Successful use of short‐term mechanical ventilation to manage respiratory failure secondary to profound hypokalemia in a cat with hyperaldosteronism

Abstract

Objective – To report successful management of respiratory failure due to severe hypokalemia in a cat with hyperaldosteronism, including short‐term mechanical ventilation strategies and aspects of medical and surgical treatment. Case Summary – A cat presented with bilateral pelvic limb weakness that rapidly progressed to tetraparesis and respiratory muscle failure. Point‐of‐care testing revealed severe hypokalemia (1.9 mmol/L) and mild azotemia. Initial management included endotracheal intubation, mechanical ventilation, and aggressive potassium supplementation. Spironolactone was started due to a high index of suspicion for hyperaldosteronism. A right adrenal mass visualized during abdominal ultrasonographic examination and a serum aldosterone level greater than 3329 pmol/L confirmed the diagnosis. The cat made a full recovery following surgical removal of a right adrenal adenoma. New or Unique Information Provided – We report successful management of respiratory failure in a cat with hyperaldosteronism using short‐term mechanical ventilation. Respiratory failure due to severe hypokalemia should be considered a complication of hyperaldosteronism in cats and may require mechanical ventilation. However, full recovery is possible.

Manual ventilation therapy and aggressive potassium supplementation in the management of respiratory failure secondary to severe hypokalaemia in a cat with exocrine pancreatic insufficiency

“…6 –8 In previous reports, initial serum potassium concentration ranged from 1.5 to 1.8 mmol/l, and the rate of potassium supplementation ranged from 0.22 mEq/kg/h to 1 mEq/kg/h. 5,6,8 Mechanical ventilation was discontinued after serum potassium concentration had increased to 2.2 mmol/l and 2.86 mmol/l, respectively. 6,8 Ventilation times ranged from 4 h to 2 days.…”

“…5,6,8 Mechanical ventilation was discontinued after serum potassium concentration had increased to 2.2 mmol/l and 2.86 mmol/l, respectively. 6,8 Ventilation times ranged from 4 h to 2 days. 5,6,8 In the patient presented here, manual ventilation was discontinued 6.5 h after initiation of ventilation therapy, which is comparable to ventilation times reported previously.…”

“…[3][4][5][6][7][8] Mechanical ventilation in combination with aggressive potassium supplementation is the treatment of choice for hypokalaemia-induced hypercapnoeic respiratory failure in cats. [6][7][8] In previous reports, initial serum potassium concentration ranged from 1.5 to 1.8 mmol/l, and the rate of potassium supplementation ranged from 0.22 mEq/kg/h to 1 mEq/ kg/h. 5,6,8 Mechanical ventilation was discontinued after serum potassium concentration had increased to 2.2 mmol/l and 2.86 mmol/l, respectively.…”

“…6,8 Ventilation times ranged from 4 h to 2 days. 5,6,8 In the patient presented here, manual ventilation was discontinued 6.5 h after initiation of ventilation therapy, which is comparable to ventilation times reported previously. 6,8 Hypokalaemia can result from decreased potassium intake, translocation from the extracellular fluid compartment to the intracellular fluid compartment, and excessive gastrointestinal or renal losses.…”

Potassium Disorders

“…4 Potassium is necessary for maintenance of normal resting membrane potential. 10 Hypokalemia can also cause rhabdomyolysis, which may have a toxic effect on the renal tubules in some speciaes. [5][6][7] Ventroflexion of the head and neck; a stiff, stilted gait; and a plantigrade stance may also be evident.…”