Potassium citrate in cats for calcium uroliths

RE: Potassium citrate in cats for calcium uroliths

gerard mclauchlan — Thu, 17 Feb 2022 22:04:36 GMT

Yes aledronate is very well tolerated. The protocol is one tablet (10mg) every 7 days. Give if after 12 hour starvation (so first thing in morning and lift food in evening). Flush with small amount of water and feed 30 mins later. Essentially very similar to doxycycline administration in cats. Never seen a problem and I have given it to many cats with idiopathic hypercalcaemia forming oxalate stones with ureteral obstructions.

Any increase in ionised calcium even if just mildly above reference range should be investigated is my personal feeling.

In terms of steroids they are actually promote calciuresis so may actually predispose a patient to more calcium oxalate stone formation - I avoid them in all my SUB cases and go for alendronate. Steroids are def not as effective as reducing calcium as the alendronate either.

Gerard

RE: Potassium citrate in cats for calcium uroliths

Sara Ramsey — Thu, 17 Feb 2022 21:54:24 GMT

yes, both PTH and PRrP were undetectable.

That is interesting regarding doing a hypercalcaemia work up even if very mild and asymptomatic. I will bear that in mind.

The previous cases I have worked up have been polydipsic and ionised calcium much higher (1.8 rings a bell but it was a long time ago)...so I suppose it was easier to get the owners on board when there were clinical signs.

I am thinking I might see if we can get him to take prednisolone liquid? if we can lower his ionised calcium then raising urinary pH might not be needed...though he had stones in the past and wasn't hypercalcaemic

I am bit concerned about the listed side effects of alendronate (oesophagitis/musculoskeltal pain), or do you find is is well tolerated

Thank you for your time

RE: Potassium citrate in cats for calcium uroliths

gerard mclauchlan — Wed, 16 Feb 2022 15:06:56 GMT

Hi Sara

When you say PTH / PTHrp were normal do you mean both we undetectable ? (as a within reference range PTH would indicate hyperparathyroidism in a hypercalcemic patient)

If so then you could consider running vitamin D levels too but realistically if both PTH and PTHrp are undetectable with an increased ionised calcium then you are very likely to have idiopathic disease. I start investigating disorders of calcium even with a very mild elevation in ionised.

RE: Potassium citrate in cats for calcium uroliths

Sara Ramsey — Wed, 16 Feb 2022 14:58:30 GMT

Thank for the replies. As always, there is more to the story which I didn't want to bombard people with!

This cat cannot be tabletted. He wasn't hypercalcaemic at the first cystomy 4 years ago. He showed a high total calcium on his CKD bloods around 6 months ago so I started monitoring ionised calcium on our in house EPOC. The reference range is 1-2 - 1.3 and he was only just outside the range. He had no crystalluria.

Around a month ago his ionised calcium rose to 1.5, he had oxalate crystals in his urine and then developed polakiuria. His radiographs showed very small radiodense stones which were removed. We took blood for the NWL PTH panel. PTH and PTrP were normal, his ionised calcium on that sample was 1.49 (1 - 1.4).

I have not used pred or alendronate due to the mild increase in calcium and the lack of symptoms (up until now). The fact he won't take tablets and occasionally has metacam alongside his Solensia is a factor.

He is not on a calcium based phosphate binder.

My main concern is that I don't want him in pain with uroliths and I really don't want a urethral obstruction.

His renal parameters are stable and each approach is discussed with owner about what she thinks he will tolerate and what she can do with him.

There are some diets low in calcium and oxalate which claim to raise pH ... but he is so fussy that this is a non-starter.

As an aside: what level of hypercalcaemia would prompt others to start a work up?

RE: Potassium citrate in cats for calcium uroliths

Julian Earl — Wed, 16 Feb 2022 12:40:29 GMT

~Iread somewhere that tomato juice is useful for cats with stones' slifghtly acidic = helps dissolve the 'liths and is quite palatable for most cats, Good luck ewith his.Plus readily available and not expensive! I used to advise this to clients with no adverse feedbak from owners or the cat!!

RE: Potassium citrate in cats for calcium uroliths

Richard Carter — Wed, 16 Feb 2022 11:24:22 GMT

Presume you tried preds- might sort out the ibd as well? And if slightly polyuric might reduce the chance of stones?

Not sure the urinary diets help with calcium oxalate anyway- thought they did practically the opposite effect you want pH wise

RE: Potassium citrate in cats for calcium uroliths

gerard mclauchlan — Tue, 15 Feb 2022 15:30:32 GMT

Hi Sara,

Are you treating the idiopathic hypercalcemia with alendronate (10mg PO Q7 days) ?

Gerard