100 mls of LRS is 20 tsp of water just so you know. It’s really important that fluids be given to flush the ketones. I would follow my vet’s advice, and if he said to give fluids today, I’d see where he is at +2 and if he’s gone up a bit or is flat, you should be able to give some fluids. Just be sure and monitor his BG and put it in your remarks so we all know.
Ok! Is it very important to keep a consistent schedule with the small feedings in between insulin? Just seeing what would work with our daily life so I do not feed him small meals at different times if that would mess up his BGs
Could be. I have never heard that though.
At the moment the most important things for Maverick is to get enough food and enough insulin to prevent the ketones, and fluids of course....so don’t worry about the food messing up his BG. If the BG is high, then the insulin dose can be adjusted.
Has he ever had any heart issues? What fluids do you have there? Some fluids are better than others. For example, if you only have NaCl, I would be careful as that can contribute to acidosis. LRS is a better choice.
Have a look on the link here. Look for carbs 10% or less
LRS is good. I’d try 50 mls tonight if you have everything. Here’s a video to help you.
If the numbers permit, you also have the option of shooting 30 minutes early once per 24 hours. For example tomorrow 8:40am and 8:40pm; Friday 8:10am and 8:10pm and then on Saturday 7:40am and 7:40pm.
Bearing in mind that you can now also give sub-q fluids, I think it might be an idea to balance that with how much water you add to Maverick's food, reasoning being that he also needs plenty of calories to help reduce/prevent ketone generation, and if too much water were to be added to his grub it might fill him up and he might end up not eating as much.
Thank you so much for sharing your experience!
It's because you typed your text before the "/QUOTE" BBcode. Fret not, we've all done it at one time or another.
Adding a teaspoon or two of water to each small feed is OK to help with fluid intake. Small, more frequent feeds can help, just make sure he has a decent amount of grub before giving insulin.
Hi! Im a newbie here so not much advice i can give but as a dka cat owner also i can say after he was released from the ER vet ketones came back a week later at small. The vet gave him subq fluids and that night they were the darkest color on the strip at large and i freaked out. My vet said the same thing and by morning they were back to negative. A week later ketones came back again at trace. Brought him in for more fluids and they went up to moderate and were negative again the next day. He's now *fingers crossed* 22 days ketone free. I hope tour kitty gets them knocked out if their system and they stay negative too!
It's because you typed your text before the "/QUOTE" BBcode. Fret not, we've all done it at one time or another.
For members following this thread, I'm going to repost Mathilda's earlier reply below.
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Mathilda wrote:
I think you were right in that the water may have made him feel full before. I the past two times he's been offered feed, he's been eating better and better! Since he is eating better now I think I'll stick with not adding water but doing the subQ and increase his dosage to .75 tomorrow so I can keep an eagle eye on him all day. The numbers has been much better today, but if he keeps on eating I think he may do better on higher dose.
Our vet closed at noon today but I have an appointment Saturday morning so I'll definitely ask about the SNAP fPL then. We have stocked up on the meds such as appetite stimulant and cerenida, and he's also on Famotidin twice daily, He has not been on any pain medicine since the ER- there he only got it a couple of days- but I'll ask the vet for this also in case he needs it, he doesn't seem to be in pain now though. I think I'll also have the vet doing a urinalysis just to be on the safe side in case he does have a UTI but not showing the clinical symptoms.
I haven't been able to catch his pee today to test for ketones, but he went pooping twice already so luckily he doesn't seem constipated.
Those are really good tips and tricks- Thank you, I really appreciate it!
Does the appetite stimulant normally work pretty quickly? I gave him this morning and I'm just wondering if that's why he is more willing to eat.
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I'm glad to hear Maverick is starting to eat a bit better now (and good that he's pooping!).
Forgot to post the following link earlier:
Nausea and appetite problems - symptoms and treatments (it's on a CKD site but all the info is applicable for nausea generally).
Keep an eye out for meatloafing or other signs of discomfort after he eats as it might give you a better idea of whether he needs pain relief. For cats with pancreatitis the nausea meds and appy stimulants work better when the pain is managed.
For cats who have a marked propensity to throw ketones, a blood beta ketone meter is a very, very good investment because it frees one from the reliance on catching urine samples. Testing is done in the same way as for blood glucose. The strips are pricey but the ability to test on demand makes the running cost well worth it (and you don't use as many of them as for BG monitoring). The BBK meter will tell you what ketone levels are at in real time - and may give you an indication of rising levels a few hours before a pee sample would.
Re nausea meds, with Saoirse I found that Cerenia would kick in a few hours after she received the injection (not available in tablet form for cats over here). With ondansetron it would be about 90-120 minutes. Also with ondansetron I found it would take about 24 to 48 hours for the dose to show its full effectiveness. Depending on the degree of nausea, ondansetron at a suitable dose size can be administered every 8-12 hours so I found it gave me more control when managing her symptoms. If nausea is present then anti-nausea meds need to be administered a little while before any appetite stimulant because either the appy stimulant is less likely to work if the anti-nausea med is not on board or if the cat feels compelled to eat while still nauseated it can lead to serious food aversions (and that's a road that should not be travelled if at all possible).
On appetite stimulants, I only gave Saoirse mirtazapine the once (she had a really bad reaction to it) and it kicked in about an hour or so after administration. Instead of the mirtz I used cyproheptadine for appetite. It would kick in about 60-90 minutes after administration. The cypro has a gentler action and doesn't last as long but it can be given every 8 hours (1/2mg for 10lb cat) so it is much more controllable than the mirtz.
Mogs
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Yay! Glad he's going down! And thank you! I've done a couple things. First off he has a bad tooth and needs a dental but im having issues finding a vet to do it while he's so unregulated. Part of the perfect storm for ketones is infection so he's now going on his third week of antibiotics. So if his tooth is infected thats hopefully keeping the infection at bay and keeping the ketones negative. The only other thing i've been doing is giving him this liquid for renal failure im cats. He doesnt have any kidney issues but he's drinking and peeing so much i thought maybe dehydration was a factor. Its called rebound recuperation. I give him a dose every day mixed with boiled chicken and he loves it. It has electrolytes in it to help keep him hydrated. So im not sure if either or even both combined have been helping but im sticking with it
Sometimes when cats have ketones and need their insulin, but the BG is not high enough, we suggest giving some higher carb food for that cycle to raise the BG so the insulin can be given. We have had some cats that have needed higher carb food for several days so that enough insulin can be given to combat the ketones. Do you have medium and high carb canned food you can give if needed?
I think I'll increase dose to .75 tonight but am worried he'll drop and I'll miss it as he's so unpredictable.
Yep. If you look at Dr Lisa's food list (see sticky at top of Feline Health for the link) it'll give the names of the flavours and the carb %s.
Yep. If you look at Dr Lisa's food list (see sticky at top of Feline Health for the link) it'll give the names of the flavours and the carb %s.
You're doing a grand job of looking after Maverick, Mathilda. Keeping fingers and paws crossed that the ketones will drop back to negative (and stay that way). Given he's eating, getting fluids and getting insulin, I think the next step is back to the vet to find out what else might be going on (infection, inflammation, other systemic stressor).
Mogs
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Complete blood count and whatever chemistry panel your vet recommends. NB, the other tests mentioned above need to be specially ordered because they're not included in the regular blood panels. Other members might be able to make additional suggestions.
I know right now is a very difficult time for you, but did you say that you had the e-mail address where you could buy a bag of fluids without a script. If so would you mind sharing. I hope that Maverick continues to improve and never gets this again. I am no help, thank goodness I have no experience with this terrible sickness.
Thank you! Please do not quote me on this, I never purchased anything from here, but someone on FB told me about mountainside-medical.com where you supposedly can get Lactated Ringer's IV bag without prescription, this person had ordered from the site before, but not this specific product.
