Message Number: YG6547 | New FHL Archives Search
From: Celia C.
Date: 2001-08-21 19:44:00 UTC
Subject: High potassium, pain

This is probably a hard one to answer by email (and a long
one!), but I am worried, and I can't reach my vet.

Cokie will be 7 in November. She's had both adrenals removed
(right one ligation) and takes Florinef and prednisone daily.
(She may have a tumor regrowth since she has lost most of her
hair, but no other adrenal signs). She has insulinoma (takes
pred), hypertrophic cardiomyopathy (takes diltiazem and
lasix), and kidney failure (gets sub-q fluids 3 times a week).

July 28 she had a complete blood panel. Her potassium was 6.0
(don't have units, but the normal range was 4.3-5.8). [BUN 57
and creatinine 1.2]. [Glucose very low, but improved later]
Everything else was normal. We increased her Florinef from
0.40 ml (of .03mg/ml suspension) to 0.45 ml. 2 weeks later
her potassium had increased to 7.0! We increased her Florinef
to 0.47 ml and substitututed oral tap water for the sub-q
lactated ringers. A week later (Aug 18), her potassium was
6.2. The vet called and recommended no change in meds (I
wasn't home!!!)

She cries out in pain at night. Mostly when she is disturbed
by me moving around (sleeps in my bed). She has done this
before in the past occasionally. I was told then that it was
due to fluids building up as she stays in one position in her
sleep, and not a big worry. She hasn't done it in a while and
never this much!! (once last week all night and 2 nights this
week). She's also cried out once when she did a tight U-turn
in a sleep pouch. And tonight I noticed she was breathing
strangely while half asleep--short shallow breaths, as if she
were sniffing something. But no crying out. But--when she
wakes up she's fine. Runs around, eats (her appetite is
huge)--no sign of pain or breathing problems, completely
normal. Poops and pees okay. (although she is somewhat
constipated) She's also very twitchy in her sleep. I can
feel her muscles twitch under her skin.

She doesn't seem to have excess fluid in her abdomen (that I
can tell), and the vets haven't mentioned it in the 3 recent
vet visits. Her belly seems tense sometimes, but when she
relaxes it's okay.

Questions!! Any long-distance opinions?? How long does it
take for an increase in florinef to decrease potassium?
Should her potassium keep decreasing after a week on the same
Florinef dose? Does the increased need for Florinef make it
less likely she has a new adrenal tumor? Should I resume
giving her lactated ringers? What if the reduction in
potassium is due to the reduction in lactated ringers?? I
think she's getting fewer (less?) fluids orally than she
received sub-q. It's hard to judge--I have to give them in
extra duck soup. I was giving her 20 cc of the ringers 3
times a week. Now I give an extra 20-25 ccs of dilute duck
soup every day. Should I keep giving her the same dose of
lasix? (0.10 ml of 10 mg/ml solution twice daily). Am I
overreacting or underreacting?

I do plan to see if my vet can see me Thursday afternoon, but
he is off tomorrow. I know this is way too long, and I'm
sorry. If anyone has any ideas, let me know!