Help! Hepatic lipidosis? Ultras or only DKA treatment? $ low

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max&emmasmommie

max&emmasmommie

Member Since 2012
Elizabeth's cat, Priss, is at ER, and they want to do an ultrasound to see if the liver has hepatic lipidosis (fatty liver disease). It's too expensive and will cost as much as 1/2 a day of the treatment the cat is getting for another illness (which I think is DKA) -- fluids and monitoring (of the electrolytes, I believe). They want to re-run the chem panel that was done 3 days ago by her regular vet, and this is all getting too expensive, of course. She's trying to decide whether to authorize an ultrasound.

Here is her post RE: the recent crisis: http://www.felinediabetes.com/FDMB/viewtopic.php?f=28&t=77976

It seems there was a lack of insulin for about a week that resulted in a failure to eat. The cat had only one poo the whole week. The regular vet refused to see the cat on Saturday, August 25th, and the cat was still eating at that time, but refused to eat Sunday morning. On Sunday, the vet had said to not give the cat insulin on Monday morning (only Sunday night) even if the cat ate. When E called the vet at 1:00 p.m. on Monday, the vet never returned her call until finally Tuesday morning at 8:30, the vet told her about the high ketone reading the vet had received as a test result on Monday!!!! The vet had done a panel on Sunday, and got a positive for high ketones result back on Monday before 1:00 p.m, but didn't call E back and tell her that she needed to get her cat in ASAP for treatment. The cat also had a bladder infection. (This is why I think the cat has DKA). The vet treated the cat for ketones and an electrolyte imbalance on Tuesday, but was not willing to continue treating through the night, and wanted E to take the Priss to an ER vet overnight and bring Priss back to the office Wed morning (today). The vet put a underskin fluid dispenser on the cat, and E took her home. At about midnight, E took Priss to an ER, and she has been there ever since.

Now, E is trying to figure out how to afford what Priss needs, and is being told that the cat may have fatty liver disease. Does anyone know whether the ultrasound is absolutely necessary or whether E should spend her money elsewhere -- on 6 more hours at the ER rather than this test? I would think that her best chance of saving Priss is for Priss to be in the ER longer, and the vet will just have to work around the lack of ultrasound, but I have NOTHING to based this on except common sense. It would seem that either the electrolyte imbalance will resolve or not, and I have no idea how an ultrasound would help the vet decide how moto treat the cat. Anyone know? Could the ultrasound make or break this and make the time needed in ER 6 hour less, and still save the cat?
 
Re: Help! Hepatic lipidosis? Ultras or only DKA treatment? $

Sorry, Dale, I think I posted this earlier in the wrong thread.

I don't know much about fatty liver. My cat, Bob was treated for DKA.

Here's what I found as far as diagnosis of fatty liver:
A typical sequence in the diagnosis of this condition would be:
Cat is obviously sick and sees the vet.
Cat may show the yellow pigment changes typical of liver disease (70% of cats with lipidosis have jaundice.)
Routine blood tests show marked ALP elevations.
Bile acids are elevated (testing bile acids is not necessary if bilirubin is elevated).
Ultrasound shows a disease process involve the liver in its entirety.
A needle aspirate or tissue biopsy shows hepatic lipidosis.
Click to expand...

It sounds to me like they have gone through the first few steps and are now at the "ultrasound" step?

I think it comes down to how the fatty liver and DKA are treated.
I believe the treatment for fatty liver is "feeding", usually with a feeding tube. Once the tube is in place, this is something, I believe, that can be managed at home.
You can't treat DKA at home.

If I had to choose one or the other, I would say to concentrate the funds on the DKA treatment?

I hope someone who has dealt with both can offer some advice soon.

Carl
 
Re: Help! Hepatic lipidosis? Ultras or only DKA treatment? $

I just replied on the other thread. There is benefit to ultrasounds but if they are just trying to rule in our out FHL I wouldn't do the ultrasound. i'd just assume fhl. treatment is food, fluids, antinausea medication (ondansetron) and a liver supplement (denosyl, marin or the combo denamarin). Calories are critical not just amount of food. A low calorie food is useless really for DKA or FHL survival.

DKA cats need 1.5xs the maintenance calories.

Thank you for helping.
 
Re: Help! Hepatic lipidosis? Ultras or only DKA treatment? $

Treatment given so far:
Critical Care Panel with PCV/TS
CBC and Chemistry Profile
Insulin Regular 100u/mL / unit
Ketodiastix
Fluid Therapy
Fluids- IV Setup
Fluid Therapy- Intravenous / hour
Intensive Care Level 1
Specialist Consult Internal Medicine
Critical Care:Blood Work - Blood Glucos
Blood Pressure, additional
Famotidine 10mg/ml Inj. / mL
Cerenia (maropitant) 10mg/ml inj per mL
Insulin Regular 100u/mL / unit $42.50
Enrofloxacin 22.7mg/ml Inj per ml
Cyproheptadine 4 mg
Vitamin B12 1000mcg/ml inj. per ml
Dextrose 50% Injection 50mL
Fluid Therapy- Intravenous / hour

The test results I do not have in writing but the vet said:
White blood cells elevated
Sodium Low
Chloride (?) Low
Potassium now Low-Normal
BG 284
Bun (?) elevated
Kroatin none/low
Liver enzymes high
No more ketones (Sunday bloodwork said 3)

The diagnostic steps now suggested:
1. Ultrasound
2. Blood Pancreas
3. Possible feeding tube

The feeding tube vet suggests because she feels the current glucose IV will need to be replaced by feeding tube if she won't eat by tomorrow, and they can't syringe feed. Some extreme cases like cancer were brought up but I don't feel this is what is going on, vet also mentioned some levels could be related to other issues like kidneys, but also dehydration. There was yellowing of the ears last night but slight. The cat didn't get her antibiotics until this afternoon for the bladder infection. Internist said she wanted to do a urine culture but I told her the paperwork from last vet detailed the bacteria and to check, we left antibiotic pills with the ER vet.

This morning vet says she is comfortable and looking around but still dull. I'm going to visit her tonight, this is the first place I've been to that invites you come in and visit right when she's checked in.
 
Re: Help! Hepatic lipidosis? Ultras or only DKA treatment? $

Elizabeth,

I'm glad your cat is doing better, and that you will visit her tonight. No ketones -- that's great!

I'm glad you posted your test results and what treatment your cat is getting. I can't tell you what your test results mean, but I can tell you what some of the acronyms and substances are, generally.

Chloride is one of the electrolytes in the body that must be present in sufficient amounts, along with sodium, potassium. phosphate, magnesium and calcium. These are the substances that have to be carefully managed when a cat is in ketoacidosis, and why only someone with medical training and the right equipment could do it at home.

Bun or BUN is Blood Urea Nitrogen, and from Tanya's CRF site: "is a by-product of the breakdown of dietary protein during the digestive process. The kidneys filter it out of the blood and excrete it via urination . . . it builds up and makes the cat feel poorly. BUN is not a toxin in itself, but if it is elevated, then the chances are high that actual toxins (which are difficult to measure, but which make the cat feel poorly) will also be elevated. BUN can also rise for . . . reasons . . . such as dehydration. I don't know how BUN relates to DKA except that dehydration is one of the DKA symptoms or causes or effects or something like that. I really don't know, but I'm sure someone here does.

(My cat has CRF, and has high BUN when he is dehydrated, but it is his higher than normal creatinine levels that tell us he has CRF. Somehow BUN figures in, based on a ratio of BUN to creatinine levels, but creatinine is the most important reading for this illness.)

Kroatin, which is really Creatinine, is an indicator of kidney function. See this page http://www.felinecrf.org/diagnosis_test_ranges_factors.htm about 1/2 way down for a chart of the range of normal test results in the U.S. (on the right side of the chart). These ranges are approximate. I don't know what having none/low creatinine means and whether it is bad or good. (If it is higher than 2.4, it means something not so good, and if it gets up above 3.4 that's pretty bad -- for the kidney function, that is.)

WBC or White Blood Cells, as I'm sure you know, are the cells that fight infection, and when they are elevated, it usually means there is an infection.

I hope someone else with more knowledge can give you more info based on the treatment and test results you posted.

Hang in there, and post as often as you need to.

Dale
 
Re: Help! Hepatic lipidosis? Ultras or only DKA treatment? $

Hi Dale,

Thank you for your help and support. We went to visit her so she wouldn't think she was left behind, this is usually her bedtime but she was sitting in the cage and not moving about too much. We pet her for a while and let her rest, she seemed to be purring. She isn't a lap cat and doesn't usually purr too much so I hope she was happy to see us and not purring from pain. They want to keep her at least another 24 hours, maybe 48. I know she needs to eat food soon so hope they would tell us that, since we would rather even come in to feed her ourselves than get the tube if needed. Did you find out your cat had the CRF at the same time as the diabetes?

Elizabeth
 
Re: Help! Hepatic lipidosis? Ultras or only DKA treatment? $

Elizabeth,

That's a good question about the feeding. I'm sure they are giving her glucose through an IV. I read something about DKA and the fact that pH and bicarbonate readings are supposed to be at certain levels before food is introduced. The nausea and vomiting caused by DKA will make eating for nutrition and glucose levels a problem. It's probably very tricky to keep the glucose levels right -- not too high as to risk ketones again, and not too low as to risk hypoglycemia. It may be that they don't feed food until they are reasonably sure that it's likely to be kept down. Otherwise, they aren't sure how much insulin to give, and giving it intravenously along with intravenous glucose in a known amount is more precise? I'm just theorizing here, of course, but this makes sense to me. What's difficult is that a human patient might be able to tell the doctor that the nausea has subsided, but a cat can't.

I suggest that you be proactive and ask questions. Tell them you want to try to syringe feed her when it is time for her to take food my mouth, and that you want to help any way you can to avoid a feeding tube. They probably would not expect that. If it's a good idea for her to start eating, they may tell you to come in.

Keeping you in my thoughts.

P.S. No, Max was diagnosed with CRF first, and about 5 months later he was diagnosed with diabetes. The CRF isn't too bad, and I'm hoping that by resolving the diabetes it will stay stable.
 
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