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Pyridostigmine bromide intoxication in two domestic cats
  1. Koen Maurits Santifort1,
  2. Matthijs van Luin2 and
  3. Paul Mandigers3
  1. 1 Neurology department, Veterinair Verwijscentrum de Pietersberg, Oosterbeek, The Netherlands
  2. 2 Apotheek, Ziekenhuis Rijnstate, Arnhem, The Netherlands
  3. 3 Department of Clinical Sciences of Companion Animals, Universiteit Utrecht Faculteit Diergeneeskunde, Utrecht, The Netherlands
  1. Correspondence to Koen Maurits Santifort; koensantifort{at}


A one-year-old female neutered cat died soon after presentation with severe signs of a cholinergic crisis. Its sibling was presented soon thereafter, in which cholinergic signs were also readily apparent. The owner, a myasthenia gravis patient, used pyridostigmine bromide tablets, and it was hypothesised that a pyridostigmine bromide intoxication was the cause of this cholinergic crisis. Treatment with 0.1 mg/kg atropine injected intramuscularly soon alleviated most of the cholinergic signs. Additional treatment, which included decontamination with enteral activated charcoal, intravenous fluid therapy, laxation and supportive care, as well as repeat administration of atropine, resulted in resolution of signs after 48 hours. A serum sample collected 30 hours after admission revealed that the total cholinesterase activity was reduced by 44 per cent, compared with a baseline value measured in a sample taken three weeks after the intoxication. This is the first report of human-prescribed pyridostigmine bromide intoxication in domestic cats.

  • toxicology
  • neuromuscular disorders
  • neurology
  • medicines
  • diagnostics
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  • Contributors KMS: conception and design, analysis and interpretation, drafting the manuscript, critical revision. MvL: analysis and interpretation, drafting the manuscript, critical revision. PM: analysis and interpretation, drafting the manuscript, critical revision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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