CRF-cat, potassium: Vets, please help us

The difficulties to judge the "real" potassium level from serum
analysis have been discussed at various occasions. Now we seem to be
hit ourselves.

History:
This cat adopted me five years ago and we are very much in love since.
Right then, I discovered symtpoms of CRF (high water intake,
occasional vomiting). Crea was about 2.2 mg/dl and on a later check
2.64.
I fed the best food available in many smaller offerings, gave high
qualitiy salad oil (2-3g after meals) and encouraged to drink.
During last year, the vomiting seemed to have disappeared.
He always had somewhat hard stools, but last week (19+ years, 4 kg),
he suffered from severe congestion, and yesterday we were busy from
9pm to 3am to release a hard rock.

Since about 1.5 weeks he began to reduce food intake, whereas he still
drinks and devours his salad oil more often than not.

3 days ago we have been at the vet, to do a check up and (much feared)
to determine wether the beloved cat had travelled to the end of his
road.

Findings:
x-ray (1 taken lying on back and 1 on side) seems to indicate some
water in his lung. Kidneys normal.

Today the blood panel arrived. Crea is 1.89, well below limit of 2.0
mg/dl.
I'll just name the out of range ones with the ranges given in brackets
[]:
++ BUN 51 [10 - 33 mg/dl]
+ Bilirubin 0.33 [ 0.3 mg/dl ]
+ Alk. Phosphatase 111 [ 105 U/l]
+ GLDH 11.4 [ 9 U/l ]
- Triglycerides 24 [ 44 to 105 mg/dl]
- Leukocytes 3.6 [ 6 to 11 G/l]
-- Erythrocytes 3.06 [ 5 - 10 T/l]
- Hemoglobin 5.87 [ 9 - 15 g/dl]
- Hematokrit 21 [ 28 - 45 %]
++ MCV 69 [40 - 55fl]
+ HbE 19 [13 - 17 pg]
-- MCHC 28 [31 - 35 g/dl]
- Lymphocytes 864 [1000 - 6000 /ul]
- Segment-cored 2736 [3000 - 11000 /ul]
and, as the reason of this posting

Potassium 4.2 [3.0 - 5.0 mmol/l]

With my last kidney patient, it had been 3.8 half a year before we had
to let her go (age 21+), and the other vet had never mentioned it.

Now, the recommendation is, to support the heart and eventually reduce
the water in the lung by giving (1/day) 25ug of Lanitop mite, which is
Metildigoxin, a heart active glycoside derived from the plant
digitalis lanta. The accompanying sheet says (among lots of others):
Not to be applied in case of hypokalemia.

During the last years I used to occasionally add 100mg of Potassium
gluconate once a day to the cats meal, which is much below the doses I
found mentioned. This seemed to have a positive effect concerning
agilitiy and alertness (if we give any weight to such observations).

Now, between a rock and a hard wall: What should I do?
Thanks in advance for your patience and eventual replies,
H.

"Heinz Schmitz" wrote in message
...
The difficulties to judge the "real" potassium level from serum
analysis have been discussed at various occasions. Now we seem to be
hit ourselves.

History:
This cat adopted me five years ago and we are very much in love since.
Right then, I discovered symtpoms of CRF (high water intake,
occasional vomiting). Crea was about 2.2 mg/dl and on a later check
2.64.
I fed the best food available in many smaller offerings, gave high
qualitiy salad oil (2-3g after meals) and encouraged to drink.
During last year, the vomiting seemed to have disappeared.
He always had somewhat hard stools, but last week (19+ years, 4 kg),
he suffered from severe congestion, and yesterday we were busy from
9pm to 3am to release a hard rock.

Since about 1.5 weeks he began to reduce food intake, whereas he still
drinks and devours his salad oil more often than not.

3 days ago we have been at the vet, to do a check up and (much feared)
to determine wether the beloved cat had travelled to the end of his
road.

Findings:
x-ray (1 taken lying on back and 1 on side) seems to indicate some
water in his lung. Kidneys normal.

Today the blood panel arrived. Crea is 1.89, well below limit of 2.0
mg/dl.
I'll just name the out of range ones with the ranges given in brackets
[]:
++ BUN 51 [10 - 33 mg/dl]
+ Bilirubin 0.33 [ 0.3 mg/dl ]
+ Alk. Phosphatase 111 [ 105 U/l]
+ GLDH 11.4 [ 9 U/l ]
- Triglycerides 24 [ 44 to 105 mg/dl]
- Leukocytes 3.6 [ 6 to 11 G/l]
-- Erythrocytes 3.06 [ 5 - 10 T/l]
- Hemoglobin 5.87 [ 9 - 15 g/dl]
- Hematokrit 21 [ 28 - 45 %]
++ MCV 69 [40 - 55fl]
+ HbE 19 [13 - 17 pg]
-- MCHC 28 [31 - 35 g/dl]
- Lymphocytes 864 [1000 - 6000 /ul]
- Segment-cored 2736 [3000 - 11000 /ul]
and, as the reason of this posting

Potassium 4.2 [3.0 - 5.0 mmol/l]

With my last kidney patient, it had been 3.8 half a year before we had
to let her go (age 21+), and the other vet had never mentioned it.

Now, the recommendation is, to support the heart and eventually reduce
the water in the lung by giving (1/day) 25ug of Lanitop mite, which is
Metildigoxin, a heart active glycoside derived from the plant
digitalis lanta. The accompanying sheet says (among lots of others):
Not to be applied in case of hypokalemia.

During the last years I used to occasionally add 100mg of Potassium
gluconate once a day to the cats meal, which is much below the doses I
found mentioned. This seemed to have a positive effect concerning
agilitiy and alertness (if we give any weight to such observations).

Now, between a rock and a hard wall: What should I do?
Thanks in advance for your patience and eventual replies,
H.

Sorry -- not a`vet, but I have some experience with feline CRF and
especially potassium supplementation.

You're absolutely right -- serum K+ isn't a true marker of total body
potassium stores since 95% of the body's K+ is contained in tissue, not in
the blood.

A few older CRF studies showed muscle potassium content was decreased in
normokalemic cats with varying stages CRF. Thus body potassium depletion
could occur despite normal serum K+ levels. This means that body potassium
depletion could develop well before the
onset of hypokalemia. So its probably not a good idea to wait for serum K+
levels to drop before beginning supplementation. The risk of hyperkalemia
is very low as long as the cat is urinating normally or he's polyuric.

Also, if the cat is receiving fluid therapy, he probably should receive even
a greater K+ supplement because fluid therapy promotes rapid urine
formation - and rapid urine formation promotes potassium secretion. Cats
have died of muscle paralysis as a result of fluid diuresis and depletion
of already depleted body potassium stores. To my mind, K+ supplementation
is essential for cats receiving fluid therapy.

There's also compelling evidence that K+ can actually improve renal function
in cats with CRF. In the Dow & Fettman study, cats in the group that
received K+ supplementation experienced either improved renal function
(reduction in serum urea nitrogen and creatinine concentration) or their
renal function stabilized. K+ supplementation was the only treatment these
cats received. Not only did renal function improve in these cats, they also
had improvements in other conditions such as`anemia, poor haircoat, and
weight loss.

If I were you, I'd speak to your vet about a K+ supplement - at least 2
mEq/day - 4 mEq would probably be even better and monitor serum K+
concentration - I'd want to keep serum K+ well in the upper half of the
normal range.

Good luck.

Phil

"Heinz Schmitz" wrote in message
...
The difficulties to judge the "real" potassium level from serum
analysis have been discussed at various occasions. Now we seem to be
hit ourselves.

History:
This cat adopted me five years ago and we are very much in love since.
Right then, I discovered symtpoms of CRF (high water intake,
occasional vomiting). Crea was about 2.2 mg/dl and on a later check
2.64.
I fed the best food available in many smaller offerings, gave high
qualitiy salad oil (2-3g after meals) and encouraged to drink.
During last year, the vomiting seemed to have disappeared.
He always had somewhat hard stools, but last week (19+ years, 4 kg),
he suffered from severe congestion, and yesterday we were busy from
9pm to 3am to release a hard rock.

Since about 1.5 weeks he began to reduce food intake, whereas he still
drinks and devours his salad oil more often than not.

3 days ago we have been at the vet, to do a check up and (much feared)
to determine wether the beloved cat had travelled to the end of his
road.

Findings:
x-ray (1 taken lying on back and 1 on side) seems to indicate some
water in his lung. Kidneys normal.

Today the blood panel arrived. Crea is 1.89, well below limit of 2.0
mg/dl.
I'll just name the out of range ones with the ranges given in brackets
[]:
++ BUN 51 [10 - 33 mg/dl]
+ Bilirubin 0.33 [ 0.3 mg/dl ]
+ Alk. Phosphatase 111 [ 105 U/l]
+ GLDH 11.4 [ 9 U/l ]
- Triglycerides 24 [ 44 to 105 mg/dl]
- Leukocytes 3.6 [ 6 to 11 G/l]
-- Erythrocytes 3.06 [ 5 - 10 T/l]
- Hemoglobin 5.87 [ 9 - 15 g/dl]
- Hematokrit 21 [ 28 - 45 %]
++ MCV 69 [40 - 55fl]
+ HbE 19 [13 - 17 pg]
-- MCHC 28 [31 - 35 g/dl]
- Lymphocytes 864 [1000 - 6000 /ul]
- Segment-cored 2736 [3000 - 11000 /ul]
and, as the reason of this posting

Potassium 4.2 [3.0 - 5.0 mmol/l]

With my last kidney patient, it had been 3.8 half a year before we had
to let her go (age 21+), and the other vet had never mentioned it.

Now, the recommendation is, to support the heart and eventually reduce
the water in the lung by giving (1/day) 25ug of Lanitop mite, which is
Metildigoxin, a heart active glycoside derived from the plant
digitalis lanta. The accompanying sheet says (among lots of others):
Not to be applied in case of hypokalemia.

During the last years I used to occasionally add 100mg of Potassium
gluconate once a day to the cats meal, which is much below the doses I
found mentioned. This seemed to have a positive effect concerning
agilitiy and alertness (if we give any weight to such observations).

Now, between a rock and a hard wall: What should I do?
Thanks in advance for your patience and eventual replies,
H.

Sorry -- not a`vet, but I have some experience with feline CRF and
especially potassium supplementation.

You're absolutely right -- serum K+ isn't a true marker of total body
potassium stores since 95% of the body's K+ is contained in tissue, not in
the blood.

A few older CRF studies showed muscle potassium content was decreased in
normokalemic cats with varying stages CRF. Thus body potassium depletion
could occur despite normal serum K+ levels. This means that body potassium
depletion could develop well before the
onset of hypokalemia. So its probably not a good idea to wait for serum K+
levels to drop before beginning supplementation. The risk of hyperkalemia
is very low as long as the cat is urinating normally or he's polyuric.

Also, if the cat is receiving fluid therapy, he probably should receive even
a greater K+ supplement because fluid therapy promotes rapid urine
formation - and rapid urine formation promotes potassium secretion. Cats
have died of muscle paralysis as a result of fluid diuresis and depletion
of already depleted body potassium stores. To my mind, K+ supplementation
is essential for cats receiving fluid therapy.

There's also compelling evidence that K+ can actually improve renal function
in cats with CRF. In the Dow & Fettman study, cats in the group that
received K+ supplementation experienced either improved renal function
(reduction in serum urea nitrogen and creatinine concentration) or their
renal function stabilized. K+ supplementation was the only treatment these
cats received. Not only did renal function improve in these cats, they also
had improvements in other conditions such as`anemia, poor haircoat, and
weight loss.

If I were you, I'd speak to your vet about a K+ supplement - at least 2
mEq/day - 4 mEq would probably be even better and monitor serum K+
concentration - I'd want to keep serum K+ well in the upper half of the
normal range.

Good luck.

Phil