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#1
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Sub-Q fluids made cat sluggish
This whole situation is in the past, but I'm still looking for
answers. I'm interested in knowing why giving a 12 y/o, indoor only cat 100 mL of Sub-Q fluids twice a week would cause him to become sluggish and stop playing (his playing involved running around the house). About a month prior, all blood work and urinary results were normal. An x-ray was done at my request just to confirm everything was ok since there was a history of stones, and the x-ray looked good. The vet did say my cat had a grade 2 (out of 6) heart murmur. In the past, the vets (two of them) had always diagnosed it as either a grade 2 or sometimes a grade 3. They both said further testing wasn't necessary at that time. The fluids were given maybe a total of six times to try to flush a stone out of the ureter (the tube that connects the kidney to the bladder). The sluggishness started after about the second or third time. I complained so much about the sluggishness that the vet relunctantly told me to stop giving the fluids. After my cat stopped getting fluids, his sluggishness improved only a little. He would play, but if his playing involved running, he would become tired very easily and stop. His appetite and thirst seemed normal. He also seemed to be using the litterbox normally, with no obvious increase or decrease in urine production. A little over three months later, my cat was taken to the vet for lethargy and loss of appetite. X-rays were taken that showed fluid around the heart. I was immediately sent to the internal medicine vet who did an ultrasound. A diagnosis of right-sided heart failure was made. Based on the poor to grave prognosis from the internal medicine vet and the regular vet, as well as my own gut instincts, I chose to euthanize my cat. After doing weeks of researching these medical problems, I still stand by my decision. Did the Sub-Q fluids cause the heart failure? I know it's possible my cat could have had some sort of undiagnosed heart problem (like cardiomyopathy), but he was acting perfectly normal until he started receiving the fluids. So, even if he did have an undiagnosed heart problem, it sounds like the fluids still caused the actual heart failure. Does anyone have any thoughts on this? I'm having a great deal of difficulty finding anything about Sub-Q fluids causing heart failure. The only website I can find that discusses this is one that is created by cat owners who don't seem to have any veterinary training. I tried to ask the internal medicine vet about what caused the heart failure, but was only given the runaround, which I'm sure they do for legal reasons. He did say the heart murmur should have had further testing years ago. |
#2
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Sub-Q fluids made cat sluggish
MJ,
A stable, low-grade heart murmur is not indicative of any particular cardiovascular condition, and, in and of itself, does not contrindicate sub-cu fluids, though increased caution and observation is indicated, along with close monitoring for any changes in the level or nature of the murmur. I'd guess they were using Ringer's Lactate. It is certainly possible that it could exacerbate an existing congestive cardiac condition while being administered [1], but it is unlikely to cause one. Since congestive heart failure is treated with, among other things, diuretics, an excess of fluid volume could have increased the congestion, and due to increased pressure, accelerated muscle damge due to constriction of the blood supply. That is particularly true if kidney function was impaired and fluid clearance decreased. But whether that did or did not happen can't be definatively determined. Of more importance to the behavior changes, what was the outcome of the stone? An obstructed ureter can cause kidney pain, and it can be second only to giving birth. One of my sisters had one and she will tell you in a heartbeat the pain was only slightly less than having her first child, and worse than having the second and third. You also didn't mention the breed, some are more prone to congestive heart problems than others. If the cat was born before the late 80's, your cat's cardiomyopathy could have been exacerbated by a lack of taurine in the diet. Taruine is an amino acid that carnivores cannot synthesize as omnivores do. They must get it from their diet, and if that diet does not contain organ meat, or is not supplemented with taurine, it can lead to vision problems progressing to permanent blindness, and condition called feline dialated cardiomyopathy, but that is reversible with taurine supplementation. All commercial cat foods that have the AAFCO approval label are required to have taurine added (I think that happened in the late 80's). If you were feeding a cat food with taurine added (it will apper near the end of the ingredients list), taurine shouldn't be a factor. However, non-certified foods and homemade foods may be deficient in taurine. Dog food is certainly inadequate, as dogs are omnivores and can synthesize taurine. All this said, I have to agree with the IMV that the persistent murmur would have better been investigated earlier. Heart murmurs are not uncommon in cats under 18 months old, but they typically disappear as growth and development complete. Since the murmur was pre-existing, the defect was probably congenital (present at birth). Whether the fluid, or a taurine deficiency, were contributory, or to what degree, cannot be known. Nor can it be known whether medication would have mitigated the normal progression of the defect or disease. My sense is that if the IMV thought vasodialators, beta blockers, angiostatins, or diuretics would have been helpful at that point, he would have said so. Congestive heart failure can be caused by many factors, including coronary artery disease, heart attack, high blood pressure, heart valve disease, heart muscle disease, infections of the heart valves or muscle, or congenital defects of the cardiovascular sytem or the heart itself. Most of the above have a remarkable onset, that is, suddenly appear. Obviously, congenital issues are present from birth. We've had 19 cats over the last 50 years (we will take in cats, usually older, with diseases or conditions that require a 'nursing' level of attention), and have had to make your decision a number of times. When that desision must be made, it isn't about us, its about the cat. It isn't about past events, its about future quality of life, or the lack thereof. I commend you for trying to learn from the past, it is the only way the past can positively contribute to the betterment of the future. But, IMO, your decision was the correct one, and certainly the one I'd have made under those circumstances. Allan [1} Relationshhipof hydration and heart physiology may be found at http://www3.interscience.wiley.com/j...TRY=1&SRETRY=0 -- One asks, many answer, all learn -- Plato, on the 'Forum --- True civility is when every one gives to every other one every right that they claim for themselves. "MJ" wrote in message ... This whole situation is in the past, but I'm still looking for answers. I'm interested in knowing why giving a 12 y/o, indoor only cat 100 mL of Sub-Q fluids twice a week would cause him to become sluggish and stop playing (his playing involved running around the house). About a month prior, all blood work and urinary results were normal. An x-ray |
#3
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Sub-Q fluids made cat sluggish
Thanks for responding.
My cat was a 12 y/o (born in '97) Maine Coon mix and I believe he was also part Himalayan. The heart murmur was diagnosed when he was 5. He may have had one before then but I don't have the records from the original vet and he never said anything about a murmur. The internal medicine vet said the ultrasound showed mitral valve regurgitation and right sided heart failure. There was also impending left sided failure. There was a dilated left atrium and auricle. The records from the primary vet show that during some exams there was a murmur (usually grade 2) and other times there was no murmur. At the time Sub-Q fluids were given, the right kidney was enlarged but the ureter was not blocked, according to the x-ray. Sometime after this, he developed two additional CaOx stones. I'm confused by their location. The ultrasound findings show a bladder stone, a right kidney/ pelvis stone, and a gallbladder stone. I have no idea which one is considered to be the pre-existing stone in the right ureter. I believe the two additional stones were caused by a change in food. The vet changed the food and even though it's formulated to prevent CaOx stones, it also acidifies the urine. The label specifically says it shouldn't be given to cats with renal failure, which my cat did not have at the time he started this food. The records from the primary vet show a differential diagnosis of hydronephrosis and hydroureter. The internal medicine vet did not say whether there was an obstruction. However, the "good" kidney (the left one that was still working) was very small and shrunken to the point of the vet having a hard time finding it during the ultrasound. What I find confusing and interesting is that 2-3 days before he died, the vet didn't hear a murmur. When I listened to his heart, there was some "whooshing" sound present that was so loud I could barely hear his heartbeat. Considering he was most likely in heart failure 2-3 days before he died, it seems like this would have been noticed by the vet during the exam. And as I'm writing this I just remembered that I had also noticed he looked bigger than normal (like he had put on weight). I'm guessing that was from the abdominal fluid. I had mentioned this "weight gain" to the vet who just ignored it. On 8 Jan, 09:45, "Allan Smith" wrote: MJ, A stable, low-grade heart murmur is not indicative of any particular cardiovascular condition, and, in and of itself, does not contrindicate sub-cu fluids, though increased caution and observation is indicated, along with close monitoring for any changes in the level or nature of the murmur. |
#4
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Sub-Q fluids made cat sluggish
NJ,
My cat was a 12 y/o (born in '97) Maine Coon mix and I believe he was also part Himalayan. The heart murmur was diagnosed when he was 5. He may have had one before then but I don't have the records from the original vet and he never said anything about a murmur. http://www.petmedsonline.org/heart-d...e-in-cats.html Note its prevalence in Maine Coons, and that it develops in young and middle-aged cats, and is not always detectable early-on. The internal medicine vet said the ultrasound showed mitral valve regurgitation and right sided heart failure. There was also impending left sided failure. There was a dilated left atrium and auricle. The records from the primary vet show that during some exams there was a murmur (usually grade 2) and other times there was no murmur. The dialated chamber is amost always present in cases of mitral valve regurgitation. Some inflammatory causes of regurgitation result in variabilily of murmur grade, depending on the current degree of inflammation. At the time Sub-Q fluids were given, the right kidney was enlarged but I'm snipping some of the reminder, for brevity. Basically, there were two issues going on - kidney and heart, and treating one would probably worsen the other. It is quite probable that the two were related, he heart issue appearing first, and the kidney later. The heart issue could be congenital, or could be the result of an infection, whether strep as in rheumatic fever, or endocarditis. It is probable that only an autopsy might have been able to discern which it was. The same is true for the sudden development of kidney disease. There is a part of me that thinks the two are related, possibly the result of the same infection, or the kidney issues developing from an existing heart condition and/or the tiny blood clots that infections (particularly strep) can produce. But without a complete blood count including white-cell differentials perhaps showing elevated monocytes and eosinophils, it is impossible to conclude. I'm guessing that was from the abdominal fluid. I had mentioned this "weight gain" to the vet who just ignored it. It is possible that serously reduced fluid-clearance capability could have resulted in increased retention, and that in turn exacerbated the congestive failure. I'm surprised your vet doesn't weigh every presenting patient, every time. Sudden weight changes are important cues. Reviewing all this, the IMV's opinion that the murmur would have been better pursued earlier remains the most salient observation. In my non-veterinarian and non-medical personal opinion, murmur suddenly developing in a young cat, even one with a breed-predisposition, should be evaluated by a CBC with Platelet Differentials to rule out detectable infection, then by an ultrasound if no infection is indicated, to determine appropriate ongoing treatment. All that said, I don't think the eventual outcome would have been much different, it is more a question of when than if. The only possibility I can see is that if an infection were promptly detected and successfully treated early, the heart and kidney damage done might have been minimized, and if no infection, any congenital cardiac condition managed appropriately. Allan -- One asks, many answer, all learn -- Plato, on the 'Forum --- True civility is when every one gives to every other one every right that they claim for themselves. "MJ" wrote in message ... Thanks for responding. On 8 Jan, 09:45, "Allan Smith" wrote: MJ, A stable, low-grade heart murmur is not indicative of any particular cardiovascular condition, and, in and of itself, does not contrindicate |
#5
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Sub-Q fluids made cat sluggish
On Jan 8, 3:51*am, MJ wrote:
This whole situation is in the past, but I'm still looking for answers. I'm interested in knowing why giving a 12 y/o, indoor only cat 100 mL of Sub-Q fluids twice a week would cause him to become sluggish and stop playing (his playing involved running around the house). About a month prior, all blood work and urinary results were normal. An x-ray was done at my request just to confirm everything was ok since there was a history of stones, and the x-ray looked good. The vet did say my cat had a grade 2 (out of 6) heart murmur. In the past, the vets (two of them) had always diagnosed it as either a grade 2 or sometimes a grade 3. They both said further testing wasn't necessary at that time. The fluids were given maybe a total of six times to try to flush a stone out of the ureter (the tube that connects the kidney to the bladder). The sluggishness started after about the second or third time. I complained so much about the sluggishness that the vet relunctantly told me to stop giving the fluids. After my cat stopped getting fluids, his sluggishness improved only a little. He would play, but if his playing involved running, he would become tired very easily and stop. His appetite and thirst seemed normal. He also seemed to be using the litterbox normally, with no obvious increase or decrease in urine production. A little over three months later, my cat was taken to the vet for lethargy and loss of appetite. X-rays were taken that showed fluid around the heart. I was immediately sent to the internal medicine vet who did an ultrasound. A diagnosis of right-sided heart failure was made. Based on the poor to grave prognosis from the internal medicine vet and the regular vet, as well as my own gut instincts, I chose to euthanize my cat. After doing weeks of researching these medical problems, I still stand by my decision. Did the Sub-Q fluids cause the heart failure? I know it's possible my cat could have had some sort of undiagnosed heart problem (like cardiomyopathy), but he was acting perfectly normal until he started receiving the fluids. So, even if he did have an undiagnosed heart problem, it sounds like the fluids still caused the actual heart failure. Does anyone have any thoughts on this? I'm having a great deal of difficulty finding anything about Sub-Q fluids causing heart failure. The only website I can find that discusses this is one that is created by cat owners who don't seem to have any veterinary training. I tried to ask the internal medicine vet about what caused the heart failure, but was only given the runaround, which I'm sure they do for legal reasons. He did say the heart murmur should have had further testing years ago. Man, you worry too ****ing much. |
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