? Need help with DK

[CopernicusDM]

Hey I'm Krista , mom of Copernicus. He was diagnosed a few weeks ago and we are STILL struggling with ketosis. Ketones were 5, came down to 2, back up to 3.4 and 3.8 this week. He did have pancreatitis that got better. Let's hope that's not back. His glucose is so insulin resistant too. He stays in the upper 300s and even 440 last night. Lantus titrated to 3 units. He is on Cerenia, zofran, some fluids, and Pepcid. Very hungry but losing weight. Any advice for these ketones?! He spent 4 very expensive nights in the ER and came out in the same condition he went in. I can't figure out how to attach his FB sugar sheet.

 

[Staci & Ivy]

Hi Krista, welcome and glad you’re here. I have been helping Krista and am familiar with what’s going on with Copernicus.
I will send her links to do a signature and stuff to get her started.
She really needs help with DK and is working very hard to pull him through.
@Bron and Sheba (GA) @Marje and Gracie
Would you be able to help here?

 

[Staci & Ivy]

I would use the drop down prefix to the left and use a question mark to get attention and put “Need help with DK” in your title.

 

[Staci & Ivy]

Here is info on what to set up around here so we can help you asap
Sticky - New? How You Can Help Us Help You!

 

[Staci & Ivy]

Krista has been trying to use a Libre 3 Plus and still struggling to get one to work well, first one done by vet was applied with glue
Of course it failed.
She can poke his ears, so that’s a huge benefit!
Her doctors have all refused to give buprenorphine for pain with pancreatitis

 

[Staci & Ivy]

Ketones, Ketoacidosis, and Diabetic Cats: A Primer on Ketones
Info - Ketones, Diabetic Ketoacidosis (DKA), and Blood Ketone Meters
Info - A Primer on Pancreatitis

 

[Staci & Ivy]

https://felinediabetes.com/FDMB/threads/how-to-create-a-spreadsheet.241706/
https://felinediabetes.com/FDMB/threads/creating-a-fdmb-profile.159626/

 

[Staci & Ivy]

Great job on your signature! I would just tweak date to 4/10/26 so we know it’s this year.
I didn’t realize you’re using an Aloha Track.
The strips are super expensive and you can’t just run to the store to get them easily.
You may want to consider getting something like the Relion Premiere (human meter Walmart brand)
The meter and strips are very inexpensive and as long as you have a local Walmart it’s easy to get more quickly.
Many people here use them reliably.
Just a suggestion for you

 

[JL and Chip]

Quick flyby but I’m sure the others will be by soon.

1) plenty of food — at least 150 percent of normal calories.

2) plenty of liquids. Soup up the canned food with extra water, give subQ fluids as instructed (important for both ketones and pancreatitis). With subQ, just need to be sure there’s not a heart problem.

3) monitor ketones daily. Even though he doesn’t have acidosis at the moment, ketones can turn into DKA quickly. At minimum use urine ketone strips (ketostix) or consider purchasing a blood ketone meter. I had a cat who had ongoing struggles with ketones and the meter was invaluable (you use it like a glucose meter but it requires special ketone test strips). I have a Precision Xtra but there are many options on the market these days — NovaMax Plus, Keto Mojo, etc.

4) if there’s a swallowing problem, you might experiment with an elevated food bowl.

Edited to add:
5) approproate dose of insulin. If feeding strictly canned, you might want to consider the TR protocol rather than SLGS. It allows you to fast track dose increases, which can be very important in getting on top of ketones.

 

[Bron and Sheba (GA)]

Hi and welcome to the forum.
JL and Chip has given you some great advice.
Food, insulin and fluids is what is needed to combat ketones, so make sure you are feeding lots of food apart from the two main meals. Lots of little snacks during the day and evening.

Are you giving sub Q fluids? You mention fluids in your opening post. And it looks like you have mentioned fluids in the SS but as it’s only a photo, it has been cut off.

It looks like you have some other spreadsheet, not ours. You will need to swap it over to one of ours as that one is not really comparable with this site and often freezes and doesn’t work properly. I will ask @Bandit's Mom to help you move all the data across to our SS. And it looks as if you have the human meter SS as well. If you are using a pet meter, you will need the pet meter SS. Than when it’s all set up, if you could put it into your signature, we can then see it easily. Thank you.

And as JL and Chip suggested, I would consider swapping to TR so that we can increase the dose of insulin more frequently than once a week.

 

[CopernicusDM]

Thank you for the welcome. I am feeding him every time he wakes up so it's about every 3 hours. His weight loss despite is concerning. I have to do small meals bc of his history of regurgitation. So here's the thing about fluids. Everyone recommends them on this group and the other, but I asked 3 different vets and they were reluctant. One finally made me do a cardiac test and gave him fluids there once. I got one bag and it's almost already gone. The vet said 200 every 48-72 hours. So I am not sure how to get more when I've asked 3 vets. I need to educate myself with "TR". I was taught that Lantus takes a week to build up under skin and system so to move slow with it for that reason. I have messaged about porting my data over to your spreadsheet. I have both human and pet meter. Trying both since new. The keto mojo is nice bc it does glucose and ketones. The vets recommend AlphaTrak bc for cats and less blood. But sounds like I will land on human for cost savings.

 

[CopernicusDM]

Quick flyby but I’m sure the others will be by soon.

1) plenty of food — at least 150 percent of normal calories.

2) plenty of liquids. Soup up the canned food with extra water, give subQ fluids as instructed (important for both ketones and pancreatitis). With subQ, just need to be sure there’s not a heart problem.

3) monitor ketones daily. Even though he doesn’t have acidosis at the moment, ketones can turn into DKA quickly. At minimum use urine ketone strips (ketostix) or consider purchasing a blood ketone meter. I had a cat who had ongoing struggles with ketones and the meter was invaluable (you use it like a glucose meter but it requires special ketone test strips). I have a Precision Xtra but there are many options on the market these days — NovaMax Plus, Keto Mojo, etc.

4) if there’s a swallowing problem, you might experiment with an elevated food bowl.

Edited to add:
5) approproate dose of insulin. If feeding strictly canned, you might want to consider the TR protocol rather than SLGS. It allows you to fast track dose increases, which can be very important in getting on top of ketones.

Hello. Since his ketones have remained high, how will I know what number means acidosis? Vets are being stingy with fluids. Can you send me a link on the different dosing options. I thought Lantus was always slow titration?

 

[Marje and Gracie]

Hello. Since his ketones have remained high, how will I know what number means acidosis? Vets are being stingy with fluids. Can you send me a link on the different dosing options. I thought Lantus was always slow titration?

Welcome, Krista. I sent you a PM so I can help with your SS and get it posted for you.

I understand why the vets are concerned because if there is any unidentified heart issue, subq fluids can overwhelm it but I don’t understand 200 mls every 48-72 hours. It is much better for him to receive less but more often. Does he have a heart murmur? Did you do the CardioPet ProBNP test? It’s just a screening tool but if it’s positive, you’d want an echocardiogram before you gave fluids.

Unfortunately, subq fluids generally requires a prescription in most states. I get mine from Chewy as it is much less than from the vet but they also require a prescription. Do you have a vet you have an established relationship with?

In post #6 above, Staci linked our info on DKA and ketones. At 2.4 on a blood ketone meter, DKA is more likely to be present.

You’ve been given great advice on calories, extra water, fluids, if possible. Right now, I’d try and get some Hills a/d or some Recovery. They have higher carbs but also more calories so if you can only feed him a small amount, you want to get as many calories in him each time as you can.

For DKA or ketone prone cats, we can fast track the dose increases. Under TR, it is advised to raise the dose by 0.5u after six cycles if nadirs are above 300. However, when we fast track, we will increase by 0.5u after every four cycles if nadirs are above 300. We can di this twice in a row if nadirs are high and then we wait six cycles on the next increase to allow the depot to catch up.

Since you just raised his dose to 3u bid, let’s give him four cycles and then reassess.

Questions?

 

[squeem3]

Unfortunately, subq fluids generally requires a prescription in most states. I get mine from Chewy as it is much less than from the vet but they also require a prescription. Do you have a vet you have an established relationship with?

Yes, Chewy's pharmacy sells fluids and the tubing but will require a prescription for both. Chewy does not sell needles, though. Terumos are preferred. 19 gauge is what many people use. They're scary large but the large diameter means the fluids get into the cat faster than a thinner needle.

 

[Staci & Ivy]

Thank you for the welcome. I am feeding him every time he wakes up so it's about every 3 hours. His weight loss despite is concerning. I have to do small meals bc of his history of regurgitation. So here's the thing about fluids. Everyone recommends them on this group and the other, but I asked 3 different vets and they were reluctant. One finally made me do a cardiac test and gave him fluids there once. I got one bag and it's almost already gone. The vet said 200 every 48-72 hours. So I am not sure how to get more when I've asked 3 vets. I need to educate myself with "TR". I was taught that Lantus takes a week to build up under skin and system so to move slow with it for that reason. I have messaged about porting my data over to your spreadsheet. I have both human and pet meter. Trying both since new. The keto mojo is nice bc it does glucose and ketones. The vets recommend AlphaTrak bc for cats and less blood. But sounds like I will land on human for cost savings.

Here is information on both SLGS and TR to help you understand the protocols.

Sticky - Dosing Methods: Start Low, Go Slow (SLGS) & Tight Regulation (TR)

 

[CopernicusDM]

Quick flyby but I’m sure the others will be by soon.

1) plenty of food — at least 150 percent of normal calories.

2) plenty of liquids. Soup up the canned food with extra water, give subQ fluids as instructed (important for both ketones and pancreatitis). With subQ, just need to be sure there’s not a heart problem.

3) monitor ketones daily. Even though he doesn’t have acidosis at the moment, ketones can turn into DKA quickly. At minimum use urine ketone strips (ketostix) or consider purchasing a blood ketone meter. I had a cat who had ongoing struggles with ketones and the meter was invaluable (you use it like a glucose meter but it requires special ketone test strips). I have a Precision Xtra but there are many options on the market these days — NovaMax Plus, Keto Mojo, etc.

4) if there’s a swallowing problem, you might experiment with an elevated food bowl.

Edited to add:
5) approproate dose of insulin. If feeding strictly canned, you might want to consider the TR protocol rather than SLGS. It allows you to fast track dose increases, which can be very important in getting on top of ketones.

Welcome, Krista. I sent you a PM so I can help with your SS and get it posted for you.

I understand why the vets are concerned because if there is any unidentified heart issue, subq fluids can overwhelm it but I don’t understand 200 mls every 48-72 hours. It is much better for him to receive less but more often. Does he have a heart murmur? Did you do the CardioPet ProBNP test? It’s just a screening tool but if it’s positive, you’d want an echocardiogram before you gave fluids.

Unfortunately, subq fluids generally requires a prescription in most states. I get mine from Chewy as it is much less than from the vet but they also require a prescription. Do you have a vet you have an established relationship with?

In post #6 above, Staci linked our info on DKA and ketones. At 2.4 on a blood ketone meter, DKA is more likely to be present.

You’ve been given great advice on calories, extra water, fluids, if possible. Right now, I’d try and get some Hills a/d or some Recovery. They have higher carbs but also more calories so if you can only feed him a small amount, you want to get as many calories in him each time as you can.

For DKA or ketone prone cats, we can fast track the dose increases. Under TR, it is advised to raise the dose by 0.5u after six cycles if nadirs are above 300. However, when we fast track, we will increase by 0.5u after every four cycles if nadirs are above 300. We can di this twice in a row if nadirs are high and then we wait six cycles on the next increase to allow the depot to catch up.

Since you just raised his dose to 3u bid, let’s give him four cycles and then reassess.

Questions?

My favorite vet is the one that said fluids every 48 to 72 hours. So he has a new murmur but ProBNP was negative, thoughts? His ketones have been above 2.4 for a month. I'm still shocked the ER couldn't get them down after a 4-night stay. They must not have done a correct protocol. Since I don't have a Libre on him, is testing once mid cycle (6 hours) enough to find nadir? The testing cycles all still above my head. It's all been a fire drill. Thank you

 

[Marje and Gracie]

Yes, Chewy's pharmacy sells fluids and the tubing but will require a prescription for both. Chewy does not sell needles, though. Terumos are preferred. 19 gauge is what many people use. They're scary large but the large diameter means the fluids get into the cat faster than a thinner needle.

I buy my needles from thriving pets.com and I buy Terumo 21g. It takes me about 5 mins to get 100 mls in my kitty.

 

[Marje and Gracie]

My favorite vet is the one that said fluids every 48 to 72 hours. So he has a new murmur but ProBNP was negative, thoughts? His ketones have been above 2.4 for a month. I'm still shocked the ER couldn't get them down after a 4-night stay. They must not have done a correct protocol. Since I don't have a Libre on him, is testing once mid cycle (6 hours) enough to find nadir? The testing cycles all still above my head. It's all been a fire drill. Thank you

I’m not a vet but 200 mls at one time is too much. You can overwhelm a healthy heart with that much fluid. And with ketones/DKA, it’s more necessary to have daily fluids. Maybe your vet would agree to 75…or even 50 mls daily?

Hard to say about the ER but I wouldn’t be surprised if they didn’t know what they are doing. Did they give him fast-acting insulin with his Lantus? Looking at his SS, they didn’t and most will to get the BG down. For tough cases here, we will work with the caregiver to use a fast-acting insulin like Humulin R along with the Lantus.

Nadirs move so just testing at +6 might not catch it. It helps to test at +2 because that will tell you if the BG will likely head down. But he could nadir anywhere from +4 to +7 or later if he’s clearing a bounce.

 

[Staci & Ivy]

I’m not a vet but 200 mls at one time is too much. You can overwhelm a healthy heart with that much fluid. And with ketones/DKA, it’s more necessary to have daily fluids. Maybe your vet would agree to 75…or even 50 mls daily?

Hard to say about the ER but I wouldn’t be surprised if they didn’t know what they are doing. Did they give him fast-acting insulin with his Lantus? Looking at his SS, they didn’t and most will to get the BG down. For tough cases here, we will work with the caregiver to use a fast-acting insulin like Humulin R along with the Lantus.

Nadirs move so just testing at +6 might not catch it. It helps to test at +2 because that will tell you if the BG will likely head down. But he could nadir anywhere from +4 to +7 or later if he’s clearing a bounce.

I thought the same thing about 200 ml in one day.
I’m glad you’ve agreed Marje.
That amount scared me. I’ve never seen such a high amount advised.

 

[CopernicusDM]

I’m not a vet but 200 mls at one time is too much. You can overwhelm a healthy heart with that much fluid. And with ketones/DKA, it’s more necessary to have daily fluids. Maybe your vet would agree to 75…or even 50 mls daily?

Hard to say about the ER but I wouldn’t be surprised if they didn’t know what they are doing. Did they give him fast-acting insulin with his Lantus? Looking at his SS, they didn’t and most will to get the BG down. For tough cases here, we will work with the caregiver to use a fast-acting insulin like Humulin R along with the Lantus.

Nadirs move so just testing at +6 might not catch it. It helps to test at +2 because that will tell you if the BG will likely head down. But he could nadir anywhere from +4 to +7 or later if he’s clearing a bounce.

I agree on the fluids. There is a calculation online and his dose was 80 max. I don't think he will let me prick his ear that many times a day. I am going to have to try to get a Libre on him but he's skin folds and bones left. They did give him some fast-acting insulin. But he was on ProZinc at the time. They were only feeding him every 12 hours. Tell me more about how you work with caregivers and Humulin R? That means I need to find a vet that aligns with all this has been my biggest challenge. The first one wouldn't even give him any fluids that's how he got so bad so quickly. Maybe someone in the group knows my area.

 

[Marje and Gracie]

I agree on the fluids. There is a calculation online and his dose was 80 max. I don't think he will let me prick his ear that many times a day. I am going to have to try to get a Libre on him but he's skin folds and bones left. They did give him some fast-acting insulin. But he was on ProZinc at the time. They were only feeding him every 12 hours. Tell me more about how you work with caregivers and Humulin R? That means I need to find a vet that aligns with all this has been my biggest challenge. The first one wouldn't even give him any fluids that's how he got so bad so quickly. Maybe someone in the group knows my area.

Was he on PZ from the 10th-13th and then switched to Lantus? What was his dose on PZ.....2.5u? If it was, his Lantus dose should have been started at 2.5u bid.

Yikes...you have to feed a diabetic cat more than every 12 hours so you are working with the insulin. Otherwise, the “fasting” in between can cause the insulin to drop the BG like a rocket and then they start bouncing. It’s hard to say what he would have done without these ketones in the mix. My concern is with ketones that level, he has DKA. We had one cat here with ketones at 5 that didn’t have DKA but in 16 years here, that’s the only one I’ve seen.

We often find many cats don’t like testing because the CG hasn’t learned how to do it properly.....how the bevel should be, where to poke, to warm the ear, etc. Here is a post which will help you learn to test him and, hopefully, he will learn to let you.

Some states do not require a prescription for R (I live in AZ and it is not required). You can usually get Novolin R (same as Humulin R but different manufacturer) cheapest at WalMart and they keep it behind the counter.

“R” has a duration of about four hours so we often have a CG give it at AMPS as long as the AMPS is higher and then track the BG hourly for at least four hours so you can see what R does. We have the CG give a very small dose to start with and see how it works with the Lantus for that cat. I think currently, only we three Moderators are experienced with using it. Some of the acro cat moms use it but I don’t think they would want to help someone else with it. It’s an investment of time, for certain as you have to be on top of the monitoring. There are other times you can give it; if his AMPS was good but then he shot up, you can give it later in the cycle. What you don’t want to do is use it when a bounce is clearing or at a time that it overlaps the Lantus nadir.

I used R with my Gracie (as did many of us experienced members) to stop her bouncing so you can look at her SS and you’ll see where I used it (examples are 1/13 and 1/4/2015). By 2015, I had enough experience with it that I didn’t have to check it hourly.

 

[JL and Chip]

Since his ketones have remained high, how will I know what number means acidosis?

I think this has been mentioned but acidosis is a metabolic issue and about pH, not really about any particular blood glucose (BG) number. High BG can increase the likelihood of DKA, but over the years we’ve seen some cats go into DKA even at lower BGs. It depends on the cat and the situation.

So here's the thing about fluids. Everyone recommends them on this group and the other, but I asked 3 different vets and they were reluctant. One finally made me do a cardiac test and gave him fluids there once. I got one bag and it's almost already gone. The vet said 200 every 48-72 hours. So I am not sure how to get more when I've asked 3 vets.

Marje has already gone over this but I concur 200ml all at once being a lot. You’d be better served to split that into lower amounts more frequently. Most of the vets I deal with say around 100ml daily. Just make sure the fluid “bump” has fully absorbed before the next round of fluids (be sure to check the legs/paws as well as occasionally fluids will pool there). I think I’d try again to politely inquire about getting another bag and perhaps indicate that you believe it is helping (if that’s true). It can’t hurt to ask— worst they can do is say no.

I am feeding him every time he wakes up so it's about every 3 hours. His weight loss despite is concerning. I have to do small meals bc of his history of regurgitation.

Diabetes can cause significant weight loss and that is usually the culprit. However, especially with ongoing ketones, it’s worth double checking a few other things:
- was a thyroid panel or T4 run?
- how was the IBD confirmed? Has there been any steroid use?
- Is Copernicus an indoor cat? (I assume parasites have been ruled out but always worth asking)

As for using R, I’ve used it in 3 cats and agree with everything Marje has written. It requires an experienced person to usher you through its use and can be dangerous if one is inexperienced or cavalier with it (I emphasize this in case there any lurkers). Even after 3 R cats (who all handled R differently, btw), I don’t feel comfortable guiding others. But I will give you an important bit of advice should you decide to use it. Put the bottle of R in a special container (such as an Amber pill bottle), especially if you are using a vial of Lantus rather than a pen. This is so you don’t so accidentally mix up the two insulins and draw from the wrong vial. You’d be surprised at how easy it is to make a mistake when sleep deprived (ask me how I know).

 

[CopernicusDM]

He doesn't have anymore weight to lose. He's 8.4 and dropping. My husband thinks he's stopped fighting. I will need to go back and look if T4 is was done. I know I asked at the time but we found the diabetes and I never circled back. No endoscopy. Just inflammation on ultrasound. Gosh I hope it's not lymphoma. I was going to schedule a biopsy but sadly I put it off. Indoor cat only. I'll add parasite check to my list. I am not using R and I just learned about it tonight on this thread. I don't feel comfortable as I am just getting the hang of the Lantus. But I will learn it if it mean saving his life.

 

[JL and Chip]

A appetite and eating is good. They can look and act very poorly when diagnosed, especially with ketones or DKA in the mix. But the desire to eat is a very positive sign.

How is he mentally? Is he reacting to you, moving around, grooming, purring, getting himself to the litter box? It’s hard to be patient when they look so rough. Cats are tough and have amazing healing abilities. Sometimes it truly is the end of the road, but many, many times with the proper dosing and treatment, some time to recover, we see them bounce back.

Also, did they check for a UTI or other infection? UTIs are common in diabetics. Dental issues can also be a culprit. Any type of infection can make ketones harder to wrangle.

 

[CopernicusDM]

He mostly lays on the hard floor. Gets up to eat and gets himself to the litter box. He doesn't always respond. Sleeps very deeply now with third eyelids out. Little grooming. He did not have a UTI at diagnosis. I asked ER to check his teeth and they didn't see an infection but he's never had a dental. My dad and I also think something is being missed to make him this unstable. I was told he would need X-rays to confirm dental infection it he can't go under anesthesia right now. Correct? I don't think they took the dental thing too serious but I had a previous cat that a dental issue was overlooked. I guess my husband wants to know how long this can go on bc he thinks he's suffering. A month seems like a long time to have ketones.

 

[Marje and Gracie]

He doesn't have anymore weight to lose. He's 8.4 and dropping. My husband thinks he's stopped fighting. I will need to go back and look if T4 is was done. I know I asked at the time but we found the diabetes and I never circled back. No endoscopy. Just inflammation on ultrasound. Gosh I hope it's not lymphoma. I was going to schedule a biopsy but sadly I put it off. Indoor cat only. I'll add parasite check to my list. I am not using R and I just learned about it tonight on this thread. I don't feel comfortable as I am just getting the hang of the Lantus. But I will learn it if it mean saving his life.

If they check his thyroid, they need to do a total and free T4.

Inflammation is not so indicative of IBD as intestinal thickening. Inflammation can be caused by infection. Diagnosis of IBD and/or lymphoma requires anesthesia. I would put that at the bottom of my list right now.

Did anyone run a superchem/cbc as with DKA, his electrolytes will be off (potassium, magnesium, phosphorus) as will blood pH and bicarbonate. I’m just wondering if there isn’t a different ER better equipped to treat him. The IV fluid type might need to be changed from time to time depending on what the kitty needs. I’m wondering if that’s why his ketones didn’t come down on IV fluids…perhaps they weren’t using the correct ones?

If he were to have DKA, there is an infection somewhere. Correct that they can’t tell much about dental issues without X-rays which require sedation.

Certainly these high numbers are going to make him feel horrible. I feel very sad for you both as it seems the vets are letting you down by not treating him as he needs.

Does he have cerenia and ondansetron to control nausea and vomiting? Is he getting enough calories?

 

[JL and Chip]

It’s very possible that something is being missed. Exactly ”what” is always the million dollar question.

Does he have any symptoms with IBD or was the diagnosis based primarily on imaging? What does his feces look like (color, consistency, etc)? Has a GI panel been run? One option that can be telling is to send blood to Texas A&M for a GI panel. That tests for pancreatitis, EPI, and folate and cobalamin levels.

Just thinking outside the box here — I had a ketone-prone cat too and I also think there was more going on than the vets ever identified.

 

[CopernicusDM]

I have always told his vets that he swallows hard. I got a video. He also always regurgitates (not vomits). It's quick after he eats. So he's had X-rays and ultrasound and novel protein but never a biopsy. The swallowing hard has progressed. Stool is normal imo. GI panel showed pancreatitis that later I was told resolved. B12 normal. Let me post some of his labs tomorrow...

 

[CopernicusDM]

If they check his thyroid, they need to do a total and free T4.

Inflammation is not so indicative of IBD as intestinal thickening. Inflammation can be caused by infection. Diagnosis of IBD and/or lymphoma requires anesthesia. I would put that at the bottom of my list right now.

Did anyone run a superchem/cbc as with DKA, his electrolytes will be off (potassium, magnesium, phosphorus) as will blood pH and bicarbonate. I’m just wondering if there isn’t a different ER better equipped to treat him. The IV fluid type might need to be changed from time to time depending on what the kitty needs. I’m wondering if that’s why his ketones didn’t come down on IV fluids…perhaps they weren’t using the correct ones?

If he were to have DKA, there is an infection somewhere. Correct that they can’t tell much about dental issues without X-rays which require sedation.

Certainly these high numbers are going to make him feel horrible. I feel very sad for you both as it seems the vets are letting you down by not treating him as he needs.

Does he have cerenia and ondansetron to control nausea and vomiting? Is he getting enough calories?

If they check his thyroid, they need to do a total and free T4.

Inflammation is not so indicative of IBD as intestinal thickening. Inflammation can be caused by infection. Diagnosis of IBD and/or lymphoma requires anesthesia. I would put that at the bottom of my list right now.

Did anyone run a superchem/cbc as with DKA, his electrolytes will be off (potassium, magnesium, phosphorus) as will blood pH and bicarbonate. I’m just wondering if there isn’t a different ER better equipped to treat him. The IV fluid type might need to be changed from time to time depending on what the kitty needs. I’m wondering if that’s why his ketones didn’t come down on IV fluids…perhaps they weren’t using the correct ones?

If he were to have DKA, there is an infection somewhere. Correct that they can’t tell much about dental issues without X-rays which require sedation.

Certainly these high numbers are going to make him feel horrible. I feel very sad for you both as it seems the vets are letting you down by not treating him as he needs.

Does he have cerenia and ondansetron to control nausea and vomiting? Is he getting enough calories?

Ok. I am taking him to a vet school tomorrow for another opinion. He did have electrolyte imbalance and ER had to tinker with his phosphorous mostly. At the time of his diagnosis (4/10/26), his pH was normal so he was DK without the A. Yes, I recently got Cerenia and zofran from a primary vet. Talk to me about calories?. I'm just feeding him and it seems like all the time and he's still losing weight. So my guess is not enough calories. Tonight ketones were 3.3 and BG 409 at +5 after his shot. I had a beautiful curve one day on 2.5 units. Otherwise, he remains in the high 300s and 400s. Food is high protein pork, pork loin, pork broth, and freeze dried chx treats.

 

[Marje and Gracie]

Ok. I am taking him to a vet school tomorrow for another opinion. He did have electrolyte imbalance and ER had to tinker with his phosphorous mostly. At the time of his diagnosis (4/10/26), his pH was normal so he was DK without the A. Yes, I recently got Cerenia and zofran from a primary vet. Talk to me about calories?. I'm just feeding him and it seems like all the time and he's still losing weight. So my guess is not enough calories. Tonight ketones were 3.3 and BG 409 at +5 after his shot. I had a beautiful curve one day on 2.5 units. Otherwise, he remains in the high 300s and 400s. Food is high protein pork, pork loin, pork broth, and freeze dried chx treats.

In my post 13 above, I discussed food:

“Right now, I’d try and get some Hills a/d or some Recovery. They have higher carbs but also more calories so if you can only feed him a small amount, you want to get as many calories in him each time as you can.”

It’s good his ketones are down but they are still too high.

I don’t know what you mean when you say he has “DK without the A”. DKA is diabetic ketoacidosis. You can’t really separate that out. Are you saying he has ketones but not DKA?

I still think he needs fluids. I am working with another member whose cat had high ketones and she’s giving him 100 mls subq fluids a day, 1.5x his normal calories, and we are fast tracking his dose up and he’s doing so much better.

I hope you can get him in soon.

 

[JL and Chip]

He did have electrolyte imbalance and ER had to tinker with his phosphorous mostly

Phosphorous or potassium?

Good luck with your visit to the vet school. I hope you find some answers. Please let us know what happens.

 

[CopernicusDM]

In my post 13 above, I discussed food:

“Right now, I’d try and get some Hills a/d or some Recovery. They have higher carbs but also more calories so if you can only feed him a small amount, you want to get as many calories in him each time as you can.”

It’s good his ketones are down but they are still too high.

I don’t know what you mean when you say he has “DK without the A”. DKA is diabetic ketoacidosis. You can’t really separate that out. Are you saying he has ketones but not DKA?

I still think he needs fluids. I am working with another member whose cat had high ketones and she’s giving him 100 mls subq fluids a day, 1.5x his normal calories, and we are fast tracking his dose up and he’s doing so much better.

I hope you can get him in soon.

I saw your note about a/d and it's on my list to ask for a Rx. Thank you. To clarify, the vets didn't specify how many calories he needs or how to calculate his calories. So I guess I should have been keeping track but it's one more thing I have not been doing. And yes he had high ketones and electrolyte imbalances, but pH was normal. It was described to me he has "DK without the A"

 

[Staci & Ivy]

I saw your note about a/d and it's on my list to ask for a Rx. Thank you. To clarify, the vets didn't specify how many calories he needs or how to calculate his calories. So I guess I should have been keeping track but it's one more thing I have not been doing. And yes he had high ketones and electrolyte imbalances, but pH was normal. It was described to me he has "DK without the A"

The vet hospital will probably have the recovery food you can buy done cans.
I believe Chewy has it and you can order (need a prescription to be sent by the vet).
I bought some cans at my local Petco (which has a vet hospital attached, I brought a hard copy script and they keep on file so I can purchase from them too).
(Get a hard copy script today in case you need it locally, add to your list!)

Good luck today!

 

[Marje and Gracie]

I saw your note about a/d and it's on my list to ask for a Rx. Thank you. To clarify, the vets didn't specify how many calories he needs or how to calculate his calories. So I guess I should have been keeping track but it's one more thing I have not been doing. And yes he had high ketones and electrolyte imbalances, but pH was normal. It was described to me he has "DK without the A"

There is no such thing. Either he had just high ketones and no DKA or he had DKA. At early stages or in some situations, the blood pH might still be normal but the cat can still have DKA.

Typically a cat needs 20-25 calories per pound of body weight. That doesn’t take into account activity level. I have another source that better defines it so I’ll look for that. If you can buy a cat scale (Amazon), you can better monitor his weight. Also, if you can estimate how many calories he eats when he’s well, start there and try to increase to 1.5x that.

Edited to add: I looked up my other source for calories but it was just for amount of balanced raw food to feed which is what I feed to it wouldn’t apply here.

I really hope he can be seen today.