Low potassium in Hyperthryoid, CKD, possible IBD or possible SCL

[Mac and Cats]

I have posted about my sweet Orange before. He was "diagnosed" back in March of 2023 with possible IBD or possible SCL. The ultrasound doctor (forgive my lack of correct medical terminology) said it was "consistent with IBD" but that we couldn't rule out SCL without a biopsy. We chose not to do the biopsy because he has a heart murmur and did poorly at his last dental cleaning and had difficulty waking up. We initially put him on 5mg daily of prednisolone for about a month and then reduced it to 2.5mg and he did great with the reduction. He also has hyperthyroid (treated with meds) and technically CKD although his numbers have apparently been "stable" for awhile. His "IBD" symptoms were strictly not eating/being EXTREMELY picky with food. He only vomited once and had half a bout of diarrhea once before the ultrasound and never had that again. He has been doing great since he has been on the Pred. He went from slightly less than 9 pounds to now slightly less than 13! Which is the most he's ever weighed since we got him three years ago. He is 15. I've noticed over the past month that he was starting to get pickier with his food (but not as bad as prior to his "diagnoisis").

He was still eating a good amount so I was just monitoring him and watching for any red flags. This last week, his desire to eat has gotten less and less and he has gotten more and more picky. Still no where near what he was prior to "diagnosis". I didn't want to wait until it got beyond our control so I took him to the vet where we had them run a blood panel (see attached). In addition to his picky food behavior/inappitence, he's been sleeping a lot. I sort of chalked that up to "Well, he is 15, almost 16 and has a lot of health problems." His bloodwork came out ok and apparently his kidneys are "stable" according to the Banfield doctor. His potassium came out at 3.3mmol/L and apparently the low range for that is 3.5. They prescribed him a potassium gel, which he hates and is maple flavored. Smells delicious to me, but I'm not a cat. I knew he would have zero interest in the gel and called around to see if I could find the powder version locally to no avail. I ended up ordering it from Chewy and it is apparently out for delivery now I just received it and will try it tonight with his afterpill liquid treat that he usually loves, but has been pickier with the last week. He has a second vet appointment with a vet I trust (not Banfield) on Monday so I can get some guidance on next steps. There is a lot going on here. It could be his IBD is progressing or it is SCL and that is progressing or it could be the low potassium was creating the symptoms or maybe even CKD? Who knows. I am going to ask her how she thinks we should proceed. If that means she thinks we should do another ultrasound and consider a biopsy, I'm leaning towards it. The Banfield vet claimed she did not hear a heart murmur any longer. However, I still worry about anestesia regardless. I'm aware of the Echocardogriam option, so I'm going to ask about that as well -- ie, if it is necessary before considering another ultrasound/biopsy. I do realize they recommend removing the steriod for a few weeks (?) prior to ultrasound, so I'm very hesitant to do that since he has done so well prior to the last week-ish. So, I will ask about thoughts on adding Chemo without an ultrasound, but not sure if that is something people "do".

For now, Banfield (who I went to for the labs on Thursday) said to increase his Pred to 5mg (which I agree with for now in case that might help) and give him the potassium supplement twice a day. In addition, I'm also giving him Cerenia and Mirataz (ear form). Historically, Mirataz/Elura/Miratazpine always backfired with him because, yes it would make him hungry, but he would still not eat anything I put in front of him. It was like creating a starving monster that could only be satisfied eating the souls and emotions of his caretaker. This time, however, he is eating a bit. I'd say maybe a can of something a day (maybe more) and yes, I have tried ALL OF THE TRICKS. Which one he will eat this day is anyone's guess, BUT he is eating at least one of the (5-9 options) I put in front of him, which is a change from prior to his "diagnosis".

Has your cat ever had low potassium? If so, what were their symptoms? The Banfield vet seemed dumbfounded about why his potassium levels would be low when his kidneys are "stable', but upon looking online (which I take with a grain of salt), I see that low potassium can happen with both CKD and Hyperthyroid cats. Could the low potassium attribute for his inappitence as the inernet states as a side effect? Or is it probably IBD/SCL progressing? Any insight on this? Like I said, he has another vet appointment on Monday with a vet I trust. I can go on a rant on Banfield, but I will hold my tongue. We still have a plan with them so I figured I would use them for what I can (ie. lab tests), but I don't trust their opinion on this complicated situation for much else. One of the vets I saw with them "didn't know" if they used Cerenia for cats and only knew that they used it for dogs. I was shocked and disgusted at this comment since I've had multiple cats on Cerenia. That's just the tip of the iceburg.

In case this is helpful instead of the attachment, here is a snapshot of his renal numbers over the past year-ish:
April 2021 (this is when we adopted him and he had undiagnosed hyperthryoid for who knows how long. He had been on meds since Jan of 2021. I'm just putting this here for a baseline of what he was at when we technically adopted him).
* BUN/Crea 20.000
* BUN 41.000 mg/DL
* PHOS 6.1000 mg/DL
* CREA 2.100 mg/DL

March 2023
* BUN/Crea none listed
* BUN 33.000 mg/DL
* PHOS 4.7000 mg/DL
* CREA 1.000 mg/DL

August 2023
* BUN/Crea 19.000
* BUN 29.000 mg/DL
* PHOS 4.5000 mg/DL
* CREA 1.500 mg/DL

January 2024
* BUN/Crea 43.000
* BUN 53.000 mg/dL
* PHOS 3.500 mg/dL
* CREA 1.200 mg/dL

Thanks in advance for any of your input!

 

[Hip]

Hi Mac,
I’m a veterinary nurse of 20 years now. My interests are in emergency, critical care and nutrition. A couple of things I’d like to mention.
1: intestinal biopsies aren’t usually done under full sedation. Typically it’s just a sedative and patients do seem to handle this procedure quite well.
2: you can certainly get your kiddo worked up by a cardiologist first, but I monitor anesthesia for patients with heart murmurs routinely and I’ve had very few problems due to the murmur.
3: lower potassium numbers can be pretty normal for kiddos with IBD/Hyperthyroid. The best thing to do is supplement like you are. There are other makers who do other flavors. I just put the desired amount of potassium gel directly onto a cat’s paw, they will lick it up!
4: Cats ability to smell their food directly effects their ability to eat it. You can always try warming up food for a few seconds to increase smell.
5: If it were my kiddo, I would take them directly to an internal medicine specialist. Treatment is necessary for both IBD and lymphoma and you might be able to focus money onto a specialist rather than multiple “general practice” vets.
6: No chance they will do chemo without biopsies!

I’m sorry your kiddo is not thriving. These are all mere suggestions based on my experience, do not make any changes to your pets care prior to talking to a vet! You’re doing a great job, you have to be your kiddies advocate and you’re doing a fantastic job, kudos.
Hip

 

[Mac and Cats]

Hi Mac,
I’m a veterinary nurse of 20 years now. My interests are in emergency, critical care and nutrition. A couple of things I’d like to mention.
1: intestinal biopsies aren’t usually done under full sedation. Typically it’s just a sedative and patients do seem to handle this procedure quite well.
2: you can certainly get your kiddo worked up by a cardiologist first, but I monitor anesthesia for patients with heart murmurs routinely and I’ve had very few problems due to the murmur.
3: lower potassium numbers can be pretty normal for kiddos with IBD/Hyperthyroid. The best thing to do is supplement like you are. There are other makers who do other flavors. I just put the desired amount of potassium gel directly onto a cat’s paw, they will lick it up!
4: Cats ability to smell their food directly effects their ability to eat it. You can always try warming up food for a few seconds to increase smell.
5: If it were my kiddo, I would take them directly to an internal medicine specialist. Treatment is necessary for both IBD and lymphoma and you might be able to focus money onto a specialist rather than multiple “general practice” vets.
6: No chance they will do chemo without biopsies!

I’m sorry your kiddo is not thriving. These are all mere suggestions based on my experience, do not make any changes to your pets care prior to talking to a vet! You’re doing a great job, you have to be your kiddies advocate and you’re doing a fantastic job, kudos.
Hip

Thank you so much for your response. I truly appreciate it! The vet we brought him to on Thursday suggested an Xray and I said I was fine with that but would rather focus our money on specifics. I figured they would suggest an ultrasound after the xray and I'm fine with that but I'd rather just jump right to the Ultrasound instead of wasting $300+ on an Xray that wasn't going to tell us much and then needing to do an ultrasound regardless. The vet agreed that was a reasonable thought process. We lost 3 cats in an 18 months span starting in 2020. One from Lymphoma, one to CKD and one from an intestinal disease I can't remember the name of, but often gets mistaken for Lymphoma. So, I am pretty familiar with what they will suggest at the bare minimum. I will ask the vet on Monday about all these things you suggested.

I have tried ALL THE THINGS with food as I have been through this so many times before. I got him to eat boiled chicken on Thursday and he hasn't touched it since. He has eaten bites of the other things I've tried (baby food, boiled chicken, bone broth, etc.). He did just eat some Fancy Feast that he has rejected for months and I did not expect him to touch, but he ate about 75% of the can! Being that he is still eating SOMETHING, I'm not worrying too much as before, he was eating practically nothing previously and is still at least eating something now. He has probably eaten a can and a half to two cans total today which is a lot considering. (I'd say around 200-ish calories) So, I am satisfied with that for now.

In my experience, using the gels when cats won't eat it on their own does nothing but create a mess. I did just take a finger full of the potassium gel and wipe it on his tongue and he did mostly eat it. So, I will do that again tomorrow if I can't get him to eat either gel or powder on his own. He did eat the entire portion he was supposed to of the gel mixed with a liquid treat twice yesterday and didn't complain. So, maybe wiping it on his tounge will work for now. I will try the paw recommedation tomorrow as a last resort. That has never ever worked for me with any cat unless my goal was to create a mess before, but I'll try anything at this point. I did get him to eat some of the powder mixed in a liquid treat tonight, but probably not the recommended dose. I would still love to hear other experiences with low potassium. The vet at Banfield made it sound like the low potassium was not the cause of any of his symptoms, so I'm still left wondering.

Again, thank you so much for your response, I really appreciate it! I will update this post once I have more information.

 

[Hip]

I think the lower potassium isn’t making him feel poorly. You might find that thriving patients with IBD may even have lower potassium. Potassium is absorbed through passive diffusion in the intestine; so an inflammatory process like SCL/GI Lymphoma and IBD would effect absorption. A more extreme route indoor potassium would be giving subcutaneous fluids with potassium a few times per week, but hydration status would need to be determined and murmur established (sounds like it may or may not be there at this point). The elevations in thyroid do cause heart murmurs so the fact that the vet did not appreciate a murmur could mean that they normal thyroid levels are no longer effecting the valves of the heart. Hope this helps!
good luck my friend!

 

[Mac and Cats]

I think the lower potassium isn’t making him feel poorly. You might find that thriving patients with IBD may even have lower potassium. Potassium is absorbed through passive diffusion in the intestine; so an inflammatory process like SCL/GI Lymphoma and IBD would effect absorption. A more extreme route indoor potassium would be giving subcutaneous fluids with potassium a few times per week, but hydration status would need to be determined and murmur established (sounds like it may or may not be there at this point). The elevations in thyroid do cause heart murmurs so the fact that the vet did not appreciate a murmur could mean that they normal thyroid levels are no longer effecting the valves of the heart. Hope this helps!
good luck my friend!

Thank you! I will ask the vet on Monday. The vet on Thursday said he was well hydrated. My main hope is to just make him comfortable at the very least. He is laying right next to me right now and seems comfortable laying on his side in a relaxed manner. So, hopefully that is positive.

 

[silent meowlook]

Hi. So, the gold standard is for full thickness intestinal biopsies to be done and this is a surgery done with general anesthesia. You can also do endoscopic biopsies but this is also full anesthesia and often the results can be inconclusive. It is also better to biopsy before Prednisolone has been started.

I am not a vet and can’t tell you what to do with your cat. I can tell you what I have done with mine. My cat is 14 yrs old and is hyperthyroid and has suspected, via abdominal ultrasound, intestinal lymphoma. I did not want to do any anesthesia on my cat because she would be at a high anesthetic risk. She also has a heart murmer and asthma, as well as kidney disease which is masked by the hyperthyroidism.

I made the decision based on ultrasound, ( thickened intestinal mucosal layer, enlarged lymph nodes, space occupying intestinal lesion) to treat with Prednisolone, Chlorambucil, and to continue her Methimazole, Cerenia as needed, and Lactated ringers subcutaneously as needed. I am careful how much I give due to the heart murmur. I also give her buprenorphine as needed for pain ( rarely) and she gets albuterol for asthma, should she have an attack.
I feed a novel protein diet. Royal Canin Rabbit canned.
This has been working for her for almost 3 years now.
When considering diagnostic procedures, ask yourself and the vet: What will this knowledge change in treatment? With my cat, biopsies would have confirmed LSA or they would have been inconclusive, or they would have only seen inflammation in that area that was biopsies. But does that mean there isn’t lymphoma in a different area of the intestine that wasn’t biopsied?

The treatment would have been the same either way.

I also give my cat injections of Vitamin B 12 because this is often low in the cats with LSA.

As for the potassium. It isn’t low enough to cause the problems you are seeing. The gel is disgusting and I couldn’t get it into my cat either. I have it added to a bag of SQ fluids that I use. The bag doesn’t last long and I don’t give more than 60 cc at a time. But it is keeping her potassium levels in the normal range now. I also don’t use it every time because low potassium is not good but high potassium is much worse.

 

[Mac and Cats]

Hi. So, the gold standard is for full thickness intestinal biopsies to be done and this is a surgery done with general anesthesia. You can also do endoscopic biopsies but this is also full anesthesia and often the results can be inconclusive. It is also better to biopsy before Prednisolone has been started.

I am not a vet and can’t tell you what to do with your cat. I can tell you what I have done with mine. My cat is 14 yrs old and is hyperthyroid and has suspected, via abdominal ultrasound, intestinal lymphoma. I did not want to do any anesthesia on my cat because she would be at a high anesthetic risk. She also has a heart murmer and asthma, as well as kidney disease which is masked by the hyperthyroidism.

I made the decision based on ultrasound, ( thickened intestinal mucosal layer, enlarged lymph nodes, space occupying intestinal lesion) to treat with Prednisolone, Chlorambucil, and to continue her Methimazole, Cerenia as needed, and Lactated ringers subcutaneously as needed. I am careful how much I give due to the heart murmur. I also give her buprenorphine as needed for pain ( rarely) and she gets albuterol for asthma, should she have an attack.
I feed a novel protein diet. Royal Canin Rabbit canned.
This has been working for her for almost 3 years now.
When considering diagnostic procedures, ask yourself and the vet: What will this knowledge change in treatment? With my cat, biopsies would have confirmed LSA or they would have been inconclusive, or they would have only seen inflammation in that area that was biopsies. But does that mean there isn’t lymphoma in a different area of the intestine that wasn’t biopsied?

The treatment would have been the same either way.

I also give my cat injections of Vitamin B 12 because this is often low in the cats with LSA.

As for the potassium. It isn’t low enough to cause the problems you are seeing. The gel is disgusting and I couldn’t get it into my cat either. I have it added to a bag of SQ fluids that I use. The bag doesn’t last long and I don’t give more than 60 cc at a time. But it is keeping her potassium levels in the normal range now. I also don’t use it every time because low potassium is not good but high potassium is much worse.

Thank you so much. I really appreciate your feedback and your story. Your vet was willing to do Chlorambucil even without the biopsy? I brought this up to our vet back in March and she said it was something we could absolutely talk about if the Pred wasn't working. We didn't discuss it further, but she made it sound like it was a possibility. I think she meant if we talked to an oncologist as well. But that was months ago, so I could be misremembering.

 

[Mac and Cats]

Just a small update: Orange scarfed down two cans of gravy lovers Fancy Feast in the last hour-ish! He started rejecting that food months ago after loving it for several months. So that makes me hopeful. He is still sleeping a lot, but hes up on the bed next to me like he use to do instead of not moving from a bed in the corner of the room like he has been doing for a couple weeks. I'm guessing it is probably the day three of the doubled Pred dose that is helping, but I will take any improvement at this point!

 

[fionasmom]

Your vet was willing to do Chlorambucil even without the biopsy?

At least three of us here on TCS have been able to take that route. I did it with my Chelsea because she was hard to handle, had FHS, and I was concerned about recovery from anything invasive.

 

[Mac and Cats]

At least three of us here on TCS have been able to take that route. I did it with my Chelsea because she was hard to handle, had FHS, and I was concerned about recovery from anything invasive.

Thank you so much. I appreciate the information. When I discussed it with our vet several months ago she sounded like that was a route we could take. We will be seeing her tomorrow, so I'll report back once I have more information.

 

[Mac and Cats]

Just a small update for you. The vet was encouraging today and thought we weren't quite at the point where we need to consider another ultrasound being that he's been eating like a champ the past few days and he is at a stable weight. She said to stick with the double dose (5mg) of Pred for two weeks and then we can try to move him back down to 2.5mg and see how that goes. After that we can reassess.

He absolutely hates the potassium supplement in either the powder or the gel. I've resorted to putting the powder in empty gel caps to get him to take it. Has anyone ever used size 2 gel caps with their cat? The largest I have used previously is size 3, but that doesn't quite fit the full dose. I did get size 2 and will try them this evening. Hopefully, they won't be too large. They don't seem like they will be, but just thought I'd ask.

 

[fionasmom]

I never used 2 with a cat, and usually used 4. There is a discussion here about capsule size and use. Will he take two capsules of a smaller size or is that out of he question?

Empty Gel caps

This is the rest of the search on the subject
Search Results for Query: gelatin capsules

 

[Mac and Cats]

I never used 2 with a cat, and usually used 4. There is a discussion here about capsule size and use. Will he take two capsules of a smaller size or is that out of he question?

Empty Gel caps

This is the rest of the search on the subject
Search Results for Query: gelatin capsules

I did consider doing two capsules, however, he's already on other meds that fit into one size 4 (or 3? I can't remember) capsule. So, I was trying to make it so he didn't have to do 3 capsules in one go twice a day. He is very good about taking his pills, although, he hardly ever eats them willingly. But I don't have to hold him down or anything. If I can't get him to eat it on his own, I just pop his mouth open, throw the pill in and he swallows. He gets a liquid treat afterwards. the size 2 aren't much bigger than a Gabapentin, so I'm hoping it will work out. I probably shouldn't have bought a pack of 1,000...

 

[Mac and Cats]

I did consider doing two capsules, however, he's already on other meds that fit into one size 4 (or 3? I can't remember) capsule. So, I was trying to make it so he didn't have to do 3 capsules in one go twice a day. He is very good about taking his pills, although, he hardly ever eats them willingly. But I don't have to hold him down or anything. If I can't get him to eat it on his own, I just pop his mouth open, throw the pill in and he swallows. He gets a liquid treat afterwards. the size 2 aren't much bigger than a Gabapentin, so I'm hoping it will work out. I probably shouldn't have bought a pack of 1,000...

Just an FYI the 2 size worked fine. I got him to eat one last night and then had to pop another one down his throat this morning. It all went well and he enjoyed his liquid treat after!

 

[Mac and Cats]

I just wanted to give a quick update on my guy. We started with an X-ray that turned up with nothing. He went in for an ultrasound this morning (his last one was in March). They said that the thickening in his intestines have progressed a bit and they're recommending Chlorambucil (2mg) every other day to start. They also gave him a B-12 injection. We will then do a blood recheck in 3 weeks and they will show me how to do the B-12 injection so I can do it at home monthly. He's been doing pretty well on 5mg once daily of Pred for the time being. Anyway, just wanted to give an update on how things are progressing.

 

[fionasmom]

Thank you for letting us know and please keep us posted. Chelsea had SCL and was treated very successfully for quite a while.

 

[silent meowlook]

Hi. My cat, Cheetah has been on Prednisolone and Chlorambucil for almost 3 years now. You will most likely see a gradual improvement over the next couple of weeks.

 

[Mac and Cats]

Hi. My cat, Cheetah has been on Prednisolone and Chlorambucil for almost 3 years now. You will most likely see a gradual improvement over the next couple of weeks.

Thank you so much for your reply! I'm hoping it will work with my boy. Can I ask what dosage and what the schedule is like? Also, what type of food is he eating? Did Cheetah have any side effects happen with him that you noticed?

Edit: I see that you commented some of what I asked in here in another comment. So you can disregard!

 

[Mac and Cats]

Hi again,

For anyone who gives their cat Chlorambucil: is there a time of day you recommend giving this? Meaning, is it better to give it in the morning or the evening? I'm trying to figure out what would be best for my cat. Currently, he takes 5mg of Methimazole (and Cerenia if needed) in the morning and in the evening he takes 2.5mg of Methimazole and currently 5mg of Prednisolone. I work from home so I am home to keep an eye on him. I just received his Chlorambucil this morning. So, I'm trying to figure out if I should wait until tomorrow morning or go ahead and give him his first dose this evening. Thoughts? Thank you in advance!

 

[fionasmom]

Chelsea only took chlorambucil and pred. You are giving more medications and so there is more of a question of timing, both for the use of the meds and for the comfort of you and your cat who may not be thrilled about having to do all of this. I see that chlorambucil is every other day in your case.

With Chelsea, we tried for the morning but it was not an exact science as she remained somewhat semi feral so it was always a little bit of an issue to put her in a purrito. It usually meant sneaking up on her with the towel if she seemed relaxed or sleepy.

The only thing I would want to know is whether or not one medication should not be given at the same time as another one and your vet could answer that very quickly and tell you how far to space them out if necessary.