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Old May 28th, 2008, 03:18 AM
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Pets drinking too much - Lecture - By Dr. Lee

There have recently been a few posts on increased water consumption in both dogs and cats so I thought I would write a small crash course lecture on it. So if you are ready, or just can’t sleep, here we go!

PU/PD 101


My pet drinks a lot of water. That’s good right?


Not always. In fact, if it is noticeable or the increase in urination is greater in amount then there may very well be a problem. Increased water consumption or increased urination is call PU/PD or PolyUria/PolyDipsia in the medical realm. Remember what goes in must come out – so increased thirst and increased urination are linked. Occasionally some medical source will sublist the causes as those that cause primary increased thirst with secondary increased urination and those that cause primary increased urination with secondary increased thirst. Usually these are all lumped together since most are a primary increase in urination. Why does this occur? Simply, because the kidneys cannot concentrate the urine so the urine isothenuric, that is the same concentration as the blood. So if my pet has PU/PD then, it must have kidney disease? No. While it is from inability to concentrate, many other factors can influence normal kidneys into PU/PD.
So what causes PU/PD. Usually you will hear vets, and myself, talk about the twelve causes of PU/PD. While this is a wonderfully biblical number, it is an oversimplification. A list which appears below, complied by Dr. Kathy James, lists a more complete 15 causes. If we look at the most common causes, then twelve usually works well. Also dogs and cats have some causes which are the most common.

Most common Causes – top five
Dogs: Diabetes Mellitus, Kidney disease, Kidney Infection, Liver Disease, Cushing’s diseas
Cats: Kidney disease, Diabetes mellitus, Hyperthyroidism, Kidney infection, Liver disease

Complete list for dogs and cats compiled by Dr. Kathy James from VIN, the Veterinary Information Network at U.C.Davis.
(some of these have some major nerdy medical terms, I included this for completeness and to show how complex this can be. I reduced the terms to English only briefly or not at all so this would stay only a thread and not turn into a sweater!)

1. Hyperadrenocorticism (Cushing’s disease)
2. Hypoadrenocorticism (Addison’s disease)
3. Hypercalcemia (high blood calcium)
4. Diabetes mellitus (basic diabetes that most people are familiar with – high blood sugar)
5. Hepatic disease (Liver disease)
6. Pyelonephritis (kidney infection)
7. Leptospirosis (bacterial spirochete infection of the kidneys – a tropic and subtropic disease)
8. Chronic Renal Disease/Renal Failure (May be present without any blood laboratory changes)
9. Hyperthyroidism (over active thyroid, similar to Grave’s disease in people (John Adams was thought to have this disease). It is rare, very rare in dogs)
10. Hypokalemia (Low blood potassium)
11. Pyometra (infection of the uterus)
12. Renal Tubular Diseases (in basenji’s it is called Fanconi’s Syndrome)
13. Chronic Partial Urinary Obstruction or Post-Obstructive Diuresis (urethral obstruction, like a urinary stone lodged in the penis – common in cats)
14. Iatrogenic (caused by human intervention, either therapeutic or not) Disease due to medications such as lasix (diuretic commonly used in heart failure management), phenobarbitol (used to control seizures) ot diets too high in salt or heavily restricted in protein.
15. Pheochromocytoma (unusual intra-abdominal tumor of the adrenal gland)
16. Polycythemia (condition where too many red blood cells are made)
17. Acromegaly (usually have concurrent diabetes mellitus)
18. Paraneoplastic syndromes (syndromes created by the affects of cancers)
19. Pericardial Effusion (fluid accumulation in a sac that envelopes the heart)
20. Psychogenic Polydipsia (as in a true behavioral disorder with a compulsive element)
21. Primary Non-Medical Polydipsia (AKA “I drink a lot because I like it or I engage in activities that promote it, but that doesn’t mean I’m sick”)
22. Primary Nephrogenic Diabetes Insipidus
23. Hypertension
24. Atypical Cushing’s and SARDS
25. Central Diabetes Insipidus

Whew!!! What a list. Thanks again Dr. James.


Luckily we rarely have to go down the whole list. Often the cause PU/PD will be picked up with initial blood and urine testing, plus or minus a few additional tests. On occasion initial testing will be negative and then the diagnostic work up becomes a little more challenging as the list would indicate. So if this happens, give you vet some slack – it may take a bit to diagnose.

How do I know if my pet drinks or pees too much??
PolyDipsia is defined as the consistent drinking of more than 100ml of water per kilogram of weight per day (>100mls/kg/day). PolyUria is defined as the consistent urination of more than 50ml of water per kilogram of weight per day (>50mls/kg/day). If you need help with the conversion of ml/kg/day – let me know I can make a new thread or we can do it by PM). Also you will notice that only half the water drank comes out as pee. Where did that other 50mls go? Insensible losses such as with stool, sweat, evaporation, tears, etc…

Why test, there isn’t anything I am going to do about it anyways?
While probably anybody that is still ready this, would never say this question, I get it a lot. So if you hear someone say it – this is what you can tell them. While these conditions may start out as just increased water consumption most will lead to severe, if not life threatening complications. Early detection can improve survivability, improve chances for a cure (if the disorder is curable such as infections), give the pet longer life expectancy, allow easier management and be less cost to the owner. This is a win-win solution! Early detection is the key. Also many of these conditions, even if not curable, can sometimes be simple and straight forward to manage early. For example, non-infectious kidney failure patients can have their life expectancy doubled by simple diet change. Pretty straight forward huh?

What else can I do to help be proactive?
Yearly blood and urine testing , especially on those dogs older than seven and cats older than ten. If younger – perhaps every other year. If funds are on the watch and we are only looking at PU/PD – then consider just a urine sample. If the urine is concentrated and otherwise normal, we have eliminated 25 diseases in one swoop! Wooohoo. Urine that is collected first in the morning is best because it has the best chance of being concentrated.

I hope this helps. Please feel comment on: whether or not this was helpful, if you would like me to write more of these, make them way shorter or keep the depth of knowledge the same, etc… Any constructive criticisms will be appreciated. Take care.
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Old May 28th, 2008, 07:13 AM
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love it!! maybe after my first cup of coffee i will have a few questions!

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Old May 28th, 2008, 07:19 AM
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Thank you, Dr. Lee, I was just talking to my vet on Monday regarding Jasper, feline, n, approx 6 years old because he drinks a lot of water (like a dog would), very low tolerance of heat and (pants and has to lie down). He was adopted last year from the SPCA so there is no medical history on him.

All blood work came back normal including thyroid. Heart and lungs sound fine.

Is there something else we should be looking at to find the answer.
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Old May 28th, 2008, 08:10 AM
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Dr. Lee, thank you for this information. This is a subject I've been dealing with for several years. When we adopted a 4-year-old Scottie, she would inhale her water bowl. She also had many accidents, producing clear, water-like urine. We thought that she was just getting adjusted to her new home and actually worried that our male Scot was not drinking enough. When we mentioned this to our vet, he was very concerned. It ended up that our little girl was drinking 12-15 cups of water per day (at 30 lb body weight.) We ran so many tests to come to the diagnosis of #20 on your list. She would get stressed and then drink. The more she drank the more she flushed the salts from her body, making her drink more (and need to urinate more). This was a serious condition and it took several months of medically supervised care to get her water levels decreased to normal. But it took tests for Cushing's, both diabetes and blood and urine checks to get our diagnosis--and it took time to get our diagnosis. The vet needed to rule out all the medical issues to come to the behavioral diagnosis.

I still monitor how much she drinks. She has multiple health issues now, and if she gets stressed, she drinks more. It is a sign to me that she is not feeling well.
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Old May 28th, 2008, 09:11 AM
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Thank you, Dr. Lee. Your article is easy to read - and understand and very informative! I don't have an issue relating to this topic but I do appreciate reading about these issues - so, if you are willing to do more topics - I'm one that is more than willing to read them.
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Old May 28th, 2008, 12:56 PM
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Thanks Dr. Lee.... all very good information!

But.... is there ever a time where a cat that drinks a lot is normal? I took in Fagan and his two brothers and sister at 5 wks old. They were born to a feral momma and stayed with me about 3 weeks. They were all adopted out to my close family (mom, brother) and a friend and me. All four are the same when it comes to water and have been since I first took them in. They drink a lot, from bowls, from taps, our glasses. And all of them have peed a lot as well, but all are healthy and two at least have been tested for diabetes etc and no problems there.

I've always imagined that like the other ferals I've taken in, the constant availability of water here is exciting because of them having to rely on puddles before.... but these kitties are all 4 years old now and still drinking like the water might disappear!

Could it be behavioural or is it more likely something genetic that hasn't showed up in tests yet?
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Old May 30th, 2008, 12:28 AM
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I see a few questions and I hope that I can answer them together. Let me know!

If a mammal drinks too little, then as long as food consumption is normal, the animal is consuming enough water for hydration purposes. While it is thought that some pets, especially male cats will benefit from more water consumption than less; as far as the purposes of existing disease less water consumption in the face of a normal appetite is not relevant.

Can an animal be normal and drink a lot of water? In short, yes. If PU/PD exists, then the water consumption is always elevated and the urine is always dilute. If the urine can be concentrated, then these diseases do not exist. This is why a first in the morning urinalysis can be so useful.

Hope that helps.
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Old May 30th, 2008, 10:49 AM
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So here's my question, after having gone 'round and 'round with urine and blood tests a few months ago, only to discover that everything was totally fine.

Have you ever seen a correlation between increased water intake (and by extension out put ) and diet?

I ask because both my dogs drink far more when they eat red meat, which then leads to a small amount of leaking in their sleep. All tests showed nothing and experiments with their diet pretty clearly shows that it's just red meat that does it.
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Old May 30th, 2008, 10:54 AM
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Well in Fagan's case I am sure it can be concentrated, we were trying to get a sample once, and the vet was amazed at how stubborn he was, held it so long it was very concentrated (they had to get it manually). I have always suspected it was habit not thirst with him, we have little routines where he drinks out of my glass or I share a bottle of water with him, more of an interaction with me than him needing water. Plus with my guys being on dry food and only one who really will eat canned, I like that they all enjoy drinking water...even if I have to give up my glasses.

Thanks again, Dr. Lee.
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Old May 30th, 2008, 11:25 AM
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Quote:
Originally Posted by pitgrrl View Post
Have you ever seen a correlation between increased water intake (and by extension out put ) and diet?
Yes there is a correlation. Dogs with diarrhea will have increased water consumption to account for the water loss in stool. Increased salt or protein consumption can require more water as well. However if the diet that you are feeding is high enough in protein to consistently increase water consumption then I would recommend considering lowering protein percentage or at the least making sure that both liver and kidney blood enzymes remained within normal limits in the future. Diets that create increased water consumption may indicate some loss of balance. "Everything in moderation." JMHO.
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Old July 21st, 2008, 04:45 PM
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Dr Lee Can You Help Me?

I have a beautiful female shepherd of 10yrs. Over the last few months she had been drinking excesively and wasnt quite hersef ,then to top this she started to lose weight.Shre now weighs 34 kg. @ weeks ago, I ran to her aid after hearing her cry(shes a talker to say the least), she had collapsed and couldnt stand up her breathing initially was very rapid, but then became quite laboured after some facial twitching(which i later came to realize were fits). The local vet nurse came out with a stretcher, and off we went to the local vets.she was deteriorating rapidly. over the next few hrs Tess.s had numerous seizures,eventually leading up to a grand mal,so b ad they wouldnt let me back in to see her for quite some time.Despite having been given vaium and phenobarb.
The tests she'd had,revealed her pcv was 77 so the next course of action was to drain some blood,Which was too thick to come through a syringe ,so they had to use a cathetar in her leg and let the blood drip into bowls. Even thought to me tess looked terrible,as she was unresponsive due to the drugs and the affect the seizures had on her.the vets felt that she had stabalized ,so after 3 to 4 hrs of observation and 3 bags of fluid later. we drove her to a specialist clinic for further obs and tests.
After the post ictal phase 48 hrsthats what they called it)which seemed like forever tess got up and walked and became more aware.
The diagnosis which is very rare out here (SYDNEY-CENTAL COAST nSW aUSTRALIA) erythrycytosis as a result of bone marrow cancer. Tess's pcv is now 63,which the vts are saying thy can live with,and has benn on hydrea 500mg at first 2 daily for seven days then one daily .we are monitoring her pcv and white cell count weekly.
Im not comfortable not having a lot of knowledge about this disease.If you have any information, case studies, ideas on prognosis,dangers of the drug hydrea etc.ANYTHING AT ALL i would be forever grateful.
I use to work as a RN but injured back many years ago.I am on a disablity pension and wouldnt have had the funds to pay for all tessas treatment only i had received an unexpeted cheque which happened to clear the day the bill was due.""PENNIES FROM HEAVEN'''.
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Old December 7th, 2008, 09:21 PM
mallen2010 mallen2010 is offline
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Hi All And Dr. Lee:

Recently, I took my dog to the vet because of a dry patch on his belly. It was not a sore; he was not itching and the area was not inflammed.

The dog was injected with dexamethasone and given a prescription of prednisone and cephelexan for two weeks. A day after coming off the prednisone, he vomited. I put this off to stress as we were packing for a move to another city.

Over the next two days he became worse. When taken to the hospital, he was diagnosed with "raging pancreatis," then kidney failure and was euthenized within 36 hours.

When I asked if the prednisone might have accelerated the pancreatitis, if not cause it, the vet at first ignored and then later said I was out of date. He allowed my wife to hold the dog when euthenized and he eliminated over our shoes and other parts of our clothing. We were not cautioned that this might happen and the vet said he was unaware such a thing could happen.

Two points: 1) should the dog, with such a mild skin condition, have been prescribed such strong steroids and might it have any connection to the onset of pancreatitis and 2) how do you think the vet handled the euthenasia?

Thanks all for reading. Any comments greatly appreciated.
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Old September 22nd, 2009, 11:37 AM
gwen519 gwen519 is offline
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Great Information thanks!
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Old March 24th, 2010, 10:01 AM
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Hello,
I am asking a question as a groomer of a very old grumpy Lhasa. He has a large tumour on his hip which has been growing at a faster rate over the last couple of grooms, it is now the size a bit larger than a tennis ball, this however is not a direct problem as his groomer, and doesnt seem to bother him when walking etc, but I fear now that internally there could be something more serious going on as he now wont let me touch him at all. Usually with a muzzle we get on famously, once he settles he stops moaning and we carry on the groom, until today. We managed to bath & dry and clip his body but he wont let me lift his tummy to stand / or even once stood, let me anywhere near him to do legs feet tummy etc. Owner says he is on some arthritis trial tablet also that he takes once a month, so also there is that to take into consideration. She has had to bath more frequent at home also due to runny really dark poo. Tried ACP to calm under direction from vet, although drowsy, its obvious he isnt happy about being groomed and I feel he is in pain. So Lhasa went home half groomed today as I wasnt prepared to go on. Does anyone have any suggestions ~ your help would be much apprieciated, as owner has said if I cant groom him anymore she may think about PTS, as his groomer, I dont want this on my conseiance so am looking for other ways of helping. Will be speaking to local vet to see about upping medication and the possibility of grooming at the vets just in case. Thank you.
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Old March 24th, 2010, 10:10 AM
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Welcome to the board, Bark4Bubbles.

Probably there isn't too much you can do for this dog--the owner is going to be making the call. Bless you for caring, though.

You might want to start a new thread of your own, since the topic differs from the topic of this thread. Go to the top of the page and click on the Pet health - Dog health - Ask the members.... line just above the top darker blue bar. That'll get you to the proper place to start your thread. Click on the New Thread button on the left of the page that comes up, type in a descriptive title, and then put your questions in the body of the message.
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