An old foster cat of mine - diabetes (hyperosmolar)

Hi All,

I know its been a LONG while since I have posted but life got in the way and fostering got in the way. Ginger is still with me and still waiting for a FUREVER HOME.

This message is because I need advice PLEASE. I recieved a call from an older adopter t a old foster kitty named Thomas now then was Mr Kitty Kitty. Apparently there has been MANY medical issues that I was not aware of and I wanted to know if anyone had any advice or experience with this before. I don't have a LOT more info than what I am giving and please bare with me as it is a little long.

Thomas was adopted out in November 2009
2010 he was diagnosed with hyperthyroidism and was given Radio Cat - it didn't work
he was given Radio Cat again in 2011 - AGAIN it didnt work
He was placed on the new hyperthyroid food Y/D
In February Thomas was diagnosed with kidney disease but his food was the canned y/d
THEN he seemed to be drinking a lot and peeing a lot and was RECENTLY 4/2 with Diabetes and was hospitalized because he wasn't eating well and seemed lethargic

This is the email that the adopter sent me about Thomas and what has been done and is doing now. ANY ADVICE YOU CAN GIVE WOULD BE SO HELPFUL PLEASE

I opted NOT to put him down until I had a second opinion from Dr. Birnbaum ad Veterinary Internal Medicine Practice. I know it's not about me, but about what's best for him, but I also wanted to be absolutely sure I'd done all I could for him before making an irreversible decision.



Dr. Birnbaum said she could see him today for an exam, and although she described him as a "metabolic disaster", she was encouraged by some of what she saw. She's admitted him to their practice to see if they can get him hydrated and stabilize his glucose level; if he's not getting any better over the next few days, we may still have to put him down, but she said we'll take it a day at a time. See below for the read-out on his condition as of about 4 pm today.



Can you please forward this to Cathy Awad? I don't have an e-mail address for her.


Thanks again for your help. I'll keep you posted.

Weight: 8.56 lbs (was 7.95 lbs on 2/27/12)
Primary problem: Thomas is presenting for recheck exam with Dr. Birnbaum after recent diagnosis of diabetes mellitus. Thomas was hospitalized at Parkway Monday through Tuesday on IV fluids and to initiate insulin therapy. He did well in hospital and began eating, so he was discharged last night. When he got home, he ate 1/2 can of y/d food and his owner gave insulin - he looked good last night. But this morning, Thomas didn't eat much at all and was staggering around the house (weak and wobbly). At Parkway today, his BG was > 600 mg/dL and he is drinking & urinating excessively.
* Chronic anemia - minimal improvement on darbopoeitin x 4 weeks (18 --> 20% HCT)
* Chronic kidney failure for at least one year.
* History of hyperthyroidism and 2 radiocat treatments (2010 and 2011). He was again hyperthyroid in 12/2011 (T4=6.5) and was put on Y/D diet in the hopes of controlling the thyroid with diet.
Diagnostics performed/pending:
1) Physical exam - quiet & alert; normal temperature (99.6 F); normal heart & lung auscultation; scruffy hair coat / urine soaked; thyroid nodule; muscle wasted; no heart murmur; doughy abdomen; breathing comfortably; hypoplastic looking optic nerves; weak but able to walk; pink slightly pale mucosa.
2) Recheck ultrasound - see findings below.
3) Urinalysis (cystocentesis) - urine is dilute (SG 1.018), large amount of glucose (> 1000 mg/dL), trace blood, trace protein, 1+ leukocytes, pH 5, sediment revealed occasional red blood cells and white blood cells, no overt bacteria but sediment was suspiciously active for a dilute cysto sample - recommend culture to rule out infection in the kidneys. No ketones present.
4) Urine culture & MIC submitted - results pending.
5) Blood pressure (Doppler) - 100 mmHg today - low but stable
6) DPP (in house chemistry) - worsened kidney failure due to severe dehydration (BUN 133, creatinine 7.0), phosphorus 11.3, potassium low normal but likely total body depleted (3.7), elevated protein (TP 8.8 - dehydration), amylase 1964 (may have current pancreatitis).
7) PCV/TS (measure of anemia) is 24% today, but likely will decrease with rehydration (TS 10.0 g/dL)
8) iSTAT 4/4 5pm - low sodium (141), pH 7.275 (low normal / borderline acidosis), glucose 613, osmolality about 320 - hyperosmolar
Ultrasound findings:
1) Pancreas appears more prominent and reactive today, especially tip of left branch, no free fluid.
2) Kidneys appear stable, aged, mild pelvic dilation (0.4 cm) likely secondary to polyuria.
3) Liver appears hyperechoic "fatty" looking, slightly rounded and uniform texture.
4) Heart stable - no atrial enlargement, no pleural effusion, good contractility (FS 50%) - heart in good shape for fluid therapy.
5) Remainder of organs imaged including spleen, gallbladder, urinary bladder, gastrointestinal tract, and lymph nodes appear normal / unremarkable. One small cystic lymph node.
Ultrasound summary: The pancreas appears more prominent and reactive today - consistent with pancreatitis. All other organs imaged appear stable / unchanged compared to 5 weeks ago.
Tentative diagnosis:
1) Kidney failure - chronic for at least 1 year with recent worsened azotemia secondary to severe dehydration from fluid losses in hyperosmolar diabetes. Pyelonephritis (deep seated kidney infection) may also be playing a role (culture pending).
2) New diagnosis of diabetes mellitus on recent lab work 4/2/12 - currently non-ketotic (i.e. not yet in DKA) but borderline hyperosmolar diabetic (marked glucose elevation causing hyperosmolar blood with subsequent electrolyte and fluid losses through the urinary tract =rapid dehydration despite him drinking excessively).
3) Prominent pancreas on ultrasound - pancreatitis is a strong possibility which can be an inciting cause for development of diabetes in cats (pancreas makes insulin and regulates insulin / glucose levels in the body). Pancreatitis can also cause poor appetite and lethargy.
4) Anemia - chronic & nonregenerative - likely secondary to kidney failure and chronic disease processes (deficiency of erythropoeitin hormone from the kidney which normally stimulates RBC production). On darbopoeitin injections x 1 month with minimal response - currently 20-24% PCV
5) Hyperthyroidism - two prior Radio-Cat treatments. We may be able to resume treatment with transdermal tapazole placed on ears if we can stabilize his renal and diabetes.
Recommendations / Options:
Hospitalization for at least 48-72 hours for IV fluid therapy / rehydration, IV regular insulin drip to quickly regulate blood sugar levels and restore normal fluid balances, lab monitoring, and supportive care.
**Thomas is in the middle of a metabolic crisis right now with multiple conflicting disease processes. His type of diabetes (hyperosmolar) causes him to dehydrate rapidly when his blood sugar is high and he has kidney failure as well which complicates management. We do not know whether we will be able to pull him through this but he is in stable enough condition to try. Thomas will need intensive care and monitoring so we will transfer him to PWEVC overnight tonight and he will come back to us tomorrow morning (4/5).
Medication: As indicated in hospital.
Activity: Self-limiting
Diet: Coax with a variety - low protein diets are ideal to support kidney function. We will discuss his thyroid levels and Y/D diet long term depending on how diabetes regulation and kidney failure goes.
Additional Comments: Call as needed with questions or concerns. Thank you!
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