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Today's VeTerinary PracTice | november/december 2015 | tvpjournal.com symPTomaTic managemenT of Primary acuTe gasTroenTeriTis Peer reviewed 48 secondary to an underlying disease, such as hypoadrenocorticism, it is essential to treat the primary condition in addition to providing symptomatic and supportive therapy. This article emphasizes symptomatic treatment of primary acute gastroenteritis rather than detailing specifc treatment of serious underlying diseases that may cause similar clinical signs. ANTIEMETIC DRUGS For acute gastroenteritis, antiemetic therapy is often used for the initial 24 to 48 hours when vomiting is a prominent clinical sign (Table 3). Benefts include: • Improved patient comfort • Decreased ongoing fluid and electrolyte losses • Earlier reintroduction of enteral nutrition • Reduced risk of esophagitis and esophageal stricture formation. Take care not to mask ongoing disease with prolonged (ie, greater than 3 days) antiemetic therapy. In addition, to reduce the risk of gastrointestinal perforation and avoid delay of surgical intervention by masking clinical signs of intestinal obstruction, do not administer antiemetic or prokinetic drug therapy when a foreign body is suspected or confrmed. Several classes of antiemetic drugs are used in small animal medicine. Occasionally, refractory cases require the use of more than one of these drugs at the same time. Ondansetron & Dolasetron Ondansetron and dolasetron are serotonin (5-HT 3 ) antagonists with potent antiemetic activity that are commonly used off-label to control nausea in dogs and cats. This class of drug blocks the chemoreceptor trigger zone and vagal afferent pathways involved in emesis. In our experience, these drugs are very effective for control of vomiting in dogs and cats. Maropitant Substance P is a neurotransmitter that binds to neurokinin-1 (NK-1) receptors and can result in vomiting. Therefore, NK-1 receptor antagonists are powerful antiemetics effective at treating both peripheral and central causes of vomiting. Maropitant, a NK-1 receptor antagonist, is currently the only licensed antiemetic for use in dogs and cats and, in our opinion, is very effective. This drug may also have an analgesic effect and, thus, is widely used in patients with vomiting and abdominal pain, such as those with pancreatitis. 1 The effcacy of maropitant for the control of presumed nausea is controversial as some studies have shown a beneft while others have not documented a beneft. 2-6 While maropitant is not licensed for IV use, we and other clinicians have administered it by this route—at a dose of 1 mg/kg Q 24 H—without apparent adverse effects. The manufacturer recommends that after 5 days of continuous Table 3. Medical Therapy for Vomiting Due to Acute Gastroenteritis DRUG DOGS CATS Antiemetics Ondansetron 0.1–1 mg/kg PO Q 12–24 H 0.1–1 mg/kg PO or IV Q 12–24 H Dolasetron 0.5–1 mg/kg IV Q 12 H 0.6 mg/kg IV Q 12 H Maropitant 1 mg/kg SC Q 24 H 2 mg/kg PO Q 24 H 1 mg/kg IV Q 24 H a 1 mg/kg SC Q 24 H 2 mg/kg PO Q 24 H 1 mg/kg IV Q 24 H a Metoclopramide 0.2 mg/kg SC or PO Q 8 H 1–2 mg/kg/H IV CRI 0.2–0.4 mg/kg PO or SC Q 6–8 H 1–2 mg/kg/H IV CRI Gastroprotectants Sucralfate 0.5–1 g PO Q 8–12 H (tablet or slurry) b 0.5 g PO Q 8–12 H (tablet or slurry) b Famotidine 1 mg/kg PO or IV Q 12 H 1 mg/kg PO or IV Q 12 H Omeprazole 1 mg/kg PO Q 12 H 1 mg/kg PO Q 12 H Pantoprazole 1 mg/kg IV Q 24 H 1 mg/kg IV Q 24 H Misoprostol 2–5 mcg/kg PO Q 8–12 H Not applicable a. Not a manufacturer recommended route of administration b. Potential reduced risk of emesis if administered as a slurry