? 4/2/17 Help, AMPs 308

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Darnell & Sprocket (GA)

Darnell & Sprocket (GA)

Member Since 2015
Sprocket has been in hospital 3 times now since March 7th. 1st time would not eat, vomiting, had ketones, cholangioheptitus, mild hepatic lipidosis, unregulated diabetes. DKA. Liver level was in 600s 1st hospital visit. Checked for pancreatitis , normal levels.
Meds list: marbofloxacillian (antibiotic), cerenia (vomitin, nausea), Denamarin (liver support), cyproheptidine ( appetite stim, 1/2 pill 2xday, then 1/4 pill 2xday cause he was eating alot, now back to 1/2pill in hospital), Ursodiol ( liver meds), famotidine, 1/4 2xday (nausea, antacid), probiotic. about 80-100ml of sub q fluids daily.
vets kept changing his dosage from 3.5 units to 2 units. Before this last hospital visit he was steady on 2.5 units 2xday for 8 days, staying in 300s & lower 400s for bg (human meter).9th day he stopped eating again. Ketones again. 3rd time this month.
bloodwork thursday, creatine slight low at .7 (range listed .8-2.4 mg/dL), ALT was 166(600s in 1st hospital visit, then 206 2 weeks later, norm is 12-130U/L), K was low, 3.4 ( norm is 3.5-5.8 mmol/L)
everything else normal besides glucose 344 ( norm 71-159 mg/dL).
At hospital thursday, still there, thurs 397 6pm, (pet meter for hospital numbers), they gave 3.5 units of lantus.
10pm, 371, starts eating DM wet & dry.
2am, 283
6am, 285, they gave 3.5 units lantus
8am they gave 1 unit of fast acting insulin.
during rest of day 75-90 bg. small amount of ketones.
6pm bg was 56, they gave dextrose. they started feeding his ff canned wet classic, and zero dry I brought. (he has been on this food at home since after 1st hospital visit).
8pm, 200
10pm, 212, midnight, 210
6am 418, they gave 3.5 units of Lantus.
daytime, stayed in 300s. trace ketones.
They said to visit at 6pm & then with his bgs after decide if to bring him home or stay.
for 8 days he was steady in 300s with 2.5 units, now with bgs all over but 300s with 3.5 units.
what could be going on?
I am so scared of what is gonna happen.
we have appt for specialist there on thursday afternoon but cost is getting outrageous. DCIN helping us but I dont understand what is happening?
advice please?
thanks
 
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Sprocket is such a cute cat. I wish The Best for him. I'm glad he's getting the care he needs. You are doing all you can for him. :bighug: With ketones, it is important that he get the insulin, and food, and hydration he needs, and to fight any infection that may be present. Can you bring him an unwashed shirt or pillowcase with your scent on it tonight when you visit just in case he has to spend another night in the hospital? I hope he gets to come home tonight with you.
 
Hey there, sorry you and Sprocket are going through such tough times.
I'm not very experienced and hoping someone else who is will check out your post.
Sometimes weekends can be slow, but don't get discouraged, for sure you will hear more when it gets busier.

One thing that stands out to me is that at 6pm Sprocket's BG went down to 56. That's really low on a pet meter, that's why they gave dextrose I'm thinking.
Then his body probably sent out counter regulatory hormones (the body's way of keeping them safe) and his numbers shot way up.
Here is a short bit of an explanation regarding that phenomenon.
"The pancreas, then the liver, release glucogon, glycogen and counter-regulatory hormones. The end result is a dumping of "sugar" into the bloodstream to save the cat from going hypoglycemic from a perceived low"
This would be considered a normal response physiologically and could be the reason things seem all over the place.
Again, just my initial thoughts.
 
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Dyana said:
Sprocket is such a cute cat. I wish The Best for him. I'm glad he's getting the care he needs. You are doing all you can for him. :bighug: With ketones, it is important that he get the insulin, and food, and hydration he needs, and to fight any infection that may be present. Can you bring him an unwashed shirt or pillowcase with your scent on it tonight when you visit just in case he has to spend another night in the hospital? I hope he gets to come home tonight with you.
Click to expand...

Yes, he has been on sub q fluids for about 13 days before this last ER visit. He was eating well too. Insulin was probably too low. I did bring a pillowcase for him last night.
I hope he comes home too. I am so scared.
 
When a kitty is in DKA they will usually use the rapid insulins to bring numbers down quickly and use the dextrose IV if the numbers go too low. Since he is at an ER a hypo should not be a concern since he is on IV and is constantly monitored ( or should be if they use R insulin) I am not sure why they are using Lantus at this point, until they have brought the glucose levels down with the R insulin and gotten it to a point where he is low enough without going too low???? Once the glucose is stabilized then they should be finding the correct dose of Lantus to keep him in a safe range. Just my own thoughts and observations.
 
Barbara & Uncle said:
Hey there, sorry you and Sprocket are going through such tough times.
I'm not very experienced and hoping someone else who is will check out your post.
Sometimes weekends can be slow, but don't get discouraged, for sure you will hear more when it gets busier.

One thing that stands out to me is that at 6pm Sprocket's BG went down to 56. That's really low on a pet meter, that's why they gave dextrose I'm thinking.
Then his body probably sent out counter regulatory hormones (the body's way of keeping them safe) and his numbers shot way up. This would be considered a normal response physiologically.
Click to expand...

Thanks, I hope the experts on this forum come on asap. I am scared.
I understand what your saying for his bg and hormones. Yet what happens after that?
Is he just stressed so its staying up or is it something else?
 
Tuxedo Mom said:
When a kitty is in DKA they will usually use the rapid insulins to bring numbers down quickly and use the dextrose IV if the numbers go too low. Since he is at an ER a hypo should not be a concern since he is on IV and is constantly monitored ( or should be if they use R insulin) I am not sure why they are using Lantus at this point, until they have brought the glucose levels down with the R insulin and gotten it to a point where he is low enough without going too low???? Once the glucose is stabilized then they should be finding the correct dose of Lantus to keep him in a safe range. Just my own thoughts and observations.
Click to expand...

I agree. of course the 2 specialists they have there that know this stuff are not working this weekend. I know this vet spoke to the specialist yesterday. She is worried about his numbers & to monitoring still but its like $1000 per night. This is his 7th night now in March. DCIN helping us but we don't have that much so its breaking us. I want to help him but I wish it wasn't so expensive. I think this vet he has currently is getting big education in feline diabetes. I just am praying he heals.
I am lost, and heartbroken.
 
Bounces can last up to 3 days, vet stress and all the strange people and noise in the hospital, eating Purina DM dry, lots of things can make his BGs rise, and don't forget that the pet meters read higher than the human meter you use.
 
Dyana said:
Bounces can last up to 3 days, vet stress and all the strange people and noise in the hospital, eating Purina DM dry, lots of things can make his BGs rise, and don't forget that the pet meters read higher than the human meter you use.
Click to expand...

yes. agreed. They gave him the DM for first day but switched to his zero dry yesterday morning. Then I brought fancy feast pates last night for him to eat as he does at home.
I am not sure if its better to take him home & still do bg with my meter & see if stress level down helps.
 
Good that he's eating his Zero Dry and FF.
I can definitely understand questioning whether it's better to bring him home now or not given the $ & kitty stress issues.
With the DKA history there is the obvious concern about getting his numbers down. As Tuxedo's Mom said that's where the rapid acting insulin is so helpful and when it's given it really needs to be monitored.
Big hugs to you and Sprocket, hoping more people will join in to help you make some decisions that feel right!
 
tell me if i missed it....
Do they know what kind of infection he has?

ENIQUIN (marbofloxacin) Tablets are indicated for the treatment of skin and soft-tissue infections in dogs and cats and urinary tract infections in dogs with bacteria susceptible to marbofloxacin.
ZENIQUIN has the highest known tissue concentrations in the skin, kidney and lung compared with other veterinary-approved fluoroquinolones at the lowest recommended dose.1,2
Click to expand...

Did they test his urine and find bacteria or is this just their drug of choice ( each vet seems to have favorites)
 
the other thing I noticed was the famotidine for nausea.

You might ask the vet for ondansetron instead ( they won't have it in stock as it is a human drug but could send you out with a prescription to get it)
It works so much better for cats and can be used with cerenia.
 
@rhiannon and shadow (GA) - The vet is giving Sprocket Cerenia for nausea.

Darnell -- either Cerenia or ondansatron (Zofran) is fine for nausea and/or vomiting.

Typically, when a cat is hospitalized for DKA, the process is that they use a basal insulin (this could be Lantus or something line Humulin N/Novolin) plus a bolus insulin (a fast acting insulin like Humulin R). Typically, they also have the cat on a dextrose drip to offset any drops in numbers and to add to nutrition since often cats with DKA don't want to eat. With ketones, it's important to make sure the kitty is getting a lot of calories since if the cat isn't eating, it has an effect on metabolism.With DKA, the electrolyte balance is off.This is what makes DKA so much of a problem. Potassium and phosphorus levels should be closely monitored along with other lab values.

I'm a little surprised they didn't jump in and start using a fast acting insulin sooner. However, your vets are there with Sprocket and we're not.Some of the high numbers are, no doubt due to the big drops followed by a bounce.

When my kitty was diagnosed with FD, her BG was out of control, she had pancreatitis and hepatic lipidosis. Two vets told me that many cats don't survive. She did. It is very scary -- I was a wreck. Cats are fighters.
 
rhiannon and shadow (GA) said:
the other thing I noticed was the famotidine for nausea.

You might ask the vet for ondansetron instead ( they won't have it in stock as it is a human drug but could send you out with a prescription to get it)
It works so much better for cats and can be used with cerenia.
Click to expand...

The famotidine was helping alot as soon as I gave it daily. I asked about other & they said no. Famotidine was fine.
 
IMHO They should be concentrating on the rapid insulin rather than the long acting insulin,


"
How is ketoacidosis treated?

Treatment depends on the severity of the condition. In mild cases, where your cat is still bright and alert home therapy may be all that is necessary. Regular monitoring of blood glucose levels should be performed.

In more serious cases, treatment includes:

  • Intravenous fluids and electrolytes to treat and correct dehydration and electrolyte imbalances. This also dilutes glucose and acid levels and helps to flush ketones out of the body.
  • Frequent administration of short-acting insulin to facilitate glucose uptake into the cells. Insulin therapy also suppresses fat catabolism (breakdown), preventing further formation of ketones.
  • Regular monitoring of blood glucose, blood chemistry, electrolytes and urine for ketones.
  • Where possible, find out the cause (such as infection) of ketoacidosis and treat.
- See more at: http://www.cat-world.com.au/ketoacidosis-in-cats#sthash.nbzENSYf.dpuf"


ETA You are consistently bringing your kitty back for DKA so this really needs to be dealt with NOW. If there is any sort of infection that may be contributing to the ketone overload that needs to be identified and proper treatment given. Otherwise if the glucose levels cannot be brought into acceptable ranges he needs to be kept and treated. Eating properly should be established before being released. If he can't/won't eat properly then a feeding tube should be put into place before he is released.
 
Hey Darnell!!

Glad that Sprocket is back home tonight!! Hopefully we'll keep him out of any more ER vet's!!

I think I'd go back to the 3.5U dose and see how Sprocket does over the next few days....that's more than he was on before this last crisis (which is GOOD) but the ER vet obviously doesn't understand bouncing either.

It IS important that you keep Sprocket eating.....at this point, there's really no such thing as "too much", but there IS "too little".....if he won't eat it voluntarily, you will have to syringe feed to get enough calories into him to keep the ketones at bay.

You also need to make sure you're testing for ketones at least once a day

Do you still have fluids? I'd continue those too to keep flushing his body of any ketones

Hopefully he'll respond to the increased insulin and we can keep him healthier ...and at home!!
 
Tuxedo Mom said:
IMHO They should be concentrating on the rapid insulin rather than the long acting insulin,


"
How is ketoacidosis treated?

Treatment depends on the severity of the condition. In mild cases, where your cat is still bright and alert home therapy may be all that is necessary. Regular monitoring of blood glucose levels should be performed.

In more serious cases, treatment includes:

  • Intravenous fluids and electrolytes to treat and correct dehydration and electrolyte imbalances. This also dilutes glucose and acid levels and helps to flush ketones out of the body.
  • Frequent administration of short-acting insulin to facilitate glucose uptake into the cells. Insulin therapy also suppresses fat catabolism (breakdown), preventing further formation of ketones.
  • Regular monitoring of blood glucose, blood chemistry, electrolytes and urine for ketones.
  • Where possible, find out the cause (such as infection) of ketoacidosis and treat.
- See more at: http://www.cat-world.com.au/ketoacidosis-in-cats#sthash.nbzENSYf.dpuf"


ETA You are consistently bringing your kitty back for DKA so this really needs to be dealt with NOW. If there is any sort of infection that may be contributing to the ketone overload that needs to be identified and proper treatment given. Otherwise if the glucose levels cannot be brought into acceptable ranges he needs to be kept and treated. Eating properly should be established before being released. If he can't/won't eat properly then a feeding tube should be put into place before he is released.
Click to expand...


This is 3rd ER visit. Each time he left he was eating well with little to no ketones at all. He is on antibiotic for infection. His bloodwork has come back as just ketones & high glucose & high liver but his liver is better now ( 3/7 he was 600s, now 166).
The insulin changes were from all vets not me. Seeing specialist on Tuesday but of course she wasn't working this weekend.
 
With these vets, food seems to ne an issue. I gave some education to this vet the past few days. I have him on zero dry only when he won't eat wet & fancy feast pates. I still have fluids and will give some tomorrow & each day.
How many calories is enough to keep ketones from forming? He was eating about 350- 400 calories before his ER visit. But his bgs were in 300s on human meter.
How much food is good??
What else can cause ketones to keep forming?
 
Darnell said:
How many calories is enough to keep ketones from forming?
Click to expand...

I don't think there's any "set" limit.....we just know it's more important that he gets more calories now than it would be if he didn't have the ketone problem. I know your other vet didn't want him eating more than 22o, so I think the current 350-400 is a good start

His BG's were probably still in the 300's due to not enough insulin, not the amount of food he was eating. Now that you're increasing, hopefully his numbers will start to look better.
 
the cholangiohepatitis is a disease of the liver, but not an infection.

usually the recipe for dka is not enough insulin +not eating enough + infection ( often can be a uti )


I would love for you to ask your vet what infection they are addressing.
I'm not sure the antibiotic you are on would address the more common infections like teeth issues or UTI.
That should be just a phone call to get clarification.

This could be a contributing factor why the repeated episodes.....
the infection may be slipping by and not getting treated.


Just my thoughts..... to try to help....
 
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