Side effects from Lactulose...Need advice ASAP!

fatlily29 · Sep 27, 2014

Hi Everyone- I'm new on here but I desperately need advice regarding my cat who has been on lactulose for the last week or so. He went into the vet a week ago because he was extremely constipated (vomiting, wouldn't eat, couldn't poop, etc). They cleaned him out & he was like a different cat...eating, happy, etc. They had me give him 3ml of lactulose, three times a day (for reference, he's 22 lbs). After about 6 days on that, he started having horrible diarrhea that was leaking out of him (sorry, gross) and hasn't eaten in a few days and this morning, he threw up foamy bile. It's very obvious that he's not feeling well because of the high amount of lactulose he's on so I stopped the medicine two days ago (against the advice of my vet...they recommended reducing the dosage to 2ml twice a day when I called yesterday) and he is still having diarrhea and just overall, doesnt feel great and won't eat.

I put a call into my vet this morning when they opened & some vet tech called me back after they closed, who didn't seem to know anything and she basically told me to go to an emergency vet clinic because they were closed and couldn't do anything. Does anyone have any ideas for what to do without taking him to an emergency clinic and paying hundreds of dollars? I asked my vet for an anti-nausea drug and they wouldn't give me one until Monday because they closed today and I just can't have him sitting here with diarrhea, throwing up, etc until my vet can get around to giving him an anti-nausea drug (quite irritated with my vet right now). I know cats can't have pepto-bismol..but is there anything else that will help him?

mosimom · Sep 27, 2014

I don't have any experience to pass on. Have you considered Miralax to help the constipation? The lactulose cannot be tolerated by some cats and I've heard it just stops working over time.
Do a search here on miralax.

micknsnicks2mom · Sep 27, 2014

@fatlily29 -- welcome to TCS! i'm sorry you're here because your boy hasn't been feeling well though.

how long has it been since your boy has eaten? has he been able to keep any food down in the last 2 or 3 days?

the first thing i'd work on and immediately is to try to entice your boy to eat a little at a time. there is the very real risk of kitty developing hepatic lipidosis (fatty liver disease) from not eating enough. fatty liver disease can be life threatening. i'd suggest trying a little meat stage 1 baby food (the kind that has for it's ingredients just poultry/ham/beef, water, and some brands have a bit of cornstarch added), very small amounts every hour or so at first (to see how he does with that. the stage 1 jar meat baby food is smooth/pureed and is very easy on upset tummies and is easy to digest. you could try 1/4 tablet of pepcid ac (it must be pepcid ac original strength or maximum strength, not any other pepcid type), and make sure your boy eats a little of the baby food with (when he swallows) the 1/4 tablet. i wouldn't give more than 1/4 tablet twice each day, until you can get your boy to a vet.

i need to ask -- is your boy on any medications, prescription or over the counter? i'm asking because i wouldn't want to suggest the pepcid ac if there was a possibility that it could have a negative interaction with another medicine.

honestly, i might consider looking for a different vet if it were me. whether you stay with your current vet or start with a different vet, you might discuss trying miralax to help with your boys constipation. miralax is an over the counter medicine, and the dosage can be lowered or adjusted up (to a maximum daily dose you'd need to ask your vet about, for your boy in particular). i use miralax for my girl every day and she does very well staying not constipated. miralax is a powder and has no smell or taste to it, so it can be easily mixed into canned cat food for kitty to eat.

peaches08 · Sep 27, 2014

I'm wondering if some boiled chicken might help as well? Not canned chicken chunks because they contain so much sodium, but plain boiled chicken? Even better if the broth was made by boiling bone in it too. You can feed the boiled chicken and the broth, but definitely throw the cooked bones away. Some pedialyte may be helpful too, since diarrhea and vomiting can upset the kitties electrolyte balance.

fatlily29 · Sep 27, 2014

Thanks everyone for the tips! I have heard that Lactulose is pretty harsh & I'm going to be switching him to Miralax after this bottle is gone. Partially because he seems to not do well with it and partially because it's horribly messy and sticky. I made some cream of rice (no salt added) and mixed it with tuna water and was able to force feed it to him with an eye dropper. I just needed to get something in his stomach & he wouldn't eat. It's been about 2 hours since I did that and he seems to have perked up a little which is good. I'm going to the store to get him some chicken baby food & some plain pedialyte to get some electrolytes back into his system.

I am definitely switching vets after this. He's somewhat of a high maintenance cat & they just don't seem to know how to handle him there. I think he's going to be better off if I take him to a cat vet that sees kitties like him more often.

fatlily29 · Sep 27, 2014

mickNsnicks2mom said:
@fatlily29 -- welcome to TCS! i'm sorry you're here because your boy hasn't been feeling well though.

how long has it been since your boy has eaten? has he been able to keep any food down in the last 2 or 3 days?

He hasn't eaten his regular food since Wednesday but today, some of his food was gone & he did drink the tuna water I gave him. I also fed him cream of rice & tuna water with an eye dropper just so he would have calories. He hasn't been vomiting any food but he did vomit foamy bile this morning

mosimom · Sep 27, 2014

I would drop the lactulose and go with the miralax immediately...but that's just my opinion.

raintyger · Sep 27, 2014

Has there been any poop at all lately? Diarrhea can be a sign of severe constipation. Nothing is able to get out, so only the drippy stuff can work its way around. Not saying he's constipated, but that would also explain not eating and vomitting. I think you need a vet visit.

fatlily29 · Sep 27, 2014

Raintyger said:
Has there been any poop at all lately? Diarrhea can be a sign of severe constipation. Nothing is able to get out, so only the drippy stuff can work its way around. Not saying he's constipated, but that would also explain not eating and vomitting. I think you need a vet visit.

Oh he's definitely not constipated. That was the original issue...however, they anesthetized him last week, cleaned him out, and kept him over night & ensured he was unconstipated by doing an X-ray. Thats why he was started on such a high dosage of lactulose- so that he wouldn't become constipated again.

lvnoah · Sep 27, 2014

I'm so sorry you have to go through this. That seems like a really high amount of lactulose your vet prescribed. My cat is heavier than yours and they only recommended 1.5 ml twice per day after he had the same procedure. He was on that amount for awhile until I switched to Miralax. I think the advice that others have given you is right, especially in regards to getting him to eat and drink a bit.

If it were me, I would probably stop the lactulose until you get in touch with your vet or a new vet who has more experience with this. I don't think that stopping the lactulose for a day or two will make him constipated again and it might make him feel much better. But that's just my opinion. Go with your gut and do what you think is right.

On a side note, please look into what caused the constipation in the first place. I know you are busy with what he's dealing with now, but just keep it in mind. I'm saying this from personal experience. My cat just had his third clean out. He now has megacolon from being constipated over and over again. I wish after his first clean out, I had made major changes but I didn't because I didn't think it would happen again.

Hope he feels better!

fatlily29 · Sep 27, 2014

Well, I was able to get some pedialyte into him using an eye dropper & then mixed up cream of rice with chicken baby food & warm water and fed him some of that with the eye dropper. I'm going to pick up the food for the night & now give him any until morning now to see if hopefully his appetite kicks in and he starts feeling better. Poor old man.

LVnoah- I stopped the Lactulose on Thursday and I'm not giving it to him again until the diarrhea is gone. Its a stool softener and clearly his stools are plenty soft! I thought that the amount was really high too. He had this procedure done at a different vet two years ago and they put him on 1ml 3x a day...so basically this vet increased it by three times which seems like a LOT. He also weighed about 5 pounds more the first time around. The X-ray didn't show a megacolon but he's now on Science Diet w/d which is a higher fiber and weight loss food.

lvnoah · Sep 27, 2014

I'm glad you were able to get some fluids and food into him. I'm also super happy the X-ray didn't show mega colon.

The first time Noah had his clean out procedure they put him on Science Diet W/D as well. However, he continued to have constipation issues and eventually needed a second clean out. Science Diet has a reputation for not being the healthiest food in the world. Extra fiber can help some cats with constipation but in others make it much worse. Sometimes cats respond better to low-residue diets which is what my cat does better on. If you want to go the high fiber route, I would find a cat food with better ingredients. If you have the time and want to learn a lot about cat food then go to this webpage http://www.catinfo.org/#Prescription/Therapeutic_Diets_ It's long, but it's fantastic and talks about Hill's prescription diet. It helped me so much.

Back to the problem at hand, when your cat had his clean out did he have an enema and manual removal of feces? What exactly did they do? Has the vomiting decreased at all since stopping the lactulose?

fatlily29 · Sep 27, 2014

LvNoah said:
I'm glad you were able to get some fluids and food into him. I'm also super happy the X-ray didn't show mega colon.

The first time Noah had his clean out procedure they put him on Science Diet W/D as well. However, he continued to have constipation issues and eventually needed a second clean out. Science Diet has a reputation for not being the healthiest food in the world. Extra fiber can help some cats with constipation but in others make it much worse. Sometimes cats respond better to low-residue diets which is what my cat does better on. If you want to go the high fiber route, I would find a cat food with better ingredients. If you have the time and want to learn a lot about cat food then go to this webpage http://www.catinfo.org/#Prescription/Therapeutic_Diets_ It's long, but it's fantastic and talks about Hill's prescription diet. It helped me so much.

Back to the problem at hand, when your cat had his clean out did he have an enema and manual removal of feces? What exactly did they do? Has the vomiting decreased at all since stopping the lactulose?

That's good to know- I know vets try to push science diet on people but I've never fed it to my animals before this. I'm not sure if he had an enema but he did have a manual removal. He didn't vomit at all until this morning and he had been off lactulose for 36 hours at that point, but still had diarrhea. His vomit was only foamy bile and he hasn't vomited again since then. However, I just walked downstairs where his litterbox is & saw him in it and he was straining to poop so I gave him lactulose again. I don't know what to do - he was literally leaking diarrhea to the point where he had to have a bath & now he's constipated? I just don't get it.

lvnoah · Sep 28, 2014

I'm so sorry. I've been through this and it sucks. Every cat reacts differently to having this done and you never know what's normal and what you should worry about.

When you can, I would try to find out if he had an enema or not. When my cat had mine, he leaked black fluid/diarrhea for days afterwards. Then a week passed and still no bowel movement - I thought he was constipated. So I brought him back to my vet, had him x-rayed and it turned out he was fine. He had some soft poo in there that finally came out a few hours later. The reason it took so long for him to go was that the enema/deobstipation cleaned him out completely and I only gave him wet food so it took awhile for the poo to form and be pushed out. He also strained a couple of times during the week which I think might have been small pieces of poo left over from the procedure which can be difficult to push out. So you're cat might not be necessarily constipated.

I'm sorry the vet that did this doesn't seem to be of much help. I also feel like my own vet didn't prepare enough me for what to expect after having this kind of procedure done. One thing I have learned is that you should always ask for all of your kitty's medical records and x-rays when he has something like this done. After paying all that money, you should have access to the x-rays and radiologist report so you can see for yourself and make sure he is getting the right treatment. You will also know every procedure that was done and every medication he was administered. Plus, if you switch vets or ever need an emergency vet you can have everything ready.

How is he doing today?

fatlily29 · Sep 28, 2014

LvNoah said:
I'm so sorry. I've been through this and it sucks. Every cat reacts differently to having this done and you never know what's normal and what you should worry about.

When you can, I would try to find out if he had an enema or not. When my cat had mine, he leaked black fluid/diarrhea for days afterwards. Then a week passed and still no bowel movement - I thought he was constipated. So I brought him back to my vet, had him x-rayed and it turned out he was fine. He had some soft poo in there that finally came out a few hours later. The reason it took so long for him to go was that the enema/deobstipation cleaned him out completely and I only gave him wet food so it took awhile for the poo to form and be pushed out. He also strained a couple of times during the week which I think might have been small pieces of poo left over from the procedure which can be difficult to push out. So you're cat might not be necessarily constipated.

I'm sorry the vet that did this doesn't seem to be of much help. I also feel like my own vet didn't prepare enough me for what to expect after having this kind of procedure done. One thing I have learned is that you should always ask for all of your kitty's medical records and x-rays when he has something like this done. After paying all that money, you should have access to the x-rays and radiologist report so you can see for yourself and make sure he is getting the right treatment. You will also know every procedure that was done and every medication he was administered. Plus, if you switch vets or ever need an emergency vet you can have everything ready.

How is he doing today?

That could be the reason- I'll ask when I call the vet tomorrow. He still isn't interested in food this morning. I tried offering him a tablespoon of chicken baby food and he won't touch it & then I offered him some dry food and he wasn't interested. It's just strange because he's not lethargic at all..he's walking around the house & everything just fine. I just truly have no idea whats wrong with him and knowing our vet, they're going to want me to spend hundreds of dollars to figure out why. His procedure last week was $300- they're making a fortune off of him!

raintyger · Sep 28, 2014

He may be constipated again, the symptoms do sound like it. $300 actually sounds kinda cheap for a clean out. You figure around $75-$100 for an x-ray, and they have to have bloodwork to knock him out ($100), plus the cleanout.

fatlily29 · Sep 28, 2014

fatlily29 · Sep 28, 2014

Well...he's worse today. I'm finding chunks of hard poop all around the basement, which is what he was doing before he had the procedure done. He also vomited up all the food I fed him with an eye dropper

I'm angry with the vet because I they promised me he would be like a new cat and a million times better after this procedure was done. I just don't understand how he could be constipated (he has the exact same symptoms as he did when he was constipated) a week after having the clean out and being on 9mL of lactulose a day. I just can't wrap my head around it.

lvnoah · Sep 28, 2014

I know it's frustrating, but try to hang in there

. I think it's a good sign that he is walking around and acting normal. The hard chunks of poo could be left over from the clean out. The colon has a curve to it and sometimes they can't get around it. So they clean out what they can, prescribe stool softeners, and wait for the rest to make its way out.

It definitely sounds like the lactulose is not doing its job. It could also be a reason as to why he's vomiting. Cats hate the sweet taste of it and it may also be causing some kind of reaction. I would think about using Miralax instead to see if it works better for him. Keep us posted.

fatlily29 · Sep 29, 2014

Update: I took Lily into the vet this morning as soon as they opened & they did another xray and he's just as constipated as he was 10 days ago. However, they said the stool is soft which means he has megacolon because he doesnt have the muscle tone to pass it. That's really sad news for me because unfortunately it means that this is something we would have to deal with forever and run the risk of Lily being in pain whenever he gets constipated again, which is inevitable. We're trying one last thing, which is another enema while he's awake and injecting him with Cispride to help him pass it. If he can't pass it on his own with the help of that, we're going to have to make a tough decision because it means that the Cisapride isn't helping him and he just cant go on his own. If it does help him, he will be on the Cisapride and a low dose of lactulose for the rest of his life but the vet said there's no guarantee that wont be back in a week for the same issue.

Tough decisions having to be made today

Side effects from Lactulose...Need advice ASAP!

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