potassium high- heart problem?

[SPillus]

Hi,
A few days ago I posted about my kitty Meetoo-20 yrs. old. She has crf w/
100ml of sub-Q fluid every day. She's been in hospital since Friday. The
original info I had was that her potassium level was low, and was the reason
for her lethargy and small appetite.
My updated info, straight from the vet's mouth is that her potassium is
*high* at 6.4
5.5 is normal.
Now that she's in the hospital, they have her on IV fluids and have added some
dextrose to draw the potassium out of the blood stream and into the cells. The
vet said with her potassium that high, her heart could stop.
The vet is calling me later this evening to tell me the results of the most
recent blood test.
We wanted to bring Meetoo home tonight as she's been in hospital since Friday.
Has anyone had experience with high potassium readings?
Susan

[Phil P.]

"SPillus" > wrote in message
...
> Hi,
> A few days ago I posted about my kitty Meetoo-20 yrs. old. She has crf
w/
> 100ml of sub-Q fluid every day. She's been in hospital since Friday. The
> original info I had was that her potassium level was low, and was the
reason
> for her lethargy and small appetite.
> My updated info, straight from the vet's mouth is that her potassium is
> *high* at 6.4
> 5.5 is normal.
> Now that she's in the hospital, they have her on IV fluids and have added
some
> dextrose to draw the potassium out of the blood stream and into the cells.
The
> vet said with her potassium that high, her heart could stop.
> The vet is calling me later this evening to tell me the results of the
most
> recent blood test.
> We wanted to bring Meetoo home tonight as she's been in hospital since
Friday.
> Has anyone had experience with high potassium readings?
> Susan


When hyperkalemia occurs in CRF cats, its usually because the cat is either
oliguric, over-supplemented with K, or in the terminal state of the disease.
Since your cat was initially hypokalemic, my guess is your vet
over-supplemented potassium (K) - since its unlikely your cat went from
hypokalemia to hyperkalemia that fast - hyperkalemia usually doesn't occur
that quickly.

If I were you, I'd speak to your vet about a diuretic (Furosemide).
Diuretics stimulate urinary output, which facilitates the excretion of
excessive K and renal toxins. Furosemide should increase urine output
within 30 mins. If it doesn't, the dose should be doubled, and then tripled
at hourly intervals - although I don't think doses above 2 mg/lb are any
more effective. That's, of course, only if your cat is oliguric.

The only advantages of dextrose over flurosemide is its cheaper, provides
some non-protein calories for energy and is readily detectable in the urine
when its effects begin. However, there is a real risk of overhydration if
your cat severely oliguric. I think Furosemide is much safer and should
begin to work in about 30 mins.

The problem with potassium levels is that most (>90%) of the total body
stores of K are contained in the tissue where it can't be measured by
routine tests and not in the blood - so blood tests don't represent the true
body stores of K.

My best wishes for your Golden Girl.and you.

Phil

[Phil P.]

"SPillus" > wrote in message
...
> Hi,
> A few days ago I posted about my kitty Meetoo-20 yrs. old. She has crf
w/
> 100ml of sub-Q fluid every day. She's been in hospital since Friday. The
> original info I had was that her potassium level was low, and was the
reason
> for her lethargy and small appetite.
> My updated info, straight from the vet's mouth is that her potassium is
> *high* at 6.4
> 5.5 is normal.
> Now that she's in the hospital, they have her on IV fluids and have added
some
> dextrose to draw the potassium out of the blood stream and into the cells.
The
> vet said with her potassium that high, her heart could stop.
> The vet is calling me later this evening to tell me the results of the
most
> recent blood test.
> We wanted to bring Meetoo home tonight as she's been in hospital since
Friday.
> Has anyone had experience with high potassium readings?
> Susan


When hyperkalemia occurs in CRF cats, its usually because the cat is either
oliguric, over-supplemented with K, or in the terminal state of the disease.
Since your cat was initially hypokalemic, my guess is your vet
over-supplemented potassium (K) - since its unlikely your cat went from
hypokalemia to hyperkalemia that fast - hyperkalemia usually doesn't occur
that quickly.

If I were you, I'd speak to your vet about a diuretic (Furosemide).
Diuretics stimulate urinary output, which facilitates the excretion of
excessive K and renal toxins. Furosemide should increase urine output
within 30 mins. If it doesn't, the dose should be doubled, and then tripled
at hourly intervals - although I don't think doses above 2 mg/lb are any
more effective. That's, of course, only if your cat is oliguric.

The only advantages of dextrose over flurosemide is its cheaper, provides
some non-protein calories for energy and is readily detectable in the urine
when its effects begin. However, there is a real risk of overhydration if
your cat severely oliguric. I think Furosemide is much safer and should
begin to work in about 30 mins.

The problem with potassium levels is that most (>90%) of the total body
stores of K are contained in the tissue where it can't be measured by
routine tests and not in the blood - so blood tests don't represent the true
body stores of K.

My best wishes for your Golden Girl.and you.

Phil

[Helen]

"SPillus" > wrote in message
...
> Hi,
> A few days ago I posted about my kitty Meetoo-20 yrs. old. She has crf
w/
> 100ml of sub-Q fluid every day. She's been in hospital since Friday. The
> original info I had was that her potassium level was low, and was the
reason
> for her lethargy and small appetite.
> My updated info, straight from the vet's mouth is that her potassium is
> *high* at 6.4
> 5.5 is normal.
> Now that she's in the hospital, they have her on IV fluids and have added
some
> dextrose to draw the potassium out of the blood stream and into the cells.
The
> vet said with her potassium that high, her heart could stop.
> The vet is calling me later this evening to tell me the results of the
most
> recent blood test.
> We wanted to bring Meetoo home tonight as she's been in hospital since
Friday.
> Has anyone had experience with high potassium readings?
> Susan

http://www.felinecrf.org/treatments.htm#High%20potassium

HTH

Helen

[Helen]

"SPillus" > wrote in message
...
> Hi,
> A few days ago I posted about my kitty Meetoo-20 yrs. old. She has crf
w/
> 100ml of sub-Q fluid every day. She's been in hospital since Friday. The
> original info I had was that her potassium level was low, and was the
reason
> for her lethargy and small appetite.
> My updated info, straight from the vet's mouth is that her potassium is
> *high* at 6.4
> 5.5 is normal.
> Now that she's in the hospital, they have her on IV fluids and have added
some
> dextrose to draw the potassium out of the blood stream and into the cells.
The
> vet said with her potassium that high, her heart could stop.
> The vet is calling me later this evening to tell me the results of the
most
> recent blood test.
> We wanted to bring Meetoo home tonight as she's been in hospital since
Friday.
> Has anyone had experience with high potassium readings?
> Susan

http://www.felinecrf.org/treatments.htm#High%20potassium

HTH

Helen

[Arjun Ray]

In >, "Phil P." >
wrote:

| When hyperkalemia occurs in CRF cats, its usually because the cat is
| either oliguric, over-supplemented with K, or in the terminal state of
| the disease.

Leaving aside the oversupplementation possibility, can oliguria happen
before the terminal stage? With adequate hydration, CRF cats usually
pee tons (okay, that's an exaggeration, but my fella's softball sized
clumps in the literbox are costing me a fortune in litter!), so wouldn't
*less* than normal urine output - which I believe is the meaning of
oliguria - mean that the kidneys are shutting down altogether?

Or is it the case that oliguria in CRF cats can also be due to some kind
of treatable blockage inside the kidneys?

[Arjun Ray]

In >, "Phil P." >
wrote:

| When hyperkalemia occurs in CRF cats, its usually because the cat is
| either oliguric, over-supplemented with K, or in the terminal state of
| the disease.

Leaving aside the oversupplementation possibility, can oliguria happen
before the terminal stage? With adequate hydration, CRF cats usually
pee tons (okay, that's an exaggeration, but my fella's softball sized
clumps in the literbox are costing me a fortune in litter!), so wouldn't
*less* than normal urine output - which I believe is the meaning of
oliguria - mean that the kidneys are shutting down altogether?

Or is it the case that oliguria in CRF cats can also be due to some kind
of treatable blockage inside the kidneys?

[Arjun Ray]

In >, "Phil P." >
wrote:
| "Arjun Ray" > wrote in message
| ...

|> With adequate hydration, CRF cats usually pee [a lot,] so wouldn't
|> *less* than normal urine output - which I believe is the meaning of
|> oliguria - mean that the kidneys are shutting down altogether?
|
| Not necessarily. Oliguria can be physiologic or pathologic and
| reversible - depending on the cause. Oliguria could occur in a cat
| with primary polyuric renal failÂ*ure if some prerenal abnormality
| develops.

What kind of pre-renal abnormalities might trigger this? E.g. severe
azotemia, dehydration, low blood pressure?

|> Or is it the case that oliguria in CRF cats can also be due to some
|> kind of treatable blockage inside the kidneys?
|
| Renal pelvic stones (nephroliths) can certainly obstruct urine flow
| to the ureters, urinary bladder, and urethra.

I guess this was my main question: how susceptible are CRF cats to
developing blockages inside the kidneys? (Or would this be due to
causes not necessarily related to the CRF condition itself?)

| Urinary obstruction can also occur in cats that have some disorder or
| abnormality of innervation from any cause that result in diminished or
| ineffective detrusor contractions or lack of relaxation of the
| urethral sphincter mechanism.

Okay, so it can be post-renal, in the bladder too.

| As an aside, the bladder should *never* be expressed in a oliguric
| or anuric cat.

I believe the standard treatment is a diuretic - is that correct?

[Arjun Ray]

In >, "Phil P." >
wrote:
| "Arjun Ray" > wrote in message
| ...

|> With adequate hydration, CRF cats usually pee [a lot,] so wouldn't
|> *less* than normal urine output - which I believe is the meaning of
|> oliguria - mean that the kidneys are shutting down altogether?
|
| Not necessarily. Oliguria can be physiologic or pathologic and
| reversible - depending on the cause. Oliguria could occur in a cat
| with primary polyuric renal failÂ*ure if some prerenal abnormality
| develops.

What kind of pre-renal abnormalities might trigger this? E.g. severe
azotemia, dehydration, low blood pressure?

|> Or is it the case that oliguria in CRF cats can also be due to some
|> kind of treatable blockage inside the kidneys?
|
| Renal pelvic stones (nephroliths) can certainly obstruct urine flow
| to the ureters, urinary bladder, and urethra.

I guess this was my main question: how susceptible are CRF cats to
developing blockages inside the kidneys? (Or would this be due to
causes not necessarily related to the CRF condition itself?)

| Urinary obstruction can also occur in cats that have some disorder or
| abnormality of innervation from any cause that result in diminished or
| ineffective detrusor contractions or lack of relaxation of the
| urethral sphincter mechanism.

Okay, so it can be post-renal, in the bladder too.

| As an aside, the bladder should *never* be expressed in a oliguric
| or anuric cat.

I believe the standard treatment is a diuretic - is that correct?