hypokalaemia

Re: hypokalaemia

Gerry Henry — Wed, 08 Jan 2014 21:37:58 GMT

Can't do the bloods for Conn's in-house, better get a sample off PDQ; we had a case last year, did a unilateral adrenectomy, cat fine 1yr on.

Re: hypokalaemia

Tracy Arend — Wed, 08 Jan 2014 18:41:17 GMT

We run most of our bloods in house as we are a hospital. Creatinine was 92 ref: 0-150. urea was 8.8 ref: 3.0-11. Phosphate 1.05 (ref: 0.7-2.1)

Since relaying the results to the owners, she has worsened over the course of the day so has been admitted for IV supplementation of potassium, and to obtain urine sample and measure BP.

Re: hypokalaemia

Rory Bell — Wed, 08 Jan 2014 18:38:58 GMT

Hi Tracy (and others)

I'd echo a lot of what has already been posted on this thread. Anthony's point about early stage CKD occurring with potentially normal range creatinine values is a good one; architectural changes to the kidneys on ultrasound (loss of corticomedulary definition etc) would support this. Neil; hyperthyroidism will cause an increased GFR which would cause potassium wasting in the urine.

Assuming there are no other obvious causes of PU/PD or hypokalemia, then measuring aldosterone is definitely a good idea. Best to do this BEFORE supplementing with potassium; potassium along with renin are the main triggers for aldosterone release and a sudden rise in circulating potassium concentrations will trigger a physiological rise in aldosterone concentrations in healthy subjects, which in turn would make differentiation of a pathological hyperaldosteronism in this case much more difficult

No proven benefit of adrenalectomy versus medical therapy for Conn's cats, maybe because a lot of these patients are quite old at the time of diagnosis. Medical therapy is therefore a very viable option; anecdotally, I think that surgically managed cats tend to do better i the long term if they survive the immediate perioperative period but for sure, adrenalectomy is not the best option for every cat (and every owner)

rory

Re: hypokalaemia

Hanna Bennett — Wed, 08 Jan 2014 18:11:01 GMT

we have a conns recently diagnosed, presented with ventroflexion as well - owners have opted for medical therapy and he is doing really well on spironolactone and potassium supplementation - I've seen three cases over ten years - not as rare as they make it out to be.

Re: hypokalaemia

Rob Loxley — Wed, 08 Jan 2014 18:03:20 GMT

And skinny cats with poor muscle mass can have lower creatinine

Re: hypokalaemia

Anthony Dennison — Wed, 08 Jan 2014 17:57:21 GMT

What was the actual Creatinine value? I know our IDEXX reference ranges are normal up to about 200 (where IRIS stage 1 is 140)

Re: hypokalaemia

Neil Wheadon — Wed, 08 Jan 2014 16:59:21 GMT

[quote user="robloxley"]Conn Syndrome?[/quote]

Yes quite possible. This value is too low for renal disease? especially with normal creatinine and urea.

According to the reference I have 40 cases reported (It's not that common, but under-reported)

31 out of 37 cats showed a high arterial blood pressure some with associated occular signs

17 out of 29 had elevated urea

I did find a reference a few months ago which claimed that 30% of hyperthyroid cats were hypokalaemic, any thoughts on this anyone? This was triggered by finding a hypokalaemic blocked cat which somewhat confused me.

Neil

Re: hypokalaemia

Claire Fisher — Wed, 08 Jan 2014 16:52:57 GMT

I would also think Conn's syndrome - after checking BP and USG you can measure plasma aldosterone levels to get an idea and consider ultrasound to look for and adrenal mass.

Re: hypokalaemia

Tracy Arend — Wed, 08 Jan 2014 16:11:23 GMT

Only bloods were done today- I was planning on obtaining cysto and BP if I admit it tomorrow (in light of blood results), as it was seen on an outpatient basis as the owners didn't want to leave her here until blood results were through.

Re: hypokalaemia

Rob Loxley — Wed, 08 Jan 2014 16:04:10 GMT

Conn Syndrome? What's the blood pressure?
Is the cat Burmese? What is the urine SG?