HELP ASAP!! Not Eating- Drinking Lots of water- high ketone test

Critter Mom said:
@Aleluia Grugru & Minnie, @JaxBenji -

Ladies, when your little ones had the feeding tube placed, did they also get appy stimulants?


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Yes, Jax came home with mirtazapine - I'm looking at his records (this was in 2018) and it said 1/4 of 15mg tablets once every 48 hours until he eats on his own. I remember using a pill cutter and then putting it in a syringe with a little water and giving it to him.

I should note feline drugs are way out of my comfort/knowledge zone but I am reading his records :)
 
JaxBenji said:
Yes, Jax came home with mirtazapine - I'm looking at his records (this was in 2018) and it said 1/4 of 15mg tablets once every 48 hours until he eats on his own. I remember using a pill cutter and then putting it in a syringe with a little water and giving it to him.

I should note feline drugs are way out of my comfort/knowledge zone but I am reading his records :)
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Thought I should add I noticed he came home with Cerenia too for antinausea - 1/4 of 16mg tab every 24 hours. I don't remember details but I'm guessing we stopped cerenia and mirtz when he started eating on his own.
 
Dr. Michael just called. She said he did great and was waking up. She is going to slowly introduce the food. They ARE testing his BG every 3 hours.
He is not constipated.
They are going to keep him tonight with fluids and observation.
She hopes he will be stable and have readings that make them feel comfortable to send him home tomorrow. She said she has LOTS of stuff (info, food, meds) to send home with me. They will review everything with me when I go pick him up.
THANK YOU ALL for the information. I am making very detailed notes with questions to ask- some I will ask when I call at 4:00 for follow up.
I am sure I will have lots of questions for you as I ease into this. Will try to get them all answered with the vet, but it is reassuring to have you all as a resource.
 
Critter Mom said:
That's why cats with ketones should be given IV dextrose so that they can receive insulin safely while they're having difficulty eating. (Insulin should not be withheld from cats throwing ketones: it's a cornerstone of the treatment.)


He needs both food AND insulin to fight the ketones. I'm relieved to hear that they've finally given some.


Due to the nature of a cat's metabolism, if it goes without food for any length of time fatty deposits start to build in the liver (hepatic lipidosis, potentially life-threatening but also treatable if the cat gets timely help with nutritional support). This is the reason why it's critical for a cat having difficulty eating due to nausea to get strong enough anti-nausea treatment straight away - possibly with additional support from an appetite stimulant - to help them to eat again. An appetite stimulant on its own is extremely unlikely to work. If the meds don't work fairly quickly to help the cat start eating under its own steam then a feeding tube is the right course of action to take. As Dr. Pierson advises in the page I linked earlier, if the meds don't work quickly it's better not to delay placing a feeding tube.


I'm very glad to hear that Murphy's going to be intensively monitored. Tomorrow, when you're collecting Murphy, I suggest asking for a copy of his blood and urine test results for your own records.

Before you take him home, please, please make sure that the vet gives you an adequate supply of anti-nausea meds (ondansetron, Cerenia). It's so important to have these meds at home to support adequate food intake during the recovery period and prevent relapse. See the section on nausea control in the following document for details of appropriate treatments for feline nausea:

IDEXX Pancreatitis Treatment Guidelines

Although the document's focus is on pancreatitis, the treatments described are also applicable for nausea due to other conditions, including ketosis and DKA. It's a good guide as to what to ask the vet for.

Did the vets say anything about infection/inflammation, and did they double-check that Murphy's not constipated?

ETA: What treatment has the vet been giving for nausea? Is Murphy getting the anti-nausea meds often enough? (Ondansetron at an appropriate dose can be given every 8 hours.)

Also, did the vet test for pancreatitis to rule it out?

I will double-check to be sure they are still giving the anti-nausea meds.
She did a blood panel, and said everything looked pretty good. A few elevated levels, but nothing out of the ordinary for extreme dehydration. This was done right as he was admitted. Not sure if pancreatitis is part of that screening.
I will be sure to ask, though.

They checked for constipation and said he was ok. She did not mention other infections. I will ask about that, as well.




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Leigh,

FYI, ondansetron is a human medication. If your vet doesn't carry it in stock you can get a written Rx from the vet and get it filled at a regular human pharmacy. It is a very good anti-nausea med.


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When my Sporty was so desperately, desperately ill, the only consolation I had was knowing that he was receiving the best care in the area. I could never have done what the acute care team did for him. (I remember when we visited him they would wheel him out on a gurney/cart and we couldn't hold him because he was pumped so full of fluids that he just peed constantly.)

But he pulled through and went on to live another 10 years without issue. He was a street stray I took in so I don't know how old he actually was, but he was at least 18 when circumstances unrelated to FD took him over the bridge.

I'm wishing you both strength.

Enid
 
Another thought, Leigh. Whiie convalescing after ketones/DKA, the key to recovery is ensuring that the kitty gets enough calories and insulin. If your vet puts Murphy onto a higher carb food than normal for the time being that's OK: the extra carbs can provide support for administration of sufficient insulin to keep ketones away.


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Yes, Minnie was kept overnight because they wanted to make sure tube was working well and observe her eating via tube after anesthesia worn off. I think it’s standard procedure. She came home with the same apetite stimulant and also anti nausea ondansetron. I was suppose to give stimulant if needed and ondansetron every 8 hours.

make sure they send you home with different size syringes. I used the large one for water as you need to flush their system before and after feeding with water and then I used the medium ones for food and small ones for meds. They should also give you some cleaning solution since you’ll need to clean around the tube once a day to avoid infection. Minnie seemed to enjoy that and would even stick her neck out so I could really get in here with the cotton ovals. I would also always apply a think layer of Neosporin before closing everything back up. She should come home with a protective collar so the site is kept clean. The key with the food is bleeding it really well so no particles get stuck on the syringe when you’re trying to fill it. I would always pound the pills into powder and mix with the food. I would also always offer her food first before tube feeding. After the first week, she started eating on her own so the tube was just for fluids and meds.
 
JaxBenji said:
@Leigh B - I can DM you a link to feeding tube info and Jax's med schedule if that would help. I was giving meds around the clock and had to keep everything straight. I also don't want to overwhelm (Jax had a LOT going on).
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It does seem quite daunting. Still hope I made the right decision.
I just have to know whether or not food would get him back into a good place and this is the only way to know that.
I'm sure I will be reaching out tomorrow.
Sounds like there's a whole lot more to this than I realized. I guess just a part of the new routine.
Really ready to have him home!
Thank you
 
Leigh B said:
It does seem quite daunting. Still hope I made the right decision.
I just have to know whether or not food would get him back into a good place and this is the only way to know that.
I'm sure I will be reaching out tomorrow.
Sounds like there's a whole lot more to this than I realized. I guess just a part of the new routine.
Really ready to have him home!
Thank you
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It’s really not daunting I promise you. First day is hard but you get the hang of it and then off you go. Just like home testing
 
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JaxBenji said:
@Leigh B - I can DM you a link to feeding tube info and Jax's med schedule if that would help. I was giving meds around the clock and had to keep everything straight. I also don't want to overwhelm (Jax had a LOT going on).
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Minnie was on a ton of meds too for pneumonia and cardiomyopathy. I had the list taped to the fridge and the schedule so I knew what meds went with each feeding. I’d pull the next ones out and set them on the counter next to her food I wouldn’t mess it up!
 
Aleluia Grugru & Minnie said:
Minnie was on a ton of meds too for pneumonia and cardiomyopathy. I had the list taped to the fridge and the schedule so I knew what meds went with each feeding. I’d pull the next ones out and set them on the counter next to her food I wouldn’t mess it up!
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And I tested the limits of my cell phone alarms :) Thankful it wasn't for a long time though it was hard to keep that in mind during that phase of life.
 
Not good news. She said he is still very sick. His ketones were in the 300's, and his bg is still around 382.
He is keeping his food down, but it sounds like he is quite miserable.
She is going to do another urinalysis to see if she can detect further infection and see if he needs some sort of antibiotic treatment.
The next step is CRI, which she explained is using human insulin that absorbs more quickly. They have been using his prozinc for the last few days, and he's not responding.
If we move forward with CRI, he may be in the hospital for days. He will need constant monitoring, etc.
The thought of putting him through all of this is heartbreaking. I just want to hold him and make him feel better. I know he is miserable in the hospital and clinic.
I should know more about the urinalysis soon, but am not feeling very hopeful.
Please keep us both in your prayers.
I had this hope that getting food in his system would cause him to start to turn around quickly. That is not happening.
I feel like I am about to have to say goodbye to my sweet boy, and I am so so so very sad about it.
 
:( :( :(

I'm glad they're going to be using the fast-acting insulin-- he really really needs it to get control of the ketones. I hope that that plus the food starts to turn things around for him.

Even if they won't let you visit, they might let you bring him something familiar-smelling (an old t-shirt of yours, his favorite towel/blanket, etc.). Sometimes that really helps to bring down the stress of being in the hospital. Poor little guy.

:bighug: :bighug: :bighug:
 
Hi Leigh,

I understand how worried and distressed you must be feeling right now.

It sounds like the vet is finally giving the appropriate treatments to bring down BG levels, stop ketone formation and balance electrolytes. I'm so sorry it has taken so long for them to get to this stage. :(

Leigh B said:
She is going to do another urinalysis to see if she can detect further infection and see if he needs some sort of antibiotic treatment.
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Please check that the sample will be acquired by cystocentesis, not free-catch, and also that a culture and sensitivity is being run.

Also, make sure she tests for pancreatitis, if only to rule it out. A SNAP fPL test will give an on-the-spot yes/no/unclear result (works a bit like a pregnancy test). A Spec fPL test gives a numerical result indicative of both presence and severity of inflammation but it needs to be sent to an external lab so takes a little longer to get the result. Should pancreatitis be present then pain relief (buprenorphine) would be needed on top of the anti-nausea and appetite stimulant meds.

Here is an extract from the WSAVA guidelines for treatment of ketosis/DKA:

Concurrent disease has been documented in approximately 90% of cats with DKA, with the most common being hepatic lipidosis, chronic kidney disease, acute pancreatitis, bacterial or viral infections and neoplasia (Bruskiewicz et al. 1997).​

Also:

Those cats with systemic signs of DKA such as anorexia/vomiting/lethargy need hospitalisation and therapy with regular insulin and intravenous fluids. Monitoring of sick ketoacidotic patients is intensive. Acid-base, electrolyte and blood glucose levels can change rapidly during therapy, and close monitoring of these parameters is mandatory. For example, it is not uncommon for 3–4 changes of fluid type to be required in the first 24 hours of therapy. If in-house monitoring of electrolytes and acid base status is not available, referral should be considered, unless an outside laboratory can supply a result in a couple of hours.

[Emphasis mine]​

Leigh, I strongly recommend you ask the vet currently treating Murphy to confirm that they have the facilities to offer the intensive treatment and monitoring described in the above paragraph. If they don't then I think you should consider asking them for an urgent referral to a facility that can provide this level of intensive care.

Keeping both of you very much in my prayers.

(((Murphy and Leigh)))

:bighug:


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YOU ALL ARE RIGHT!! That first vet did not test for infection in his urine. I am SO INFURIATED!!
The current vet is helping me with it.
He has a UTI. They are starting him on antibiotics.
I am about to speak with the clinic manager. We are TWO DAYS behind on his treatment.
I asked all of the questions to the previous vet, and she reassured me she was doing the right things. She was NOT!
They think we can turn it around but he's been in DKA for 2 days longer than he should have, so it will be several days of CRI in the hospital to get him back to a good place.
 
Critter Mom said:
Hi Leigh,

I understand how worried and distressed you must be feeling right now.

It sounds like the vet is finally giving the appropriate treatments to bring down BG levels, stop ketone formation and balance electrolytes. I'm so sorry it has taken so long for them to get to this stage. :(


Please check that the sample will be acquired by cystocentesis, not free-catch, and also that a culture and sensitivity is being run.

Also, make sure she tests for pancreatitis, if only to rule it out. Snap fPL will give an on-the-spot yes/no/unclear result (works a bit like a pregnancy test). A Spec fPL test gives a numerical result indicative of both presence and severity of inflammation but it needs to be sent to an external lab so takes a little longer to get the result. Should pancreatitis be present then pain relief (buprenorphine) would be needed on top of the anti-nausea and appetite stimulant meds.

Here is an extract from the WSAVA guidelines for treatment of ketosis/DKA:

Concurrent disease has been documented in approximately 90% of cats with DKA, with the most common being hepatic lipidosis, chronic kidney disease, acute pancreatitis, bacterial or viral infections and neoplasia (Bruskiewicz et al. 1997).​

Also:

Those cats with systemic signs of DKA such as anorexia/vomiting/lethargy need hospitalisation and therapy with regular insulin and intravenous fluids. Monitoring of sick ketoacidotic patients is intensive. Acid-base, electrolyte and blood glucose levels can change rapidly during therapy, and close monitoring of these parameters is mandatory. For example, it is not uncommon for 3–4 changes of fluid type to be required in the first 24 hours of therapy. If in-house monitoring of electrolytes and acid base status is not available, referral should be considered, unless an outside laboratory can supply a result in a couple of hours.

[Emphasis mine]​

Leigh, I strongly recommend you ask the vet currently treating Murphy to confirm that they have the facilities to offer the intensive treatment and monitoring described in the above paragraph. If they don't then I think you should consider asking them for an urgent referral to a facility that can provide this level of intensive care.

Keeping both of you very much in my prayers.

(((Murphy and Leigh)))

:bighug:


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The new vet did say that it was intensive treatment. She said they check his bg and adjust if needed every hour. It can get very expensive. I have told them I think they should help with the finances, since they wasted 2 days worth of treating the infection.
I feel like she knows what she is talking about. I did not have a good feeling with the last one.

I will let y'all know what happens...
 
Leigh B said:
It can get very expensive. I have told them I think they should help with the finances, since they wasted 2 days worth of treating the infection.
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I could not agree more. They did not run adequate initial diagnostics and they delayed the intensive treatment Murphy needed as soon as you brought him in, introducing unnecessary jeopardy to the situation.

I am sitting here apoplectic with anger on your behalf, Leigh. Fingers, paws, and everything else possible are well and truly crossed that the vet now treating Murphy will get things going in the right direction.

I really appreciate your posting of updates to let us know how things are going. As always, if there's anything we can help with just shout.

(((Murphy and Leigh)))

:bighug:


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Leigh B said:
She said they check his bg and adjust if needed every hour.
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He also needs his electrolyte levels and acid-base status monitored/balanced.

The WSAVA DKA guidelines I linked to above are very helpful. Although they're a bit 'technical', there's enough of it in plain English to help you understand what treatments are appropriate, typical time needed to treat, and also what to ask the vet about.


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Critter Mom said:
I could not agree more. They did not run adequate initial diagnostics and they delayed the intensive treatment Murphy needed as soon as you brought him in, introducing unnecessary jeopardy to the situation.

I am sitting here apoplectic with anger on your behalf, Leigh. Fingers, paws, and everything else possible are well and truly crossed that the vet now treating Murphy will get things going in the right direction.

I really appreciate your posting of updates to let us know how things are going. As always, if there's anything we can help with just shout.

(((Murphy and Leigh)))

:bighug:


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Thank you. I am so mad! He has been continuing to suffer since Sunday, to the point of a feeding tube...and it is because of a "not-so-uncommon" UTI infection!!:mad::mad::mad::mad::mad: That could have been caught if she'd just done a thorough urinalysis.
They are taking their time calling me back, so I hope that means they are coming up with a plan to assist me.
 
Leigh B said:
I have told them I think they should help with the finances, since they wasted 2 days worth of treating the infection.
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It's not just lost time; neglecting to do a basic search for infection in a diabetic cat who is already throwing large ketones, and then also not doing the intensive care necessary to take care of the ketones themselves, has put Murphy's health and even life at risk. And now it has necessitated a longer course of extremely expensive treatment. It's absolutely inexcusable, in my view.

Please keep us posted!
 
Nan & Amber (GA) said:
It's not just lost time; neglecting to do a basic search for infection in a diabetic cat who is already throwing large ketones, and then also not doing the intensive care necessary to take care of the ketones themselves, has put Murphy's health and even life at risk. And now it has necessitated a longer course of extremely expensive treatment. It's absolutely inexcusable, in my view.

Please keep us posted!
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Makes me so angry. Happens too often
 
Leigh B said:
They are taking their time calling me back, so I hope that means they are coming up with a plan to assist me.
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A thought: maybe you could request a hard copy of Murphy's treatment records and test results then use the WSAVA feline DKA management guidelines as a foundation for any discussions with the vets. The WSAVA recommendations are pretty standard in terms of what one should automatically expect a vet to do when treating a feline patient with ketosis/DKA. If there are incongruities between the guidelines and their actions, perhaps ask them for a full explanation of the reasons why? Preferably in writing.

I am so sorry about what's been happening/not happening, Leigh. :(

Prayers continue for both of you.

(((Murphy and Leigh)))


Mogs
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Thanks, again, to all of you.
The good news is that the new vet seems to be extremely competent. She has mentioned things that you all have told me to be sure to mention, before I have even had a chance to ask. (he is getting the supplements with his insulin, getting the anti-nausea, etc. and she has tested his pancreas).
She is sending me text updates with BG and feeding info every hour.*
I am going to pick him up at 7:00 from that clinic and take him to the ER for overnight observation. The tiny silver lining in that is that I will be able to see and love on him (husband is driving, so I can be with Murphy in the back seat <3). I hate that he has to spend more time away from home, but glad I get some time with him. And, I'll take a t-shirt for him to sleep with. <3

Anyway- he is certainly not out of the woods yet. And I am certainly not finished with my discussions about the first doctor's neglect.
But, I have been holding onto the anger of the situation all day, and it is not doing any good. I need to focus on positive prayers and energy for Murphy and deal with the initial neglect once we (hopefully) get him stable.
I have told them several times that it is overwhelming for me to think about the fact I contemplated putting him to sleep today, only to learn he had an infection that should have been treated with antibiotics, and caught immediately. ESPECIALLY because of what he is going through. He has two IVs and a feeding tube!!!! ARG...getting mad again....

*His info: 12:46- BG 383/ 2:33 BG 335/ 3:01- BG 434- but he had just been fed/ 4:00 BG 418

She said they are going to have the ER put him on a freestyle libre so that they can wave a reader over it to get his bg reading. I have seen commercials for these (my husband has jokingly asked if we could get one for Murph-now we know). She said they last 2 weeks and will save him from as many glucose sticks and save a little money, too.

Hoping that he will be as comfortable as possible at the ER tonight. With the antibiotic and CRI insulin administration, I hope that those ketones are under control SOON.

Again, will post updates.

THANK YOU....My support group:bighug:
 
What a long day!! Just took him from the vet to the ER. He is pitiful! He was drooling a bit and had a hard time holding his head up. I think some of that was from the feeding tube stuff around his neck. Anyway, he slept on my hand and I was able to love on him.
The NEW vet is wonderful. She said she feels like he is heading in the right direction, even though he still looks pitiful. She reviewed all that she had done today, including supplements to his IV to target his low heart rate this am. That appears to have worked.

ANYWAY- so tired...as much from worry as from anger. But, praying hard that tomorrow will be a better day.

I DID have a realization...I was thinking through what could have contributed to his UTI. Last weekend, I went to get them (I have 2 kitties) more litter, and the store was out of my usual brand. I had to get a different brand. I wonder if that could have contributed to his infection? I DO have more of their usual litter ordered and on the way through Chewy, because my pet store keeps selling out.

Good night! Hope to send a good report in the morning.
 
Aw, I'm so happy you got to see him and love on him (drool and all)! And that the new vet is a good 'un! Sounds like he is in good hands, which is all you can ask right now...

Dunno about the litter, hmm. I don't think it could cause a problem directly (unless it were contaminated with bacteria, which I've never heard of). I definitely wouldn't worry too much about the possibility. UTIs happen, especially in diabetic cats.

Sleep well, hoping for a good report about your little guy in the morning!
 
Leigh B said:
ANYWAY- so tired...as much from worry as from anger. But, praying hard that tomorrow will be a better day.
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Be kind to yourself. Hope you are able to get a good nights rest. There is always hope for tomorrow, when the sun will shine.

Drool away little Murphy! Bet he is extra tired too. Could still be groggy from all the treatments at the vets today.
Progress. Tiny little baby steps, but Murphy sounds like he is making progress. All paws crossed here for his recovery.

Think of it this way. A sugar rich environment, like the urinary tract system of a diabetic cat, is a perfect environment for bacteria to thrive, with all that extra sugar to feed on.
 
Got the earlier tag re: feeding tubes but am a bit late to the party. Sorry about that. Anyway, I’m glad you went forward with the feeding tube. They can be absolute life savers and often the fear of “putting them through that” is more in our head than based in reality. I’ve dealt with feeding tubes several times and have no regrets.

It sounds like you finally found a good, competent vet who has a handle on how to treat Murphy’s issues and that’s exactly what he needs right now — proper medical care and time. Sounds like you’re finally exiting the “Twilight Zone” of confusion and that the world is starting to make sense again. The whole process can be so stressful and confusing. Whew! :)

Cats can look like absolute heck warmed over in the early days and that is to be expected, though it’s very jolting to see. Your vet saying that Murphy is improving gives reason for cautious optimism. Hang in there, it might take awhile.

Just curious, but have you been testing before every shot and getting any mid-cycle tests leading up to this? I know you said the spreadsheet isn’t up to date, I just wasn’t clear whether you had the data but hadn’t entered it, or whether you weren’t testing as regularly. I mention this because after this episode, it will be even more important to be diligent about BG testing as well as more frequent ketone tests. Murphy now has DKA in his history, which changes things.

Sending positive vibes for both you and Murphy. I hope the news continues to be good.
 
JL and Chip said:
Just curious, but have you been testing before every shot and getting any mid-cycle tests leading up to this? I know you said the spreadsheet isn’t up to date, I just wasn’t clear whether you had the data but hadn’t entered it, or whether you weren’t testing as regularly. I mention this because after this episode, it will be even more important to be diligent about BG testing as well as more frequent ketone tests. Murphy now has DKA in his history, which changes things.
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Thank you for the information and encouragement. Everyone here is helping me get through this!
Yes, I am diligent with his bg monitoring. He's been doing so well that I have not taken the time to enter the numbers to his spreadsheet.
Once we're through this, I will be sure to enter the numbers.
I have ketone test strips, and use them when he seems a bit off (only about 3-4 times over the last few years) This is the first time he's been over the "low/ little detected" level.
I will certainly look into further ketone testing. It was suggested here that I get a test that I can use when I check his BG.

I am at the ER now picking him up for transport back to the vet. Really anxious about today, and hoping I have answers about a more clear path for him.
This is also killing me financially. I have CareCredit, and I'm willing to do what I need to to get him better, but it's just one more added stress.
Anyway, thank you and I will follow up soon.
 
I picked him up from the ER, and he was a little more awake/aware. He definitely looked better than he did when I took him last night.
His bloodwork is getting much better:
9:00 pm 298/ 10:00 258/ 11:00 218/ 12:00(midnight) 228/ 1:00am 229/ 2:00am 279/ 3:00 321*/ 4:00 297/ 5:00 281/ 6:00am 266
*at 3:00 they had supplemented his IV and it caused his bg to go up, so they added a bit of dextrose for a few minutes.

My vet called me as soon as she got to work to review his information and check on him. I absolutely love her. The first thing she asked me was "how did you sleep?" I told her that I had certainly had better nights. She said that she had woken up a few times in the night thinking about Murphy, too. <3
Anyway- his potassium dipped overnight and that was addressed in the ER. Now that it is under control and his BG is getting/staying lower, his demeanor is improving.
Her plan today is to continue the insulin IV and try to let him rest. Yesterday, he had an additional IV, a bladder stick, bloodwork and a freestyle libre. On top of tube feeding, that is so much for the little guy!! Glad that she is taking that all into consideration.
Hopefully, we will get his insulin regulated and ketones down so that I can bring him home.

Will update again later.

Hope you are all having a great day. I feel like I can actually go to work and be productive today. The last few days have been tough and exhausting.
Oh, BTW, I told Dr. Bellman about this group. She was thrilled to hear about the support and information you have all been giving to carry me through!:bighug:
 
Dr. Bellman (the ANGEL vet) is off today, and I am working with Dr. Todd (She is my former vet at this clinic. We moved several years ago, and started using a vet that was closer to our house. But, I have always LOVED her, too. She sat in the floor and cried with me when I lost a cat years ago (from old age))
ANYWAY- all of that to say that I have the most AMAZING vets taking care of him now. Dr. Todd blew me away on our last phone call. She said that she'd spoken with Dr. Bellman twice today already (reminder- it is her day off) because she wanted to check on Murphy. Dr. Todd said that Dr. Bellman said "I'm invested in Murphy and just need to know how he is." :D
THEN Dr. Todd offered to take Murphy home with her overnight. That way, she can continue his treatment and help me a bit with finances.

***As I was typing, Dr. Todd called. I don't really know how to take the news. The GOOD news is that his electrolytes are better, no ketones or glucose in the urine, much less bacteria in the urine. His bg is also hanging out in a good range.

The BAD news is that his bilirubin levels are REALLY high (showed in urine, which is very abnormal in cats unless it is REALLY high), and his white blood cell count is really high. You may all know that those are indications of infection and liver issues. They did an echocardiogram(?) to look at his gall bladder and liver. Gall bladder looks fine, but the liver showed abnormalities. The vet doing the exam said that it showed up as a different color, but that there was no mass or tumor.
SO- they are adding a THIRD antibiotic, and she is going to take some fluid from his liver and send it to the lab.
I keep asking her if I need to let him go. She keeps reassuring me that if it gets to that point, she will be honest. She has his wellbeing ahead of everything else.
She explained that the liver is one of the few organs that can regenerate. The infection reflected in the white cells can, in fact, be tied with the liver abnormality.
She said he seems to be comfortable, and is responding to them when they have him walking around and call out his name, etc.

Any experience with liver issues from any of you.
I am wearing thin. It is crushing to me that he keeps having new issues...:arghh::(:(:(:(:(:(

White cell count- 16,000 is considered "the high side of normal"- his is at 32,000 (as reference, Sunday, when this all started, he was at 19,600. Tuesday, when the antibiotics were started, he was at 7,000)
Bilirubin-his was at 3.5 and has gone up to 5.5 Again, she said she knew it would be elevated when she saw it in the urine because that is very unusual for cats (not unusual to see it in dog urine, but unusual for cats) unless it is REALLY high

:(:(:(:(:(:(
 
Just stopped by to check on you and Murphy :bighug: I don't have experience with labs and numbers but someone here will :bighug:

BTW, can the vet email you his labs w/ reference values? When members on the board have asked for help w/ labs, it helps to have all the info - you can enter the labs on your SS (on the labs tab...and update the reference values) or black-out your personal info and upload as picture.

I had bookmarked this site if I ever needed it - perhaps it will help - someone posted it on the board at some point - http://felinecrf.the-colonel.info/Documents/index.html?Interpreting_Labwork.html

Hang in there Leigh :bighug::bighug::bighug:
 
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