Karen, a 12 year old female domestic shorthair, presented to PEC as a transfer from her regular veterinarian. Karen had been diagnosed with diabetes mellitus about 7 months previous. Karen had been treated with insulin 4 units under the skin twice daily but according to her regular veterinarian had been hard to control. The day that Karen presented, her owner had come home and found her lying on the floor with her head cocked to the side and she was lying near a puddle of urine. The owner did not realize there was something serious wrong at that time and gave her the normal evening dose of insulin. Shortly after he observed Karen actively seizuring and took her to her regular veterinarian. The owner states that Karen had been completely normal that morning and was eating well. Previous to this incident she had been very healthy.
Karen’s veterinarian checked a blood sugar (glucose) level when she presented and it was within the normal range. At that time Karen was recumbent, unable to walk, and appeared blind. She had an IV catheter placed and was given some dextrose and a bolus of IV fluids. Karen was transferred to PEC for ongoing care as well as further tests to figure out why she was seizuring.
On presentation to PEC Karen was recumbent, poorly responsive (stuporous), appeared blind, and was breathing hard with harsh lung sounds. She also had a heart murmur which is an abnormal heart sound that can indicate turbulent blood flow in the heart and can indicate heart disease. Karen was placed on flow by oxygen and had a blood glucose checked which was very low. Karen had a bolus of dextrose (sugar) given intravenously. Chest radiographs (x-rays) were performed which showed pulmonary edema (fluid in the lugs) and an enlarged heart which was concerning for congestive heart failure. It was thought that Karen likely had an underlying heart condition and the fluid bolus she had gotten may have been too much for her heart to handle.
Karen was given a diuretic (furosemide) to help draw the excess fluid off her lungs and within an hour her breathing had improved dramatically and her lung sounds were clear. Karen was still very abnormal neurologically at that time.
There are many differentials for seizures in cats including brain tumors, infections, inflammatory diseases, trauma, and metabolic causes. In Karen due to her history as a poorly controlled diabetic and her low blood sugar (hypoglycemia) on presentation it was presumed that the likely cause was her hypoglycemia. We recommended running additional bloodwork and looking for any other cause of seizures. The owner agreed and a full CBC (complete blood cell count), Chemistry panel, electrolytes, and acid base panels were run. There were no significant findings on these.
Karen was kept in hospital overnight on a very low rate of IV fluids that was appropriate for her heart with dextrose in them. Her blood glucose was checked frequently to make sure she was being maintained in a normal range. At 5 am the next morning Karen had an additional seizure despite being maintained at a normal blood glucose. Karen still had remained unresponsive and was unable to move around. At this time Karen was started on Phenobarbital, an anticonvulsant, to control and prevent further seizures.
Karen had additional tests run including an abdominal and thoracic ultrasound with a boarded radiologist the next day. This ultrasound showed mild liver enlargement which was likely secondary to being a diabetic and mild hypertrophic cardiac disease. A thyroid panel was sent out which came back normal.
Karen’s blood glucoses had remained normal for 24 hours and she was able to be weaned off the dextrose containing fluids her second day in the hospital. Karen had starting to eat on her own and had not had any additional seizures although she was still dull, not able to sit up, and still appeared blind. It is typical that animals that undergo seizures will have a period of time called a post-ictal period in which they are not neurologically normal and can appear blind. In Karen, this period was significantly longer than is typical.
Karen had a consultation with a boarded veterinary neurologist who practices in our facility, Dr. Kortz. During this consultation Dr. Kortz recommended an MRI or imaging of the brain to make sure there were no tumors or other lesions in the brain which could be causing her seizures and ongoing neurologic signs. Karen’s owner agreed to the MRI which was performed the same day. This showed no tumors or brain lesions but did show cerebral edema (brain swelling). Dr. Kortz’ assessment was that she likely had brain swelling secondary to prolonged seizure activity initially which was most likely due to hypoglycemia. This type of brain swelling takes time to resolve and that with prolonged nursing care Karen would likely improve although we could not be sure that there had not been some permanent damage to her brain.
Karen was kept hospitalized for a total of 11 days at PEC while she slowly regained her ability to eat and walk. During this time she became part of the PEC family and the nurses enjoyed making fluffy beds for her, petting her, and feeding her. A day or so before being discharged, Karen finally regained her sight. Karen’s blood sugars became fairly well regulated on a much lower dose of insulin and Karen went home on 1 unit of insulin twice daily. Karen was also sent home on Phenobarbital which she will be weaned off in the next several months if she has no additional seizures. Luckily Karen’s heart condition is mild at this time and does not require any medication although we recommended a repeat echocardiogram (ultrasound of the heart) in 6 months to assess if the heart disease was worsening.
Follow up phone calls to Karen’s owner show that Karen is doing very well. She is able to eat and move around her environment well and has begun to act like herself again.
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