Blood Ammonia level, help with data

[John Popp]

i've been having trouble trying to decipher where Dooley's Blood Ammonia levels should be after eating, i.e. Postprandial. Yesterday Dooley measured as high as he has been since he has been stable and relatively healthy. Preprandial (fasted) he has been measuring an unremarkable high normal and the biggest issue is I haven't been able to find information on normal postprandial levels of blood Ammonia.

I was finally able to find some data on normal postprandial blood Ammonia levels and just want to make sure I'm looking at the right thing.

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-95961999000300001

With the little I know about medical things, I do know enough about statistics to understand this is a very small postprandial sample size and not nearly enough samples to support the broad test results. Conversely, with the data presented, it looks like 90% of healthy cats fall in a range of 250-340 µg/dL, Dooley measured 340 according to the doctor, but I don't yet have the full lab report.

Anyone that can provide some help it would be appreciated and hopefully with some better understanding I will be able to better help Dooley.

Thanks in advance.

 

[Brigitte Cowell]

How long postprandial? The results show levels for 30 minutes, 24 hours and 48 hours...

But from that it does seem that Dooley falls into a healthy range, even if the study was a small number of cats. It does seem that there is not much research looking at this, when they are referencing a study from 1985 and this paper is 1998. Have you asked the vet specialist for information? They should be able to hunt out some data...

 

[John Popp]

Thanks for responding Brigitte!

Blood was drawn somewhere between 30-45 minutes after eating 3-4ozs of food along with his meds. He ate at the vets office so a bit of a challenge getting him to eat in an environment he's not totally comfortable with.

Unfortunately there isn't a lot of data out there and we have had plenty of conversations with the IM doc. Lots of data on preprandial Ammonia levels and it seems the only measure in use is the fasted results.

As I see it, If you fill up a bath tub, pull the plug and 8 hours later it's empty, it doesn't mean the drain is working as it should. For me personally, when I was experiencing type II diabetes symptoms and kept getting back preprandial results suggesting there wasn't an issue, only after I pushed to get a glucose stress test done were they able to resolve I actually did have type II diabetes.

Anyway, I'm just frustrated as he's still on all his meds and seems to be doing well. His labs came back solid, sans the blood Ammonia level which no one seems to have a Postprandial scale of a normal range.

Oh, and last thing based on the data from the article, does the 250-340 µg/dL I mentioned for what a normal postprandial range seem reasonable?

 

[Brigitte Cowell]

Anyway, I'm just frustrated as he's still on all his meds and seems to be doing well. His labs came back solid, sans the blood Ammonia level which no one seems to have a Postprandial scale of a normal range.

Oh, and last thing based on the data from the article, does the 250-340 µg/dL I mentioned for what a normal postprandial range seem reasonable?

I understand. I always want to know what is wrong and get frustrated when it isn't possible. After everything I've been through with Zari and still no diagnosis and so no way of knowing how she will do in future... it's frustrating.

The range seems reasonable from the data reported there. The reason I suggested asking the specialist is that they might have access to better searches of papers than we the public have... but I do know that feline research is very much hampered by funding hence this might just be something there is little data available on :-(

 

[John Popp]

Thanks again Brigitte!

Dr Sharon Center at Cornell is probably the best authority on the feline liver and hepatic diseases and has tons of published data online. Unfortunately just not what I'm looking for. Just about all the stuff relating to the feline liver in the Merck Manuals has Dr Center's name attached. Our IM vet has contacted her a couple times exchanging information and neither of them keep many patient hours.

Perhaps pulling some Dino numbers would be helpful, otherwise I'll just need to keep searching and digging.

 

[John Popp]

I'm sure Zari is under the same type of care Dooley is, just painful at times there aren't more resources available to them.

 

[Patti]

Well firstly I'm wondering why your vet is ordering a test if he can't even tell you the significance of the results. I agree that the test sample was small, but I have found that most lab studies on healthy cats are done on very small samples - it is what it is, and I think if it's the best reference we have then accept it. Perhaps more importantly is the consistency of Dooley's results - if he is consistently running a normal preprandial and running similar postprandial numbers as well, it seems as though he is stable. Of course, it sounds like that means he is stable on his current meds, so not sure what would happen if you start weaning them...

 

[John Popp]

The reason we continue to run the tests are twofold, reducing his meds and also increasing his protein. Thus far we have reduced his meds by about a third, and increased his protein intake by about 40%. He's had 5 separate seizure events, and went into cardiac arrest twice. Preprandial the results have always come back as a high normal. Postprandial he just came back with the highest numbers he's posted since he has been on his current program.

After the last set of tests, we didn't get the green light to change anything. That was pretty discouraging as Dooley's probably 10-15% below where we would like him to be with his protein levels, and we are hopeful that one day we will be able to leave him with something less than professional care so we can get a vacation in. Love the hell out of Dooley, he's a true character and a fighter, the 8 hours of daily care he needs just keeps us hoping for a reprieve.

 

[Brigitte Cowell]

You mention wanting to reduce his meds and increase his protein... are those two things linked? Forgive my shoddy memory, I don't remember what meds he is on... seizure meds?

I blame all fuzziness of the brain on my recent pregnancy and mommy brain. Not sure how long I can milk that and when I have to just admit to having a crap memory...

 

[John Popp]

Thanks for responding Brigitte, I know you have lots on your plate.

Yes, the greater amount of protein, the higher the amount of toxins in the blood stream. The three meds are all twofers, primary functions anti-seizure, antibiotic and then lactulose which makes sure he is regular and also reduces the amount of Ammonia in the bloodstream. Keppra, the anti-seizure medication also bonds with copper I believe.

Writing that out gave me an idea with where some of his dosage and protein was on recovery from surgery. They gave the green light to give him some extra protein during his recovery which he managed well, and when he went back on his regular diet we needed to reduce the lactulose.

Thanks for kick starting my brain.