1/1/20 Radar - not feeling well - left him at ER for IV fluids

Jan Radar (GA)

Jan Radar (GA)

Member Since 2015
yesterday's post

Yesterday afternoon and last night Radar was much more reluctant to eat than normal - even for him. When we assist feed him he usually will accept 7-12 units of food in a session. But last night he wouldn't tolerate any more than 3 units. It was really hard to get any food into him and I know that he wasn't getting very much water either. I monitored him all night and even tried to feed him a few times in the night and his condition really didn't change. He peed in the LB a couple of times but there was no poop. He didn't look good at all this morning... So we decided to take him to the ER thinking that waiting 24 hours to see his regular vet was just too long to get help for him.

They told us that he was severely dehydrated and needed to stay overnight so they could give him iv fluids and monitor him closely. The ER vet saw his high insulin dose and my spreadsheet numbers and informed us that she was lowering his dose to 5 units because he's hypoglycemic. She went on to tell me that a human meter is inaccurate and suggested that this is why Radar is ill. I knew she was using her knowledge of a pet meter scale and that's why she concluded that the dose was taking him too low. She didn't listen when I tried to explain so I smiled, paid the bill and requested that Radar's care be transferred to his regular vet as soon as possible.

The ER vet said that his kidney values are elevated and indicate he's in Kidney failure. :nailbiting: He had complete blood work done not too long ago and the regular vet said everything looked good for a cat of his age, although of course that could have changed. I have a copy of the blood gas, electrolytes and metabolic tests they did today but none of it really makes any sense to me.

Ketones: <0.1
Crea: 2.64 (0.5 - 1.90 is the range) - flagged as high
Glu: 441 (63-133 is range) - flagged as high
mTCO2: 25.1 ( 16-25 is the range) - flagged as high

BUN: 24 (15-32 is the range) Ca++ : 1.27 (1.21-1.51)
Lact 1.51 Cl: 114 (111-128)
AGapK: 14 (9-26 is the range) K+: 3.9 (3.6-5.6)
Na+: 148 (148-163) BE(ecf): -1.2 (-5.0-2.0)
ph: 7.342 (7.250-7.430) pO2: 29.4 (27-50)
o2SAT 51.9% (50-80) pCO2: 45.3 (31-51)
HCO3-act: 24.5 (15-27)


@Marje and Gracie - if you have a moment could you tell me what you think? They will test him again in the morning after he's gotten all his iv fluids but I'd love to know something sooner rather than later, if it's at all possible.
 
Any chance of getting all those lab numbers transferred to the labs page of the spreadsheet? Did they do urinalysis? Would be interesting to see a urine specific gravity, been over a year since the last one.

Kidney disease is different from kidney failure. Cats can have kidney disease for years.

Sending healing and feel better vines for Radar. These are for you Jan. :bighug:
 
I'm sorry to hear Radar isn't feeling well! I'm glad you asked to transfer his care to your regular vet - that vet doesn't sound like she's open to learning anything about FD except what she already knows.

I hope Radar will feel better as soon as he gets some fluids on board. Sending vetty vines and prayers your way! :bighug::bighug:
 
Wendy&Neko said:
Any chance of getting all those lab numbers transferred to the labs page of the spreadsheet? Did they do urinalysis? Would be interesting to see a urine specific gravity, been over a year since the last one.

Kidney disease is different from kidney failure. Cats can have kidney disease for years.

Sending healing and feel better vines for Radar. These are for you Jan. :bighug:
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Thanks for the encouragement, Wendy. I am trying to put the information into the spreadsheet as I type this but I don't know what all those abbreviations mean and I don't want to put information into the wrong box... I'll do the best I can. I don't think they've done a urinalysis today. I know my vet has done one recently and I just haven't put it in the spreadsheet. Will work on getting the information up to date. :bookworm:
 
If the lab tab is correct, he hasn’t had labs in a year and things can really change. Having said that, ERs usually run in-house labs and IMHO, they don’t always run the ones you need to tell you what you need to know. For example, there can be reasons why the creatinine and BUN are elevated that don’t involve CKD but without a urinalysis or an SDMA, it is not definitive. I’m not saying he doesn’t have CKD because his kidney values are elevated. Some of the reasons he might have an elevated creatinine but not have CKD include pancreatitis, high blood pressure, kidney infection or kidney stones. Without a urinalysis, it’s hard to tell and once she gives him fluids, then it rather becomes a bit of a moot point because what you want to see is the urine specific gravity. Giving fluids will cause the USG to be lower than it might normally be. Heart disease can also cause the creatinine to be elevated.

They ran alot of blood gas values which really doesn’t tell you anything in regard to CKD. I’m sure they were looking for metabolic acidosis but his blood pH is normal and most of his blood gases are as well. The interesting thing I see is his oxygen saturation is really on the low end. Was he having any issues breathing?

I would ask them if it’s safe to give him fluids without knowing it there are any potential heart issues. When Gracie was in the ER, I had to tell them that I would draw and give her her insulin at the dose I wanted. That meant I had to be over there really early but it was worth it and then I told them exactly what times to test and when to call me. Because these ER clinics do not test as they should, it probably makes sense to back his dose down a little as you did by giving 6u. It’s so aggravating that they want to put the focus on his FD instead of where it really belongs.

I hope some of this helps. Many vines and hugs for you both.
 
FYI, dehydration can raise bun and creatinine too. I second Marje’s comment on checking his heart. And by the way, when I took Neko into the specialist that ended up with her CHF and lymphoma dual diagnosis, the vet was all worried about her BG and thought hypoing might be the issue. Months later when she ended up in the ER, I did the preshot tests and dosing. I did end up skipping once or twice because the ICU wasn’t testing enough for my comfort, or assist feeding to make sure she got enough food. Best be conservative in the ER, as long as no ketones.
 
Marje and Gracie said:
If the lab tab is correct, he hasn’t had labs in a year and things can really change. Having said that, ERs usually run in-house labs and IMHO, they don’t always run the ones you need to tell you what you need to know. For example, there can be reasons why the creatinine and BUN are elevated that don’t involve CKD but without a urinalysis or an SDMA, it is not definitive. I’m not saying he doesn’t have CKD because his kidney values are elevated. Some of the reasons he might have an elevated creatinine but not have CKD include pancreatitis, high blood pressure, kidney infection or kidney stones. Without a urinalysis, it’s hard to tell and once she gives him fluids, then it rather becomes a bit of a moot point because what you want to see is the urine specific gravity. Giving fluids will cause the USG to be lower than it might normally be. Heart disease can also cause the creatinine to be elevated.

They ran alot of blood gas values which really doesn’t tell you anything in regard to CKD. I’m sure they were looking for metabolic acidosis but his blood pH is normal and most of his blood gases are as well. The interesting thing I see is his oxygen saturation is really on the low end. Was he having any issues breathing?

I would ask them if it’s safe to give him fluids without knowing it there are any potential heart issues. When Gracie was in the ER, I had to tell them that I would draw and give her her insulin at the dose I wanted. That meant I had to be over there really early but it was worth it and then I told them exactly what times to test and when to call me. Because these ER clinics do not test as they should, it probably makes sense to back his dose down a little as you did by giving 6u. It’s so aggravating that they want to put the focus on his FD instead of where it really belongs.

I hope some of this helps. Many vines and hugs for you both.
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Thanks, Marje. I feel better just knowing that you are out there listening. :) I will know more tomorrow after we transfer Radar to our regular vet's care and will of course let you know whatever I find out.

Radar has had more recent blood work done but I'm sorry to say that I have not kept the ss labs tab up to date. I will get copies of the reports from the vet's office tomorrow and get the information updated so you can see it easily.
I wondered if that abbreviation meant oxygen saturation.... he was not having any obvious breathing distress. I did note when he was being tested and shot this morning that he was trying to purr as he often does during our morning routine, but his motor sounded like it just couldn't quite get going.
 
Jan Radar said:
Thanks, Marje. I feel better just knowing that you are out there listening. :) I will know more tomorrow after we transfer Radar to our regular vet's care and will of course let you know whatever I find out.

Radar has had more recent blood work done but I'm sorry to say that I have not kept the ss labs tab up to date. I will get copies of the reports from the vet's office tomorrow and get the information updated so you can see it easily.
I wondered if that abbreviation meant oxygen saturation.... he was not having any obvious breathing distress. I did note when he was being tested and shot this morning that he was trying to purr as he often does during our morning routine, but his motor sounded like it just couldn't quite get going.
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You’re welcome. Just tag me. Poor, sweet Radar. I’m sure he wants to be home with his parents.
 
Jan, Marje has a very good question. The main thing that got me to take into the specialist with Neko was her sudden drop off in appetite. Turns out heart issues also cause inappetance.
 
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