![]() ![]() Hypergastrinaemia was demonstrated in feline CKD (Goldstein et al., 1998), where the prevalence of high plasma gastrin concentrations increased with the clinical stage of CKD. It had been assumed that gastric hyperacidity and uraemic gastritis contribute to the reduced appetite, nausea and vomiting seen in cats. Many anti-emetic drugs licensed for human use are labelled as anti-nausea as well as anti-emetics. The neurophysiological mechanisms underlying the sensation of nausea are not well understood and are difficult to study, but neuronal activity in the brain stem that triggers the vomiting reflex seems to radiate to higher CNS levels and give rise to the sensation of nausea. In cats, it is possible that nausea may underlie the poor appetite that is associated with IRIS CKD IRIS Stages 3 and 4. The most common signs suggestive of nausea are salivation, lip licking and restlessness (Kenward et al., 2015), followed by excessive swallowing, abnormal body posture, lethargy and depression. However, in feline patients we can only observe physical signs or behaviours that suggest a cat is nauseous. Nausea is a reported symptom, a sensation we can perceive and describe. People describe waves of nausea ('feeling sick to the stomach') that precede vomiting and are relieved when the action of vomiting occurs but, if the signals to the brain do not reach the trigger threshold, the waves of nausea may continue. It occurs when multiple stimuli from the periphery and other areas of the brain stimulate the vomiting centre in the medulla and exceed the threshold to trigger the vomiting reflex. Vomiting is a protective mechanism leading to the expulsion of the contents of the stomach. the irritant effects of urea at high concentrations on gut mucous membranes). ![]() Vomiting might result from central effects (uraemic toxins stimulating the chemoreceptor trigger zone, for example) and peripheral mechanisms (e.g. Accumulation of nitrogenous waste products other than urea and creatinine affect the appetite centres in the brain and are thought to underlie the reduced appetite of cats with CKD. Inappetence and weight loss are more common than vomiting in IRIS CKD stages 3 and 4. The prevalence of these signs is not well characterised in the literature. Poor appetite is the main reason owners perceive their cat's quality of life is reduced with CKD (Reynolds et al., 2010 Bijsmans et al., 2015). As cats reach IRIS CKD Stages 3 and 4 they start to lose weight, eat less and vomit. Vomiting and inappetence are clinical signs associated with the later stages of chronic kidney disease (CKD) in cats. Jonathan Elliott, Royal Veterinary College, University of London, UK (revised 2022) ![]()
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