Download Table 10.3.1 Stages of chronic kidney disease in dogs and

Table 10.3.1 Stages of chronic kidney disease in dogs and cats
Serum creatinine values (mg/dL)
Stage
Dogs
Cats
Stage 1
<1.4
<1.6
Stage 2
1.4–2.0
1.6–2.8
Stage 3
2.1–5.0
2.9–5.0
Stage 4
>5.0
>5.0
Source: Brown S. Evaluation of chronic renal disease: a staged approach.
Compendium on Continuing Education for Veterinarians 1999; 21:752–763;
http://www.iris-kidney.com.
Table 10.3.2 Causes of acute renal failure
Antibiotics
Trimethoprim–sulfa
Gentamicin
Amikacin
Polymyxin
Rifampin
Medications
Amphotericin B
Cyclosporine
Allopurinol
Penicillamine
NSAIDs
Diuretics
Heavy metals
Lead
Mercury
Chromium
Arsenic
Toxins
Ethylene glycol (antifreeze)
Grapes
Raisins
Lillies (cats)
Mushrooms
Snake venom
Spider venom
Chemotherapeutics
Cisplatin
Carboplatin
Doxorubicin
Azathioprine
Methotrexate
Table 10.4.1 Urine crystal types, characteristics, and significance
Crystal type
Characteristics and significance
Bilirubin
“Red or yellow elongated spicules”; low numbers may be normal in a dog, but if there are high numbers or if
seen in urine from a cat, they signify liver disease or hemolysis.
Struvite
“Prism or coffin lid” crystals; form in alkaline urine, most often seen in normal dogs but also may be present with
concurrent urolithiasis in association with a urease-producing bacterial UTI. In cats, they may also be normal but
can be associated with urolithiasis.
Calcium oxalate
dihydrate
“Envelope-shaped” crystals; can be normal in dogs and cats, but if there is support for ARF and large numbers
are present, ethylene glycol should be considered.
Calcium oxalate
monohydrate
“Picket fence” or “dumbbell”-shaped crystals; their presence is usually associated with ethylene glycol toxicity.
Ammonium
urate
“Thorn apple shape”; they can form in any pH but usually form in alkaline urine. Often found in Dalmatian dogs
and in some English bulldogs. Concurrent urolithiasis may or may not be present. Urates also occur in animals
with severe liver insufficiency (e.g., portosystemic shunts, liver failure).
Cystine
“Hexagon” crystals; forms in acidic urine and is never a normal finding. Its presence indicates that the kidneys
are not reabsorbing certain amino acids properly due to an error in metabolism. Documented in many canine
breeds, but the Newfoundland, English bulldog, and dachshund are predisposed. Also reported in cats.
Amorphous
Aggregates of crystalline material without any particular shape generally have no clinical significance unless they
are xanthine crystals that occur following administration of allopurinol for urate urolithiasis.
Cholesterol
Rare crystal type in animals and has been seen in normal dogs.
Drug crystals
The most common drug crystal is the sulfonamide crystal, which forms in acidic urine. Other drugs that can form
crystals in urine include radiographic contrast dyes, ampicillin, and primidone.
Source: http://ahdc.vet.cornell.edu/clinpath/modules/ua-rout/crystsed.htm.
Table 10.4.2 Localization of azotemia
Clinical feature
Prerenal azotemia
Renal azotemia
Postrenal azotemia
Azotemia
Mild to moderate
Possible evidence of dehydration
on physical examination
Mild to marked
Mild to marked
Urine specific gravity
>1.030 dogs
>1.035 cats
<1.030 dogs
<1.035 cats
Often 1.007–1.015
Variable
Physical signs of urinary tract obstruction
and/or signs of urinary tract rupture
Absent
Absent
Present
Response to fluid therapy
Azotemia resolves in 1–2 days
Partial or no
resolution of azotemia
Complete, partial to no
resolution of azotemia
Table 10.4.3 Diseases or conditions associated with systemic
hypertension
Hypertension
Dogs
Cats
Chronic kidney disease
Chronic kidney disease
Acute kidney disease
Hyperadrenocorticism
Idiopathic
Idiopathic
Iatrogenic
Iatrogenic
Diabetes mellitus
Diabetes mellitus
Obesity
Obesity
Primary hyperaldosteronism
Primary hyperaldosteronism
Pheochromocytoma
Pheochromocytoma
Hypothyroidism
Hyperthyroidism
Table 10.6.1 Comparison of modalities when imaging the urinary tract
Procedure
Structures
visualized
Sedation
indicated
Contrast
route
Dose
Basic radiographs
Entire abdomen
No
No
NA
Excretory urogram
Kidneys, bladder,
ureters, urethra
No
IV
600–880 mg iodine/kg
Iodinated contrast media
Cystogram
Bladder
Yes
Urinary
catheter
3.5–13.1 mL/kg
Iodinated contrast
media—diluted 100 mg
iodine/mL
Cystourethrogram
Bladder, urethra
Yes
Urinary
catheter
10–15 mL boluses
Iodinated contrast
media—diluted 100 mg
iodine/mL
Double contrast
cystogram
Bladder
Yes
Urinary
catheter
0.5–1.0 mL per cat;
1–3 mL per dog <12 kg;
3–6 mL per dog >12 kg
Iodinated contrast
media—diluted 400 mg
iodine/mL
Vaginourethrogram
Vagina, distal
urethra
Yes
Urinary
catheter
20–30 mL boluses
Iodinated contrast
media—diluted 100 mg
iodine/mL
Abdominal
ultrasound
Entire abdomen
Possibly
No
NA
NA
CT scan
Entire abdomen
Yes—anesthesia
IV
1.4 mL/lb
Iodinated contrast media
NA, not applicable.
Contrast media
Table 10.7.1 Potential nephrotoxic medications in dogs and cats
Class
Examples
Class
Examples
Antifungals/antivirals
Amphotericin B
Miscellaneous
Angiotensin-converting enzyme
inhibitors (ACEIs)
Acyclovir
Foscarnet
Antimicrobials
Aminoglycosides (e.g., Amikacin)
Aztreonam
Carbapenems
Cephalosporins
Fluoroquinolones
Antiprotozoals
Apomorphine
Calcium, EDTA
Cimetidine
Dextran 40
Mannitol
Nafcillin
Non-steroidal anti-inflammatory
drugs
Penicillins
Penicillamine
Polymyxin
Streptokinase
Rifampin
Thiacetarsemide
Sulfonamides
Thiazide diuretics
Tetracyclines
Cholecalciferol
Tobramycin
Methoxyflurane
Vancomycin
Lipid-lowering agents
Trimethoprim–sulfamethoxazole
Lithium
Sulfadiazine
Thiacetarsamide
Phosphorus-containing urinary
acidifiers
Pentamidine
Tricyclic antidepressants
Dapsone
Immunosuppressants/
chemotherapeutics
Allopurinol
Azathioprine
Cyclosporine
Bisphosphonates
Carboplatin
Cisplatin
Doxorubicin
Interleukin-2
Methotrexate
Source: Complied from Langston C. Acute uremia. In: Textbook of Veterinary
Internal Medicine, 7th edition, eds. SE Ettinger, EC Feldman, p. 1972.
Canada: St. Louis, MO: W.B. Saunders; 2010; Polzin DJ. Chronic kidney
disease. In: Textbook of Veterinary Internal Medicine, 7th edition, eds. SE
Ettinger, EC Feldman, p. 1972. Canada: St. Louis, MO: W.B. Saunders; 2010;
Stokes JE. Diagnostic approach to acute azotemia. In: Kirk’s Current
Veterinary Therapy, 14th edition, eds. JD Bonagura, DC Twedt, p. 856. St.
Louis, MO: Saunders Elsevier; 2009.
Table 10.7.2 Medications that may need dosage alterations in patients with decreased renal function and medications that do not need dosage
alterations in patients with decreased renal function
Drug
a Route
Standard dose
Modified dosage based on IRIS staging
Stage I
Stage II
Stage III
Stage IV
Amikacin
IV
15–30 mg/kg
q 24 h
11–22 mg/kg
q 24 ha
7.5–15 mg/kg
q 24 ha
3.75–7.5 mg/kg
q 24 ha
3.75–7.5 mg/
kg q 24 h-EODa
Amoxicillin
IV, PO
10–20 mg/kg
q 24 h
NA
NA
10–20 mg/kg
q 24 h
10 mg/kg
q 24 h
Ampicillin
IV
10–20 mg/kg
q 8–12 h
NA
10–20 mg/kg
q 12 h
10–20 mg/kg
q 12–24 h
10 mg/kg IV
q 24 h
Atenolol
PO
0.25 mg/kg
q 12–24 h
NA
0.19 mg/kg
q 12–24 h
0.125 mg/kg
q 12–24 h
0.06 mg/kg
q 24 h
Azithromycin
PO
5–10 mg/kg
q 24 h
NA
NA
NA
NA
Benazepril
PO
0.25–0.5 mg/
kg q 12–24 h
NA
NA
0.2–0.3 mg/kg
q 24 h
0.125 mg/kg
q 24 h
Cefazolin
IV
10–30 mg/kg
q 8 h
NA
7.5–22.5 mg/kg
q 8 h
5–15 mg/kg
q 12 h
5–15 mg/kg
q 24 h
Ceftriaxone
IV
15–20 mg/kg
q 12–24 h
N.A
NA
12–16 mg/kg
q 24 hb
7.5–10 mg/kg
q 24 hb
Diltiazem
IV, PO
0.5–1.5 mg/kg
q 8 h
NA
NA
NA
NA
Doxycycline
IV, PO
5–10 mg/kg
q 12 h
NA
NA
NA
NA
Enalapril
PO
0.5 mg/kg
q 12–24 h
NA
0.375–0.5 mg/
kg q 12–24 h
0.25–
0.375 mg/kg
q 12–24 h
0.25 mg/kg
q 24 h
Enrofloxacin
IV, IM,
PO
2.5–5 mg/kg
q 12 h
NA
1.25–2.5 mg/kg
q 12 h
1.25–2.5 mg/kg
q 24 h
0.825–
1.65 mg/kg
q 24 h
Famotidine
IV, PO
0.5–1 mg/kg
q 12–24 h
NA
0.5 mg/kg
q 24 h
0.5 mg/kg
q 24 h
0.5 mg/kg
q 24 h
Fluconazole
PO
5–10 mg/kg
q 12–24 h
NA
5–10 mg/kg
q 24 h
5–10 mg/kg
q 24-EOD
5–10 mg/kg
q EOD-ETD
Imipenem
IV
5–10 mg/kg
q 8 h
5.75 mg/kg
q 8 h
2.5–5 mg/kg
q 8 h
2.5–5 mg/kg
q 8–12 h
1.25–2.5 mg/
kg q 12–24 h
Ketoconazole
PO
5–10 mg/kg
q 12 h
NA
NA
NA
NA
Metoclopramide
IV, PO
0.2–0.4 mg/kg
q 8 h
NA
0.15–0.3 mg/kg
q 8 h
0.1–0.2 mg/kg
q 8 h
0.1–0.2 mg/
kg q 8 h
Mirtazapine
PO
3.75 mg per
cat q 24 h
NA
1.88 mg per cat
q 48 h
1.88 mg per cat
q 48 h
1.88 mg per
cat q 48 h
Metronidazole
IV, PO
10–15 mg/kg
q 8–24 h
NA
NA
NA
5–12.5 mg/kg
q 8–24 h
Ondansetron
PO
0.1–1 mg/kg
12–24 h
NA
NA
0.05–0.5 mg/kg
q 12–24 h
0.025–
0.25 mg/kg
q 12–24 h
Prazosin
PO
1–4 mg per
dog q 12–24 h
NA
NA
1–2 mg / dog
q 12–24 h
0.75–1.5 mg /
dog q 12–24 h
Propranolol
PO
0.1–0.2 mg/kg
q 8 h
NA
NA
NA
0.08–
0.16 mg/kg
q 8 h
Ranitidine
IV, PO
0.5–2 mg/kg
q 8–12 h
NA
0.25–1 mg/kg
q 8–12 h
0.25–1 mg/kg
q 12–24 h
0.25 mg/kg
q 24 h-EOD
Spironolactone
PO
1–2 mg/kg
q 12 h
1 mg/kg
q 12 h
0.5 mg/kg
q 24 h
0.25 mg/kg
q 24 h
C.I.
Tramadol
PO
1–4 mg/kg
q 8–12 h
1–4 mg/kg
q 12 h
0.5–2 mg/kg
q 12 h
0.5–1 mg/kg
q 8–12 h
0.5–1 mg/kg
q 12–24 h
Vancomycin
IV
10–20 mg/kg
q 6–12 h
10 mg/kg
q 12 ha
5 mg/kg
q 12–24 ha
1.25–2.5 mg/kg
q 12–24 ha
1.25–2.5 mg/
kg q 24 h-EODa
Preferable to monitor serum levels.
Reduce further with hepatic insufficiency.
IRIS, International Renal Interest Society; NA, no adjustment required; PO, by mouth; IV, intravenous; EOD, every other day; ETD, every third day; C.I.,
Contraindicated.
Source: Compiled from Karriker M. Drug dosing in renal failure and the dialysis patient. In: Proceedings of the Advanced Renal Therapies Symposium, pp. 8–12.
New York; 2006; Plumb DC. Plumb’s Veterinary Drug Handbook, 6th edition. Ames, IA: Blackwell; 2008; Cowgill LD, Kallet AJ. Systemic hypertension. In: Current
Veterinary Therapy IX, Small Animal Practice, ed. RW Kirk, p. 360. Philadelphia, PA: W.B. Saunders; 1986.
b Table 10.7.3 International Renal Interest Society (IRIS) chronic kidney
disease (CKD) substaging system based on urine protein to creatinine
ratio
Substage
Dog
Cat
Non-proteinuric (NP)
<0.2
<0.2
Borderline proteinuric (BP)
0.2–0.5
0.2–0.4
Proteinuric (P)
>0.5
>0.4
Source: http://www.iris-kidney.com/pdf/IRIS2009_Staging_CKD.pdf.
Table 10.7.4 Assessment of hydration status based on physical examination
Hydration status
Clinical signs
Skin
Eyes
Mucous membranes
Heart rate
<5%: Normal hydration
Turgor < 2 s
Moist, normal
position
Moist, pink, CRT < 2 s
Normal for species
6–8%: Mild dehydration
Turgor > 3 s, inelastic and leathery;
twist disappears immediately
Duller than
normal, sunken
Tacky to dry, CRT < 2 s
Normal to possibly
increased
8–10%: Moderate
dehydration
Turgor > 3 s, inelastic and leathery;
twist disappears slowly
Duller than
normal, sunken
Tacky to dry, CRT
normal to increased
Heart rate
increased
10–12%: Severe
dehydration
Turgor remains, no elasticity; twist
remains
Dry, deeply
sunken
Dry, cyanotic, CRT
prolonged or absent
Heart rate
increased, pulse
weak
12–15%: Shock
Death is imminent
CRT, capillary refill time.
Source: Jack CM, Watson PM. Veterinary Technician’s Daily Reference Guide, 2nd edition, p. 360. Ames, IA: Blackwell Publishing; 2008.
Table 10.7.5 Drugs used in the management of acute renal failure and chronic kidney disease
Drug
Standard dose
Adverse effect
Therapies to treat hyperkalemia
Calcium gluconate 10% solution
0.5–1.0 mL/kg IV slow bolus
Arrhythmias
Sodium bicarbonate
0.5–2 mEq/kg IV slow bolus
Hypernatremia, hypokalemia, decreased
ionized calcium
Dextrose
0.1–0.5 g/kg IV or 1–2 mL/kg 25% solution
Hyperglycemia, hyperosmolality
Regular insulin/dextrose
0.25–0.5 U/kg insulin with 1–2 g dextrose per
unit insulin given, IV
Hypoglycemia
Therapies to treat nausea/vomiting
Cimetidine (Tagamet®)
5.0 mg/kg PO, IM, IV q 6–8 h
Altered drug metabolism
Ranitidine (Zantac®)
0.5–2 mg/kg PO, IV q 12 h
Rare, agranulocytosis, vomiting
Famotidine (Pepcid®)
0.5–1 mg/kg PO, IV, SC, IM
q 12–24 h
Bradycardia (IV), agranulocytosis,
vomiting
Misoprostol (Cytotec®)
1–5 µg/kg PO q 6–8 h
GI upset, uterine contraction
Sucralfate (Carafate )
0.25–1gram PO q 8–12 h
Constipation (d)
Aminopentamide hydrogen sulfate
(Centrine®)
0.1–0.4 mg SC, IM q 8–12 h
Dry mouth, dry eyes, blurred vision,
urinary hesitancy/retention
Metoclopramide (Reglan®)
0.2–0.4 mg/kg PO, SC, IM q 8 h
Anorexia, vomiting, depression,
mydriasis, neurological signs
Chlorpromazine (Thorazine®)
0.2–0.4 mg/kg SC, IM q 8 h (d); 0.5 mg/kg IV,
IM, SC q 6–8 h (c)
CNS depression, vomiting, diarrhea,
anorexia, paradoxical excitement (c)
Dolasetron mesylate (Anzemet®)
0.6–1 mg/kg PO q 12 h
Dose related ECG interval prolongation
Ondansetron (Zofran )
0.6–1 mg/kg PO, IV q 12 h (d); 0.1–0.15 mg/kg
slow IV q6–12h
Constipation, extrapyramidal clinical
signs, arrhythmias, hypotension
Maropitant citrate (Cerenia®)
1 mg/kg SC q24h, 2 mg/kg PO q 24 h (d);
extra label use at same dose (c)
Swelling/pain at injection site, diarrhea,
anorexia
®
®
Therapies to manage hyperphosphatemia/hyperparathyroidism
Aluminum hydroxide (Amphogel®,
Alu-caps®)
30–90 mg/kg/day PO
GI upset, constipation, aluminum toxicity
with advanced CKD
Aluminum hydroxide/magnesium
hydroxide (Maalox®)
30–90 mg/kg/day PO
GI upset, constipation, aluminum toxicity
with advanced CKD
Aluminum carbonate (Basalgel®)
30–90 mg/kg/day PO
GI upset, constipation, aluminum toxicity
with advanced CKD
Calcium acetate (PhosLo®)
60–90 mg/kg/day PO
Hypercalcemia
Calcium citrate (Citracal )
60–90 mg/kg/day PO
Hypercalcemia
Calcium carbonate
90–150 mg/kg/day PO
Hypercalcemia
25–40 mg/kg PO q 12 h
Potentially GI upset
30–90 mg/kg per day
Potentially GI upset
1 gm/5 kg PO q 12 h with a meal
Hypercalcemia
If creatinine 2–3 and P < 6 mg/dL =
2.5–3.5 ng/kg/day PO
Hypercalcemia (particular concern with
calcium-based P binders, e.g., calcium
carbonate)
®
®
Sevelamer (Renagel )
®
Lanthanum carbonate (Fosrenol )
Epakitin
®
®
Calcitriol (Rocaltrol )
If creatinine >3 and P < 6 mg/dL, obtain PTH
level = 3.5 ng/kg/day PO
Therapies to stimulate appetite
Diazepam
0.05 to 0.15 mg/kg IV (c)
Avoid PO administration due to
behavioral changes, hepatic failure
0.25–0.5 mg/kg PO q 12–24 h
Sedation, ataxia
Cyproheptadine (Periactin )
0.2 mg/kg PO q12h (d), 0.35–1 mg/kg PO
q 12 h (c)
Sedation, mucous membranes dryness,
paradoxical agitation (c)
Mirtazapine (Remeron®)
3.75 mg PO q 24 (c)
Increased vocalization and affection
Oxazepam (Serax®)
®
Assorted therapies
Sodium bicarbonate
8–12 mg/kg PO q 8–12 h (d)
1 mEq/cat PO q 8–12 h (c)
Hypernatremia, hypokalemia, decreased
ionized calcium
Potassium citrate (Cytra K Liquid®)
35 mg/kg PO q 8 h
Metabolic alkalosis, decreased ionized
calcium, hyperkalemia
Potassium gluconate
2 mEq per 4.5 kg PO q 12 h
Hyperkalemia
If <2.3 kg, 1 cap PO q 24 h;
Possible vomiting and diarrhea
Azodyl
®
If 2.3–4.5 kg, 1 cap PO q 12 h;
If >4.5 kg, 2 cap AM, 1 cap PM PO
Rubenal
®
If 8–12 kg, 0.5 tab PO q 12 h;
None listed
If 13–25 kg, 1 tab PO q 12 h;
If 26–45 kg, 2 tab PO q 12 h;
If >45 kg, 3 tab PO q 12 h
Essential fatty acids/omega fish oil
(Dermapet Eicosaderm® and OFA
plus EZ-C caps®; F.A. caps; Omega
EFA capsules®)
Due to the unique composition of each
product, see actual label directions
If contains vitamin A the acute toxicosis
may result
CKD, chronic kidney disease; c, cat; d, dog; creat, creatinine; P, phosphorus; PO, by mouth; SC, subcutaneous; IM, intramuscular; IV, intravenous; h, hour; d, day;
BW, body weight.
Source: Modified from Lane IF. Treatment of urinary disorders. In: Small Animal Clinical Pharmacology Therapeutics, ed. DM Booth. Philadelphia, PA: Saunders;
2001.
Table 10.7.6 Potassium supplementation based on serum potassium
concentrations
Serum potassium
concentration (mEq/L)
Recommended concentration
in fluid (mEq/L)
3.5–5.5
20
3.0–3.5
30
2.5–3.0
40
2.0–2.5
60
<2.0
80
Table 10.7.7 Normal blood pressure ranges and stages of
hypertension in dogs and cats
a Blood
pressure stage
Systolic
Diastolic
Potential
adaptationa
Normal
120
80
None
Minimal risk
<150
<95
<10 mmHg
above RR
Low risk
150–159
95–99
10–20 mmHg
above RR
Moderate risk
160–179
100–119
20–40 mmHg
above RR
Severe risk
≥180
≥120
≥40 mmHg
above RR
Although not widely available currently, it is ideal to use normal blood
pressure ranges determined for specific breeds and to compare
measurements to the upper limits of the normal range. Certain breeds (e.g.,
sight hounds) have a higher reference range.
RR, reference range.
Source: Modified from IRIS. Staging of CKD. http://www.iris-kidney.com/
education/en/education06.shtml; 2009.
Table 10.7.8 Medications used in the treatment of hypertension in dogs and cats
Drug
Standard dose
Adverse effect
Furosemide (Lasix®)
2.5–5 mg/kg PO, IV, IM q 12–24 h
Fluid and electrolyte abnormalities, prerenal
azotemia, ototoxicity
Spironolactone (Aldactone®)
1–2 mg/kg PO q 12 h (c)
Mild fluid and electrolyte abnormalities, azotemia,
acidosis
Propranolol (Inderal®)
2.5–5 mg/cat PO 8–12 h (c)
Bronchoconstriction, hypotension, bradycardia,
congestive heart failure
Atenolol (Tenormin®)
2 mg/kg/day (c),
Bronchoconstriction, hypotension, bradycardia,
congestive heart failure
0.25–2 mg/kg/day (d)
Enalapril (Vasotec®)
0.25 mg/kg PO q 24 h to 0.5 mg/kg PO q 12 h
Hypotension, decreased renal perfusion, hyperkalemia,
GI upset, rarely myelosuppression, seizures
Benazepril (Lotensin®)
0.25–0.5 mg/kg PO q 12–24 h
Hypotension, decreased renal perfusion, hyperkalemia,
GI upset, rarely myelosuppression, seizures
Amlodipine (Norvasc®)
0.625–1.25 mg/cat PO q 12–24 h (c);
Hypotension, cardiac arrhythmias, GI upset
0.05–0.25 up to 1 mg/kg PO q 24 h (d)
Hydralazine (Apresoline®)
0.5–2 mg/kg PO q 8–12 h (d); 2.5 mg/cat PO
q 12–24 h (c)
Hypotension, reflex tachycardia, sodium/water
retention, GI upset
Nitroprusside sodium
(Nitropress®)
1–2 mcg/kg/min (d);
Hypotension, nausea
0.5 mcg/kg/min (c)
c, cats; d, dogs; PO, by mouth; IM, intramuscular; IV, intravenous.
Table 10.7.9 Antimicrobial agent-specific factors that influence
selection for urinary infections
1. Easy to administer
2. Associated with few, if any, adverse effects
3. Affordability
4. Able to attain urine concentrations (e.g., prostatitis) that
exceed the bacterial minimum inhibitory concentration
(MIC) by ≥4-fold
5. Unlikely to adversely affect gastrointestinal flora
Table 10.7.10 Antimicrobial agents commonly used in urinary conditions
Drug
Administration
route
Standard dose
Adverse effect
Amikacin
IV
15–30 mg/kg q 24 h
Nephrotoxicity, ototoxicity, neuromuscular blockade
Amoxicillin
PO, IV
10–20 mg/kg q 24 h
Anorexia, vomiting, diarrhea
Ampicillin
IV
10–20 mg/kg q 8–12 h
Hypersensitivity reactions (fever, bone marrow
disorders)
Amoxicillin–
clavulanic acid
(Clavamox)
PO
12.5–13.75 mg/kg q 12 h
Anorexia, vomiting, diarrhea, hypersensitivity
reactions
Cefazolin
IV
10–30 mg/kg q 8 h
Hypersensitivity reactions (fever, bone marrow
disorders)
Cefovecin
(Convenia®)
SC
8 mg/kg q 14 d
Hypersensitivity reactions (fever, bone marrow
disorders), injection site pain
Ceftriaxone
(Rocephin®)
IM, IV
15–50 mg/kg q 12 h
Hypersensitivity reactions (fever, bone marrow
disorders)
Cephalexin
PO
30–40 mg/kg q 8 h
Salivation, tachypnea, excitability, nephrotoxicity,
hypersensitivity reactions
Chloramphenicol
PO
45–60 mg/kg q 8 h
Dose-related, reversible bone marrow suppression,
aplastic anemia (human)
Clindamycin
PO, SC, IM
5–11 mg/kg q 12 h
Vomiting, diarrhea, esophageal injuries
Doxycycline
PO, IV
5–10 mg/kg q 12 h
Vomiting, esophageal injuries (stricture)
Enrofloxacin
PO, IM, IV
2.5–5 mg/kg q 12 h
Vomiting, anorexia, ocular toxicity causing
blindness, potential cartilage abnormalities
Gentamicin
SC, IM, IV
6–8 mg/kg q 24 h
Nephrotoxicity, ototoxicity, neuromuscular blockade
Nitrofurantoin
PO
4–5 mg/kg q 6–8 h
Vomiting, hepatopathy
Imipenemcilastatin sodium
SC, IV
5–10 mg/kg q 8 h
Vomiting, anorexia, diarrhea, CNS toxicity,
hypersensitivity
Penicillin G
IM, IV
25,000–40,000 U/kg q 12–24 h
Hypersensitivity reactions (fever, bone marrow
disorders)
Tetracycline
PO
16 mg/kg q 8 h
Vomiting, anorexia, diarrhea, discoloration to teeth
in young animals
Trimethoprim/
sulfadiazine
PO
30 mg/kg q 24 h
Keratoconjunctivitis sicca, acute hepatitis,
hypothyroidism, acute hypersensitivity
Vancomycin
IV
10–20 mg/kg q 6–12 h
Nephrotoxicity, ototoxicity
PO, by mouth; SC, subcutaneous; IM, intramuscular; IV, intravenous; h, hour; d, day; BW, body weight; CNS, central nervous system.
Table 10.7.11 Medications used in the therapy of urinary incontinence
Drug
Administration
route
Standard dose
Adverse effect
Bethanechol
PO
5–25 mg (total dose) q 8 h
Vomiting, diarrhea, salivation, anorexia,
bradycardia, arrhythmias, hypotension
Baclofen
PO
1–2 mg/kg q 8 h
Sedation, weakness, pruritus, salivation
Phenoxybenzamine
PO
0.25 mg/kg q 12–24 h
Hypotension, hypertension, miosis, increased
IOP and heart rate
Prazosin
PO
1 mg per15 kg of BW q 12–24 h
Hypotension, lethargy, dizziness, vomiting,
diarrhea
Diazepam
PO
0.2 mg/kg or 2–10 mg total
dose q 8 h
Sedation, excitement, irritability, weakness,
depression
Dantrolene
PO
1–5 mg/kg q 8–12 h
Hepatotoxicity, weakness, sedation, dizziness,
vomiting, constipation
Phenylpropanolamine
PO
1.0–1.5 mg/kg q 8–12 h
Restless; increased heart rate, BP, IOP;
hepatic glycogenolysis
Diethylstilbestrol (DES)
PO
0.1–1 mg q 24 h × 3–5 d; then
1 mg/wk
Bone marrow suppression, alopecia, behavior
changes, signs consistent of estrus
Testosterone cypionate
IM
2.2 mg/kg q 4–8 weeks
Prostate enlargement
Imipramine
PO
5–15 mg q12h
Sedation, seizures, constipation, vomiting,
tachycardia, bone marrow suppression
Flavoxate
PO
100–200 mg (total dose) q 6–8 h
Weakness
Oxybutynin
PO
2–5 mg (total dose) q 8–12 h
Diarrhea, constipation, urine retention,
hypersalivation, sedation
Propantheline bromide
PO
7.5–30 mg (total dose) from q 8
to 24 h
Dry mouth and eyes, urinary hesitancy,
elevated heart rate, constipation
PO, by mouth; IM, intramuscular; h, hour; d, day; BW, body weight; IOP, intraocular pressure; BP, blood pressure.
Table 10.9.1 Selected commercial diets for patients with chronic kidney disease
Canine
Feline
Royal Canin Veterinary Diet Canine Renal Low Protein (LP)
Royal Canin Veterinary Diet Feline Renal Low Protein (LP)
Royal Canin Veterinary Diet Canine Renal Medium Protein (MP)
Royal Canin Veterinary Diet Canine-Reduced Protein
Royal Canin Veterinary Diet Feline-Reduced Protein
Hill’s Prescription Diet Canine k/d
Hill’s Prescription Diet Feline k/d
a
a Iams Veterinary Formulas Canine Renal Early Stage
Iams Veterinary Formulas Feline Multi-Stage Renal
Purina Veterinary Diets Canine NF
Purina Veterinary Diets Feline NF
Only available in dry kibble.
Table 10.9.2 Selected commercial diets for the treatment and
prevention of canine uroliths
Canine
urolith diets
Dissolution
Prevention
Struvite
Hill’s Prescription
Diet Canine s/d
Hill’s Prescription
Diet Canine c/da
Royal Canin
Veterinary Diet
Urinary SO
Royal Canin
Veterinary Diet
Canine Urinary SO
Royal Canin
Veterinary Diet
Canine Preventative
Calcium
oxalate
NA
Hill’s Prescription
Diet Canine u/d
Royal Canin
Veterinary Diet
Urinary SO
Urate
a Hill’s Prescription
Diet u/d
Hill’s Prescription
Diet u/d
Royal Canin
Veterinary Diet
Urinary UC Low
Purine
Royal Canin
Veterinary Diet
Urinary UC Low
Purine
Canine struvite uroliths are usually infection induced; dietary modification
for prevention is usually not required.
NA, not applicable.
Table 10.9.3 Selected commercial diets for the treatment and
prevention of feline uroliths
Feline
urolith diets
Dissolution
Prevention
Struvite
Hill’s Prescription
Diet Feline s/d
Hill’s Prescription Diet
Feline c/d Multicare
Iams Veterinary Formula
Urinary-S-low pH/S
Purina Veterinary
Diet UR st/ox
Purina Veterinary Diets
UR st/ox
Royal Canin
Veterinary Diet
Feline Dissolution
Royal Canin Veterinary
Diet Feline Preventative
Royal Canin Veterinary
Diet Urinary SO
Calcium
oxalate
NA
Hill’s Prescription Diet
Feline c/d Multicare
Iams Veterinary Formula
Urinary-O-Moderate pH/O
Purina Veterinary Diets
UR st/ox
Royal Canin Veterinary
Diet Feline Urinary SO