Cat staring off into distance, listless, and often unaware of surroundings

[bsmith]

Edwin is acting very strangely today. He is staring off into the distance with little awareness of what is going on around him. He is listless and spending some of his time in the meatloaf position, but at other times lays on his side. Here's where we last left on with him http://www.felinediabetes.com/FDMB/threads/subqs-and-litterbox-flooding-odd-behavior.136542/ . The vet did the cysto and the urinalysis with cultures and sensitivity last week. It came back negative for any infection. He did have some yellow eye discharge at the same time, but that has gone away and I assume, if it had been an infection, it would have shown up on the urinalysis. To sum up:

• BG looking normal, 79 yesterday and 110 today. He is currently off insulin and diet controlled. He has stage 2 CKD.
• Eating normally, drinking normally, normal amount of urine and stool. No problems using the litterbox. The only possible change here is that he started eating Young Again Zero Carb Mature on its own again without me having to grind it up and mix it with canned food. This was about 5 days ago. At that time I also added a bit of Young Again's flavor packet to get him eating that food on its own again.
• Skin hydration checks look normal, but gum check shows gums a little tacky. I'd consider giving him a small subq, but subq's are how we got into our current mess. I'm watching the water bowl closely, but so far it seems normal.
• No recent medication changes.
• Breathing normal. Temperature and heart rate seem normal.
• He seems a bit wobbly walking, but that may just be pain and stiffness. He still seems to be getting around okay.
• He had been behaving normally again until two nights ago when I found him crouching inside the garage door instead of outside enjoying the day.
• Last night I found him down on the neighbor's porch crouching and looking confused as if he thought maybe that was his porch or he didn't know how to get home.
• Today I let him out for a bit, but brought him in early. He was sleeping in the sun on the driveway. I went out to check on him and got him up and moving a bit. I later found him down the driveway a bit staring into the distance at nothing. Even though I was calling his name, he did not react until I was a foot away.
• It seems that he may be hallucinating and he is twitching his tail angrily. I've recently come to suspect that he has had feline hyperesthesia for some time. I'm not sure if this is just a bad spell of that. It would explain the odd behavior, hallucinations, twitching tail, and the meowing in the middle of last night. However, he is not displaying the skin rolling and twitching that usually accompanies his hyperesthesia spells.
• If you approach him and pet or interact with him he seems to "come to" and behave normally as long as you're actively interacting with him.

I'm at a loss here as to what is going on. He's just really out of it and off. Is he over medicated, though there have been no recent medication changes? Is there an infection that even the urinalysis with cultures and sensitivity missed and should I press my vet for antibiotics just on that off chance? Is this pain? Is this feline hyperesthesia or some new neurological issue? I'd think he was staring off into the "other side," but the angry tail seems to indicate that he's not quite ready to cross that bridge.

I'm confused and concerned, but I don't know if he's off enough to warrant two vet visits in two weeks. Plus, I'm not even sure what they would test for at this point. We just recently did a full blood panel, an ultrasound, a Spec fPL, B12 levels, folate levels, a urinalysis, and a urinalysis with cultures and sensitivity. Any suggestions about what might be going on or things I should look for? Right now I'm just going to keep an eye on him and see if he will snap out of it. I'm considering skipping or reducing tonight's medications.

 

[manxcat419]

Ugh. I really don't want to alarm you (which of course means I'm probably going to now), but our CKD kitty Shadow has had 2 episodes (one when first diagnosed and another one about a year and a half ago) where she reached the point of being poorly controlled. In her case, it was extremely low potassium that was causing the problem because she was peeing insane amounts and was apparently losing just about as much potassium as we could get into her because of that. Reading through Edwin's list of symptoms, the being a bit out of it and being wobbly on her back legs were the first warning signs we had. Given that both times for us involved a very expensive ER vet stay for 3 days each time, I do think I'd be inclined to err on the side of caution and see if you can get updated bloodwork done to make sure there isn't something out of balance in his system. I see from your previous thread that you had bloodwork done about 3 weeks ago, but I still think I'd be inclined to rule any changes to that out if possible - from our experience, things can change fairly quickly sometimes.

 

[SuePea]

I don't know about cats, but I have had hypokalemia a few different times and severe weakness and disorientation is a classic symptom in humans. Does anyone know what high-potassium sources are safe for cats? bananas, potatoes?

 

[bsmith]

Ugh. I really don't want to alarm you (which of course means I'm probably going to now), but our CKD kitty Shadow has had 2 episodes (one when first diagnosed and another one about a year and a half ago) where she reached the point of being poorly controlled. In her case, it was extremely low potassium that was causing the problem because she was peeing insane amounts and was apparently losing just about as much potassium as we could get into her because of that. Reading through Edwin's list of symptoms, the being a bit out of it and being wobbly on her back legs were the first warning signs we had. Given that both times for us involved a very expensive ER vet stay for 3 days each time, I do think I'd be inclined to err on the side of caution and see if you can get updated bloodwork done to make sure there isn't something out of balance in his system. I see from your previous thread that you had bloodwork done about 3 weeks ago, but I still think I'd be inclined to rule any changes to that out if possible - from our experience, things can change fairly quickly sometimes.

Okay, I guess I'm waking up early to call the vet to get him in for new blood work. His peeing is now back to normal, but that period of litterbox flooding could have depleted his potassium stores (in related news, I think my cat and I may definitely be waaaay to close as I've been having low potassium/magnesium issues lately too). You're right about the wobbling being in his back legs, but I was chalking that up to arthritis.

I'm pretty sure a new blood panel is much cheaper and way less stressful than a three day ER visit. Actually, I'm going to call the vet right now and just leave them a message so they can be updated and call me back tomorrow morning. Thanks for the heads up.

 

[bsmith]

I don't know about cats, but I have had hypokalemia a few different times and severe weakness and disorientation is a classic symptom in humans. Does anyone know what high-potassium sources are safe for cats? bananas, potatoes?

This is a good question, but I think I'd want to see what Edwin's blood panel looks like before supplementing potassium. I do also already have human versions of potassium supplements. I'm not sure what they give cats though.

Okay, I think I might give the on-call vet a call now.

 

[bsmith]

On-call vet tonight was my regular vet, which was good since she's familiar with Edwin. New blood tests and check up scheduled for tomorrow morning. I guess Edwin's going to get really familiar with the vet's office as we've been there quite a bit lately. I'm pretty sure he'd like to take a ride somewhere more fun at some point in time. Thanks for the potassium idea @manxcat419 and @Sweet Pea.

 

[manxcat419]

No problem - I'm just glad I noticed your post and recognized the symptoms. And that your vet can see him tomorrow so you're not waiting too long to find out. I really hope it's something more straightforward for Edwin, but I figured an extra set of bloodwork is easier to deal with than an ER vet stay!

 

[Chris & China (GA)]

Just one important thing to remember...You don't want to supplement potassium if you don't know for sure they need it...too much can cause big problems too. Potassium is one of those things you want your vet to guide you on

 

[manxcat419]

Definitely agree @Chris & China - the bloodwork results first are essential. Potassium dosing is a tricky thing at the best of times and really does have to be done with vet guidance.

 

[BJM]

Excessive urination can unbalance any of the minerals, aka electrolytes, in the body. A vet visit and blood work is a good idea.

 

[Dusty Bones]

Wow! My civie was acting the same way with Young Again Zero Carb. I took it away from him and he went back to normal after a day on FF. I later gave it to him again and sure enough, same symptoms. Take YA away and see what happens!!

 

[bsmith]

No problem - I'm just glad I noticed your post and recognized the symptoms. And that your vet can see him tomorrow so you're not waiting too long to find out. I really hope it's something more straightforward for Edwin, but I figured an extra set of bloodwork is easier to deal with than an ER vet stay!

It's always a good thing when you spot a post with symptoms you happen to recognize. Potassium was totally not on my radar. Thanks also for the warning about alarming me before alarming me . Extra blood work >> ER vet stay.

Just one important thing to remember...You don't want to supplement potassium if you don't know for sure they need it...too much can cause big problems too. Potassium is one of those things you want your vet to guide you on

Potassium can definitely be tricky. You really need to know what the levels are before treating for it. Plus, it could be that the potassium is totally normal and then you could miss what might really be going on.

Wow! My civie was acting the same way with Young Again Zero Carb. I took it away from him and he went back to normal after a day on FF. I later gave it to him again and sure enough, same symptoms. Take YA away and see what happens!!

How long was your cat on Young Again before having issues? Edwin's been on YA for 7 weeks, but I did just recently get and add their flavor pack to his food to get him eating it dry again (~5 days ago). We had a bunch of inappetence issues, after Edwin went OTJ, and I had been only been able to get him to continue eating YA by grinding it up and mixing it with canned food.

With his diabetes, CKD, and fish issues, YA is really the only appropriate food I can find. Apparently Friskies Special Diet canned food, which I had been also feeding, is not appropriate for CKD cats as it's too acidifying. I've been through the food lists so many times that they're starting to make me nuts. I think I'll try taking up the food that has the flavor pack stuff on it and see if that helps. Thanks for the additional idea.

Update: all the YA with the flavor packet stuff on it has been taken up and new YA without the extra flavoring has been put out.

 

[SuePea]

that's a scary thought.. some form of contamination? heavy metals? that can cause mental confusion, coordination problems...

 

[bsmith]

Wow! My civie was acting the same way with Young Again Zero Carb. I took it away from him and he went back to normal after a day on FF. I later gave it to him again and sure enough, same symptoms. Take YA away and see what happens!!

that's a scary thought.. some form of contamination? heavy metals? that can cause mental confusion, coordination problems...

Was Dusty Bones okay on the Young Again Zero Carb? I'm assuming it was just your civvie who had the issue. If it was contamination or heavy metals, you would think it would effect both cats. Though, different cats can react differently to all sorts of things.

 

[Dusty Bones]

I just started them (Dusty and my Civie Beni) two weeks ago. No real issues with Dusty although he did seem a little off now that I think if it. Beni on the other hand had all the symptoms you described. It is scary! What could it be? He did bounce back in a few days so no permanent damage was done whatever the cause.

 

[bsmith]

I just started them (Dusty and my Civie Beni) two weeks ago. No real issues with Dusty although he did seem a little off now that I think if it. Beni on the other hand had all the symptoms you described. It is scary! What could it be?

I don't know. Though it should be noted that you're feeding regular Zero Carb and I'm feeding the Zero Carb Mature. It would be interesting to see if other people are having the same issues with YA or if it's just coincidence. I'm crossing my fingers for coincidence since, as I said, I'm really out of other appropriate food ideas for Edwin.

 

[Dusty Bones]

I was thinking it was the phosphorus content affecting Beni for some reason. Maybe he has a hidden health issue. Only thing is I think the phosphorus content in YA is actually pretty low. ???

 

[bsmith]

I was thinking it was the phosphorus content affecting Beni for some reason. Maybe he has a hidden health issue. Only thing is I think the phosphorus content in YA is actually pretty low. ???

Oh, I happen to have a spreadsheet from them with that info. DMA phosphorus for the mature zero carb version is 0.53% and for the regular zero carb version is 0.87%, which is still pretty low. The level of phosphorus in the regular zero carb version could even be fed to CKD cats. I can guarantee you that the phosphorus levels in YA are way lower than in any of the Fancy Feast versions. (So many hours with Tanya's canned food list, but I'll have a present for all of you soon!)

Potassium, by the way, is DMA 0.77% for the mature and 1.02% for the regular.

Maybe I should just share that whole file (pages 3-4): https://docs.google.com/file/d/0B7McS2Jro_99c2VyYU1PX1lFTmc/edit?usp=docslist_api

 

[Kitty mom]

We use the YAZC not the mature one but the original.... No problems here. If you even suspect that it's the food call the company and see if they have any other calls about it or perhaps they know of if there is some kind of sensitivity with some cats that they've heard of.

 

[bsmith]

We use the YAZC not the mature one but the original.... No problems here. If you even suspect that it's the food call the company and see if they have any other calls about it or perhaps they know of if there is some kind of sensitivity with some cats that they've heard of.

I'll give them a call, umm..., I guess next week. I forgot it was Friday night for a moment there. That's what I get for taking a long nap. I'll ask them if they've heard about any sensitity issues. Thanks for letting me know that YAZC is working fine for your kitties. I definitely hope I'll be able to keep using it as it seems to be my best choice for Edwin's multiple issues at this time.

 

[bsmith]

Update on Edwin. Vet visit today (Friday) and I'll get the blood work results back Saturday. The vet did a thorough physical exam including checking his vision. His vision seems fine. (With cat's vision it's hard to tell as they just won't read the letters on the eye chart. Cats tell you that every letter is μ, which is fine if it's a Greek cat, but Edwin is from the U.S.)

The vision test did reveal that Edwin may have done something to his neck. His neck muscles are very tight and stiff and he seems to have difficulty moving his neck to look up. I've been massaging his neck and I will get the local animal accupuncturist's number from the vet if it doesn't resolve itself. Accupunture could be helpful with those really tight muscles. Of course, tight muscles might be another sign of electrolyte imbalances.

They had a really difficult time getting blood out of Edwin. I once again had the door, going from the exam room into the back room, open to check what was going on. They finally just brought him back to let me restrain him and then they were able to get blood. In the past he's always been good and has not made a fuss when they take him away to get samples, but during a couple of the past few visits they've had issues with him getting really ornery. I'm pretty sure that in the future they'll just let me be the one to restrain him in the first place.

As the vet said, "many animals do better with giving samples when they're away from their owners, but Edwin seems to do better with you." I've had this discussion with some of you here about vets allowing you to hold your kitty for their exams and labs. I'm glad that my vet at least recognizes that, at this time, it's best if she just lets me restrain Edwin in the first place.

I also had a bit of a chuckle when then brought an Alphatrak in to check his BG. The vet tech went to try to get a sample from his paw at which time I suggested she really wanted to use his ear (I've never been able to get a paw blood sample). She tried the paw, no go. The ear worked better, but I had to show them how to properly rub his ear to get the blood flowing. They seemed a bit shocked at how familiar I was with BG testing. You do it enough times on your specific cat and you learn few things. BG on the Alphatrak was a nice 105 (at least before they tried to get a blood sample from him).

Hopefully the blood test results will give us a better idea of what is happening.

 

[bsmith]

@manxcat419, good call on the low potassium. Edwin's test results are back and his potassium is 3.3 (normal 3.4-5.4) so he's slightly low, but he generally runs at about 4.0 so he's much lower than normal. We're starting him on Renal-K plus.

His bicarbonate levels were also low so there is some metabolic acidosis going on too. I'm adding 35 mg of baking soda to his diet twice a day to deal with that. The vet was also worried about ketones (that gets a sugar cat's bean out the door in a hurry). I took him in for a urine sample and we're good there. No keytones or glucose in his urine.

Hopefully we caught this early enough that I'll be able to get him back to "normal" soon. He seems to be feeling better. I let him out on the deck with the gate up so he could get some fresh air. Yesterday he just stayed on the deck for a bit and then went back inside. Today he immediately jumped the gate as soon as my back was turned. That's usually an indication that he's perking up. I'll go find him in a bit to check on him. (The pet loc8tor really comes in handy for finding him in short order. Thank goodness I managed to get his collar back on him before he went over the gate.)

 

[BJM]

If he has ever had ketones before, you may wish to invest in a blood ketone meter such as the Precision XTra or the NovaMax.
Otherwise, urine testing with KetoDiaStix or KetoStix or generic versions of these are helpful whenever the glucose is high.

 

[manxcat419]

I'm so glad you were able to find out before he went lower. You should be able to get his levels back into normal with a supplement thankfully - catching it early is the key to avoiding him needing a hospital stay and with a level only just under normal, he should be fine.

They do get back to normal pretty quickly once everything's back into normal range - Shadow only took a few days to get back to walking normally and being more alert and her levels had started out a lot lower (which was why she was hospitalized at the ER vet for 3 days).

I've not dealt with low bicarbonate levels before but adding baking soda seems like a fairly straightforward fix for that which helps. And no ketones is always good news!

Doesn't take them long to get back into trouble once they start feeling better does it? For all they might drive us mad sometimes, it's lovely to see them back to their usual tricks as they start to improve!

 

[Dusty Bones]

@manxcat419, good call on the low potassium. Edwin's test results are back and his potassium is 3.3 (normal 3.4-5.4) so he's slightly low, but he generally runs at about 4.0 so he's much lower than normal. We're starting him on Renal-K plus.

His bicarbonate levels were also low so there is some metabolic acidosis going on too. I'm adding 35 mg of baking soda to his diet twice a day to deal with that. The vet was also worried about ketones (that gets a sugar cat's bean out the door in a hurry). I took him in for a urine sample and we're good there. No keytones or glucose in his urine.

Hopefully we caught this early enough that I'll be able to get him back to "normal" soon. He seems to be feeling better. I let him out on the deck with the gate up so he could get some fresh air. Yesterday he just stayed on the deck for a bit and then went back inside. Today he immediately jumped the gate as soon as my back was turned. That's usually an indication that he's perking up. I'll go find him in a bit to check on him. (The pet loc8tor really comes in handy for finding him in short order. Thank goodness I managed to get his collar back on him before he went over the gate.)

So was any of this due to YA? Are you still feeding it to him?

 

[bsmith]

If he has ever had ketones before, you may wish to invest in a blood ketone meter such as the Precision XTra or the NovaMax.
Otherwise, urine testing with KetoDiaStix or KetoStix or generic versions of these are helpful whenever the glucose is high.

Luckily Edwin has never had any keytones show up in any of his tests. Even with the test that diagnosed him as diabetic, when his blood sugar was really high, there were no signs on keytones. Though, I think I'll probably get some of those keytones test strips just in case.

 

[Blamethecats and Hannah]

The vet tech went to try to get a sample from his paw at which time I suggested she really wanted to use his ear (I've never been able to get a paw blood sample). She tried the paw, no go. The ear worked better, but I had to show them how to properly rub his ear to get the blood flowing. They seemed a bit shocked at how familiar I was with BG testing.

LOL... that had to be a really satisfying moment for you! Love it!!

 

[bsmith]

I'm so glad you were able to find out before he went lower. You should be able to get his levels back into normal with a supplement thankfully - catching it early is the key to avoiding him needing a hospital stay and with a level only just under normal, he should be fine.

They do get back to normal pretty quickly once everything's back into normal range - Shadow only took a few days to get back to walking normally and being more alert and her levels had started out a lot lower (which was why she was hospitalized at the ER vet for 3 days).

I've not dealt with low bicarbonate levels before but adding baking soda seems like a fairly straightforward fix for that which helps. And no ketones is always good news!

Doesn't take them long to get back into trouble once they start feeling better does it? For all they might drive us mad sometimes, it's lovely to see them back to their usual tricks as they start to improve!

I'm really glad you noticed the symptoms and got me to go into the vet sooner rather than later. It's good to hear that once you start treating them for it that they get back to normal pretty quickly. Adding baking soda for low bicarbonate levels is definitely a cheap and easy fix and, even better, something I already had in stock. No keytones is always good news. Just the mention of keytones gets me going to the vet in a hurry.

I definitely agree with you that trouble making is always a good sign that your kitty is feeling better. I always get worried when he doesn't want to make at least a little bit of trouble. The fact that he was placidly laying on the towel in his carrier, when going to the vet yesterday and today, instead of burrowing under it or trying to dig a hole to China was very troublesome too. He just layed there like "please take me to the vet." He's never done that before and it's probably his way of letting me know that something really was going on. Either that or we've been to the vet frequently enough lately that he's gotten used to it and he's just resigned himself to the fact that he's going whether he likes it or not.

 

[bsmith]

So was any of this due to YA? Are you still feeding it to him?

I don't think it's the YA and I'm still feeding it, but without the flavoring package additive. I'd like to check on the flavoring packet ingredients, even though some of it comes already mixed into all the YA foods, to make sure there's not something additional in there that may be the issue. He was fine on plain YA, but this started right after adding the flavor packet stuff. Maybe the flavor packet just includes "more" of something that might cause an issue.

If anything, it could also be the Friskies Special Diet that I was still giving him up until last week. Apparently the "Special Diet" foods are typically acidifying and not recommended for CKD cats. (I just recently learned this and it sucks as the Friskies Special Diet foods are low carb, low phosphorus, and have options with no fish. Most importantly, Edwin agrees to eat them.) I was only feeding 1/4-1/3 can a day (mixing in ground YA and he was eating additional unground YA), while looking for a better canned option that would work for Edwin. This extra acidification in his diet may have been enough to push his bicarbonate levels low, though I had already stopped the Special Diet right when this issue became apparent.

It could also just be the CKD and the litterbox flooding of a few weeks ago, due to some ill advised subq's, that got his electrolytes all out of balance. It's so hard to point to just one cause. It's probably a combination of all, or just some, of these things. I don't know that I'll ever know for sure, but at least it seems that we caught it fairly early and hopefully we'll be able to reverse it. Though, I will be calling YA on Monday just to double check a few things.

 

[Meya14]

The kidneys, respiratory system, and metabolism all work to control the acid/base balance. Metabolic acidosis is very common in CKD, because the kidneys are unable to concentrate urine as effectively in early stages, and this leads to bicarb loss, as well as accumulation of acids due to the buildup of nitrogen (BUN) and other minerals.

Here's an article r/t ckd and acidosis in humans. The process in cats is similar, but the normal levels are different for many of the labs. Cats are desert animals, so their kidneys are adapted for low fluid intake.

http://www.uptodate.com/contents/pa...-metabolic-acidosis-in-chronic-kidney-disease