Sorry guys, I meant to go to the pool and read all of this, but instead I fell asleep and just woke up.
I read through this and I understand what's going on. Major disclaimer though - I am not a vet, I take care of human patients, so this is just basically explanation of values. I cannot give you advice on what to do with your cat. I will tell you what I know of a cat who got a blood transfusion though at the end.
So like I said before, these are blood gasses - not sure if they're arterial or venous, but these are usually taken when a human patient is in the ICU, or sometimes for a faster set of results. That's why they look different than regular labs, and can seem confusing.
So first, I am going to explain the meaning of each set of labs from 6/24-6/26 and summarize what I think is going on based on these labs. I'll try to explain it the best I can.
So on 6/24, I see that his Ph is lower than normal. meaning his blood is slightly acidic. I also see that CO2 is low, which is an acid, which means that his body is trying to compensate for a low acidity. Bicarb (HCO3) is at the low end of normal, which is due to kidney failure, probably causing the low pH. (It is low after fluids are given, so it may be falsely elevated here? not sure). I think this is uncompensated metabolic acidosis. His sugar is also 150, so there's probably no ketones present. His oxygen saturation is 94%, which is OK. His Hemoglobin is 9. and hematocrit is 27. That is lower than the reference range, which could also be due to kidney failure - kidneys produce erythropoietin, which makes red blood cells (RBCs), and when they are not functioning well, they produce less of it. His potassium is also low on those labs, but other electrolytes are OK. This may be due to insulin administration, as it tends to drive potassium into the cells. Not too concerned about that, would be more concerned if it was high, as kidneys excrete potassium. BUN and Cr are pretty high, 118/8.4, but bear in mind that the cat's normal range is higher than that of a human, so it might look higher to me than it actually is.
6/25. His pH on this set of labs is still low, so he is still in metabolic acidosis. CO2 is at the low end of normal, so it is still not compensated. HCO3 is still at the low end of normal, which I think is causing the acidosis. After fluids were given, I see that H/H are even lower. This is probably due to dilution effect by the IV fluids, and 7.7 is pretty low for a human. I don't know what the threshold for a cat is for a transfusion, but for a human it's 7, if they are not actively bleeding.
Magnesium is high on this set of labs, which may be due to decreased excretion from kidneys. BUN an Cr are lower than the day before, because of the fluids given. Oxygen saturation in blood is 96.9%, which is good.
6/26 - so here we are still acidic with a lower CO2, and we see that bicarb is low at 14.7, and the body is trying to compensate for the low bicarb. his oxygen saturation on there is 88%, which is low. This is concerning, and could be due to a low H/H, or could just be variation in labs, since the previous 2 days O2 saturation was better. His hemoglobin is lowest here, 7.6/23, again lower because he was given fluids. BUN and Cr are lower too than before, due to fluids, although still higher than normal. So the fluids are working.
As for question of whether to give a transfusion - again, I do not know the transfusion threshold for cats. Based on his labs, it does look like he has kidney failure that is starting to affect his electrolyte excretion, hemoglobin production, and will eventually cause his blood oxygen saturation to go too low. I realize the cost, but I would probably do the transfusion. My friend's "miracle" kitty that I posted about a few posts back (probably in the Cushing's forum), got multiple blood transfusions. The way we found out she was anemic was that she started having seizures from the low oxygen. I think her hemoglobin was 5 something at that time. She had some kind of autoimmune bone marrow issue, and is now in remission on medication. Of course we do not want to wait that long to give a transfusion to your kitty, so it would be worthwhile asking your vet, or a vet on here what their transfusion threshold is.
Also, what was the reason the cat was in the hospital? What were his symptoms? Was he lethargic? Short of breath or tired with minimal activitY? Those CAN be symptoms of anemia (but are not specific to it, either).
I hope this helps a little bit. Let me know what questions you have!
Hi Ana, WOW do you know a lot! Thank you times a million for taking the time to explain all of that to me. I knew that IV fluids could affect things, but I didn't really understand how.
A quick recap of what landed us in the hospital:
3/1- diagnosed with diabetes by a regular veterinary practice
4/4- saw an internal medicine diabetic specialist at the AMC in NYC.
5/26- went for follow up at AMC, and to do a fructosamine. That night she started acting very odd- super lethargic, not really interested in food, blood sugar spiked (at least it was a spike for her, I've since been told it wasn't really that high). Emailed the IM doctor, she said to keep an eye, there wasn't much to be done unless symptoms persisted. She also told me the fructosamine was low, and it was a sign we might be headed into diabetic remission, to reduce insulin to one unit once a day. Symptoms persisted for 72 hours and I noticed a huge increase in water intake, but chalked this up to higher than normal blood sugar.
5/30-6/4- saw an improvement, less lethargic, better appetite.
6/9- appetite starts to decrease again, lethargy increasing, and is disinterested in a lot- won't play, but will still greet us at the door.
6/10- Something wasn't sitting right, so I made an appointment with a vet who only deals with cats.
6/15- we visit said vet. He thinks it is a virus, possibly feline herpes, possibly something picked up at the AMC. He prescribes anti-viral and appetite stimulant, gives her cerenia injection and sub q fluids in office- he weighs her and she is down almost a pound in 2.5 weeks. Says keep an eye- doesn't recommend running labs.
6/17- I call the vet and say I'm still worried, I don't see much improvement, and she's really struggling to eat. He says take her to ER if things get much worse, otherwise come back in.
6/23- I bring her back to the vet. The look on his face immediately tells me that something is wrong. He says her kidneys are huge, she is dangerously dehydrated, does an x-ray, notes spots on kidneys that he thinks are stones, temperature and blood pressure are normal, says to go to another emergency hospital so they can do an ultrasound.
6/23, one hour later- I get to the ER, and they take her in for what I thought was going to be in and out. They come back and say I cannot take her home, she must be admitted. Now I'm scared to death, so I let them admit her.
6/23-6/24- communication is basically IMPOSSIBLE. I'm told no doctor has examined her, but that the ultrasound showed "obliterated kidneys" and a cyst in the liver. I drive into the city during the Pride Parade, have to park 5 avenues and 5 blocks away from the hospital because I can't get any closer due to street closures, I walk in, demand the cat be released, and then proceed to walk back to the car and drive to an animal hospital in Westchester.
6/24- she is admitted for another 48 hours in the 2nd hosp, I get a lot more information and updates.
6/26- I bring her home, with daily antibiotics, daily famotodine, daily cerenia and sub q fluids.
6/27- We are back in the ER at 10PM because she was hypoglycemic. She gets two oral dextrose doses, and one IV dextrose. They want to keep her overnight, I say no (can't afford it).
6/28- She urinates all over the couch. She stays outside for a little while with my boyfriend, he brings her in, she pees all over the kitchen floor. I relocate to sleeping on the floor in the office/cat room with her. She has a bout of diarrhea that night. I'm convinced I will wake up to a dead cat.
6/29-7/2- some improvements (no more incontinence). Better appetite
7/3- incontinent again, on the couch, in the morning while I was asleep on the couch. Clean up couch again. Has another episode of incontinence in the evening.
7/4- appetite much better today- but still very lethargic. She is seeking my attention, wants to sit on my lap a lot.
So there's that!
