Page 779 - Small Animal Clinical Nutrition 5th Edition

Chronic Kidney Disease 807

Progress Notes Table 1. Selected serum biochemistry values from a cat with generalized weakness.
VetBooks.ir An intravenous catheter was inserted in the Parameters Day 1 Day 2 Day 3 Day 4 Day 6 Day 25 Reference
cat’s jugular vein and 20 ml of lactated
values
Ringer’s solution was administered per hour
ND
ND
8-15
9.9
ND
6.7
ND
Hemoglobin (g/dl)
during the first eight hours. After eight Hematocrit (%) 31 20.3 ND ND ND ND 30-45
hours, the rate was reduced to 12 ml/hour. Total protein (g/dl) 7.9 7.1 6.1 6.3 6.5 ND 6.1-7.7
Urea nitrogen (mg/dl) 53 58 47 48 51 36 15-25
Sixteen mEq of potassium chloride were Creatinine (mg/dl) 3.0 3.1 2.0 1.9 2.1 2.3 0.8-1.8
added to each liter of lactated Ringer’s solu- Sodium (mmol/l) 165 167 160 158 153 152 140-157
tion to produce a final potassium concentra- Potassium (mmol/l) 3.0 3.4 4.2 5.5 4.6 5.2 3.8-5.3
Chloride (mmol/l) 137 134 124 122 116 118 115-128
tion of 20 mEq/l. During the first day of Total CO (mmol/l) 11 17 23 29 28 23 18-23
2
hospitalization, 4 mEq of potassium glu-
a
conate gel (Tumil-K ) were administered per Key: ND = not done.
os every 12 hours. Water was offered free
choice. Body weight was measured daily using the same pediatric scale, and urine output was estimated by weighing the litter box
before and after voiding.
The cat’s weakness was noticeably improved by Day 2.The cat’s resting energy requirement (RER) was calculated at its estimat-
ed ideal body weight of 3.5 kg (RER at 3.5 kg = 175 kcal [732 kJ]). The cat was offered small quantities of dry and moist forms of
a commercial food for mature adult cats with controlled amounts of protein and phosphorus, every three to four hours.The cat was
consuming sufficient food to meet its RER by Day 4.
The azotemia, hypokalemia, acidosis and muscle strength progressively improved over the next three days (Table 1). Six days after
initial hospitalization, the patient was discharged to the owner’s care with instructions to gradually transition to feeding a dry vet-
b
erinary therapeutic renal food and to administer 4 mEq potassium gluconate gel every 12 hours. The quantity of food was
increased to a daily energy requirement of 1.4 x RER.
The owner reported that the cat was bright, alert, active and eating well with normal muscle strength 25 days after initial exam-
ination. Physical examination was normal except the patient was still underweight (body weight 2.8 kg, BCS 2/5) and the kidneys
were still palpably small and irregular. Results of a serum biochemistry profile included mild azotemia, normal serum electrolyte
concentrations and normal acid-base status (Table 1). Oral potassium gluconate was discontinued and the dry veterinary therapeu-
tic renal food was continued. The owners asked about purchasing moist food from the grocery store to add to the dry veterinary
therapeutic renal food. Because most grocery brand foods contain excessive phosphorus and protein compared with therapeutic
renal foods, this was not recommended. Instead, several cans of the veterinary therapeutic renal food were dispensed so the owners
could determine if the cat preferred moist food in addition to the dry food.

Endnotes
a. Daniels Pharmaceuticals Inc., St. Petersburg, FL, USA.
b. Prescription Diet k/d Feline. Hill’s Pet Nutrition, Inc., Topeka, KS, USA.

Bibliography
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