From:
Celia Clinkinbeard
Date: 2002-01-17 22:26:00 UTC
Subject: How to decrease potassium/raise sodium
I need some ideas on how to increase Cokie's Sodium/Potassium
ratio! (She is 8 yo, bilateral adrenal, on florinef and pred
for years, previously well controlled insulinoma, chronic
kidney failure, hypertrophic cardiomyopathy) She has been very
sick for over 2 weeks. She was brought to the vet very
listless and unable to walk, and with a tooth infection. The
tooth infection was treated and resolved, but her
sodium/potassium ratio was 19, and her glucose was 49. We
increased her florinef from 0.47 cc/day to 0.48 cc/day (from
0.0141 mg/day to 0.0144 mg/day), and increased her pediapred
from 0.55 cc twice a day to 0.6 cc twice a day (from 0.74 mg
twice a day to 0.8 mg twice a day). She also received a lupron
shot (vet thought it wouldn't hurt and might help), and an IV
port. We gave her 1cc 0.9% NaCl fluids with 5% dextrose IV
every 3-5 hours (less often overnite) for a week. (We had to
decrease it to every 5 hours due to breathing problems, even
with extra lasix).
She was greatly improved--alert, inquisitive, and could even
get out of bed occaisonally and walk for a few feet (even with
the port). But at the end of the week her values were still
off. Her glucose was 59 and her ratio was improved, but
still off-- (sorry I didn't get the numbers). Her BUN/creat
was okay, and she was well hydrated. We increased her iv
fluids to flush out the potassium, and she dramatically
worsened. So we backed off to every 4 or 4 1/2 hours
yesterday. (Her breathing is fine at this level.) Now she's
better than she was with fluids every 3 hours, but she's still
worse than she was at the beginning of the week. And she
refused to eat tonight for the first time.
She's also on cephalexin (sp?) to avoid infection with the
port, and I've been giving her crushed lactinex--she won't eat
yogurt. It hasn't helped much with the runny poops, but I
don't know what dose to give so I may not be giving enough.
Bottom line--is there any other way to get her Na/K ratio back
to normal? Doesn't it seem like we could increase her florinef
and/or her pred? Why wouldn't adding salt to her food help?
Why would her potassium go up in the first place?? (it was
6.47 mmol/l the first time she was checked, with a range of
4.6-7.6)
I know she is seriously ill, but I was so happy when she
showed so much improvement!! And now she's regressed...
My vet has been wonderful, but we go back to see him tomorrow,
and I'm afraid he's going to say he's out of ideas...
Any ideas out there???!
Thanks for listening!!
Celia