Yellow cat

Re: Yellow cat

Busybee — Tue, 27 Mar 2012 19:50:59 GMT

Unfortunately, the cat was PTS this morning. The owner came to visit and decided she didn't want to continue.

[quote user="Kate Richardson"]I assume haematology was normal? How low was the potassium? It could be secondary to anorexia, and causing the weakness, however, also consider other primary hypokalaemic problems. What was USG? (NB was the leucocyte + in the urine from the dipstick? if so ignore it, designed for human use, not a reliable indicator in animals). Any other liver function markers- albumin/urea/creat levels? Sorry to be pedantic about numbers, but the degree of elevation/reduction does tell me an awful lot sometimes.[/quote]

Haematology normal. Potassium I think was down at 2.8mmol/L initially but managed to get it up to 3.2mmol/L (normal 3.8-4.2mmol/L I think!) with IVFT + K+. USG 1.034 and yes dipstick was human so I know it's not reliable. Albumin normal but lower end, urea was slightly increased (~12 I think) but normal on 2nd bloods, creatinine wouldn't read on our machine as the blood was so icteric but concerned may have been high as cat very PUPD.

[quote user="Kate Richardson"]So treatment wise if owners really don't want to do an ultrasound (and I would advise someone fairly experienced if possible- a large mass may be easy to pick up, but something small and subtle or pancreatic/subtle hepatic changes not easy to be certain of unless you have experience) then as you are doing- ivf/potassium supplementation (is cat still on ivf/potassium? cos if not eating well, it's potassium levels will not improve unless you maintain the intake- I can put doses up later if that would help), clav good, but consider adding marboflox and metronidazole so you have full 4 quadrant cover, destolit good idea. Add pain relief (buprenorphine)- cat may or may not be painful, but sometimes can only tell by treating. Consider adding anti-emetics eg maropitant, also antacids. SAMe (Hepatosyl or similar) as well. And nutrition so important, so either syringe feed or feeding tube of nec.[/quote]

Was on IVFT + K+ til the end. Cat was looking pretty rubbish this morning, becoming more ataxic and having episodes of pain (or neuro involvement?) by way of vocalising, then champing down on the bars of the kennel and almost straining. Nurse at one point thought he was on his own way out. Gave the owners option of ultrasound again or treating with metronidazole and buprenorphine but with the risks of using both in an animal with liver compromise (last ditch attempt!). Unfortunately, owner decided to PTS as cat not responding to present treatment and both clinically and on bloods was getting worse.

Re: Yellow cat

plantagenet — Tue, 27 Mar 2012 14:33:04 GMT

I have found Denamarin very helpful.

Re: Yellow cat

Kate Richardson — Tue, 27 Mar 2012 08:45:01 GMT

[quote user="Busybee"]

Been seeing a cat this week who, in brief, presented with weakness, anorexia and jaundice. Male netuered cat, about 12yrs old, had an episode of cholangitis/cholangiohepatitis 18months ago. Urine: BIL + PRO + LEU + USG 1.034 pH 6.0. Blood - hyperbilirubinaemia, hypokalaemia, high ALT, high ALP. Normal T4. Treatment started - IVFT with added potassium, amoxyclav and ursodeoxycholic acid.

Clinically the cat seems to be a bit stronger, though still not eating amazingly well and is obviously jandiced. Bloods today (day 5) - further increased hyperbilirubinaemia, hypokalemia (but improved slightly), hyponatremia, hypophosphataemia, ALT and ALP as before. Am worried this may have progressed from a cholangiohepatitis to a cholestasis or I am missing something. O reluctant to do too much by way of investigation.

[/quote]

I agree with Dagmar, ultrasound would be the diagnostic of choice- a lot of the time I think we end up spending more on trial therapy in these cases than we do on diagnostics, but I share your frustration if the owners won't go there.

I assume haematology was normal? How low was the potassium? It could be secondary to anorexia, and causing the weakness, however, also consider other primary hypokalaemic problems. What was USG? (NB was the leucocyte + in the urine from the dipstick? if so ignore it, designed for human use, not a reliable indicator in animals). Any other liver function markers- albumin/urea/creat levels? Sorry to be pedantic about numbers, but the degree of elevation/reduction does tell me an awful lot sometimes.

DDx- hepatitis/cholangiohepatitis as you have, include all causes of hepatopathy (inflam/infectious/neoplastic), pancreatitis, phsyical biliary obstruction ie mass would be my main diffs at this stage. Assuming haematology normal and no anaemia, you can rule out haemolysis.

So treatment wise if owners really don't want to do an ultrasound (and I would advise someone fairly experienced if possible- a large mass may be easy to pick up, but something small and subtle or pancreatic/subtle hepatic changes not easy to be certain of unless you have experience) then as you are doing- ivf/potassium supplementation (is cat still on ivf/potassium? cos if not eating well, it's potassium levels will not improve unless you maintain the intake- I can put doses up later if that would help), clav good, but consider adding marboflox and metronidazole so you have full 4 quadrant cover, destolit good idea. Add pain relief (buprenorphine)- cat may or may not be painful, but sometimes can only tell by treating. Consider adding anti-emetics eg maropitant, also antacids. SAMe (Hepatosyl or similar) as well. And nutrition so important, so either syringe feed or feeding tube of nec.

Pricing up all those treatments and hospitalisation and comparing it to ultrasound costs may help persuade the owners to scan?

Hope that helps

Re: Yellow cat

Dagmar Steele — Tue, 27 Mar 2012 08:15:14 GMT

at this age I'd try to talk the owner into a sonographic examination. Maybe it helps if you tell them they're wasting money if there is a tumor involved? Last three yellow cats at this age I've seen all had a tumor compressing bile duct....

Re: Yellow cat

tess — Mon, 26 Mar 2012 22:53:19 GMT

I think metaclopramide can help to relax the bile duct, possibly given as a continuous infusion in the drip. Not sure of dose offhand-sorry.