Normoglycaemic, glucosuric cat.

Re: Normoglycaemic, glucosuric cat.

Helen Perryman — Thu, 05 Jul 2012 18:14:03 GMT

We had a similar case here a couple of weeks ago in a 5 year old FN Persian - has always been small and slightly skinny. Acute onset lethargy and pyrexia (40.6C) with pain in lumbar spine region.

Radiographs showed mild interstitial lung patterning but otherwise chest and abdo unremarkable. In-house biochemistry slightly low urea (5mmol/l), glucose 9.5mmol/l. Blood glucose level was at a normal level throughout hospitalisation.

Urinalysis - glucose 4+, protein 4+, ketones 1+, leukocytes 3+, SG1.067, after 24h on fluids this was repeated - glucose 4+, ketone 2+, protein 3+, leukocytes 3+, SG 1.016.

Abdominal ultrasound was unremarkable.

The cat improved clinically on fluids and amoxy/clav and was sent home where she is doing really well. Urinalysis has not been repeated.

We are assuming a UTI but as above cannot understand the ketonuria. The dipsticks are in date.

Re: Normoglycaemic, glucosuric cat.

Kate Richardson — Wed, 04 Jul 2012 22:36:06 GMT

Firstly check the date on the urine dipsticks- if out of date, results not to be believed. I would get the urine tested by an external lab.

But thinking renal dysfunction- clinically dehydrated but usg low. Proteins- would check UPC ideally to assess for proteinuria. If blood gluc correct then ketones seems unlikely so would be thinking error, but check bloods for beta hydroxybutyrate plus fructosamine. Renal threshhold is variable but wouldn't expect ketones at these glucose levels. Was cat fat in first place? Not imposs for DM but again gluc levels not consistent. What were remainder of bloods like- liver enz normal?

Ultrasound findings included- gut feeling- pyelonephritis. have you got culture pending? Even if negative growth, would still be treating for this with ivf and abs.

Re: Normoglycaemic, glucosuric cat.

james herriot lied — Wed, 04 Jul 2012 22:13:20 GMT

Sorry! Missed the bit about ultrasound.....

Re: Normoglycaemic, glucosuric cat.

james herriot lied — Wed, 04 Jul 2012 22:11:58 GMT

Plus one for a Fanconi's; also, of course, the possibility of glucose coming from somewhere in the LTU. Not sure how big a ketone body is, but as a level is always present in the bloodstream, it could be leaking also. A scan of both liver and UT would be the way forwards, methinks

Re: Normoglycaemic, glucosuric cat.

graeme eckford — Wed, 04 Jul 2012 22:10:30 GMT

Thanks for the suggestions.

I've checked the BG measurements on 2 separate machines so suspect they are correct however the tech support for the hand held analyser suggested the results could be artificially low due to lipaemia.

Hepatic ultrasound appeared normal.

I can ask the lab for fructosamine once they have the bloods.

Will keep you posted.

Re: Normoglycaemic, glucosuric cat.

Stephen Courtney — Wed, 04 Jul 2012 22:03:18 GMT

Definitely get a fructosamine - I'm reluctant to diagnose DM without one - and if it is normal then you probably have some variation of Fanconi syndrome - renal tubular damage leaking glucose - smaller molecule than protein; or tubular damage preventing reabsorption of glucose in the initial filtrate?

also try get a cysto sample for culture and sensitivity, or at very least a good sediment exam including cytology.

I do struggle to see how you can have ketonuria without DM - can't remember the renal threshold for glucosuria in cats but i thought it was higher than 8 mmol/l - happy to be corrected though! It might relate to lipaemia and possible fatty liver syndrome - any chance of an ultrasound?

Re: Normoglycaemic, glucosuric cat.

Nicola Lawlor — Wed, 04 Jul 2012 20:57:46 GMT

Have you run controls on the blood machines to be certain that the levels you are measuring are true?
Have you considered and fructosamine to look at the longer term recent blood glucose picture?

This could be a primary renal glycosuria but I am not sure why the ketone levels you are seeing with this?