Hi Tracy, mary anne sent me..
Hi
first of all, we live in mexico where care is terrible..so i am a nurse and doing this on my own...
my cat is benny male 12 , was drinking alot of water and blood test came back with alt 530..i put him on metronidzle and baytril..he had a bladder infection also..one week later the alt was 430 still with infection..now 4 weeks later we have no infection alt at 36o but a high tbillrubin of 16..i dont know ur chart refrences there but its 3xs normal here..
he is now on metro, baytril, denamarin, and as of yday ursodiol...yday i switched him to amoycillin but he lost his appetite within 3 doses.. so we are back on baytril today.
so today, sunday he has barely had any appetite..he will eat a few bites and walk away..hes been a voracious eater throughout the past 5 weeks since diagnosis..as soon as i put him on the ursodiol and amoxy he lost interest.
I hope tomorrow his desire for food will return..
could it be the ursodiol?
so on thursday we will fly to nyc for an ultrasound by a specialist.
he refuses the hills l/d of course..even with tuna , warmed, mixed ...no part of it...he eats a few bites fancy feast or whiskas wet and thats it..
sigh...hes such a sweet gentle soul.
so any advice you can offer, would fall upon grateful ears.
thank you
christy and benny( giant, well was before, rescue orange tabby)
Cat liver issues
Re: Cat liver issues
Was the ALT the only enzyme that was altered or high? What about the BUN? What about his electrolytes (was a CBC done?) If a CBC was done, did it show elevated WBC counts, or evidence of an inflammatory condition?
Is he indoors only or does he have access to the outdoors - could he have gotten into something toxic?
Whenever the liver enzymes are altered, I always suggest testing the ammonia enzymes and bile acids as well, this tells a lot about the liver's function and sort of helps differentiate between hepatic lipidosis and cholangiohepatitis. Hepatic lipidosis commonly occurs due to inappetance through some sort of insult like extreme stress, sudden weight loss or possible toxin. Cholangiohepatitis is a bit different in that it can develop from biliary inflammation (that affects the liver), bacterial infection, parasites like liver flukes (which I strongly suggest ruling out), toxoplasmosis, pancreatitis and even sometimes infectious disease like FIP. Both conditions can affect the liver, pancreas, gall bladder, bile ducts. In the latter case, it would be known as a condition called triaditis (IBD+liver disease+pancreatitis).
If there happened to be any evidence of bile duct obstruction or inflammation of the ducts, or pancreatitis, then ursodiol probably should NOT be used. Additional testing would determine this.
Fluid therapy and aggressive nutritional support are paramount in treatment, you have to get Benny eating, and if you can, give sub-q fluids as your vet recommends. Try Hill's Rx canned A/D if the liver is suspect for hepatic lipidosis, it has high calories and is excellent for nutritional support.
Amoxicillin would be the best choice for antibiotic therapy, but talk to your vet about that because some cats do get nauseated or vomit with certain antibiotics. Also, don't assume the antibiotics are causing nausea or vomiting and/or anorexia, it could be any number of things from dehydration (not eating/drinking, lack of fluid and nutritional support), to any process involving the liver, pancreas, bile ducts etc. That said, the metronidazole could actually be causing the nausea and inappetance (especially in high doses or prolonged dosing), so ask the vet about ceasing the metronidazole and opting instead for the amoxicillin.
Regardless of the particular condition when properly diagnosed, it is imperative that fluid and nutritional support are initiated immediately. If fluid therapy and nutritional support are delayed, the degeneration of the liver is rapid. Also, in pancreatitis, there is no evidence that food should be withheld in cats (as opposed to dogs), UNLESS there is severe and frequent vomiting, in which case, antiemetics should be used to control nausea and vomiting.
The Baytril may not be the best choice, and it may be too hard on his system - try the amoxicillin and see how that goes.
Forced feeding may need to be initiated, but depending on when you have the ultrasound scheduled, will depend on how critical the feeding is. If your vet is not equipped, cannot diagnose without the scheduled ultrasound, or does not have the experience to insert a surgically placed feeding tube, then force feeding at home may need to be done until the ultrasound provides a diagnosis. Use a syringe (without the needle), and use the Hill's Rx A/D mixed with water to make a soupy mixture, feed about 20-30 cc's to start, going very slowly to ensure kitty is not overly stressed by the procedure, make sure he swallows and doesn't gag, etc. Feed every 4-6 hours, or, defer to your vet's instructions. Sub-q fluid therapy is ideal at home, and depending on the weight of your kitty and degree of dehydration, I'd suggest at least 100 ml's daily or every other day - but the CBC should show the degree of dehydration if any, and your vet should direct you on how much sub-q fluids to give daily, or every other day etc.
Ask the vet about using a safe veterinary antiemetic (like metoclopramide - and if you're comfortable with sub-q injectibles, the sub-q injectible metoclopramide may be ideal, since it is relatively fast acting) to prevent nausea and vomiting - when a cat is nauseated or vomiting, they will not eat. You can't afford for Benny to not eat, nor to lose weight. When inappetance occurs for more than a couple days, the liver starts to degenerate rapidly, uses fat stores to compensate, develops lipids on the liver, and the cat quickly loses weight that is extremely detrimental to health - dehydration is common and serious in liver or pancreatitic disease, so the sub-q fluids should be necessary.
Other meds which might be helpful include carafate and/or famotadine, which help prevent ulcers in the stomach or esophagus. Pain medication might be helpful, but you must ask your vet about that - generally, pain medication is not always needed for liver disease, but if pancreatititis is a concern, it should be given (I like buprenorphine, in small doses, given orally - small doses though, as it has sedative-like effects if given in too high doses)
If the NYC clinic suggests an ultrasound-guided biopsy, please, this is extremely important, get a blood clotting factor test done first! Hopefully, just the ultrasound alone will be sufficient for diagnosis.
So, at home, I think you could continue the denamarin, amoxicillin, but I would suggest asking your vet about the ursodiol and maybe ceasing it until the ultrasound. Try to get the sub-q fluid therapy initiated right away, and try the Hill's Rx A/D, as long as your vet agrees. If Benny is refusing most foods right now, it is risky to take a wait and see approach - therefore, it may be necessary to syringe-feed him.
Please update, ok?
Is he indoors only or does he have access to the outdoors - could he have gotten into something toxic?
Whenever the liver enzymes are altered, I always suggest testing the ammonia enzymes and bile acids as well, this tells a lot about the liver's function and sort of helps differentiate between hepatic lipidosis and cholangiohepatitis. Hepatic lipidosis commonly occurs due to inappetance through some sort of insult like extreme stress, sudden weight loss or possible toxin. Cholangiohepatitis is a bit different in that it can develop from biliary inflammation (that affects the liver), bacterial infection, parasites like liver flukes (which I strongly suggest ruling out), toxoplasmosis, pancreatitis and even sometimes infectious disease like FIP. Both conditions can affect the liver, pancreas, gall bladder, bile ducts. In the latter case, it would be known as a condition called triaditis (IBD+liver disease+pancreatitis).
If there happened to be any evidence of bile duct obstruction or inflammation of the ducts, or pancreatitis, then ursodiol probably should NOT be used. Additional testing would determine this.
Fluid therapy and aggressive nutritional support are paramount in treatment, you have to get Benny eating, and if you can, give sub-q fluids as your vet recommends. Try Hill's Rx canned A/D if the liver is suspect for hepatic lipidosis, it has high calories and is excellent for nutritional support.
Amoxicillin would be the best choice for antibiotic therapy, but talk to your vet about that because some cats do get nauseated or vomit with certain antibiotics. Also, don't assume the antibiotics are causing nausea or vomiting and/or anorexia, it could be any number of things from dehydration (not eating/drinking, lack of fluid and nutritional support), to any process involving the liver, pancreas, bile ducts etc. That said, the metronidazole could actually be causing the nausea and inappetance (especially in high doses or prolonged dosing), so ask the vet about ceasing the metronidazole and opting instead for the amoxicillin.
Regardless of the particular condition when properly diagnosed, it is imperative that fluid and nutritional support are initiated immediately. If fluid therapy and nutritional support are delayed, the degeneration of the liver is rapid. Also, in pancreatitis, there is no evidence that food should be withheld in cats (as opposed to dogs), UNLESS there is severe and frequent vomiting, in which case, antiemetics should be used to control nausea and vomiting.
The Baytril may not be the best choice, and it may be too hard on his system - try the amoxicillin and see how that goes.
Forced feeding may need to be initiated, but depending on when you have the ultrasound scheduled, will depend on how critical the feeding is. If your vet is not equipped, cannot diagnose without the scheduled ultrasound, or does not have the experience to insert a surgically placed feeding tube, then force feeding at home may need to be done until the ultrasound provides a diagnosis. Use a syringe (without the needle), and use the Hill's Rx A/D mixed with water to make a soupy mixture, feed about 20-30 cc's to start, going very slowly to ensure kitty is not overly stressed by the procedure, make sure he swallows and doesn't gag, etc. Feed every 4-6 hours, or, defer to your vet's instructions. Sub-q fluid therapy is ideal at home, and depending on the weight of your kitty and degree of dehydration, I'd suggest at least 100 ml's daily or every other day - but the CBC should show the degree of dehydration if any, and your vet should direct you on how much sub-q fluids to give daily, or every other day etc.
Ask the vet about using a safe veterinary antiemetic (like metoclopramide - and if you're comfortable with sub-q injectibles, the sub-q injectible metoclopramide may be ideal, since it is relatively fast acting) to prevent nausea and vomiting - when a cat is nauseated or vomiting, they will not eat. You can't afford for Benny to not eat, nor to lose weight. When inappetance occurs for more than a couple days, the liver starts to degenerate rapidly, uses fat stores to compensate, develops lipids on the liver, and the cat quickly loses weight that is extremely detrimental to health - dehydration is common and serious in liver or pancreatitic disease, so the sub-q fluids should be necessary.
Other meds which might be helpful include carafate and/or famotadine, which help prevent ulcers in the stomach or esophagus. Pain medication might be helpful, but you must ask your vet about that - generally, pain medication is not always needed for liver disease, but if pancreatititis is a concern, it should be given (I like buprenorphine, in small doses, given orally - small doses though, as it has sedative-like effects if given in too high doses)
If the NYC clinic suggests an ultrasound-guided biopsy, please, this is extremely important, get a blood clotting factor test done first! Hopefully, just the ultrasound alone will be sufficient for diagnosis.
So, at home, I think you could continue the denamarin, amoxicillin, but I would suggest asking your vet about the ursodiol and maybe ceasing it until the ultrasound. Try to get the sub-q fluid therapy initiated right away, and try the Hill's Rx A/D, as long as your vet agrees. If Benny is refusing most foods right now, it is risky to take a wait and see approach - therefore, it may be necessary to syringe-feed him.
Please update, ok?
..........Traci
-
christymexico
- Posts: 97
- Joined: Mon Feb 27, 2012 1:21 am
- Location: mexico
Re: Cat liver issues
COLESTEROL
mmol/L
5.45
1.81-3.88
ELEVADO
BILIRRUBINA T.mol/L
16.70
<6.84
ELEVADO
BIL. CONJUGADAmol/L
10.10
<5.8
ELEVADO
BIL. NO CONJ.mol/L
6.60
<1
ELEVADO
ALT
U/L
302
<72
ELEVADO
AST
U/L
152
<61
ELEVADO
He was eating fine until i added the ursodiol and switched to amoxycillan
and he has been drinking lots of water.
as soon as i changed he only nibbles at his food..he will eat some, just not a whole plate like normal.
he has not vomited
for 5 weeks his appetite and water intake has been great
the change of meds really affected him
i dont have a BUN reading as no urine was done.
mmol/L
5.45
1.81-3.88
ELEVADO
BILIRRUBINA T.mol/L
16.70
<6.84
ELEVADO
BIL. CONJUGADAmol/L
10.10
<5.8
ELEVADO
BIL. NO CONJ.mol/L
6.60
<1
ELEVADO
ALT
U/L
302
<72
ELEVADO
AST
U/L
152
<61
ELEVADO
He was eating fine until i added the ursodiol and switched to amoxycillan
and he has been drinking lots of water.
as soon as i changed he only nibbles at his food..he will eat some, just not a whole plate like normal.
he has not vomited
for 5 weeks his appetite and water intake has been great
the change of meds really affected him
i dont have a BUN reading as no urine was done.
-
christymexico
- Posts: 97
- Joined: Mon Feb 27, 2012 1:21 am
- Location: mexico
Re: Cat liver issues
there was no high wbc..all b counts were normal..a bit high protein and some bands not many.
he was tested for fiv fip and one other on the elisa test
my vets here are not able to do anything else for him
it is very old fashioned here
i hate that i changed his antiiotic..he was doing fine on baytril
also i wonder if the ursodiol made a difference
all this happened in 24 hours
he was eating great before the changes and feeling fine
he was tested for fiv fip and one other on the elisa test
my vets here are not able to do anything else for him
it is very old fashioned here
i hate that i changed his antiiotic..he was doing fine on baytril
also i wonder if the ursodiol made a difference
all this happened in 24 hours
he was eating great before the changes and feeling fine
-
christymexico
- Posts: 97
- Joined: Mon Feb 27, 2012 1:21 am
- Location: mexico
Re: Cat liver issues
i just gave him 35cc of sludge..a mixture of royal canin recovery and water.
its 130 am here so i will see if he is hungry in morning..thank you again.
christy
its 130 am here so i will see if he is hungry in morning..thank you again.
christy
-
christymexico
- Posts: 97
- Joined: Mon Feb 27, 2012 1:21 am
- Location: mexico
Re: Cat liver issues
i have all our lab work online if you want me to forward it to you
if i can just get him to vet in nyc ok by thursday we see the specialist friday
if i can just get him to vet in nyc ok by thursday we see the specialist friday
Re: Cat liver issues
Christy, ask the vet to discontinue the ursodiol for now.
Also, while rare, it is possible for pets to react to any antibiotic, so if you and the vet feel the amoxicillin was also causing him nausea or anorexia, then discontinue it as well.
That said, I'm not sure if you should continue Baytril until after you've seen the specialist in NYC. Benny has been on quite a course of different antibiotics lately and he may need a break from them. Ask the vet about that, ok?
In the meantime, keep him eating, if you mix the food with water, this is also a good way to get extra water into him. Again, ask the vet about sub-q fluids. At least he is eating a little something rather than absolutely nothing, but see if some force feeding for about a day or two might help. If for some reason, he vomits shortly after force feeding, then ask the vet for veterinary antiemetics, ok?
Just want to make sure, is the vet certain the lab work is accurate? Maybe a second chemical profile should be done, paying particular attention to the liver enzymes, just to ensure accuracy.
Also, while rare, it is possible for pets to react to any antibiotic, so if you and the vet feel the amoxicillin was also causing him nausea or anorexia, then discontinue it as well.
That said, I'm not sure if you should continue Baytril until after you've seen the specialist in NYC. Benny has been on quite a course of different antibiotics lately and he may need a break from them. Ask the vet about that, ok?
In the meantime, keep him eating, if you mix the food with water, this is also a good way to get extra water into him. Again, ask the vet about sub-q fluids. At least he is eating a little something rather than absolutely nothing, but see if some force feeding for about a day or two might help. If for some reason, he vomits shortly after force feeding, then ask the vet for veterinary antiemetics, ok?
Just want to make sure, is the vet certain the lab work is accurate? Maybe a second chemical profile should be done, paying particular attention to the liver enzymes, just to ensure accuracy.
..........Traci
-
christymexico
- Posts: 97
- Joined: Mon Feb 27, 2012 1:21 am
- Location: mexico
Re: Cat liver issues
i went ahead and gave him 125 cc of sub q this morning at 7 and will force feed later if neccesary. thank you so much
-
christymexico
- Posts: 97
- Joined: Mon Feb 27, 2012 1:21 am
- Location: mexico
Re: Cat liver issues
I was thinking that also, just to take him off the ursosal antibiotics till we get to nyc
yes, this last chem profile i had sent to mexico city so i know it is good.
it is his 3rd all consitant high alt, but this one is first with high billirubin
so this morning i will only give him his denosyl and metronidazole as he has ibd for diareah with this heavy food.
yes, this last chem profile i had sent to mexico city so i know it is good.
it is his 3rd all consitant high alt, but this one is first with high billirubin
so this morning i will only give him his denosyl and metronidazole as he has ibd for diareah with this heavy food.
Re: Cat liver issues
Do not give more than 100 ml sub-q fluids a day without first talking to your vet, since you need to know the degree of his dehydration status, as well as have the vet calculate the need for fluids based on Benny's weight.
..........Traci