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Delayed vomiting is more common in our patients. This is due to direct damage to rapidly dividing GIT cells (crypt cells) or via the centrally mediated CRTZ stimulated via gut vagal efferents. Delayed vomiting is most commonly 2 to 5 days post-chemo and seen with doxorubicin
and the vinca alkaloids. Clinical signs include vomiting, diarrhea, anorexia, lethargy, weakness, + dehydration.
For work up, I recommend CBC, chemistry panel, UA, +/- fecal floatation and cultures. If abdominal pain is present, consider AXR or AUS to rule out foreign body, obstruction, and intussusception. For patients with GI neoplasia, it can be challenging to differentiate chemotherapy side effects vs. disease, and a good history can be key.
For outpatient treatment, I recommend NPO, food & water trial, bland diet, anti-emetics, antibiotics with severe diarrhea and a probiotic. Do not forget to discontinue oral chemotherapy or delay chemotherapy treatment. In addition, I recommend prophylactic therapy with the next chemotherapy.
For inpatient, I add injectable antiemetics, IV fluid therapy, and IV antibiotics. An important note, I strongly encourage owners to NOT EUTHANIZE at this time. It is amazing with 1 to 2 days of good supportive care how quickly these patients improve. And with prophylactic therapy and a dose reduction, these patients can tolerate the same chemotherapy drug.
REFERENCES
1. Gustafson DL, Page RL. Cancer Chemotherapy. In: Small Animal Clinical Oncology. 5th ed. St. Louis Missouri: Elsevier Saunders; 2013: 157-179
2. Rodriquez CO. Chemotherapy. In: Cancer Management in Small Animal Practice. Saunders 2010. Page 101-121.
3. Dhaliwal RS. Managing Oncologic Emergencies. In: Cancer Management in Small Animal Practice. Saunders 2010. Page 122-136.
4. Chretin JD, et al, JVIM, 2007; 21(1):141-8. 5. Rau SE, et al, JVIM 2010; 24(6):1452-7.
An Urban Experience
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