? Pleural effusion

Sebastian had an emergency vet visit yesterday with a diagnosis of pleural effusion. They drained about 200ml from him and he's doing much better today. I'm looking to get some more background info on the relationship between long-term diabetes and pleural effusion. Sebastian has been diagnosed diabetic about 9 years now and initial research shows pleural effusion is relatively common in long term human diabetics, so logic suggests a potential relationship for cats.

The ER vet said the most common causes are heart failure or cancer. Tests showed no signs of heart issues or obvious masses. Waiting to get blood work results back to check for cancer indicators but I'm skeptical. It's feeling like this is just a side effect of the diabetes that vets aren't very familiar with.

What are we looking at long term here? Any medication to manage it? Extra tests I should ask for?

 

@Suzanne & Darcy
@Wendy&Neko

 

What dose is Sebastian on? I can’t see a spreadsheet.

What tests has he had so far? Did that include an echocardiogram? Highly recommend if not. I haven’t seen a tie between long term diabetic cats and heart issues, unless the cat also has acromegaly. Has he ever been tested for that? Of course, some small percent of all cats can have heart issues, diabetic or not, some breeds more common than others, like Maine Coon.

Are you seeing a cardiology vet? Diagnosis first before talking drugs or treatment. Neko has congestive year failure, so I have familiarity with drugs to manage that. But she was complicated with CKD and the drugs to treat one make the other worse.

 

Did they send a sample of the fluid for cytology?

I’d pay close attention to resting respiration rate (the number of breaths in one minute while the cat is relaxed — an in and an out equals one breath). It should be under 30 or so. Depending on the underlying cause, the fluid can sometimes come back quickly. Resting respiration rate can be a clue.

I’ve too have never heard of pleural effusion being caused by long-term diabetes in cats.

 

I'd ask the vet if they had ruled out pulmonary hypertension. The condition occurs in cats but it's not been well studied. I attached an article. There's a higher incidence of pleural effusions if PHTN is an underlying condition.

 

They did do a ECG, heart looks good. They sent the fluid off for cytology and it came back with a carcinoma diagnosis. We wound up having to go for another chest tap on Sunday (100ml) and then again on Monday (230ml). Met with an oncologist yesterday and started him on chemo. Taking an aggressive approach, combination of IV Carboplatin (10mg/ml) that they'll administer at the vet, Palladia (10mg) that we'll give M/W/F at home, and then PrednisTab(5mg) daily because I'm as positive as I can be without actually being a vet that he also has asthma that is compounding the breathing issues. They also did another chest tap (90ml). It's not great that the taps are so frequent but we're staying on top of it and hopefully can slow it down with the treatment.

We're now closely monitoring his resting respiratory rate, food intake and oral syringe feeding as needed, and glucose and blood ketone levels. They advised us that Prednisone can often result in a spike in glucose, so we're handling that accordingly.

Resting breath rate last night was 28/bpm and 33/bpm this morning. He is eager to eat the syringe fed slurry when I bring it and finally ate a bit of pate on his own this morning. Still jumping up on my desk to keep me company during work. They told us the prognosis is pretty poor for this kind of thing but I'm doing my best to stay optimistic. He's beaten the odds a few times already and we're going to do our best.

Follow up apt with our primary vet on Friday to get on the same page and likely do another tap and then follow up at the oncologist on Tuesday to check vitals.

 

Hi, I just came on here to search these posts. My almost 14 yo also just had a pleural effusion and thoracentesis, and the cytology for fluid came back inconclusive - lymphocyte rich so the pathologist concern for lymphoma. Couldn’t rule out heart issue but seems unlikely. I’m trying to decide what to do.

 

@nerominka you might want to start your own post to get eyes onto your different cituation.

 

I did, in the main health forum. Thank you