? 3/3 Ducia AMPR 381,+3 390, DKA Symptoms, Vet Appt 4PM

[Tanya and Ducia]

Hello

Post DKA, Post Hypo 02/28/2017, possible Pancreatitis, possible Fatty Liver, Anemic, possible Jaundice, E-Tube Fitted Ducia was high on BGs since yesterday and this morning displays symptoms of DKA such as increased appetite, more frequent litter box visits, sits by the place where her drinking water usually is (now removed) was caught leaking water inside the bath tub.

Her +3 is higher then AMPR. She recovers from Hypo and maybe in bouncing period. At the moment I do not have ketone measuring strips but will get one later on today. Her Hypo recovery plan is supposed her to eat 1 can wet food divided into smaller portions and given every 4-6 hours. She is given meds via E-tube which requires her to have 6 ml of water after each use of the E-tube. Meds are given twice a day and in the form of water diluted pills. SS is updated with the latest Glucose Test on 03/01/2017.

Her +3 is 390. Her 2nd meal portion is due right now, 10 am - 12 pm Pacific. I am holding on it. There is no reachable water around for her. I will test BG again at +5 or +6. We use human ReliOn Prime meter.
She is 6.5 lbs as of 03/01/2017. Due to her Fatty Liver condition she requires food regularly.

Should I feed her?

We have vet appointment with regards to her E-Tube placement/ safety and odd breathing sounds. What the vet can do for us today given that our finances are tight?

We were planning on increasing her Lantus 1 U current dose after the weekend observation to 1.5 U. I will buy half unit marked syringes later on today. Should we increase tonight?

Every advice is greatly appreciated.

Thank you
Yesterday post link
http://www.felinediabetes.com/FDMB/threads/wheezly-breathing-in-post-dka-post-hypo-cat.174102/

 

[Kris & Teasel]

and this morning displays symptoms of DKA

Usually they are extremely lethargic and barely move with DKA. Extreme hunger, thirst and peeing a lot or in the wrong place can be due to high BG.

We have vet appointment with regards to her E-Tube placement/ safety and odd breathing sounds. What the vet can do for us today given that our finances are tight?

This is what I would do:

1. Have the feeding tube thoroughly checked.
2. Urine or blood ketone test.
3. Discuss most important blood work needed to keep track of liver, etc. and when this should be done.

We can help you with insulin dosing in the days ahead and you already have a good BG testing routine. You'll be adding urine ketone testing at home but I think it's important to get that checked today.

 

[carfurby (GA)]

If she's been getting food regularly at this time, I'd go ahead and feed her. Sending prayers for the vet visit.

 

[Kris & Teasel]

If you're buying half unit syringes you can increase to 1.25 u tonight by eyeballing between marks.

 

[Tanya and Ducia]

I am going out for the syringes to Walmart now.
What kind/brand of home ketone testing strips can I buy there?

 

[Tricia Cinco(GA) & Harvey]

Relion, which is a Walmart brand, are usually the most inexpensive. Any of them that are for urine testing of ketones should work.

Sending good vetty vines for Ducia.

 

[Kris & Teasel]

I am going out for the syringes to Walmart now.
What kind/brand of home ketone testing strips can I buy there?

I use the Bayer brand Keto-Diastix but there are others. Walmart pharmacy will have them. They show urine glucose too but it's the ketone test you want to look at. NOTE: On these strips, "negative" and "trace" ketone look very similar. View under a good light.

 

[Squalliesmom]

Hi Tanya, glad to hear Ducia is at least taking some interest in her surroundings today! Just curious, why are you restricting her water intake? Is it because of the e-tube possibly leaking?

 

[Tanya and Ducia]

but it's the ketone test you want to look a

Is it what is aka cistocenthesis ?
When sterile urine is obtained via puncturing the bladder? It will require mask sedation, just like we had the last time, and it may cause her more problem because she cannot rid herself of toxins (sedation agent) properly (liver issue), she was recovering from the Etube fitting anesthesia too long and also there is risk of infection

 

[Tanya and Ducia]

12pm BG 331

 

[Kris & Teasel]

Is it what is aka cistocenthesis ?
When sterile urine is obtained via puncturing the bladder? It will require mask sedation, just like we had the last time, and it may cause her more problem because she cannot rid herself of toxins (sedation agent) properly (liver issue), she was recovering from the Etube fitting anesthesia too long and also there is risk of infection

Cystocentesis can be done without sedation. If your vet has a blood ketone meter the test can be done with an ear prick just like a BG test.

 

[Squalliesmom]

Is it what is aka cistocenthesis ?
When sterile urine is obtained via puncturing the bladder? It will require mask sedation, just like we had the last time, and it may cause her more problem because she cannot rid herself of toxins (sedation agent) properly (liver issue), she was recovering from the Etube fitting anesthesia too long and also there is risk of infection

No, not at all the same thing. The ketone test strips have a little pad on the end of them, you just hold it in the kitty's urine stream when they use the litter box and it changes color. Then you wait (exactly) the amount of time the bottle says, usually 15 seconds, and compare the color on the strip to the color chart on the bottle. Very easy, no needles or sedation!

 

[Tanya and Ducia]

Cystocentesis can be done without sedation

The last time he wanted to get sterile sample of her urine for precision I suppose. She put up a fight, and he asked permission to sedate via mask.

If your vet has a blood ketone meter

He used to have "in home" Lab but now the blood work is outsourced. Maybe urine too. I am not sure if he has the keton meter. I will ask him.

 

[Tanya and Ducia]

ust curious, why are you restricting her water intake? Is it because of the e-tube possibly leaking?

No, she had about 6 ml+ this am with her meds routine. She was peeing too much. I thought I should hold on on water. She actually just tried to open the toilet sit, probably smells water. I will post this question later on.

 

[Tanya and Ducia]

Sending good vetty vines for Ducia

Thank you , we need them!

 

[Tanya and Ducia]

If you're buying half unit syringes you can increase to 1.25 u tonight by eyeballing between marks.

That it our plan for tonight. I will test her again later.

 

[Tanya and Ducia]

Urine or blood ketone test

Any idea, roughly, how much it might cost?

 

[Tanya and Ducia]

I wanted to update that I am leaving her with her meal portion, it's been watered. She took a few bites so far. I am off to Walmart for supplies Please keep posting your thoughts as I want to get the most from visit to the vet this afternoon. It is difficult for me to go there frequently. Thank you.

 

[Kris & Teasel]

Any idea, roughly, how much it might cost?

I have no idea. I'm in Canada and vet fees might be different. I would think that a blood ketone test is cheaper because it's an ear prick and not cystocentesis.

You could wait until you have test strips at home and test her urine yourself. I'd start doing it ASAP and then at least once a day until she's well recovered.

Methods to test urine ketones:

1. catch kitty in litter box and put the end of the test strip in her urine stream as she's peeing (tricky!)
2. put a long-handled shallow kitchen spoon under her backside as she's peeing and catch a very small amount of urine (this works well for me - that spoon nows sits permanently beside the litter box)
3. cover the area of the litter box with 2 or 3 layers of plastic kitchen wrap and make depressions in it to trap some pee.

 

[Squalliesmom]

No, she had about 6 ml+ this am with her meds routine. She was peeing too much. I thought I should hold on on water. She actually just tried to open the toilet sit, probably smells water. I will post this question later on.

Unregulated diabetic kitties do drink and pee a lot; that's okay. I wouldn't recommend restricting her water - if she's thirsty, let her drink. Cats have a very low thirst drive; if she is thirsty and seeking water she is probably a little bit dehydrated. Also, I would imagine that the drinking and peeing would help flush the ketones out of her system.

 

[Tanya and Ducia]

If you're buying half unit syringes you can increase to 1.25 u tonight by eyeballing between marks.

I brought half unit syringes. The marking is so small! I will keep testing her until it's time to go to vet. We'll increase depending on BG reading. Here is what I got

 

[Kris & Teasel]

I brought half unit syringes. The marking is so small! I will keep testing her until it's time to go to vet. We'll increase depending on BG reading. Here is what I gotView attachment 26766

Perfect! You'll get used to eyeballing doses. Did you get the ketone test strips too?

 

[Tanya and Ducia]

Did you get the ketone test strips too?

No, the store ran out of them. But I will check another tonight. Thank you!

 

[CassAndGordy(GA)]

Good luck at the vet!!! Hopefully they can figure out the wheezing.

 

[Glennie]

Unregulated diabetic kitties do drink and pee a lot; that's okay. I wouldn't recommend restricting her water - if she's thirsty, let her drink. Cats have a very low thirst drive; if she is thirsty and seeking water she is probably a little bit dehydrated. Also, I would imagine that the drinking and peeing would help flush the ketones out of her system.

I only mentioned water intoxication because of how easy it is to overwater when flushing the feeding tube which is what I did with our foster baby. I didn't mean to suggest restricting Ducia from free drinking when she's thirsty. I'm so sorry I wasn't clear about that. Thanks, Squalliesmom! And sorry, Tanya, for making you think you had to restrict her drinking. Hanging head here....

 

[Gill & George]

I thought I should hold on on water. She actually just tried to open the toilet sit, probably smells water. I will post this question later on.

I don't think you should be removing her water bowl, if she is thirsty let her drink.

Both unregulated Diabetes and DKA can lead to dehydration.

 

[Squalliesmom]

Tanya, I am copying here, with her permission, a post made on a different thread by another FDMB member who has experience with DKA kitties:

...

For feeding, you want to be getting at least 200-250 calories in her a day. This is about a 5.5 oz can of a higher calorie food wet food. If she will eat dry or treats, you can put those out and let her graze as well. Some higher calorie wet foods include most wellness brands if you can find them around. Calorie count should usually be listed on the cans. It's very important that she get as many calories as she can. Food and insulin is what heals DKA. Feeding should be about every 2-3 hours or so around the clock if possible.

For fluids, cats need about 350ml per day, this includes the 200-250ml that is in a 5.5oz can of wet. So she'll need an extra minimum of 100ml a day mixed with the syringe feeding or drinking on her own.

For insulin, it's very important that you do not skip insulin doses even though she is not eating well right now. If you have concerns that her blood sugar might go too low, it's better to give the dose, and then mix 2-3ml honey with the food every time you syringe (every 2 hours). You want to try to keep the blood sugars between 150-220ish at this point. If they start to go lower than 150, add a little more honey. If higher reduce honey if you are feeding it, or we might have to increase insulin.

It's important to monitor for ketones, this is how you know that what you are doing is working.

Hang in there. It's a lot of nursing care post recovery, but once cats recover they are just fine after. It may take a couple days to see improvement.

I thought this might give you a better idea of Ducia's food and water intake needs. Hope it helps!

 

[Squalliesmom]

Tanya, how did the appointment with your vet go?

 

[Ozzy Pawzbourne]

My kitty had severe DKA and we almost lost him (nice way to find out your kitty has FD!). He was extremely lethargic and wouldn't eat and drank a lot. As others have said, you probably should not be restricting water with possible DKA in the mix. The water flushes out the toxins and high sugars in their system. When Ozzy was in DKA, he was in the hospital for 4 days and on a continuous IV with water flushing his system as well as restoring electrolytes and short acting insulin. His hospital bill was well over $5k. You definately need to nip any possible DKA in the bud as soon as possible and thats by giving adequate amounts of insulin, food, and lots of water.

I am not experienced with feeding tubes so definitely look to advice from the others here, but the water is important.

It's been over 3 months since Ozzy had DKA and we still water his meals down since he is still unregulated on insulin and throwing high numbers.

Sending prayers and luck your way. I know how stressful this is. Hang in there. You have your very own personal support group here!!

 

[Squalliesmom]

Tanya, when you can, please let us know how everything went at the vet's today, and how Ducia and you are doing. We worry when we don't hear anything!

 

[Tanya and Ducia]

Tanya, when you can, please let us know how everything went at the vet's today, and how Ducia and you are doing. We worry when we don't hear anything!

Hello, and Thank you all so much for advice and support.

Ducia’s been to vet and he said that tube looks good, it well fit, and there are no signs of inflammation or infection. He listened thru the stethoscope and said nothing wrong with lungs either. So it’s a good news.

The wet coat right underneath tube’s supporting color that I observed yesterday remains unexplained. Today the front of her body is completely dry. He suggested observing. The same about the wheezing sounds – observe. He could not hear them in the office, advised that I record and give it to him to listen. She does sound like someone with a stuffy nose when she sleeps. The sounds are there but not all of the time. It enhances when I pet her or talk to her. And it's hard to believe that wheezy noises are her new sweet purrs. The human medic whom I have at home says it is possible that the tube touches the trachea air passage as they sit close. Once the tube is removed the issue should resolve. Vet said that he doesn’t see any signs of discomfort in her and the breathing is at the normal rate.Keep observing.

We are expecting ketone test results tomorrow morning. Fingers crossed. She left hospital with the trace level amounts of ketones last Monday and we’d like to keep it this way. The Walmart closest to me ran out of the testing strips but I will go to another store tomorrow.

We increased Lantus to 1.5U tonight. Her PMPR was 317. It is lower than I‘d expect it to be after stressful vet visit. I hope it works out well for her.

 

[Tanya and Ducia]

Good luck at the vet!!! Hopefully they can figure out the wheezing

Nope. Suggested dynamic observation. The sound and breathing rate was normal thru his stethoscope. The main thing it's nothing that hurts her and the tube is fine.

 

[Tanya and Ducia]

for making you think you had to restrict her drinking

No no, you did not. The hydration is vital and balancing it in Ducia's condition is extremely important. And extremely difficult too. She needs to drink to flush out ketone but it must be balanced very well as Ducia was hypo-kalemia, -chloremia, -calcemia due to DKA. Over hydrating is as dangerous as the dehydration is. I wasn't paying close enough attention until now.

 

[Tanya and Ducia]

Hopefully they can figure out the wheezing

He didn't. Suggested we observe, record if we can and than talk. But I was glad to hear from him that it's nothing to discomfort her.

 

[Squalliesmom]

Thank you for updating us on Ducia's vet visit, so happy to hear that everything seems to be okay for the moment! Sending prayers for a full, speedy recovery! Please do keep us posted on her progress.

 

[Kris & Teasel]

I'm so glad to read this! We were all very worried for Ducia. You mentioned the ketone test. Did the vet take a blood sample for that test?

 

[Kris & Teasel]

Another request: could you please post only one thread per day? I was searching to find this thread where you mentioned the vet visit and ketone testing. I'm worried about the ketone test strip result on your SS.