SOS - Extremely low potassium, supplementation not "taking"

[hoosiercatlady]

I'm hoping someone can give me some urgent feedback as we will have to make a decision on whether or not to let 16 year old Liz go later this evening.

She had been acting weak and lethargic and walking timidly for a few days, and so we took her into the emergency vet yesterday.

Kidney counts were fine and no signs of diabetes, but the veterinarian did feel a small nodule on her thyroid and was thinking we might be dealing with hyperthyroidism.

They also noticed that her potassium counts were incredibly low and that, they said, could account for all of the listless symptoms we had been seeing.

It was devastating for me to leave her overnight at the vet because she cried on the drive over, and she's not spent a night away from us in over 10 years. To top it off, she has been blind from retinal detachments for a year now.

I was hopeful for good news this morning, but they are now telling us that despite giving her potassium intravenously, follow up counts on the potassium aren't showing that it is even registering.

They have no idea what is causing it, but they said, if it keeps up like this she will not make it.

she has a heart murmur, so I know they want to be careful and not give her too much potassium, but I'm just wondering if anyone has any insight. I'm heartbroken.

They are, of course, suggesting we put her in an intensive care facility, but unfortunately we just don't have the funds for that. These emergency vet bills alone will be $2,000+.

Please, does anyone with experience with potassium deficiency have any insight on what might prevent the body from absorbing it and showing that it's available.

 

[mrsgreenjeens]

I don't know what this might be from, but just wanted to let you know I'm thinking about you and your Liz and hoping for the best

 

[hoosiercatlady]

Her thyroid test came back clear (we were actually hoping for that as it would at least be treatable).

Given her unaccounted for high blood pressure last year and the recently revealed heart murmur last night, they are thinking it is likely hyperaldosteronism (adrenal gland tumor), and we are not going to be in a position to address that financially, nor is treating it something with think it would be fair to put her nearly 16-year-old body through.

We will likely have to make the hard decision tonight.

I am devastated.

Making this tougher, their covid restrictions (which I can absolutely respect) mean we cannot be there when they PTS. We may go into a room to see her and say goodbye, but I'm wondering if that's not more cruel. If I can't hold her through to the end, I think she will be panicked when we leave again. On one hand, I want to see her one more time, but I want to do what's kindest to her, and the idea of her feeling us nearby but then being taken back alone again seems unnecessarily cruel.

 

[cat nap]

I'm so sorry that you are going through this, H hoosiercatlady .
I also don't have any experience with hyperaldosteronism (adrenal gland tumor), but just wanted to add my support to you and your cat Liz at this difficult time.

If there were a way in which they could give you medications, which you could take home, and that your Liz would get better...then that would be the best outcome. But it doesn't sound like this is an option.
It also sounds like you have done and tried all that you can to get her well, and that she knows this, too.

This covid and all its restrictions...does make it absolutely more difficult.
For me, I would have to say goodbye, ...but as you said...it may be tougher on you and on her.
You know her best. And She would only want what is best for you, too.
It's such a hard decision, ...so I only send thoughts of Peace, Strength and Love your and Liz's way.

 

[Antonio65]

Hi H hoosiercatlady ,

I'm sorry for what you and your Liz are going through.
You are describing exactly what my sweet cat Lola (you see her in my avatar) had 4 years ago, she was 16 too.

The first symptoms appeared October 2015, a quick visit and blood check at the vet revealed a slight worsening of her kidney disease, but a few days later we had an ultrasound done and this revealed a slight enlargement of one of her adrenal glands, but the vet thought it wasn't worrisome. I can't remember whether the vet prescribed a therapy. Anyway, a few days later everything was fine again.

Fast forward to February 2016. On a morning Lola went suddenly blind. I rushed her to a specialist vet and she found out that Lola had a retina detachment in both her eyes due to a BP spike. The vet prescribed a med (Amlodipine), the BP went back to normal and Lola's sight, miraculously, was regained, against all odds.

But the bad news hadn't finished.
Slowly, a month later, Lola started acting weak and lethargic, to the point she couldn't stand anymore, let alone walking to the litter box. She started peeing in her bed. Until, on a night, she fell on a side and couldn't move a muscle.
Another rush to the vet. To cut this story short, it took me weeks to find the perfect vet who was able, at last, to diagnose what it was going on.
Lola was diagnosed with Hyperaldosteronism, an extremely rare disease where a tumor attack one or both the adrenal glands (the one the US vet had seen in the scan 6 months earlier) and push these glands to produce a huge amount of a hormone called Aldosterone. A higher level of this hormone depletes the Potassium in the system, to the point when even supplementation can't help the poor cat anymore.
Hyperaldosteronism was also responsible for the BP spikes that detached her retinas, so I think this is what is occurring to your Liz.

Lola was attached to an IV line for a week and the vets were giving her the highest Potassium equivalent dose possible, but her Potassium wouldn't move up at all.

The only and one possibility to fix this problem is a surgery. The surgery has to remove the adrenal gland(s) who is (are) hyper.
Hopefully in your case it's just one gland, so Liz can survive.

In my case it was the right adrenal gland. In order to allow the cat survive the surgery I had to "retrieve" her physical condition, something that even at the clinic the vets were unable to do. I found out that a human grade Potassium supplement (in tablets) was able to help her a lot. It's an OTC supplement, usually intended for sportsmen. I would give Lola half a tablet (400 mg Potassium each tablet) twice a day. We had a blood check every week, for the following 6-7 weeks, but from the first week her Potassium level were back to normal and it showed! Lola was able to move, run, jump, eat and use the litter box as usual.
This "home-made" therapy was paired with the prescribed one, a pill a day of Spironolactone.
When I and the vet saw that Lola's conditions were stable, we contacted a high-end clinic, the only one able to perform such a heavy and difficult surgery, which had a 50% of success.

Lola survived the surgery and was back to her normal life where no other meds or supplements were necessary.
Unfortunately, Lola had an Oral Squamous Cell Carcinoma, who went unnoticed a few months later, and she died to it the following year.
Apart from this, the surgery was a success, it was one of the most precious things I did for my cats, it is something that I'm proud of even 4 years later.

So, please, before taking any irreversible decision, consider asking your vet to look into this extremely rare condition. It's extremely rare so it is too easy that no vet might know it. During my and Lola's ordeal I had my cat visited at so many vets' and clinics, but none of them had never seen anything like that before. Even the high-end clinic told me to thank my vet for the very difficult diagnosis and candidly admitted that they wouldn't have been able to understand it.
A friend of mine is studying veterinary medicine at the University and said that this disease is so rare that most Universities choose not to include it in their lessons because no vet will ever see something like this in their career.
When my Lola was diagnosed, I was told that she was the 35th cat diagnosed with it in the last 40 years. I don't know if this is true, but it could give you an idea of how hard it is for a vet.

If your vet is unable to follow you, please, go to another clinic and don't feel ashamed to tell them what I told you.
Please, save your Liz.

If you want, you might read about one part of her life in this post
The senior age and the rare disease
Please, let me know you have read this post of mine, tell me you are considering save your Liz.

 

[Antonio65]

Given her unaccounted for high blood pressure last year and the recently revealed heart murmur last night, they are thinking it is likely hyperaldosteronism (adrenal gland tumor), and we are not going to be in a position to address that financially, nor is treating it something with think it would be fair to put her nearly 16-year-old body through.

If you can't allow the surgery to fix the issue, try to supplement her with Spironolacton pills and Potassium tablets, as I told you in my previous post.
But 16 years of age isn't that old. My Lola was 16 years and 2 months old when she underwent that surgery. She had gone through other very bad things before, so her real physical age might have been at least 18 years when she was sick, according to the vets. Nothing is impossible, believe me!

 

[FeebysOwner]

Hi. If you choose to take to your advantage all the information Antonio65 gave you, please ask your vet to consult with a vet university for some additional guidance on how to proceed. It is worth a try to see what they can come up with!!!

 

[Antonio65]

Hi H hoosiercatlady ,
I hope you have read my replies, I hope you are thinking about them.
I hope you are considering having another opinion from a different vet.

Please, give your Liz the chance to live, she doesn't want to leave you. Do not let her down for something that doesn't depend on her. She deserves to live, she loves you, you love her.

Let me know you want to try.

 

[stephanietx]

Did the vet not give you a potassium supplement? We are giving our 15 yr old girl RenaKare gel (rx from vet) twice a day in her wet food. My girl's water intake and output has been way up so my vet thinks she is flushing out the potassium as she urinates. Since stopping another supplement we were giving her and adding the RenaKare, her water intake has decreased significantly, but it's still more than she was normally drinking. You can also use potassium gluconate (human supplement) capsules or powder and mix into wet food as well. If you decide to give potatssium supplements, give with food.

About Potassium Supplements - CRF Supplies

 

[Antonio65]

Did the vet not give you a potassium supplement? We are giving our 15 yr old girl RenaKare gel (rx from vet) twice a day in her wet food.

stephanietx ,
The Potassium supplement is a good idea, but this disease needs a pharmaceutical therapy as well, like the Spironolactone that I mentioned earlier.

 

[Antonio65]

Haven't got any news or update.
I'm so worried! Please, let us know what is going on.

 

[hoosiercatlady]

Haven't got any news or update.
I'm so worried! Please, let us know what is going on.

I'm so sorry for the months long reply. The end result was too painful that I couldn't bring myself to revisit.

Poor Liz continued to lose intravenous potassium like it was through a sieve. I spoke with multiple vet's at the clinic (who in turn, had spoken with an internal medicine vet in a consult), and they did agree that hyperaldosteronism sounded like the cause, but she was deemed too far gone to retrieve. The potassium would just not maintain.

After two nights away from us, I couldn't put her through any more, and by then, the vet bills had climbed to over $2,500. My husband is furloughed do to Covid cutbacks, and we simply couldn't afford additional treatments. We couldn't even be with her when she was euthanized, due to Covid restrictions. (Not to get political, but I supported their limits, despite how heartbreaking they are. I've had Covid, and my lungs/veins are still botched up. It was terrifying.) We were allowed back into an exam room to see, though, her just before they took her back for the EU. I'm glad we at least had that, despite always imagining I'd be able to hold her when the time came.

Right now, we're here on Christmas day, in the ER vet parking lot with her litter mate, Gus, with an almost identical situation (lots of drinking, peeing, gradual weakness followed by profound lethargy this morning). I'm... numb. I know so many people have had it so much worse in 2020, but in still really hurting right now. I don't want to lose this sweet boy right now. I knew it would happen one day, but another potential pet loss during a pandemic is breaking my heart.

We're waiting on our turn. They said it would be up to two hours, and we can't leave the parking lot or we lose our place in line. I always loved both Liz and Gus equally, but Gus is my sensitive dude. Vet visits terrify him; he goes limp, wets/messes himself, has gotten stress UTIs after. His urine is dilute and he's been drinking a ton for months, but because of his phobia, I've waited to take him in, pondering what's best for him in terms of what he'd want. If it's "just" diabetes, CKD, or hyperthyroidism, I know we can potentially manage that. If it's hyperaldosteronism like his sister, we can neither financially afford nor feel good about putting him through the anxiety of overnight long-shots at the vet. Thank you so, so much for your notes above. I'm terribly sorry for how your sweet girl's story wrapped up. I will use your notes to help us advocate for Gus should he need it based on what he hear from the vet once we get him seen. While surgery will not be an option for us, perhaps the human-grade medication will help. (Forgive me, I've forgotten, did you say they were intially unable to successfully get her potassium back up in the vet as well? If so, how did they ultimately manage it for you to be able to take her home and get her renewed in health enough for the procedure?)

Apologies again for the long and delayed reply. Her loss sent me reeling and the prospect of losing her brother less then a year later have gutted me. I do so appreciate your earlier replies and I hope, if needed this time around, we will be able to put your experiences to use for Gus.

 

[mrsgreenjeens]

I'm so sorry about Liz, and now this issue with Gus I'm hoping Gus simply has a UTI. One of my guys was doing something similar his summer, and I thought for sure it was something bad, and it turned out to be a UTI. I was shocked because he wasn't urinating anywhere but the litterbox, however, his coat was unkempt, he was drinking tons of water, just not himself at all, sleeping more, etc. When he was diagnosed with a UTI I was blown away. That being said, I did have them run a culture after the first antibiotic didn't fix the problem, So it took 28 days on antibiotic to clear it up because he was on the wrong antibiotic to begin with. Something to consider.

Keep us posted, we worry as if all of these cars are our own.

 

[Antonio65]

I apologize for my slow reply

I'm so sorry for the months long reply. The end result was too painful that I couldn't bring myself to revisit.

I'm really sorry for the loss of your Liz, I can understand your feelings and I, too, was like numb after the death of my cats, I couldn't even breath.
Your Liz will be grateful for all your did for her, despite all the obstacle and difficulties of this horrible year.

While surgery will not be an option for us, perhaps the human-grade medication will help. (Forgive me, I've forgotten, did you say they were intially unable to successfully get her potassium back up in the vet as well? If so, how did they ultimately manage it for you to be able to take her home and get her renewed in health enough for the procedure?)

Yes, when I first submitted my cat for the surgery that would have changed her life for good, the vets at the hi-end clinic tried to restore her Potassium levels to what was necessary to safely perform the surgery, but they failed, despite all the supplements they gave her, and after a week or a little longer, they returned the cat to me and told me that nothing more could be done... essentially they told me to wait for her to die at home.
I didn't give up, though, and once at home I gave her those human grade supplements I had found on a website and that were available OTC at any pharmacy. They worked, it was like a miracle!
In about 3-4 days my cat was visibly better, she was able to walk on her own again, to use the litter box and have a nearly normal life. I had her checked weekly for two months, all her blood levels were back to normal and perfectly withing the ranges, so two months and a half after the first failed attempt, the vets were able to do the surgery that saved her life, and she recovered fully and was discharged from the clinic a week later.

I hope this helps. English isn't my first language, so I also hope I have understood the sense your question and doubt.
Let me know if I can be of more help.
All the best to Gus!

 

[hoosiercatlady]

Thank you. Gus was diagnosed with CKD, which honestly, I expected to be one of the possibilities (the others being hyperthyroidism or diabetes). Unfortunately his numbers are at the highest margin of Stage III, so I'm not sure how much longer we'll have. I'll be starting at home sub-q this week, switching foods, and getting him started on anti-nausea and regular Vitamin-B12.

I will probably need to start a new chain on him. The thought of losing them both so close is very upsetting, but I'm trying to be grateful that we were able to bring him home reasonably comfortable for a few more weeks or months and didn't have to say goodbye on Christmas.

 

[hoosiercatlady]

I'm so sorry about Liz, and now this issue with Gus I'm hoping Gus simply has a UTI. One of my guys was doing something similar his summer, and I thought for sure it was something bad, and it turned out to be a UTI. I was shocked because he wasn't urinating anywhere but the litterbox, however, his coat was unkempt, he was drinking tons of water, just not himself at all, sleeping more, etc. When he was diagnosed with a UTI I was blown away. That being said, I did have them run a culture after the first antibiotic didn't fix the problem, So it took 28 days on antibiotic to clear it up because he was on the wrong antibiotic to begin with. Something to consider.

Keep us posted, we worry as if all of these cars are our own.

He was diagnosed with CKD. We're still waiting on the urine culture to come back to see if that might have falsely elevated his creatinine, but since he's been so thirsty and losing weight for months now, and his CREA was all the way at 5.0, I'm supposing this is the main beast.

 

[stephanietx]

Make sure they check his potassium as well. My CKD girl is on a potassium supplement (powder) twice a day and it's helped with lethargy.

 

[Antonio65]

Thank you. Gus was diagnosed with CKD, which honestly, I expected to be one of the possibilities (the others being hyperthyroidism or diabetes). Unfortunately his numbers are at the highest margin of Stage III, so I'm not sure how much longer we'll have. I'll be starting at home sub-q this week, switching foods, and getting him started on anti-nausea and regular Vitamin-B12.

The same cat of mine who had hyperaldosteronism also had CKD.
She was first diagnosed with CKD at the age of 6, she had the Potassium issues at 16 years of age. In my experience, the renal issues can be fought rather well if caught early and treated stubbornly.
Best of Luck to Gus!

 

[mrsgreenjeens]

I'm sorry to hear of Gus's diagnosis. I've had three kidney cat's, so am pretty familiar with it. If you have not seen this website before, take a look around it. I found it so very helpful: http://www.felinecrf.org/index.htm There is tons of info there, but well worth the read.