PU/PD for "other" reasons?

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Looking for thoughts on Cami's situation.

She has had PU/PD since I got her last October. It did not go away when she was regulated on insulin like it did with Beau or Jeddie. I had her tested for HyperT in Nov and again two weeks ago and her T4 is normal. Blood work was normal in Oct and July (old vet records) with no indication of renal failure. She has been OTJ since Jan except for a few tiny doses over the past two weeks (see recent health issues below).

She has also had a bloated belly since I got her and been tested for worms (neg). I was told it was malnutrition, or diet change or food allergy. An xray in July showed no fluid build up, just gas filled intestines. She had vomiting and diarrhea when I got her, off and on, until she vomited up a plant stem of some kind (unidentified) that I believe she had in her stomach for months. It isn't from anything I cooked here. It might be from eggplant or bell peper (nightshade family). After that the vomiting and diarrhea stopped abruptly. She has always had a good appetite: 18+ ozs in the beginning, tapering to perhaps 8 ozs now - hard to tell with free fed cats. She is always eating. She has not gained weight though.

Most recently, she had a bout of respiratory distress (rapid, labored breathing) with a fever and I took her to the vet. An xray showed a large amount of fluid in her belly. I took her to an internist immediately after that and she received oxygen and had an ultrasound. There is a possible diagnosis of intestinal (or other) lymphoma. Her liver and kidneys are enlarged and her pancreas and intestines are thickened and there were several large lymph nodes.

After blood work came back it is more indicative of severe inflammation/infection than lymphoma, but that can't be ruled out yet. Her BUN was only slightly elevated and her creatinine was normal (I don't know the ratio). She is slightly anemic and her WBC count was in the normal range, but the cells show toxic changes. I asked the vet about Cushing's and she doesn't think so because Cami's skull looks normal and her diabetes is in remission.

I have been measuring her water consumption and it is 14-15 ozs in 24 hours. This is not to far about the 12 ozs a normal 8lb cat is supposed to drink. I don't know about you, but none of my other cats drink nearly that much. The two 5 year olds drink about 3 laps of water a day and Beau drinks maybe 4 ozs. Cami weighs 6.4 lbs including all the fluid in her belly, which I would gestimate at up to a half lb. She is slightly dehydrated. She eats canned food.

Does anyone have suggestions on what might be causing this? How to deal with it? What I should ask the internist at the followup visit this Thurs.?

Thanks.
 
You might ask the vet what he thinks is causing each of the issues.

The online Merck Veterinary Manual is searchable and I found a few things looking.

Searching on "polyuria" here
Liver issues -
"Clinical signs of liver injury vary depending on the type, mechanism, and chronicity of injury. Common clinical features may include anorexia, vomiting, diarrhea, weight loss, fever, jaundice, polyuria (PU) and polydipsia (PD), coagulation abnormalities, ascites, and change in fecal color (acholic feces with complete occlusion of bile ducts; green feces with increased enteric bilirubin elimination). Ascites indicates portal hypertension and development of acquired portosystemic shunts and (APSS) usually develops in association with concurrent hypoalbuminemia. "

Search on "ascites" (fluid in abdoment) brought up heart failure and liver issues.

Searching on 'Thirst' brought up hypercalcemia

Fluid in the abdomen (ascites)
- Has she been tested for FIP?
- Has the a sample of the fluid been aspirated?
 
I forgot to mention that her liver markers were raised:

ALT 280 (<100) = should be less than 100
AST 127 (<25)
Bilirubin 1.0 (< .4)

Thanks, BJM. I didn't stumble across that info in my searches - not that specifically. I am concerned that her liver is greatly compromised and/or her gallbladder. She does have lighter colored stool again. When I first got her it was very pale, then after she vomited the plant thing it got darker (more normal), but has gotten lighter again in the past couple of months.

I'm kinda afraid she needs very expensive care to sort this out - like exploratory surgery, etc. - and I just can't afford to do that. I can't afford what I am doing already.

She has not been tested for FIP. I did ask about that and, generally, she is too old for that to be a possibility. Plus, my understanding is that she would be a lot sicker and, since this has been going on for months now, dead by now. No fluid was aspirated. I think because she was so compromised at the time that I brought her in. Drawing fluid off the abdomen can be risky. But I will ask about it on Thursday since they are doing another US, they could do an US guided aspiration.
 
If it is a liver problem, you might consider milk thistle extract (ex Denmarin).
There are bile acid (Rx) which may be given, as well as pancreatic enzymes to help digest the food (something containing lipase helps digest fats which the bile is supposed to help process.)

You may want to go with the empirical approach - if it could work and the vet is OK with it, give it a shot and monitor for effect.
 
She is getting Denamarin, maybe for 10 days now. I have been adding probiotics and enzymes to all the cats' food for a couple of years now, so she has had them for a while - although I ran out and was giving another product that was only probiotics for the last week or so. The vet suggested probiotics and was enthusiastic about the Denamarin when I suggested it based on the ALP, AST and bilirubin results.

She is also getting pepcid (1/4 tab sid), Baytril, and prednisolone and I am giving her high collagen broth daily (4-6 ozs).
 
Because the liver is on the fritz (pale poop, etc) check with the vet about bile acid supplements and enzyme supplements. These operate differently than probiotics and Denmarin. They may help her digest better too.
 
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