Old dehydrated sick cat...next step...

Re: Old dehydrated sick cat...next step...

Julien Bazelle — Tue, 24 Jun 2014 14:38:27 GMT

I agree with the previous posts about the differential diagnoses for such a high hypercalcaemia.

Renal disease seems unlikely given the low phosphorus. And even if the value of creatinine can be decreased by the degree of emaciation of this cat, high IRIS stage renal disease seems unlikely. I would add that CKD is generally associated with mild total hypercalcaemia (if any) and ionised hypocalcaemia.

My top diagnoses would be idiopathic (not uncommon and in that case potentially incidental finding), spurious result, granulomatous disease and paraneoplastic (although I agree this is not a common feature in cats). Primary hyperparathyroidism is rare in cats. Dehydration can falsely increase total calcium although not to this level.

If there are financial restrictions, this may become difficult to investigate this. An ionised calcium is ideal obviously but will not change dramatically the management of this case. Investigating the causes of hypercalcaemia can be done with PTH assays, AUS +/- neck US, cytology LN or any abnormal organs but again money can limit your possibilities.

Treatment is above all fluidotherapy. High rate of fluid are often necessary to control dehydration induced by hypercalcaemia. Monitoring this cat's electrolytes may be needed to avoid iatrogenic hypokalaemia. After correction this cat hydration, if the calcium is still high, cheap non specific treatment options include furosemide and prednisolone (and euthanasia).

Good luck with this case

Julien Bazelle

Willows Veterinary Centre and Referral Service
Highlands Road
Shirley
Solihull
West Midlands
B90 4NH

Re: Old dehydrated sick cat...next step...

Robin Grimmer — Sun, 22 Jun 2014 19:47:49 GMT

I agree with Kate. The prognosis is very guarded to poor and if the owners aren't willing to pursue further investigation then you should advise euthanasia. Another point, whatever the cause - prolonged hypercalcaemia will cause irreversible kidney damage anyway.

I had a memorable case once of hypercalcaemia in an older cat. It also had palpable goitre. T4 was normal. I removed the mass which was confirmed as a parathyroid adenoma on histology. The hypercalcaemia resolved and the cat improved initially. However, he succumbed to renal failure 6 months later.

Re: Old dehydrated sick cat...next step...

Laura Marshall — Sun, 22 Jun 2014 15:17:19 GMT

Just an additional point with regards to creatinine level. Its important to keep an open mind about creatinine levels in an emaciated cat. The levels cannot be high if there's not the muscle present to produce it in the first place.

Re: Old dehydrated sick cat...next step...

Kate Richardson — Fri, 20 Jun 2014 07:11:15 GMT

If there is no obvious findings on physical exam to explain the severe weight loss in this cat such as dental disease or a palpable abdominal mass and financial resources are limited then I think you should advise euthanasia as this cat sounds as though it is suffering. I would ideally repeat the calcium to be sure it is a true result and not error and if high then neoplasia or parathyroid disease would be most likely- first one poor prognosis second will require more diagnostics/therapy/monitoring and lots of cost involved- these are all or nothing cases in my opinion and not fair to allow the cat to continue to suffer. You have to ask yourself how compliant an owner will be as well given they presented the cat to you in this condition and didnt seek veterinary treatment earlier.

Re: Old dehydrated sick cat...next step...

Martin Atkinson — Thu, 19 Jun 2014 09:59:22 GMT

Neoplasia would also be high on my list, especially intestinal lymphoma in an old cat but that said IME Ca is not such a flag of this as in dogs. The renal function is not bad enough to produce a secondary hyperparathyroidism, Crea and phos are a better indicator than BUN. The moderate azotaemia may be due a focus of infection especially with that moderate granulocytosis - how are its teeth. Also chest x-rays and examine nasopharynx/larynx to make sure the the sneezing isn't due to a more sinister cause.

Ionised Ca is not that big a deal you just need enough serum to fill a tube with no air space although labs will usually supply smaller tubes for this purpose. Parathyroid hormone estimation is obviously a more expensive and complicated.

Re: Old dehydrated sick cat...next step...

Sammy82 — Wed, 18 Jun 2014 22:26:50 GMT

was the sample taken before or during/after fluid therapy? TP and HTC seem suspiciously low if the cat was dehydrated at the time. Emaciation can mimic clinical signs of dehydration e.g. skin tenting and sunken eyes. Raised Urea with normal Creatinine does not look like advanced CKD to me. Could you check a urine sample for SG before i.v. fluids? Neoplasia would be my greatest worry, the hypercalcaemia might be paraneoplastic syndrome. Chest/nose x ray would be my next step, but I guess there are no funds for this if you can't send a BS f Ca++.

Did the respiratory symptoms resolve? If not nasal FB or tumour would be on my list of DD. Did it d

rop the weight very quickly/ whilst still eating ok or has it been picky for a while?

All the best for the cat.