? Could use help diagnosing issue

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Websterthecat

Member Since 2014
Hi everyone.

I've been nursing along my cat for over 2 years now after he unexpectedly came down with DKA and we discovered that he was diabetic.

He's been doing well on 1.0-1.25 U of Lantus 2x a day for the past couple of years.

The past 4 weeks have been a roller-coaster ride. His numbers unexpectedly jumped up into the 300-500, he stops eating for 2-3 day, constantly vomits, drinks lots of water, becomes dehydrated, extremely lethargic, lays with his head in the water bowel and moans when you touch him. Additional insulin does not seem to affect his numbers.

I took him to the vet and he received fluids along with blood work and test for UTI. UTI test came back negative and blood work was normal except for keytones and elevated liver.

After receiving fluids, his BG lowered and he bounced back to normal and started eating again. Several days later, he stopped eating again. We went back to the vet for more fluids and I came back home with a bag to give him 200ML a day. He bounced back and was ok for several days and once again, back to not eating, vomiting, etc. After a 3 day hunger strike, he started eating again and is looking better.

The vet believes that it may be pancreatitis but can't give me a definitive answer unless he does a scope.

After spending a couple thousand $$ over the past 2 years, I'm not willing to do any further testing.

What do you guys think? Is this a normal cycle for pancreatitis? Perhaps there's something else going on? What can I do to get over this hump?
 
The Spec fPL test was negative for pancreatitis, so I'm not sure why your vet is still suspecting that, unless he thinks there was something weird about the test when it was done. Spec fPL is usually considered the gold standard test for pancreatitis. The only thing I can find on that that might indicate that those results might sometimes not be accurate is this, from Marje's Primer on Pancreatitis:

"The more definitive test, the Spec fPL, requires that a blood sample be sent to TAMU or IDEXX. It is important to note that a 6 - 12 hour fast is required for the most accurate results."

But then, it's not like his results were borderline, so even if he hadn't been fasting I still don't know if I'd jump to a pancreatitis suspicion. The symptoms do fit, but they could fit a lot of other things.

I'm sorry that I'm not an expert on reading labs, so I can't say much more than that to help figure this out. @Marje and Gracie may be able to help more, so I'll go ahead and tag her on this.
 
I don't think this is pancreatitis with the SfPL so low. False positives due to diabetes and kidney disease are common but very rare to see a false negative. Max had chronic pancreatitis for six plus years andaleays ran high. The high neuts seems to show inflammation or infection. Are you seeing an IM or reg vet? I think you need to see someone very experienced. Hoping Marje sees something I don't.
 
Websterthecat said:
Hi everyone.

I've been nursing along my cat for over 2 years now after he unexpectedly came down with DKA and we discovered that he was diabetic.

He's been doing well on 1.0-1.25 U of Lantus 2x a day for the past couple of years.

The past 4 weeks have been a roller-coaster ride. His numbers unexpectedly jumped up into the 300-500, he stops eating for 2-3 day, constantly vomits, drinks lots of water, becomes dehydrated, extremely lethargic, lays with his head in the water bowel and moans when you touch him. Additional insulin does not seem to affect his numbers.

I took him to the vet and he received fluids along with blood work and test for UTI. UTI test came back negative and blood work was normal except for keytones and elevated liver.

After receiving fluids, his BG lowered and he bounced back to normal and started eating again. Several days later, he stopped eating again. We went back to the vet for more fluids and I came back home with a bag to give him 200ML a day. He bounced back and was ok for several days and once again, back to not eating, vomiting, etc. After a 3 day hunger strike, he started eating again and is looking better.

The vet believes that it may be pancreatitis but can't give me a definitive answer unless he does a scope.

After spending a couple thousand $$ over the past 2 years, I'm not willing to do any further testing.

What do you guys think? Is this a normal cycle for pancreatitis? Perhaps there's something else going on? What can I do to get over this hump?
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I am just curious on the 200s of fluids a day?! How much does your kitty weigh, it just seems like alot. :) welcome
 
I will look at his labs for you shortly...working on something for another member. But I agree that 200 mls is really a lot of fluid to give at one time.

I think a more prudent path would be to ultrasound him and then go from there. But I will BBS with a review of his labs.
 
Thanks everyone for the info so far.

So 200ML of fluid a day is too much? How much should I give him when he gets dehydrated from throwing up etc? He's currently around 10 lbs.

As for his lab work, these are numbers from a couple years ago. I will have to check with the doc and update with his recent results.
 
Marje and Gracie said:
I will look at his labs for you shortly...working on something for another member. But I agree that 200 mls is really a lot of fluid to give at one time.

I think a more prudent path would be to ultrasound him and then go from there. But I will BBS with a review of his labs.
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Thank you for the suggestion. Do you have any idea how much the ultra sound costs?
 
Interestingly enough, after 3 days of laying motionless next to his water bowl, he pooped yesterday and then started eating, purring, walking around, looking out windows, holds down his food and seems to be back to normal? His appearance went from near death to normal in this short period of time.

This seems to be the new trend. He shows signs of sickness for 2-3 days and then returns to normal for several days before becoming sick once again... Anyone ever experience this?
 
Websterthecat said:
Thank you for the suggestion. Do you have any idea how much the ultra sound costs?
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Depends where you live. In So. Cal. it ranges from $350-550. I would have it done by a boarded radiologist or a very experienced Internal Medicine vet. I once had a vet have a traveling vet do it who found everything abnormal with my cat and suggested exploratory surgery. I went to an IM for a second opinion and had to pay for his very experienced radiologist to do another one. It was pancreatitis and surgery was not needed. Max lived 7 more years and passed from heart disease/ old age at 19.Good luck. I hope it's nothing serious.
 
Sorry it took me so long to get back to you on the labs but I agree with Elise that the only thing I am seeing is some potential inflammation/infection based on the elevated white blood count. Since this can be due to a variety of things, I think its smart to start with a full abdominal ultrasound and see if any organs show any inflammation.

I also agree that the price is quite variable depending on where you live but I do suggest that you use a board certified radiologist or at least board certified internal medicine specialist if you can. They are better trained to read the ultrasound.
 
Marje and Gracie said:
Sorry it took me so long to get back to you on the labs but I agree with Elise that the only thing I am seeing is some potential inflammation/infection based on the elevated white blood count. Since this can be due to a variety of things, I think its smart to start with a full abdominal ultrasound and see if any organs show any inflammation.

I also agree that the price is quite variable depending on where you live but I do suggest that you use a board certified radiologist or at least board certified internal medicine specialist if you can. They are better trained to read the ultrasound.
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@Marje and Gracie

The labs posted are from quite awhile ago.

"As for his lab work, these are numbers from a couple years ago.I will have to check with the doc and update with his recent results"

@Websterthecat

If you could get a copy of the latest bloodwork and add them to your labs it would be much more useful. Labwork can change a lot even within a few months so updated information would be most useful.
 
Phoebes said:
I am just curious on the 200s of fluids a day?! How much does your kitty weigh, it just seems like alot. :) welcome
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Vets usually prescribe this sort of huge fluid intake subq. I do think it's easier on your cat to do 100 twice a day. I suspect vets don't think we will be dedicated enough to go thru the procedure twice a day,so they let us off with instructions to administer a whole lot of fluids once a day.
 
Tuxedo Mom said:
@Marje and Gracie

The labs posted are from quite awhile ago.

"As for his lab work, these are numbers from a couple years ago.I will have to check with the doc and update with his recent results"

@Websterthecat

If you could get a copy of the latest bloodwork and add them to your labs it would be much more useful. Labwork can change a lot even within a few months so updated information would be most useful.
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Oops. I missed that. Thank you!
 
Websterthecat said:
@Marje and Gracie

I have received and posted his most recent labs. I do appreciate you taking the time to look at them. Thank you.
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Thank you. Four things stand out to me:
--he has a mild elevation in his ALT which is a liver value; this is pretty indicative of liver cell damage but gives no indication of what is causing it. ALT can change rapidly either direction as it's half life is 12 hours. Usually as a singular finding, this mild of an elevation just warrants watching or you could talk to the vet like giving liver support like milk thistle.
--his potassium is a bit on the high side and his chloride low
--he has ketones in his urine
--his specfPL is up to the high end of normal range

His BG is pretty high so coupled with the electrolytes (potassium)being off, the ketones being present, the elevated liver values, his previous DKA history, his symptoms....it makes me wonder if he's developing DKA. Normally, potassium levels might be low but, from Medscape:

The most characteristic disturbance is total body potassium loss. This loss is not mirrored in serum potassium levels, which may be low, within the reference range, or even high.
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Have you been checking his urine ketone level religiously?

I would be checking urine ketones at least 1-2 times a day and talking to the vet if you are getting any ketones at home.
 
Marje and Gracie said:
Thank you. Four things stand out to me:
--he has a mild elevation in his ALT which is a liver value; this is pretty indicative of liver cell damage but gives no indication of what is causing it. ALT can change rapidly either direction as it's half life is 12 hours. Usually as a singular finding, this mild of an elevation just warrants watching or you could talk to the vet like giving liver support like milk thistle.
--his potassium is a bit on the high side and his chloride low
--he has ketones in his urine
--his specfPL is up to the high end of normal range

His BG is pretty high so coupled with the electrolytes (potassium)being off, the ketones being present, the elevated liver values, his previous DKA history, his symptoms....it makes me wonder if he's developing DKA. Normally, potassium levels might be low but, from Medscape:



Have you been checking his urine ketone level religiously?

I would be checking urine ketones at least 1-2 times a day and talking to the vet if you are getting any ketones at home.
Click to expand...

Thank you for the response. The vet also suggested that he may be developing DKA. Unfortunately, in my area 24 hour hospitalization cost $2k - 3k to treat DKA.

I gave him fluids for several days, upped his insulin and have been monitoring his keytones using a meter. Fortunately, over the past 2 weeks his keytone levels fell from 4.1 to 3.5 to most recently 0.1 today! The vomiting has stopped, and he's 100% back to normal. It's amazing to see how fast he went down hill and how quickly he recovered.

Hopefully this was just an isolated incident and will not happen again anytime soon.

With a SPEC fPL in the higher "normal" range, do you think that it's possible that a case of pancreatitis caused all of this?
 
Websterthecat said:
Thank you for the response. The vet also suggested that he may be developing DKA. Unfortunately, in my area 24 hour hospitalization cost $2k - 3k to treat DKA.

I gave him fluids for several days, upped his insulin and have been monitoring his keytones using a meter. Fortunately, over the past 2 weeks his keytone levels fell from 4.1 to 3.5 to most recently 0.1 today! The vomiting has stopped, and he's 100% back to normal. It's amazing to see how fast he went down hill and how quickly he recovered.

Hopefully this was just an isolated incident and will not happen again anytime soon.

With a SPEC fPL in the higher "normal" range, do you think that it's possible that a case of pancreatitis caused all of this?
Click to expand...
Since ketones begin to show up on a blood ketone meter between 2.4 and 2.55, he definitely had ketones.

On the pancreatitis, I don't know since he is within the normal range. I just mentioned it as something to watch to ensure he didn't go over the normal range.

You might talk to your vet about approaching any ketones with fluids any time you see them. You also need to be sure he is getting all his calories and that you stay on top of his insulin dosing per whatever dosing method (TR or SLGS) so that his numbers are as close to normal as possible.

If it's possible for you to do, TR is often better for cats who have a history of DKA so they don't stay in high numbers too long. OR if you follow SLGS, that's fine but use common sense and realize you will have to modify it for Webster if he's spending too much time in high numbers....don't let him stay there for a week just waiting to do a curve, I'd suggest running the curve sooner and adjusting the numbers as needed.

But...don't forget the role infection plays in developing DKA so it might be worthwhile to have a urinalysis done to rule out a UTI or have his teeth checked since those are the two most common infections we see that cause issues in diabetic cats.

I'm so glad he's better!
 
Marje and Gracie said:
Since ketones begin to show up on a blood ketone meter between 2.4 and 2.55, he definitely had ketones.

On the pancreatitis, I don't know since he is within the normal range. I just mentioned it as something to watch to ensure he didn't go over the normal range.

You might talk to your vet about approaching any ketones with fluids any time you see them. You also need to be sure he is getting all his calories and that you stay on top of his insulin dosing per whatever dosing method (TR or SLGS) so that his numbers are as close to normal as possible.

If it's possible for you to do, TR is often better for cats who have a history of DKA so they don't stay in high numbers too long. OR if you follow SLGS, that's fine but use common sense and realize you will have to modify it for Webster if he's spending too much time in high numbers....don't let him stay there for a week just waiting to do a curve, I'd suggest running the curve sooner and adjusting the numbers as needed.

But...don't forget the role infection plays in developing DKA so it might be worthwhile to have a urinalysis done to rule out a UTI or have his teeth checked since those are the two most common infections we see that cause issues in diabetic cats.

I'm so glad he's better!
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Thank you very much. Great info on the meter.

He had a urinalysis which I posted the results at the bottom of his most recent lab sheet.

Ill get him up-to-date on the dental.
 
Websterthecat said:
Thank you very much. Great info on the meter.

He had a urinalysis which I posted the results at the bottom of his most recent lab sheet.

Ill get him up-to-date on the dental.
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I'm sorry:blackeye: I did look at his UA before. I just look at so many labs that I sometimes forget who had UAs and who didn't.

You're welcome!
 
Max had chronic pancreatitis for many years and his ALT was often elevated during an episode. Webster's is only mildly elevated. My vet was never concerned if double the high end of normal.
 
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