscles rendered non-functional by convulsive muscle spasms. This combination of gastrointestinal and neurologic symptoms always raises a vet’s suspicion of exposure to a toxin, but to what poisons did Puddles have access?

Some of Puddles’ symptoms were typical of poisoning with insecticidal families of toxins. There hadn’t been any recent use of flea or tick products, nor contact with Advantix-treated dogs.  Pest controllers had visited the previous week, to spray for ants and roaches, but the other cats and rabbits, that shared Puddles’ environment and food, were all well.

The nursing home pharmacy dispensed hundreds of pills a day; over 50 different drugs, ranging from anti-inflammatories and psychotropics, to blood thinners and heart medications. Initially, I was skeptical of drug intoxication, as it’s hard enough to get a cat to eat food, let alone a pill dropped by a resident.

‘Well, no. About one third of drugs are crushed and served up in custard or jam.’

Could one of the residents have inadvertently shared their meds with Puddles?

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The patient was admitted to hospital for blood tests and intravenous fluids. His blood was thick and dark and slow to collect. Tests revealed severe dehydration, elevated blood potassium, and severely depressed white cell counts.  Feline Panleukopenia, a life-threatening virus, can manifest as gastrointestinal signs with suppressed white cells, but this was a disease to which Puddles was immune, virtue of kittenhood vaccinations.

Liver and kidneys were functioning well, and reason for hope. There were none of the characteristic red blood cell abnormalities of paracetamol poisoning.

Fortunately, much of the time, clinicians don’t need to pinpoint an exact toxin, drug or pathogen causing a disease. We can simply use treatments that counteract the symptoms. Fluids and electrolytes correct dehydration and salt imbalances, anti-emetics stop vomiting, Valium relaxes muscle spasm, and atropine antagonises some of the neurologic effects.

Within 12 hours, Puddles was sniffing food and able to stand; one day later he was eating and keeping it down; and once the diarrhoea abated, he was happily reunited with his family of 60 residents.

The underlying cause of Puddles’ illness will remain a mystery, but the combination of gastrointestinal and neurological signs makes intoxication more likely than infectious agent.  Was it a pharmaceutical, dressed-up in custard? Or an insecticide sprayed by pest controllers? For as long as Puddles and his feline companions remain in good health, these are questions we can feel comfortable leaving unanswered.

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LESSONS LEARNT

  • While most drugs can be used in treating both man and animal, there are some drugs that are uniquely toxic in one species. Paracetamol (Panadol) is one such drug in the cat.
  • Doses of drugs, destined for man, are usually much higher than those for pets, and a human dose is likely to result in OD in a cat.
  • Hiding drugs in food is a useful strategy for getting your grandmother or cat to take their medication, until cat eats the custard, or granny takes to cat food.
  • If gastrointestinal and neurological symptoms are combined, think toxin, see vet.

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2 Responses to “C.S.I Bangalow: Spiked Custard?”

  1. antonia staff says:

    When I was working in a big community hosptital in my youth the pigs got a lot of largacitl!!

  2. matt says:

    Phenothiazines like largactil are quiet reliable and safe in the pig.

    I’m sure there would have been pig-fights over who got the custard.

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