I need eyes on Yoda's CBC results

Yoda is my new flame point siamese foster kitty as of last week. He came to me severely dehydrated, malnourished, in the beginning stages of DKA, and very lethargic overall. Since then he has gained a pound and a half just in a diet change alone and is sitting around 10lbs 8oz right now. We took him into the vet yesterday to get a blood workup and exam since the previous owners only did a glucose test at the vet. Obviously his glucose was high - but they also found a few other things. Despite having a dental back in September of last year, his gums are inflamed again and they are thinking possible stomatitis. He is anemic (RBC, HGB, and HCT levels are all low). His MCHC is on the very high side of normal (this can mean a b-12 deficiency in humans sometimes from my reading). His BUN and Creatinine are on the high side of normal, but the ratio is smack dab in the middle. CPK level is on the very low side of normal. His sodium/potassium ratio is low, but the sodium levels and potassium levels are fine. And the magnesium levels are on the low side of normal.

I have attached a scan of his CBC results (there are 2 pages). The shaded areas to show the normal range didn't scan very well, so you will have to go by the range values.

The vet has put him on an iron supplement for the anemia and clindomyacin for the mouth. They want us to come back in a month for a re-check.

My big question is - is it still safe for me to be giving him 50ml of fluids each night? He still has an elevated ketone level, and the BUN and Creatinine suggest that I should, but I am worried about the sodium/potassium ratio. His hydration is much improved from last week so far.

 

Wish I could help, but it's all out of my league.

Just curious, did you have a clue of what you were getting into when you agreed to take Yoda? It seems like he was in really dire straits and his owners were doing nothing!?!

 

Hi --

As with Donna, while I can give a basic interpretation on some CBC results, your question on whether it's safe to continue with fluids is out of my league as well. Perhaps Jess or Jojo or Larry might know?

I did poke around on the net to learn about the sodium/potassium ratio, and ran across this abstract over at NIH, which says:

So, while the low Na/K ratio could indicate Addison's disease (which would predispose Yoda to developing diabetes), there're other possibilities as well. Not sure whether or how much that might've helped, but I pass it on for whatever it's worth.

Give Yoda some cuddles from us! --

Jean and her Gwyn

 

Hey there. Sounds like Eeyore, although Eeyore was a bit farther gone. We got him turned around, and now he's fine.

I wouldn't worry so much about the anemia; that can be a dehydration thing, as is the BUN and Cre elevation. The ratios are good, so I'm betting a nickel it's also connected to dehydration.

What is he eating every day? The Na/K ratio is something I'd be a tad worried about (but just a tad...); are you giving him normal saline, or just water? You may want to switch to Normal Saline or Lactated Ringers Solution (they have additives to match the normal blood constituents, with LR having sugars added...hrm. Maybe just NS and NOT LR).

How far underweight is he? Does he/did he have fleas? In re stomatitis, I'm not thinking of that for his gums, not right yet. I'm thinking that the ABX will give him some relief. That also may be contributing to his high BS numbers. (BTW, what insulin, how much, and how often?)

How is he peeing/pooping? The ABX may make his poop kinda runny, and there may be some accidents because of that. Just bear with it. As for his pee, I'm wondering what color it is, and how strong it smells. That will tell you about how well he's regaining hydration; there's a lot to rehydrate, and it does take some time.

I can't open your attachment, sorry...could you post up the WBC, H/H numbers, and his Na/K numbers? Do you have a MCV (mean cell volume?)?

(Venita asked me to come poke my head in because of Eeyore's history and other experience...hope I can help).

Best-
Michele

 

Hopefully, I've typed this in without any typos ....

(sorry for using the CODE format; PRE(serve formatting) doesn't seem to work here ... The list is scrollable, if you need stuff further down the results.)

Code:

SUPERCHEM:
Total Protein:    8.7  (range 5.2 - 8.8)
Albumin:          3.4  (range 2.5 - 3.9)
Globulin:         5.3  (range 2.3 - 5.3)
A/G ratio:        0.6  (range 0.35 - 1.5)
AST (SGOT):       19   (range 10 - 100)
ALT (SGPT):       40   (range 10 - 100)
Alkaline Phosphatase:
                  55   (range 6 - 102)
GGT:              2    (range 1 - 10)
Total Bilirubin:  0.1  (range 0.1 - 0.4)
BUN:              36   (range 14 - 36)
Creatinine:       2.1  (range 0.6 - 2.4)
BUN/Creatinine ratio:
                  17   (range 4 - 33)
Phosphorus:       5.4  (range 2.4 - 8.2)
Glucose:          412  (range 64 - 170)   *** HIGH ***
Calcium:          9.8  (range 8.2 - 10.8)
Magnesium:        1.6  (range 1.5 - 2.5)
Sodium:           152  (range 145 - 158)
Potassium:        5.1  (range 3.4 - 5.6)
Na/K ratio:       30   (range 32 - 41)    *** LOW ***               
Chloride:         111  (range 104 - 128)
Cholesterol:      160  (range 75 - 220)
Triglyceride:     98   (range 25 - 160)
Amylase:          938  (range 100 - 1200)
Lipase:           103  (range 0 - 205)
CPK:              65   (range 56 - 529)


CBC:
WBC:  10.9 (range 3.5 - 16.0)
RBC:  5.6  (range 5.92 - 9.93)           *** LOW ***
HGB:  8.7  (range 9.3 - 15.9)            *** LOW ***
HCT:  24   (range 29 - 48)               *** LOW ***
MCV:  42   (range 37 - 61)
MCH:  15.5 (range 11 - 21)
MCHC: 37   (range 30 - 38)

Differential:
Neutrophils:   6867 (63%)   (range 2500 - 8500)
Lymphocytes:   3161 (29%)   (range 1200 - 8000)
Monocytes:      218 (2%)    (range 0 - 600)
Eosinophils:    654 (6%)    (range 0 - 1000)
Basophils:        0 (0%)    (range 0 - 150)

Platelet Estimate: Adequate
Platelet Count: 418         (range 200 - 500)

T4:  1.3   (range 0.8 - 4.0)

 

Michele,
I'm nearly 100% sure Yoda is getting LRS. You can see pics of Yoda here:
viewtopic.php?f=24&t=17053&p=174143#p174143
BUT, Kelly is doing a superb job and Yoda is putting on a lot of weight.. but still more needed. I'm doubting fleas are an issue - but I could be wrong.

 

JJ, thanks for that. It helps to see the whole picture.

Gator - thanks.

I **think** the reason LR would be used is because it's additives have an alkalizing effect on the body - which is a good thing if you're dealing with DKA. But it also can throw off electrolytes, which is, of course, not a good thing. In humans, we tend to use NS for rehydration, and LRs during surgery and post op. What kind of insulin, and how much/shooting schedule is Yoda on?

In looking at the numbers, I'm noting that the liver is pretty darned solid - ALT, AST, et al are right in line. Actually, most of the individual components are right in line, electrolyte wise. I wouldn't be concerned if one is edging high or low towards the parameters - if you have nothing to compare it to, you don't know what's "normal" for Yoda. Some trend higher, some trend lower...ECID in this regard, too. I'm not too worried about his kidneys - they will have cockeyed results if there is dehydration, and can be brought back in line with hydration.

Where are ketones showing up - in the blood or in a pee test? And is there a lot of them, or just a 'warning'? Ketones can come from malnourishment, too...when the body begins to break down muscle for energy instead of getting food; with diabetes, this is compounded because the food/sugar cycle is disrupted, and while there may be enough food, the body can't use the sugar; the body thinks it's starving, so it breaks down muscle; by product of that is ketones, and the acid/base balance in the body gets bolluxed up. The kidneys are tasked to filter out protein, and ketones go through, muck up the tubes, and block the kidney that way. So any ketones could be because of elevated blood sugars, whether from diabetes or something else, and the body breaking down muscle to use for energy.

And honestly, I'm looking at his blood components, and thinking "well, he's dehydrated." If you look at Eeyore's before/after post, you can see what dehydration does, and when it turns around, how well the blood components respond. Yoda doesn't seem to be having any issues with his H/H ratio - 1:3, Hemoglobin:hematocrit. If that were out of whack, I'd think more towards kidney issues (they are big in the origination of RBC) or a spleen issue. But the ratio is a solid 1:3, so I'm not concerned. The iron supplement may be helpful, but what is really important is hydration.

I'd be more interested in hearing what/how much he's eating, how his pee looks/smells, what's his oral water intake, and what his poo is like (color, smell, consistency). How are his gums - sticky? Pale? Have you done a skin tent test? What's that like? And of course his blood sugar numbers, too...

I'm thinking that if he's getting a goodly amount of food, is drinking normally and peeing normally, and is pooping, I probably wouldn't worry so much about fluids daily. I'd make sure the insulin is adequate, and that the BS stabilize (if possible), and that he has plenty of good food...

With Eeyore, I was told to start subq fluids. I didn't, choosing rather to see what a solid, good diet, consistent insulin, and plenty of TLC would do. As you can see, it changed it around for Eeyore - and he was in worse shape than Yoda. I didn't follow my vet's advice, and when the revetting happened, she was totally thrilled at his turn around. His heart murmur was gone; his anemia was gone; his kidneys were right in line. Dehydration is evil, evil, evil.

I am not advising you to not follow your vet's advice; I'm simply sharing my story, and giving some explanations, and giving some ideas as to how to deal with Yoda. It's only been a week, right? Give it some time, and see how well he turns it around. I'm not seeing anything which makes me cringe...I wish most of my human patients had as good a panel as Yoda does. LOL. The body is an amazing thing - if we can support it in healing, it's ability to turn things around is completely astounding. Good food, good hygiene, things going in and coming out the right holes...yeah, the body is an amazing place, and some incredible things can happen. :mrgreen:

Best-
Michele

ETA: You're using prozinc and Humulin in tandem, and it's looking all right. I'm not as familiar with those as I am with Lantus, so I have no real advice there. In looking over your first post, and reading his ss, I'd say if this were my kitty, I'd not worry so much about the fluids, but rather make sure he had some good, high quality food, and that the BS got more level, and of course lots of TLC and cuddles. I won't say don't give them, but I didn't give Eeyore fluids, and he's turned it right around without that. And yes, it can be throwing the Na/K ratio off, as it's LR and not NS. :mrgreen:

 

Michele,
Levemir and R I think... Kelly's Oscar [not Yoda] is a ProZinc kitty. BTW you are quite an amazing knowledge-base wow.

 

The main reasons for a high MCHC are lipemia, cold agglutinins and spherocytes.

Did they do a reticulocyte count to see if the anemia is regenerative or not? I'm not so sure that I would wait a whole month for a recheck on an anemic cat.

Whether or not it is safe to continue the fluids is a conversation that you really should be having with your vet. If he still has high ketones, he would probably benefit more from a day of IV fluids than subQ.

 

[quote="Michele and Esse
I wouldn't worry so much about the anemia; that can be a dehydration thing, as is the BUN and Cre elevation. The ratios are good, so I'm betting a nickel it's also connected to dehydration.
[/quote]


Hemoglobin and hematocrit are increased with dehydration, not decreased. That means those numbers will go down even more as he becomes re-hydrated.

 

Hi Kelly

The MCHC is still within the normal range, but in any case it can be pushed up artifactually. I agree with Deanie, I would not wait a month--I want to know why this cat is anemic. You want to do a reticulocyte count, to see if the cat is actively making more red blood cells, and ask your vet about a pathology review of the blood smear (or s/he can just take a look in house). If he has not been tested for FeLV/FIV at least 6 months from his last possible point of exposure (last time outside, last time in contact with a cat whose status was not proven negative), retest him.

Flea anemia is rare in adult cats, even cats who aren't doing too hot, but if he was severely malnourished, it's possible (though I still think unlikely).

This doesn't matter.

I wouldn't worry about it. You are looking for a scary na:k ratio, like in 25 or so. Remember that every blood test is a snapshot, capturing a single moment in time in a live animal, so if you want to hang your hat on something, in most cases you need to prove it through multiple tests in an asymptomatic animal.

He is not on an ACE-inhibitor (benazepril, enalapril), right?

Make sure the food you feed him is not magnesium-restricted (some urinary formulas are).

This can cause constipation, as an FYI. An internist I used to work with said that was the only thing oral iron supplements ever do ;-) . Iron deficiency and i-d anemia are rare in cats, and iron supplementation is best done by injection.

What fluids are you giving? LRS? Did you ask your vet this question about the na:k ratio? S/he is the only one with the full clinical picture here. Generally speaking, then, if he is dehydrated, give it. If he has been eating very well and not having vomiting or diarrhea for a week now, and he is not urinating uncontrollably from the diabetes, he is probably hydrated. I wouldn't hesitate to give balanced fluids to a dehydrated, ketotic cat in 99% of cases. You'll be testing him next week when he goes in to check out this anemia anyway ;-)

 

Wow, everyone replied while I was sleeping!

Yes, he is on LRS right now. My vet doesn't like to give me a script for fluids because they think I am taking things into my own hands too much - so I didn't even try cat(2)_steam

He is on ProZinc right now because the donated Levemir has not come in yet. I have decided to give the R bolus if he is over 400 (with the exception of this morning since I will be gone until around noon)

He is eating lots - with the exception of last night, but that could be because of the first round of antibiotics. He pees about once an hour, and poos about 3-4 times a day. It is solid but oh so stinky!

He was very dehydrated last week, but his hydration is almost normal now. He has no fleas. The Fancy Feast grain free food is what he eats right now.

His ketones were in the beginning stages of DKA last week and are half what they were right now, though they are still quite elevated. The ketone level is the reason we are giving the fluids.

After scratching his chin last night during some TLC time I discovered that is right lymph node under his jaw is swollen, so I think the mouth infection may be more inflamed than we think. (the left node is normal size). His WBC is well within normal range though and he is negative for Feline Leukemia - so no systemic worries.

 

Ok. ... now that I have more time, I re-read everything more thoroughly and found I missed a few questions.

We did not do this yet because I was told that DKA can cause anemia sometimes. How long would be an appropriate amount of time to wait for a re-check?

Yoda was tested and found negative for heartworm, FeLV/FIV on 6/6/10

No, he is on no other meds

I read this too, so the iron supplements confuse me as well. Good thing is that the clindomyacin causes the runs, so maybe they will counteract one another :shock:

Ketones are being tested via the blood so I don't have to steak out the litter box. Last week there were A LOT of them. Currently, it is more at a warning level.

 

Any ideas with the updated answers? How long should we wait to have him tested again? Yoda's gums are a medium pink I would say. Our vet is going on vacation at the end of this week, so it will have to be at least 2 weeks from now.

 

Sorry I missed the question. I would re-test CBC and test reticulocyte count as soon as possible.

 

:shock: :mrgreen: Yoda is so lucky that you came into his life Prayers and Angels coming to help you you both Thank you for being here for him Hugsssssss LOL Kath