electrolyte derangements

RE: electrolyte derangements

Robin Grimmer — Mon, 12 Oct 2015 14:27:52 GMT

Disagree with your first point Martin. You need to address this very low potassium promptly - oral isn't going to work quickly. And there's a simple guide in the formulary that tells you how much KCl to add to the fluids.

RE: electrolyte derangements

Martin Atkinson — Mon, 12 Oct 2015 14:21:43 GMT

[quote user="Kate Richardson"] I don't think it's appropriate to treat a K of 2.2 with oral supplementation, this cat needs it iv.[/quote]There is a danger that I/V fluids may lower K levels lower if the operator is too cautious about the amount they put in the drip and the opposite if they overdo it. I have always believed from what I was taught that unless the patient is moribund oral KCl should be given before fluids.

[quote user="Kate Richardson"] Fructosamine isn't a bad idea, but a urine sample will be quicker and give instant answers.[/quote]I've had cats with glycosuria with stress hyperglycaemia, after all the renal threshold is 14mmol/l is it not and this cat has a glucose of 21. Plus as indicated in this case it isn't always easy to get a urine sample and a UTI may give a false +ve.

RE: electrolyte derangements

Kate Richardson — Mon, 12 Oct 2015 13:42:01 GMT

[quote user="Anthony Todd"]Anorexia and itchy aren't pleasant, so both should be helped ASAP.[/quote]

I 100% agree

RE: electrolyte derangements

Anthony Todd — Mon, 12 Oct 2015 13:40:08 GMT

[quote user="Kate Richardson"]The cat won't start eating until the potassium is corrected.[/quote]

Touche, point taken, even before the steroid dig....

Anorexia and itchy aren't pleasant, so both should be helped ASAP.

RE: electrolyte derangements

Kate Richardson — Mon, 12 Oct 2015 13:28:45 GMT

[quote user="Anthony Todd"]

[quote user="Martin Atkinson"]Chronic diarrhoea would be the most likely cause of the hypokalaemia[/quote]

Why not fix that first, and then progress if that doesn't sort all the associated problems?

Dietary restriction, with most clients, is harder to understand let alone comply with, than nuclear physics.

[quote user="Martin Atkinson"]But it definitely needs a potassium supplement,[/quote]

Probably not, if it goes to D-ve?

[/quote]

The cat won't start eating until the potassium is corrected. So yes, you need to fix the underlying problem (which we are yet to determine in this case), but the cat needs immediate supplementation as the longer it remains inappetant the worse the hypokalaemia will become. Bit like fixing the immediate itch with a corticosteroid injection whilst looking for an underlying cause

RE: electrolyte derangements

Anthony Todd — Mon, 12 Oct 2015 13:22:13 GMT

[quote user="Martin Atkinson"]Chronic diarrhoea would be the most likely cause of the hypokalaemia[/quote]

Why not fix that first, and then progress if that doesn't sort all the associated problems?

Dietary restriction, with most clients, is harder to understand let alone comply with, than nuclear physics.

[quote user="Martin Atkinson"]But it definitely needs a potassium supplement,[/quote]

Probably not, if it goes to D-ve?

edited to "probably not WHEN goes to D-" after my deserved [partially] admonishment

RE: electrolyte derangements

Kate Richardson — Mon, 12 Oct 2015 13:19:08 GMT

[quote user="Martin Atkinson"]Chronic diarrhoea would be the most likely cause of the hypokalaemia.The glucose is high but not high enough to totally exclude stress hyperglycaemia so I would want a fructosamine. I would also want to look at pancreatitis, what is the result of the haematology? But it definitely needs a potassium supplement, orally if they don't want I[/quote]

IME hypokalaemia secondary to chronic GIT disease is usually borderline low, rarely below 3. If it is below 3 it is usually associated with inappetance or anorexia. I don't think it's appropriate to treat a K of 2.2 with oral supplementation, this cat needs it iv. Fructosamine isn't a bad idea, but a urine sample will be quicker and give instant answers.

How's the cat doing Lucy?

RE: electrolyte derangements

Martin Atkinson — Mon, 12 Oct 2015 12:55:45 GMT

Chronic diarrhoea would be the most likely cause of the hypokalaemia.The glucose is high but not high enough to totally exclude stress hyperglycaemia so I would want a fructosamine. I would also want to look at pancreatitis, what is the result of the haematology? But it definitely needs a potassium supplement, orally if they don't want IV.

RE: electrolyte derangements

Lucy Fleming — Sat, 10 Oct 2015 00:23:10 GMT

[quote user="Robin Grimmer"]

Why didn't you get a urine sample? Would have confirmed if diabetes and if ketoacidosis.

[/quote]

No palpable bladder when he was in, unfortunately.

RE: electrolyte derangements

Robin Grimmer — Sat, 10 Oct 2015 00:10:40 GMT

Why didn't you get a urine sample? Would have confirmed if diabetes and if ketoacidosis.

RE: electrolyte derangements

Rob Loxley — Fri, 09 Oct 2015 21:46:04 GMT

I'd be thinking DKA also

RE: electrolyte derangements

Kate Richardson — Fri, 09 Oct 2015 21:13:53 GMT

The recent and repeated depomedrone is another factor raising suspicion of diabetes as well.

RE: electrolyte derangements

Kate Richardson — Fri, 09 Oct 2015 21:11:58 GMT

would have thought if ketoacidosis then it must be acidotic. Are you thinking this because of the ph? assume it was a venous sample? If so as far as I am aware ph is unreliable if venous.

RE: electrolyte derangements

Lucy Fleming — Fri, 09 Oct 2015 21:07:14 GMT

Thanks Kate, that's pretty much the plan for tomorrow. He had perked up a little since he had been sent home with cerenia and a little sub cut fluid on board, so the owner wasn't keen to come back in tonight. Daft question, probably, but is it possible for the cat to be in DKA without an acidosis?

RE: electrolyte derangements

Kate Richardson — Fri, 09 Oct 2015 20:59:25 GMT

i tend to focus on the potassium- that is really low- could be excess k loss exacerbated by reduced intake. But that cat needs potassium supplementation via Iv fluids ASAP - NaCl spiked with KCl- can let you know exact amounts tomorrow if you need doses. I wouldn't rule out diabetes as ketoacidosis will cause hypokalaemia- (even if serum k levels are normal whole body k can be depleted) and aggressive potassium supplementation is necessary especially if you start insulin. Recheck glucose and check urine- I'd be tempted to get cat back tonight if at all possible to start fluids as if this dka this cat could go downhill rapidly

RE: electrolyte derangements

Silvia Maldonado — Fri, 09 Oct 2015 20:42:41 GMT

Very simple and briefly, just 2 points.

Look at the picture: in general, when K is high, H is low, and viceversa. You might have an alkalemia, and the body is trying to remove the H excess by exchanging it with K. That is, the body system is bringing H out of the cells by exchanging it with K, and that's why K is low. That is more consistent with your normal-high pH 7.43, and the chronic diarrhoea. I would ask owners if the cat has been vomiting as well.

As for chloride, it has to be compared with Na, and check if it is not following Na at all. Also consistent with an alkalosis process. Both Na and Cl might be low due the chronic diarrhoea.

As for ddx, I would consider IBD, pancreatitis, GIT disorder (obviously), but surely there is some cat specialist with a better answer