Help with ventroflexion?

Hi everyone,

My 14 1/2 year old sweet boy has recently been diagnosed with (likely) mild CKD, an adrenal tumor, and pseudomonas.  We initially took him to the vet because he lost a lot of weight, was not eating and was dehydrated.  He spent 3 days getting IV fluids and came home looking better but, just a week and a half later, we had to take him back in because he was weak, walking strangely, and had ventroflexion of his head and neck.  We were scared it could be fatty liver but it turned out he had bad hyperkalemia.  The vet predicted this was a result of our administration of subcutaneous fluids every two days flushing out his kidneys, but in my research, I've found it could also be the result of aldosteronism due to his adrenal tumor.  On a side note, his kidneys look a lot better (creatinine down from 4.9 to 3.0 and BUN down from 189 to 37).  We've been giving him a potassium gluconate oral supplement twice daily and have enriched his subcu fluids with potassium and B vitamin supplements.  However, after a couple days of these treatments he still has the ventroflexion, is very lethargic, looks depressed, and isn't eating much or drinking much water.  Does anyone know how long it usually takes for kitties to regain their muscle strength and overcome the ventroflexion once put on potassium supplements?  I just want him to be closer to normal so I don't have to worry so much!  Thank you!

In addition to low potassium, one of the main causes of ventroflexion is thiamine deficiency, and he had not been eating so he could well have a thiamine deficiency too. The weakness and incoordination can also be caused by thiamine deficiency.  You said you are giving him B vitamin supplements, but he may need  much more concentrated doses to recover.  Cats can actually develop  lesions in their brains secondary to thiamine deficiency and these actually clear up with intense thiamine replacement.   Anyhow, it's something you might mention to your vet.

Here is an excerpt from one case report of two cats with thiamine deficiency:

Both cats were given vitamin B complexes (Vitamedin; CJ Pharma, Korea) at a total dose of 50 mg thiamine hydrochloride twice daily. For Case 2, oxygen supplementation and vitamin B complexes [an initial dose of 70 mg/kg body weight (BW), intravenous injection, followed by 30 mg/kg BW, subcutaneous injection, for 3 more days; Yuhan, Korea] were initially administered. Three days after thiamine supplementation, the neurological abnormalities resolved significantly including recovery of vision and disappearance of vestibular signs. One week later, no other clinical signs were observed in Case 1. Mild tremors and incoordination were still noted in Case 2. However, these clinical signs resolved 3 weeks after presentation. After 3 weeks of thiamine supplementation, MRI was repeated on Case 1 to reassess the lesions. Except for changes in the cerebellar nodulus, the lesions had resolved (Figs. 1 and ​and3).3). Long-term supplementation with thiamine along with consumption of a nutritionally balanced diet was recommended.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3885747/

The symptoms you describe are pretty classic for low potassium. That can happen from a cat not eating and being on IV fluids. With potassium supplementation it should have resolved by now. It sounds like your cat has some complex things going on. Has his potassium been rechecked?

If you are not already with an internal medicine veterinarian I strongly urge that you get a referral to one ASAP. When you start getting into things this complex you need a specialist to help your cat. Regular veterinarians are expected to know to many things about multiple species that they just cannot have the knowledge in these things that a specialist will. A specialist would have supplemented the potassium in the IV fluids to begin with. They also have more equipment and would have been able to monitor the electrolytes with a drop of blood on an in house machine.

There is no way someone on line is going to be able to give you any medical advice because your cats disease and multiple problems are way to complicated and involved to even try. There is to much going on.

The way I look at is that I would rather have a specialized vet treating my cat that has treated cases this complex thousands of times than to have a vet that has never seen all of the issues in one cat before or maybe has only once. So please get your cat into a specialist as I don't think you have any wiggle room to try to let the current vet continue with him.

They should  have known that the potassium should have been supplemented to start with and this wouldn't have been a problem. Also without monitoring the potassium levels there is one thing worse than potassium to low and that is potassium to high.

The kidney values have dropped because of the fluids that is all.

I hope your cat gets to a specialist and they are able to help him