Page 300 - Problem-Based Feline Medicine

292 PART 5 CAT WITH ACUTE ILLNESS

ACUTE HEART FAILURE* Clinical signs
Typically there is a history of weight loss, polyuria
Classical signs and polydipsia, together with a normal appetite or
polyphagia in the preceding weeks or months prior to
● Acute dyspnea.
an acute onset of anorexia, vomiting, dehydration, and
● Lethargy and inappetence.
depression. Other signs that may be evident with the
onset of depression include icterus and dyspnea.
See main reference on page 124 for details (The Cat
With Abnormal Heart Sounds and/or an Enlarged Heart).
Diagnosis
Clinical signs
Diagnosis requires demonstration of ketonemia or
Acute onset of depression, anorexia and dyspnea. In ketonuria, and hyperglycemia. Ketones may be
severe cases, collapse may occur, especially if stressed. falsely negative in urine because urine test strips
measure primarily oxaloacetate (and to a lesser
Pulmonary crackles, a heart murmur, arrhythmia and/or
extent acetone), which may be present in concentra-
weak pulses may be found on physical examination.
tions in urine below the limit of detection by the test
Some cats have a history of vomiting. strip in cats. Several drops of hydrogen peroxide
may be added to the urine sample in an effort to con-
Diagnosis vert β-hydroxybutyrate to oxaloacetate to increase
the concentration of oxaloacetate in urine. Alternatively,
Pulmonary edema and cardiomegaly are evident on
β-hydroxybutyrate may be measured in serum using
radiographs. The radiographic appearance of pul-
a point-of-care test, or the urine test strip may be
monary edema is variable in cats.
used to detect oxaloacetate in heparinized plasma.
Furosemide may be given and radiographs repeated in Using a standard urine test strip, a negative plasma
one hour to see if the pulmonary changes have test rules-out ketosis, and a positive urine test
improved. Definitive diagnosis of cardiomyopathy rules-in ketosis, in cats. Finally, bicarbonate (total
requires echocardiography. CO ) concentrations in plasma may be used to
2
demonstrate acidosis.
Differential diagnosis
Other causes of depression and dyspnea. See The Dys- Differential diagnosis
pneic or Tachypneic Cat (page 47).
Acute pancreatitis or sepsis (depression), hepatic lipi-
Treatment dosis or cholangiohepatitis (depression and icterus),
ethylene glycol or lily intoxication (depression and
Furosemide and nitroglycerin ointment at standard polyuria), acute heart failure (depression and dyspnea)
dosages. See details of additional treatment page 130 may all cause vomiting and dehydration and appear
(The Cat With Abnormal Heart Sounds and/or an similar to diabetic ketoacidosis.
Enlarged Heart).
Treatment
DIABETIC KETOACIDOSIS*
Intravenous fluids are required to correct dehydration
and electrolyte imbalances.
Classical signs
Regular insulin should be administered using intravenous,
● Polyuria, polydipsia, and weight loss.
intramuscular or subcutaneous administration protocols
● Recent onset of acute depression and anorexia.
depending on the status of the cat’s peripheral perfusion.
See main reference on page 236 for details (The Cat Appropriate antibiotics should be administered if urine
With Polyuria and Polydipsia). has evidence of bacteria or inflammation. Many diabetic