Page 777 - Small Animal Clinical Nutrition 5th Edition

Chronic Kidney Disease 805

considered if the plasma bicarbonate or total CO con- Table 1. Selected serum biochemistry values from a cat with vomiting
2
centration remains below the recommended range. and weight loss.
VetBooks.ir Phosphorus binders should be considered if hyperphos- Reference
phatemia persists despite avoiding excessive dietary
phosphorus. Retinal examinations are important to eval- Parameters Day 1 Day 57 Day 160 values
10-32
Urea nitrogen (mg/dl) 104
66
78
uate for end-organ changes associated with systemic Creatinine (mg/dl) 7.4 5.4 5.0 0.1-2.1
hypertension.The owner should be encouraged to close- Phosphorus (mg/dl) 8.2 5.4 5.2 2.4-6.1
Potassium (mg/dl) 3.4 4.7 4.8 3.2-6.2
ly monitor the cat’s daily food intake to ensure that ade- Total CO (mmol/l) 12.8 20.0 18.5 18-21
2
quate energy is being consumed.
Progress Notes
The cat was stabilized with parenteral fluid therapy and was discharged from the hospital. The owner was instructed to gradually
a
transition to a commercially available veterinary therapeutic renal food. The DER was calculated at 1.2 x RER for an ideal body
weight of 4.5 kg to promote weight gain. This was approximately 250 kcal (1,046 kJ) or one-half cup of dry food daily.
Subcutaneous fluids (120 ml/24 hours) and oral famotidine were administered at home.
Two months later (Day 57), the cat was examined and found to have gained weight (body weight 3.1 kg). Serum urea nitrogen,
creatinine and phosphorus concentrations were decreased and serum potassium and total CO concentrations were increased (Table
2
1). These serum biochemistry changes persisted when the cat was reevaluated on Day 160; however, body weight was not record-
ed at that time.The owners reported that the cat was active, maintained a good appetite and had no evidence of vomiting when the
combination of dietary therapy and subcutaneous fluids was used.
The owners did not return with the cat again until one year later.The cat was experiencing an acute uremic crisis and was eutha-
natized at the owners’ request without further diagnostic or postmortem evaluation.

Endnote
a. Prescription Diet k/d Feline. Hill’s Pet Nutrition, Inc., Topeka, KS, USA.
Bibliography
Elliott DA. Gastrostomy tube feeding in kidney disease. In: Bogaura JD, Twedt DC, eds. Kirk’s Current Veterinary Therapy XIV.
St. Louis, MO: Saunders Elsevier, 2009; 906-910.
Jacob F, Polzin DJ, Osborne CA, et al. Clinical evaluation of dietary modification for treatment of spontaneous chronic renal fail-
ure in dogs. Journal of the American Veterinary Medical Association 2002; 220: 1163-1170.
Polzin DJ, Osborne CA, Ross S. Evidence-based management of chronic kidney disease. In: Bogaura JD, Twedt DC, eds. Kirk’s
Current Veterinary Therapy XIV. St. Louis, MO: Saunders Elsevier, 2009; 872-879

CASE 37-3

Generalized Weakness in a Cat
Timothy A. Allen, DVM, Dipl. ACVIM (Small Animal Internal Medicine)
Lawrence, Kansas, USA
Patient Assessment
A 13.5-year-old spayed female domestic shorthair cat was examined for lethargy, weakness and anorexia of two days’ duration.The
owner reported that the cat was so weak that it could not lift its head. Physical examination revealed a thin cat (body condition
score [BCS] 1/5) weighing 2.2 kg. The coat was dull and unkempt. Generalized weakness, cervical ventriflexion and ataxia were
noted. Small, irregular kidneys were evident during abdominal palpation. Dehydration was suspected on the basis of dry mucous
membranes.
The cat was hospitalized and a blood sample obtained for a complete blood count and serum biochemistry profile. Urine was
obtained by cystocentesis for urinalysis. The complete blood count was normal except for a low hematocrit. Serum biochemistry
profile abnormalities included azotemia,hypernatremia,hyperchloremia,hypokalemia,decreased total CO and increased total pro-
2
tein concentration (Table 1). Urinalysis results included a urine specific gravity of 1.013, 2+ protein on the dipstick and normal sed-
iment examination.
On the basis of renal azotemia (i.e., increased urea nitrogen and creatinine values with low urine specific gravity and small, irreg-
ular kidneys) with associated dehydration and evidence of blood volume contraction (i.e., tacky mucous membranes and increased