Pomeranian CHF/PULM EDEMA

Question
My 10 year old pom, who's been diabetic for 4 months, went into flash pulmonary edema & chf on saturday.  She started fainting, then had breathing difficulty, & developed a loud murmur.  She's been to the vet everyday since.  She received an Im of a steroid, iv lasix,enacard, and po theophyline on sunday & by monday am she was vomiting & hasn't been able to keep anything down, not even water.  Her BG was >500 & it is now down to 325 at midnoc.  She had her last dose of NPH at 430pm.  i brought her in monday for iv fluids & im lasix (since she won't take anything po).  They also gave her an Im of ?pepcid? too.  What is going on?  Is her GI problem now related to any meds?  Her breathing is better, her heart is still pounding away, she's dying of thirst, & can barely stand to walk.  Help me please....

Answer
I would give her small amounts of pedialyte to help keep her hydrated.   Try some meat baby food to see if she will keep that down instead of regular dog food.  She will need to continue on the lasix and enacard longterm...there is a possibility that the enacard could be upsetting her stomach, therefore, you could try to split the dose and give it twice a day.  The vomiting may simply be from her diabetes not being controlled.  If she is not coughing and having asthma symptoms, I would not keep her on the theophylline as that may be increasing the heart rate (see below).

SIDE EFFECTS

The negative side effects of theophylline include: restlessness/caffeine type jitters (this can be minimized by starting the medication at a lower dose and gradually increasing to the recommended dose), diuretic effect (some individuals only), upset stomach, racing heart rate with abnormal rhythm.

INTERACTIONS WITH OTHER DRUGS

Enrofloxaccin (Baytril), for example, will increase blood levels of theophylline dramatically and the side effects listed above may actually become a problem.  Other medications which can increase the activity of theophylline include cimetadine (tagamet), clindamycin, erythromycin, lincocin, and allopurinol.  Theophylline may decrease the effect of beta blockers (heart medicines) such as propranolol.




Usually in this case, I would recommend she go to a veterinary specialty cardiologist so s/he can prescribe the correct therapy for the CHF as it sounds like she will need additional meds.   And since she is so ill, a 24 hour care facility would be your best bet in getting her stable.