Saturday, July 18, 2015

Risky Sodium Solution for Myrna's Weakness

Myrna's blood was tested Thursday to see if she is low in potassium or red blood cells or if her kidney values had risen-all possible causes of her symptoms of vomiting, weakness, not eating.   But the blood work showed she's fine.  Myrna's BUN is down a tic to 36 from 37 in June and creatinine is up a tic to 2.8 from 2.7 in June and potassium is up to just over 5, up from a low of 2.3 in June.  BUN and creatinine are stable and have been in this range for almost a year now.   The kidney vitamin and iron support we give her I believe is why her values have remained stable even as she is on high doses of Torsemide. Chloride and sodium are slightly low. Albumin is slightly high. These are signs of dehydration.  

Stomach clots and/or ulcer has caused her not to eat, and has caused black diarrhea.  As her stomach bothered her more, as she began eating less on her own, she also began to drink less.  We could see the water in the bowl wasn't decreasing and that her urine output had begun to become smaller.  We had been giving her water by mouth to compensate.  The overall effect of dehydration from lack of water and the chronic diarrhea is why the sodium and chloride are low (the diarrhea and constant urination due to Torsemide took these out of the body.)  That sodium and chloride are low and she's dehydrated actually effects kidney function.   One sign of that is that potassium is high-because the kidneys are not able to properly filter waste and byproducts such as potassium. 

So, because her sodium was below normal, even just a tic (145 when the minimum normal is 147) I added salt to her liquid food we were feeding by mouth.  The kidneys need salt to properly function as does the heart (sodium is necessary for regulation of heart beat) and the blood needs it.  The whole body needs it really. In 2 oz of prepared liquid food, I added 10 or less grains of salt, just a touch.  I could slightly taste it but not because it tasted of salt but because it enhanced the flavor of the liquid food.  We gave 3ml of this to her at 5:30 and again at 7:30 p.m.  By 9 p.m. she was eating regular food.  She continued to eat regular food every couple of hours when offered.  I gave her treats overnight for litter box use and if she woke me to say she was hungry.  She drank the bowl of water nearly dry overnight and urinated large amounts often.  I gave her just 2ml of liquid food with her 6 a.m. meds.  So, as risky as it was-because sodium means fluid retention which isn't what we want for a cat that has chronic congestion (CHF), it may be the trick that worked to help her kidneys and help her feel better-however it works in the body to make one feel better.

Yes, we need to slow down chronic diarrhea and calm her stomach ulcer.  And the more she urinates now, the faster her potassium will soon decrease. But we have Renal K supplement to help along with the potassium pills we give.   And salt shouldn't be given except in extreme cases so i won't give it again for a few days if she doesn't eat.  But if she eats regular commercially prepared food, she will get enough salt.  

I'm not going to give her Mirtazapine, Cerenia, Cypro, etc. for a couple of days. The Mirtazapine wasn't working, as if she's immuned.  The others didn't seem to help.  Perhaps the absence of enough salt was the reason.  We will continue to use sucralfate. 

Facebook post 7/16/15

Little girl still won't eat. I think the baby food backfired and can no longer be tolerated. We didn't push food last night due to her upsets yesterday but did give 3ml tuna juice at bedtime. We monitored water intake and gave extra PO. Today she's had kitten KMR with condensed milk for a touch of energy source and tuna juice. The potassium powder is added to water, vitamin goop, liquid food but the amount of potassium cannot be counted since so little of it is in 3ml of any liquid. I thought I was giving enough of the gel which is 1/2 tsp equals 2 meq. But when I actually measured using a 1/2 tsp it turned out that I was only giving a 1/8-1/4. So, now I'm actually using a 1/2 tsp to measure correct amount. She needs four or more tabs of potassium at 595 each and about seven teaspoons of gel to equal 3000mg minimum she needs. We need about 75meq if I have calculated correctly. And she should have even more due to the large dose of torsemide she takes. She had been receiving 3000mg or more in tabs but lately it's been difficult to get it all down. I hoped the gel would make it easier to increase potassium but a 1/2 tsp is also a lot to get down.

Facebook post 7/15/15

Tuesday I hand fed Myrna and despite a lot of Mirtazapine she did not want to eat until very late at night. She ate today at 6 a.m. and had treats at 10 a.m but then came to a halt. I've continued feeding PO (by hand) and giving Mirt to no avail. I'm hoping that she may be low on potassium which can make her feel miserable, lead to vomiting we saw yesterday, and decrease appetite. The stomach/ulcer med is making her gag so I'll stop that again for now.

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