Cat with weight loss

RE: Cat with weight loss

Anthony Todd — Fri, 03 Jun 2016 00:01:32 GMT

[quote user="Anthony Dennison"]I've been busy working so haven't followed it up[/quote]

Thanks, keep us posted,let's hope your hunch is right.

RE: Cat with weight loss

Anthony Dennison — Thu, 02 Jun 2016 09:02:59 GMT

[quote user="Anthony Todd"]

I hope this isn't yet another case where we never hear the outcome......

[/quote]

Sorry Anthony, I've been busy working so haven't followed it up. The client declined all further investigations due to financial reasons so the cat has been started on 2.5mg Methimazole SID with a view to check up in a couple of weeks.

RE: Cat with weight loss

Anthony Todd — Wed, 01 Jun 2016 18:08:30 GMT

I hope this isn't yet another case where we never hear the outcome......

RE: Cat with weight loss

Lindsey Edwards — Fri, 27 May 2016 20:15:46 GMT

Cachexia, tachycardia and resp difficulty - always wary of intrathoracic/mediastinal masses. Any changes in chest compliance or altered air flow on auscultation?

RE: Cat with weight loss

Anthony Todd — Fri, 27 May 2016 18:10:26 GMT

Dare I ask, or has it been eliminated,..... has the cat got diarrhoea??

I thought heart problems, unless really gross cardiac insufficiency, weren't usually associated with weight loss?? I mean the average cat has the cardiac demand of a large snail....

And, this is back in the day, as usual, but I, and I'm sure many others, looked at the treatment options rather than the diagnostic options, because the treatment options were cheaper, instantly available, and almost always what or where you'd end up anyway.

So do a trial of your hunches [and, let's face it you'll probably be on the money] and see what happens.

What has the client, and the cat, got to lose except a load less money for the same outcome.

RE: Cat with weight loss

David Mills — Fri, 27 May 2016 17:46:32 GMT

[quote user="Martin Atkinson"]

[quote user="Anthony Dennison"]I'm not going to get any further diagnostics unfortunately, no matter how much I'd like to.[/quote]So treat the one thing you can: the hypokalaemia. And don't dismiss doing an NT-proBNP as David has! I find it immensely valuable in the diagnosis of cardiac disease in cats. In the absence of significant renal disease, as in this cat, it is virtually diagnostic. Don't do the silly SNAP tests they are worthless, it only costs you £32.30 to send a sample to Idexx - charge the client what you like.

[/quote]

I don't want to get into yet another probnp argument but it's not going to tell you any more than you already know and in impecunious clients it's a wedge of money for what? What are you going to do with the results? And don't say ace I. A far better use of money would be free t4.

The hypokalaemia is asymptomatic. I wouldn't treat it but if you really want to cheaply you can use lo-salt which is 66% Kcl and costs about £2 for a big tub.

Keep us updated!

RE: Cat with weight loss

Martin Atkinson — Fri, 27 May 2016 17:26:19 GMT

RE: Cat with weight loss

Anthony Dennison — Fri, 27 May 2016 16:59:05 GMT

Thanks for everyone's input. I discussed all the recommended investigations and work ups with the client and just the bloods were a big outlay for them - I'm not going to get any further diagnostics unfortunately, no matter how much I'd like to.

[quote user="Kate Richardson"]I think it would be unusual not to have any clinical signs related to a potassium of this level[/quote]

Only clinical sign was weight loss. I was confused, hence why posting the case on here.

[quote user="Kate Richardson"]have you checked the teeth thoroughly-[/quote]

Teeth fine - I made a conscious effort to have a good look.

RE: Cat with weight loss

Kate Richardson — Fri, 27 May 2016 10:17:52 GMT

I think it would be unusual not to have any clinical signs related to a potassium of this level, so I would double check appetite and repeat K measurement to ensure not an error, because I do think it is significant- it could be primary or secondary; using frusemide runs a significant risk of dropping it further and causing clinical signs related to it so I would advise extreme caution and further monitoring. If it has progessively developed hypokalaemia over a long period of time, it may well be coping better clinically than if it had developed rapidly, but I wouldn't be happy ignoring it at 2.6. I have only ever seen 1 cat with hypokalaemia due to hyperthyroidism, it is reported but IME is a rare finding. I also agree with Martin that it would be unusual to have obvious cardiac signs such as a gallop rhythm with a T4 of 32, unless the cat had pre exisiting cardiac pathology, or unless something else is suppressing the T4- have you checked the teeth thoroughly- also a very common cause of weight loss in the face of an apparently normal appetite. Ref ALT/ALKP, I commonly see hyperthyroid cases with normal ALKP levels, but usually ALT is elevated.You can't say anything about the cat's renal status without checking a urine sample to assess renal function, not pupd according to the owner doesn't rule it out. I still think checking BP is necessary, easy rule out for Conns if it is normal. Obviously not diagnostic for it if hypertensive, as could be due to other conditions.

RE: Cat with weight loss

Martin Atkinson — Fri, 27 May 2016 09:03:03 GMT

[quote user="David Mills"]I tend not to get too excited by hypokalaemia.[/quote]I agree up to a point I would not expect anorexia at the level the OP indicated but would still like to supplement it.

[quote user="David Mills"]Most hypert4 I think will have a pre-full-blown hypert4 period where t4 creeps up, before there's any goitre or ravenous appetite.[/quote]IME they also tend to have raised ALP/ALT. In this case the ALP is low.

RE: Cat with weight loss

David Mills — Thu, 26 May 2016 20:27:21 GMT

[quote user="Martin Atkinson"]Dyspnoeic, gallop rhythm, hypokalaemia - could be so I would want to investigate that funds permitting.[/quote]

Quite right (minus the proBNP of course ).

I tend not to get too excited by hypokalaemia. Hx suggests no inappetance, acting normally, eating etc. Could easily be caused by increased renal perfusion from hypert4. I wouldn't be rushing to supplement in this cat. I remember a Conn's case that was referred for emergency fluids and stabilisation - brightest cat you could ever hope to see, acting normally, K+ 1.9. I wouldn't be chasing the numbers in this case.

Most hypert4 I think will have a pre-full-blown hypert4 period where t4 creeps up, before there's any goitre or ravenous appetite.

RE: Cat with weight loss

Martin Atkinson — Thu, 26 May 2016 18:58:04 GMT

[quote user="David Mills"]likely hypert4.[/quote]It was my go-to diagnosis until I saw that the T4 was 34. I know some cats can be symptomatic with levels below 55 (I work on an upper end of normal of 45-50) but they're rare and to be so symptomatic they're generally well over, usually in the 100's.

[quote user="David Mills"]I've only seen cardiac cachexia in cats with end-end-stage heart failure.[/quote]Dyspnoeic, gallop rhythm, hypokalaemia - could be so I would want to investigate that funds permitting.

RE: Cat with weight loss

Anthony Dennison — Thu, 26 May 2016 18:02:43 GMT

That's to say, if the client can afford it

RE: Cat with weight loss

Anthony Dennison — Thu, 26 May 2016 18:02:29 GMT

Yes, HR around 200bpm. Will organise getting some kaminox in for the cat.

RE: Cat with weight loss

Utlendigur — Thu, 26 May 2016 17:55:32 GMT

Also needs some potassium supplementation asap - whatever the cause, the hypokalaemia could be contributing to the weight loss (muscle weakness -> wasting, inappetance, possibe GI disturbances) and respiratory signs.

Was it tachycardic along with the gallop rhythm?

RE: Cat with weight loss

Anthony Dennison — Thu, 26 May 2016 17:53:39 GMT

[quote user="Kate Richardson"]If bloods were run externally then the actual K could be even lower[/quote]

Internal. Plasma separated within a couple of minutes of sampling and run within 10.

RE: Cat with weight loss

Kate Richardson — Thu, 26 May 2016 17:50:26 GMT

Haven't got time to write much but I'd be very wary using frusemide in a hypokalaemic cat- I'd check BP. If bloods were run externally then the actual K could be even lower, gallop/cardiac arrhytmia could be sec to hypertension

RE: Cat with weight loss

David Mills — Thu, 26 May 2016 17:25:50 GMT

[quote user="Anthony Dennison"]I will look at trialling a low dose of methimazole. 2.5mg once daily?[/quote]

Yep either that or 10mg vidalta SID if you have it would be my approach.

RE: Cat with weight loss

Anthony Dennison — Thu, 26 May 2016 17:17:39 GMT

[quote user="David Mills"]

Gallop + weight loss + high-norm t4 (a lot of people call it >40 these days esp in presence of creatinine >120) = likely hypert4.

I've only seen cardiac cachexia in cats with end-end-stage heart failure.

I'd run a free t4. Failing that - if costs an issue - then trial some methimazole.

[/quote]

Thanks David. Costs are an issue so I will look at trialling a low dose of methimazole. 2.5mg once daily?

[quote user="Martin Atkinson"]I would do an ECG regardless if you have an arrhythmia but if you suspect cardiac disease then perform thoracic X-rays and a NT-proBNP, a very reliable indicator IME. If that is sky high I would justify medication but would offer a referral for echocardiography (or do that myself if I felt competent)! [/quote]

You've got no idea how much I'd love to do all this. Thing is a lot of my clients are from a lower income so I don't get much of a chance - I tell a client a cat has a murmur and I would say under 10% want to investigate it.

RE: Cat with weight loss

David Mills — Thu, 26 May 2016 17:05:40 GMT

Gallop + weight loss + high-norm t4 (a lot of people call it >40 these days esp in presence of creatinine >120) = likely hypert4.

I've only seen cardiac cachexia in cats with end-end-stage heart failure.

I'd run a free t4. Failing that - if costs an issue - then trial some methimazole.

RE: Cat with weight loss

Martin Atkinson — Thu, 26 May 2016 16:26:13 GMT

[quote user="Anthony Dennison"] Is this weight loss a form of cardiac cachexia, or could there be some other cause, like possible Conn's Syndrome or another hormonal disturbance? [/quote]The potassium is usually a lot lower in Conn's Syndrome (<1.5) and teh Cl should be raised not low. There would be more symptoms PU/PD, vomiting, diarrhoea, hypertension etc. Diagnosis would be by measuring aldosterone levels.

I would do an ECG regardless if you have an arrhythmia but if you suspect cardiac disease then perform thoracic X-rays and a NT-proBNP, a very reliable indicator IME. If that is sky high I would justify medication but would offer a referral for echocardiography (or do that myself if I felt competent)!