Cat with kidney disease has low potassium level under 3.0 mEq/L

tamu708

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Hi,

My 18 year old cat, Sandra, has kidney disease (was diagnosed in 2013).  When she was first diagnosed, they prescribed her a k/d diet.  For some reason back then, she would not eat the prescription food.  I began feeding her Royal Canin Indoor Adult and Fancy Feast Classics canned food.  She was doing very well. 

A couple of weeks ago I noticed she had weakness in her back legs.  I took her to the vet, and they said since she is eating and going to the litter box normally, it was probably arthritis.  They put her on Adequan.  She has been receiving the Adequan twice weekly at .18ml.  She had had 4 injections, subQ, so far.  In the last couple of weeks her back legs have gotten weaker.  She is wobbly and walking on her hocks.  I took her back to the vet, Monday 1/4.  This time they ran tests and found her kidney numbers elevated.  Her potassium is very low, at 2.8 mEq/L.  The normal range is 3.5-5.1.  They prescribed her a k/d diet (Hills) and sent her home with a potassium supplement.  I'm supposed to give her 1/2 teaspoon of the potassium supplement twice a day.  She is sometimes stubborn with taking the supplement, and I have to mix it with the canned food.  It is now Wednesday, 1/6.  I know it has only been a couple of days, but she still has weakness in her back legs.  Her face though looks better-more bright.  Her coat also looks very well, not at all dull.  She can still make it to the litterbox to pee, but she quickly wobbles out and lays down.  She can wobble 5-7 steps then she needs to lay down.  She has a good appetite and is eating the Hills prescription k/d canned and will also eat the Hills k/d dry.  She is drinking more water.  Her urine output has increased, but not a lot.  She does not have vomiting or diarrhea.

They also did xray.  Her hips and legs look ok.  She does have arthritis in her spine.  The vet wants her to stay on the Adequan. 

I have been reading online and found that potassium levels under 3.0 mEq/L are life threatening.  At this level it is better for the potassium to be given intravenously and once the cat is stabilized to give her the supplement.  The vet did not do this.

My question is how long will it take for the potassium supplement to start working and strengthen her legs.  It's so horrible to see her going through this.  I lost my other cat, Thomas, in June to heart failure.  Now I'm so scared that I will lose Sandra also.

If anyone has experience with this illness and can please provide advice, I would greatly appreciated.

Thanks/
 

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I don't have personal experience with your situation, so please feel free to run what I say over with your vet. My Tiger was a CKD kitty also, so I did a fair bit of reading on potassium and why it is very critical to maintain the proper balance of this electrolyte.  It is very likely you have come across Tanya's Website, but here is a link to information regarding low potassium. There is also a Support Group you can join, which I found very comforting. http://www.felinecrf.org/potassium.htm    If you scroll down to the picture of Ollie, it says that after 24 hours of supplements, there was improvement, and after 48 he was not walking on his hocks any longer.  It will be important to check your kitty's levels because too much potassium is as bad as too little. Sending positive healing vibes for your kitty.
 

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I have a senior kitty who's having liver issues, her kidneys are working great but on her bloodwork a couple days ago her potassium was very low, 2.8 like yours.  She was also given supplements to mix in her canned food 2x per day and has been eating it willingly since her appt on Tues, however she hasn't had any difficulty with her legs or walking. 
 

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I've had three kidney cats, but none of them had ever ended up with low potassium.  Maybe because we use Lactated Ringers for their sub-q fluids, and that contains potassium
?   I'm guessing that's the reason.  Anyway, I'm obviously not an expert on this subject, but from what I've read, if you are giving her the required dosage (and she's not spitting any out), I would have expected her to be better by now.  I thought the improvements were almost instantaneous.

 

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My only experience with the walking like that was when my Lucky was toward the end (literally, the day before we put him to sleep). But I'm guessing your kitty's values weren't devastatingly bad like his were (otherwise you'd be worrying more about that. He also had a slightly elevated potassium level, which was a bit different than "the norm".

Going by what @RuthM  stated above, there could indeed be a connection between the low potassium and difficult walking. I having low or high levels of potassium in general are bad because it can mess with the heart's electrical system. 

Now that I think about it though, it may be like when we don't get enough potassium and end up with leg cramps. That would never show on an x-ray
 
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tamu708

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Sandi has a vet appointment tomorrow morning.   I noticed she has not had a bowel movement in about 3 days.  She is not going into the litter box and straining.  She just goes to pee.  I let the vet know this.  The vet said if she has a lot of stool in her stomach, they will do an enema.  Sandi will have to start taking a stool softener.  She is still weak in her hind legs.  But I did notice she is walking for a little longer, but slow.  She is not as wobbly.  Before she was wobbling real fast a few steps and quickly laying down, like she was afraid she was about to fall.  She is still eating her food and drinking water.  I gave her the potassium supplement with a syringe tonight.  She no longer will take it on her own or mixed with canned food.  I'm hoping she gets better in a few days.  She started the prescription diet just three days ago.  I was reading that an improvement can be seen within 7-10 on the prescription diet.  Thank God she is not vomiting.  I don't have her test results with me right now, but will post the numbers tomorrow.  Her BUN and Creatine were elevated.  Her phosphorus was also elevated.  The vet said mentioned the possibility of using phosphorus binders; but for now she wants to wait and see how Sandra responds to the prescription diet and potassium supplement.

Thank you so much for your responses.
 

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Wht a sweetie pie


So...how'd the Vet visit go?  Did she have to get an enema
?
 
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tamu708

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Sandra's vet appointment was at 9am this morning.  The vet did a recheck of her potassium level, and it is now at 4.5 so the supplement is working.  She also did an x-ray.  Sandra has advanced arthritis in her lower spine.  The vet thinks that is what's causing her back leg weakness and wants to keep her on the Adequan injections and see how it goes for a few more weeks.  She said the Adequan has to load up in Sandra's system before results can be seen, and this can take 4-6 weeks (about 8-12 injections).  So far, Sandra has had 5 injections.  The x-ray also showed she was impacted.  I ended up having to leave her at the vet's office for a few hours.  She had an enema done early in the morning in which the vet was able to get some of the stool out.  The vet said later in the afternoon she used her finger to see if she can get more stool out and Sandra ended up pooping it all out.  Everything was cleared out from her.  The vet also found her anal sacs impacted and expressed them.   She was also given fluids for hydration and a dose of Buprenorphine for pain.  They also put her on an antibiotics since she has also been sneezing and sniffling a bit.  I'm also supposed to give her Miralax twice a day, 1/4 teaspoon, mixed with canned food.  The vet also recommended feeding a small amount of canned pumpkin to prevent future constipation.  She will also continue taking the potassium supplement.  

When we finally got home, Sandi's walking seemed better than it has been in a while.  She ate some canned food and seemed more perky.  Since about an hour after she got home she has been mostly sleeping.  She has eaten little bites of her food on and off.  I don't know if this is from the Buprenorphine.  The vet said she would be pretty tired today.  

The vet suggested I bring her back in a couple of weeks to check her BUN, creatine and phosphorus. Sandra may have to placed on a phosphorus binder.  Her phosphorus level from Monday's vet visit was at 15.  Her BUN was 83 and her Creatine was 4.4.  She is not vomiting and continues to eat.  

I hope she get's better.  She's had a rough day.  I keep going to check on her.  She's like my little baby.  It's so depressing seeing her go through this.
 

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The vet suggested I bring her back in a couple of weeks to check her BUN, creatine and phosphorus. Sandra may have to placed on a phosphorus binder.  Her phosphorus level from Monday's vet visit was at 15.  Her BUN was 83 and her Creatine was 4.4.  She is not vomiting and continues to eat.  

I hope she get's better.  She's had a rough day.  I keep going to check on her.  She's like my little baby.  It's so depressing seeing her go through this.
Regarding her levels, from what I've read and what my vet said, appetite often doesn't get impacted until the creatinine is at 5. Hopefully you'll have awhile before it gets to that.

I can't stress this next point enough - take care of yourself. You need to be there for her but that means you need to take care of you also. It's depressing, but eventually it becomes "the new normal". I had to take a crash course in that "new normal" with Lucky unfortunately, but if there's anything I would have done a little different, it would have been to make a little more time for myself. Outside the house. Not researching the heck out of things.
 

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Sandra's vet appointment was at 9am this morning.  The vet did a recheck of her potassium level, and it is now at 4.5 so the supplement is working.  She also did an x-ray.  Sandra has advanced arthritis in her lower spine.  The vet thinks that is what's causing her back leg weakness and wants to keep her on the Adequan injections and see how it goes for a few more weeks.  She said the Adequan has to load up in Sandra's system before results can be seen, and this can take 4-6 weeks (about 8-12 injections).  So far, Sandra has had 5 injections.  The x-ray also showed she was impacted.  I ended up having to leave her at the vet's office for a few hours.  She had an enema done early in the morning in which the vet was able to get some of the stool out.  The vet said later in the afternoon she used her finger to see if she can get more stool out and Sandra ended up pooping it all out.  Everything was cleared out from her.  The vet also found her anal sacs impacted and expressed them.   She was also given fluids for hydration and a dose of Buprenorphine for pain.  They also put her on an antibiotics since she has also been sneezing and sniffling a bit.  I'm also supposed to give her Miralax twice a day, 1/4 teaspoon, mixed with canned food.  The vet also recommended feeding a small amount of canned pumpkin to prevent future constipation.  She will also continue taking the potassium supplement.  

When we finally got home, Sandi's walking seemed better than it has been in a while.  She ate some canned food and seemed more perky.  Since about an hour after she got home she has been mostly sleeping.  She has eaten little bites of her food on and off.  I don't know if this is from the Buprenorphine.  The vet said she would be pretty tired today.  

The vet suggested I bring her back in a couple of weeks to check her BUN, creatine and phosphorus. Sandra may have to placed on a phosphorus binder.  Her phosphorus level from Monday's vet visit was at 15.  Her BUN was 83 and her Creatine was 4.4.  She is not vomiting and continues to eat.  

I hope she get's better.  She's had a rough day.  I keep going to check on her.  She's like my little baby.  It's so depressing seeing her go through this.
It sounds like  your vet was super through, that's such a relief!   Glad she caught the impaction and was able to express those anal sacs, hooray for poop and no vomiting; constipation is common in ckd kitties, and so it vomiting. Almost all ckd kitties that I know need Miralax, it is easy to administer and tasteless. My Tiger got constipated from Bupephrenorphine, so be sure to maintain the miralax and pumpkin, it will help, plus bupe made Tiger loopey, so I only gave 1/3 of the recommended dose.  Your little girl is a real trooper, and you sound like a super mom as well!   ETA: that is an adorable picture!!
 
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mrsgreenjeens

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That was quite an ordeal she went thru at the Vet
.  Hopefully she's recovered from THAT now and now that the impaction has been dealt with, she'll rally start to improve all the way around.

Do you give sub-q fluids for her kidney issues?  As I mentioned earlier, I've had three kidney cats (have one now who's 16) and yes, they are definitely prone to constipation, so my last two have been on a regime of Miralax.   Callie gets it twice a day, like Sandra.  BUT, she also gets sub-q fluids to keep her well hydrated (and those fluids contain some potassium), AND I add a LOT of water to her canned food.  She eats several meals per day (8 or 9),and with each one I probably add 1 - 2 teas. water, if not more to her food.  Always filtered water too, since our water is so hard. 

Callie's numbers are actually worse now that Sandra's
.  We just had her quarterly blood draw 2 weeks ago, and clinically she's doing great, but her numbers put her right on the borderline of stage IV.  Creatinine is 5.  We were all shocked, including the Vet.  But she advises  the only thing we can really do for it is to increase her fluids.  Callie isn't even on a kidney diet...we just feed her what she will eat.  Some foods are fairly low in phosphorus, and others aren't, but the main thing is to get food in her.  And her appetite is pretty good, really.   I think in kidney cats, appetite tells it all, so if Sandra is eating well, things are good.  Sometimes you cannot go by the numbers! 
 
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tamu708

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Sandra seems depressed today.  I think it's because I keep syringe forcing stuff down her throat.  She is on a liquid antibiotic twice a day.  I also give her the potassium supplement which is a gel consistency by syringe twice a day.  I dread giving her the antibiotic and potassium as I feel like it really upsets her, especially the potassium.  I try to give her the potassium .5 ml at a time with 1 min breaks in between; she keeps trying to wobble away from me so she doesn't take it.  I'm going to ask the vet tomorrow if it can be compounded in liquid form as I think this will be easier to give her.  I keep going to hug her and she turns her face away from me.  It just breaks my heart to know she is upset with me.

She has been taking the Miralax with the canned food.  She has not had a bowel movement since Friday when she was at the vet.  But the vet said she probably wouldn't go for possibly 3 days since they had cleared out all the stool from her,  She is still eating the prescription canned food.  I warm it up for her which she likes.  I also have been adding water to the canned food.  I feed her small meals throughout the day.  I also leave out the prescription dry food for her so she can nibble throughout the day. I did notice today she is drinking less water on her own. Yesterday she drank a lot of water.  I hope this is just a one time thing.  

My vet did talk to me about giving her sub-q fluids at home.  I am very scared of trying this.  I don't think she is a cat that will allow me to do this, but I'm willing to try.  

My vet also mentioned that she has seen some cats with numbers much worse than Sandra's and they were doing well.  She said some cats have very good kidney numbers and are very sick.   She said it was a good sign that Sandi is still eating and not vomiting.  

I'm supposed to give the vet a call tomorrow morning with an update.  I'm also going to ask her about pain medication for Sandi's arthritis.  She seems very uncomfortable. I'm hoping that there is a medication that is safe for her kidneys and won't constipate her.  Hopefully the Adequan improves her arthritis after she is done with the month loading phase.
 

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IMHO, giving meds is the hardest part of any illness in cats.  We give all of Callie's meds either as transdermals or injectibles, as she is absolutely impossible to give anything by mouth.  We even hired a Vet Tech once to give her her pills after TWO of us could not seem to get one single pill down her throat
(and she needed them for 30 days).  Even the Vet Tech gave up.  Needless to say, she did NOT get those pills
.  

Anyway, yes, talk to your Vet and see whether they can be compounded into some other consistency.  Maybe transdermal? 

There are lots of people who think they cannot do Sub-qs, but they end up doing them with no problems.  You just have to have the frame of mind that you are not hurting her, you are helping her.  And if you need to,you can use a "burrito bag" or some other devise to contain her while you do it, if you don't have anyone there to help you.  Lots of people do it by themselves, but I must admit, I've always had another set of hands around.  I would imagine your Vet or a Tech would take the time to teach you, even letting you do it there in their office a few times.  We can help you with the best places to purchase supplies, as it's much cheaper to get them off site rather than from your Vet.  (that website mentioned in an earlier post also has lots of info about sub-q fluids
 

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One thing I'll say about subqs - she may growl, and growl a lot. But she'll feel SO much better afterwards. And eventually, she'll get used to the idea that it's going to happen. She won't like it - but she'll get used to it. I eventually learned all the tricks for things like keeping the needle from coming out. Like, holding the chest from the front with my one hand. I've heard of folks with cats that sit there and don't move at all during subqs. I don't think any of my cats would ever be like that.
 

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Sandra is beautiful, her face reminds me of my Simon but orange.  Thanks for posting, I'm in the elimination stages with my female Chestnut now, we're waiting for Urine test to come back.  I'm finding all this information very educational.  I never knew about potassium levels in cats, and unlike your vet, mine has been less then helpful, and made me feel like a horrible human being and unworthy of my little one, though that's for an entire other thread.  Thank you again for sharing and like Top Cat Donutte said, take care of yourself, I've been up for 4 days with mine and haven't shaken this cold I've had for two weeks now.  Best of luck to you and your wee one.
 
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Sandra is beautiful, her face reminds me of my Simon but orange.  Thanks for posting, I'm in the elimination stages with my female Chestnut now, we're waiting for Urine test to come back.  I'm finding all this information very educational.  I never knew about potassium levels in cats, and unlike your vet, mine has been less then helpful, and made me feel like a horrible human being and unworthy of my little one, though that's for an entire other thread.  Thank you again for sharing and like Top Cat Donutte said, take care of yourself, I've been up for 4 days with mine and haven't shaken this cold I've had for two weeks now.  Best of luck to you and your wee one.
Thank you.  Best of luck to your baby Chestnut too.  Sending prayers that Chestnut gets better 
.
 
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tamu708

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I called the vet this afternoon to let her know Sandra is doing the same, not better or worse.  I let her know Sandi has been taking the Miralax and hasn't had a bowel movement since Friday.  The vet said if she doesn't have a BM by Wednesday that I should bring her in Thursday.  My hear sank when she told me this.  I don't like to keep taking her to the vet; she gets so very stressed.  I also let the vet know how Sandra no longer wants to take her potassium supplement; the vet is going to see if it can be compounded into a liquid. 

As soon as I got home from work, I went straight to the litter box and was so relieved to see she had pooped.  I was so relieved!  She was also very slightly more perky and she demanded food.  I heated her up some canned food and she had a good meal.  She also has eaten from her k/d dry food.  And she is drinking water better today.  Sandra is still wobbly, but seems to be taking more steps. I'm supposed to give her her sixth injection of Adequan tomorrow evening which I'm dreading.

I did notice she vomited the antibiotic, Amoxi, she has been taking.  It was a small liquid amount and pink colored which is the same color as the antibiotic.  I'm going to skip giving it to her tonight.  I'm scared she will end up throwing up her meals that I'm feeding her tonight.  I'll give it to her in the morning and if she vomits it again, I'm going to let the vet know.  

I asked the vet about pain medication for Sandra's arthritis.  She suggested Buprenex, but said this is only for short term.  I was under the impression that there is long term medication for treating arthritis pain.  I'm going to browse the topics and see what other members have posted.  
 
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tamu708

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IMHO, giving meds is the hardest part of any illness in cats.  We give all of Callie's meds either as transdermals or injectibles, as she is absolutely impossible to give anything by mouth.  We even hired a Vet Tech once to give her her pills after TWO of us could not seem to get one single pill down her throat
(and she needed them for 30 days).  Even the Vet Tech gave up.  Needless to say, she did NOT get those pills
.  

Anyway, yes, talk to your Vet and see whether they can be compounded into some other consistency.  Maybe transdermal? 

There are lots of people who think they cannot do Sub-qs, but they end up doing them with no problems.  You just have to have the frame of mind that you are not hurting her, you are helping her.  And if you need to,you can use a "burrito bag" or some other devise to contain her while you do it, if you don't have anyone there to help you.  Lots of people do it by themselves, but I must admit, I've always had another set of hands around.  I would imagine your Vet or a Tech would take the time to teach you, even letting you do it there in their office a few times.  We can help you with the best places to purchase supplies, as it's much cheaper to get them off site rather than from your Vet.  (that website mentioned in an earlier post also has lots of info about sub-q fluids
My other cat, Basil, is an absolute nightmare to medicate.  He had to be on antibiotics not to long ago when his anal glands got impacted and infected.  His WBC count got up to 53; the vet was shocked at how bad his infection was.  I could not get the pill into him.  He would keep spitting it out.  A couple of times I thought I had gotten it in and was so happy only to find it on the floor later on.  He would scratch up my hands and bite.  I even tried crushing the pill and mixing with water to give it to him by syringe.  This made him foam at the mouth so I never new if he was getting any of the antibiotic.  I ended up having to take him to the vet each evening and have a vet tech pill him.  Even they struggled with him.  The last night, I was just so tired, I cut the pill in small pieces and mixed it with some Fancy Feast.  He ate it up but I think with the last bite he tasted the pill in the food and realized what I had done; he just suddenly stopped eating and ran off to hide behind the couch.  I was so relieved when that ordeal was over with.  

Sandra has to go back for a follow up in 2 weeks.  I will ask the vet for more information about sub-q fluids and a demonstration.  
 
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