Successful management of chloralose-intoxication in three cats causing status epilepticus and myoclonus

Chloralose is a rodenticide potentially accessible to outdoor cats. Clin- ical data on intoxication with this substance is needed for improve- ment of treatment and prognosis.
Cat one (DSH, 3 years, fn) showed peracute orofacial seizures with secondary generalization and status epilepticus (SE) managed with midazolam and levetiracetam IV. Laboratory changes were mild hyperammonia and hyperglycemia. Radiographs revealed radio- opaque material in the stomach. Via endoscopy and gastric lavage wrapping of alpha-chloralose mouse bait was salvaged. Subsequent symptomatic treatment resulted in complete remission and discharge after two days.

Cat two (DSH, 8 years, mn) and three (BSH, 6 years, fn) belonging to the same household were presented in SE with 8 hours interval. The cats showed mild hypothermia, bradycardia (124/min; 118/min) and hypersalivation. Laboratory changes included moderate electrolyte imbalances, hyperglycemia and ALT elevation in cat two and moderate hyperglycemia and liver enzyme elevation and hyperbilirubinemia in cat three. Both cats received oxygen, crystalloid fluids, lipid infusion boli, anticonvulsants (intravenous diazepam, midazolam, phenobarbi- tal, followed by oral levetiracetam for one week), glycopyrrolate IM, N-acetylcystein IV, omeprazole IV/PO and lactulose PO. After gener- alized seizures in cat two stopped, myoclonus was seen for 36 hours as well as ataxia until 96 hours later. Cat three developed recurring myoclonus for 30 hours. Both cats were discharged without pathological findings and five-month follow-up was unremarkable. Urine of cat two analyzed via gas chromatography demonstrated absorption of chloralose.
Intoxication with chloralose causing SE has a good outcome if managed rapidly.