11/11 B the C - in the hospital for ketones

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kotek

Member Since 2011
Here is yesterday's condo with the backstory: B's condo from 11/10

If you were with us yesterday, please be sure to read my last post on yesterday's condo expressing my gratitude for all of your tremendous help and support.

I had an update on B this morning, but her bloodwork wasn't back yet. They did do an initial electrolyte check and this was looking okay, although they said it could shift once she started on the fast-acting. Their non-differentiation between high ketones vs DKA stance seemed a bit odd -- they considered her DKA even though she wasn't acidotic? Because the approach to treatment is the same? That part didn't make sense to me, maybe it will to one of you.

So they put her on IV fluids, waited for her to get re-hydrated a bit before starting insulin on a drip, and are giving her dextrose to balance out her BG as needed. Her BG wasn't too high -- the low 500s. The hadn't re-checked her ketones as they said they only do this every 12 hours. She is apparently still quite bright and responsive. I did remember to bring a used t-shirt for her. :smile:

As for feeding, I pressed hard on their getting calories into her, although they were very reluctant. Cats don't respond well to being force-fed, can develop a food aversion etc. I had to insist that she had been fed (assist fed, I like better than force fed) at the regular vet's and did fine on that -- better than when she wasn't at the other emerg. They agreed reluctantly. They gave her food and she ate on her own, but she was throwing up so they've taken it away for now. I will be monitoring this closely. After they've confirmed her liver values are okay, they are going to give her Cerenia for anti-nausea, which apparently doesn't have too many side effects although I haven't researched it yet. (She was on metochlopramide last DKA, but it made her really speedy/anxious).

I will make sure they check for infections -- thanks Sienne and Marje. Definitely wondering what happened in the last couple of days to shift things. Maybe she has been constipated for a bit? Maybe just the high-ish BGs? Infection?

I also left some messages for the regular vet -- they are closed Sunday but check messages and have encouraged me to leave updates -- and she called me back (one of the reasons why they're awesome). She's good with everything emerg is doing for B, and advised that if B is stable tomorrow morning I should be able to shift her over to them safely. I am very much hoping for this because it will mean B is physically much closer to us, they will definitely get food into her, and I can likely bring her home at night (as they know I monitor closely). It will probably also be a bit less expensive than being in emerg. The only downside is I don't think they can give insulin on a drip, only IM...but that has worked before.

Incidentally, B's thyroid test came back and she is still within normal range.

So, that's the update. I am calming down a bit. As Sienne wisely noted, it's not like this treatment is particularly invasive or risky, and of course she will be better being treated than not. And happily we caught things before they were life-threatening. However, it has been a repeated string of crises since late August, which has been difficult. :YMSIGH:

As always, I welcome your thoughts and suggestions...and your keen expertise!
 
:YMHUG: :YMHUG: :YMHUG: Sorry to hear that B is having another crisis. Good work on getting her in the ER right away. Sending healing vines and white light for a speedy recovery.
 
I'm happy she is stable. You are a great mom!!! I hope you can move her closer to you and where you are most comfortable with her being. Sending many prayers that she will recover quickly and get back home.

oh...and the reason we want them to feed her is she can get hepatic lipidosis if she goes too long with a reduced number of calories. I am glad they are keeping an eye on those liver values. Metaclopramide is a gastric motility drug.
 
Wow! I don't have any experience in this arena, but I just wanted to send healing vines and big hugs to you! You are doing an amazing job with B! I hope she gets back on track quickly.
 
Thank you for the update. I've been on pins and needles.

In general, treatment for DKA and ketones is the same providing the electrolyte values are not out of whack. If the electrolyte values have shifted, they need to slowly titrate the potassium and phosphorus levels back to normal. This is a slow process since these are the values which make DKA so dangerous and the electrolytes need to be in balance.

Since the electrolytes were good, the basics of fluids, insulin, and food are the same. The need for insulin, along with constant monitoring to make sure the electrolytes don't head south, is, at least in part, what makes the hospital stay necessary. The vets will use a combination of long-acting and fast-acting insulin to bring levels down. The lower the BG, the less the risk for ketones. (However, ketones can develop even with lower numbers.)

Many vets will use metaclopramide (Reglan) for nausea or vomiting. It's not particularly good for that purpose unless the vomiting is due to a gastric motility problem. Many cats here will get Cerenia (maropitant) or Zofran (ondansatron) for nausea/vomiting. Either of these drugs are very effective for this purpose.

I hope everything remains stable and B is at your vet's office and home with you in the evenings by tomorrow. You did a great job.
 
Hi Kotek,

Very happy to hear that B is doing better. :smile: Sending prayers that will continue and that she will be able to come home soon.

To answer a question you asked at the end of yesterday's condo...
Yes, DH is shorthand for dear husband. Some people use "SO" for significant other, but you could compromise and say DSO if he's near and dear to your heart :-D

Looking forward to more news,
Carl
 
Hi Kotek, Happy and relieved B is doing better, sorry she has had another crisis. You are doing a terrific job watching over her and making sure she gets the right care, she could not be in better hands. Hope she can come home soon adn you and your DH/SO can relax and recover too. Sending you hugs :YMHUG: and healing vines cat_pet_icon
 
Hi - am sorry to read this, but glad that things are better. Mannie and I send many get better soon vines. I applaud you for your care of B - there could not be a better bean. Hugs to all.
 
Thanks everyone -- your good wishes mean a lot, and help tremendously.

I had a good visit with B a little while ago, and she seems to be doing okay. Definitely on the subdued side and not moving around a great deal, but with her head up and paying attention, and enjoying chin scratches (much better than her previous full-blown DKA). She ate a couple of tablespoons of food while I was there and kept it down, so that's great. Can't imagine she can be feeling great -- in addition to whatever the ketones might do, she's being poked at all the time, hasn't eaten much in the last day, and has always hated being at the vet.

The vet wasn't around, but is supposed to be calling me soon. The tech was unfortunately not super-helpful -- in regard to my questions about B's electrolytes the answer was that she was doing "about as expected". I pointed out there's no way I can know what that means (how do they expect her to be at this point? good? bad?), but still didn't get much information. It's okay -- I appreciate that it's not really the tech's job to interpret, that's for the vet to do. I think I mostly react to finding them a bit reluctant in general to give information, or somewhat surprised (irritated?) at my questions/need for information. The clinic seems extremely competent but it's not my favourite -- it's large, busy and impersonal...I guess like most ERs!

They are supplementing her with potassium, but I'm not quite sure what that means as she was on potassium at home as well. They hadn't managed to get another ketone test, which was disappointing. Same with her blood work which was not back -- it's Remembrance Day here (holiday to honour veterans) so they thought that might be slowing things down.

That's about it for now. I am exhausted, but feel much less panicky -- and all of your support has helped this a lot! Going to try and get a good night's sleep tonight, and still hoping she'll be stable enough to transfer to our regular vet tomorrow morning.
 
I think this is my first visit to your condo, but I just had to stop by and offer many healing vines for B...I hope she is home with you soon!!!
 
(((Kotek)))). Thank you for updating us. I'm glad she ate. Try to get some rest and hopefully you can talk to the vet tomorrow and get more answers.
 
If you run into problems with lack of information from a tech in the future, just ask for a copy of her lab results, and post them here. There are many people who post here who can look at those results and translate them to plain english.
Best to you and B,
Carl
 
I hope you get a chance to speak with the vet sooner rather than later. I'd ask about the potassium like you planned. I'd also suggest you ask if B's phosphorus levels are off. If both electrolytes need to be titrated, then you need to ask if this is DKA. They may need to be supplementing with potassium due to giving fluids.

In any event, I hope B continues to make good progress and is home with you soon.
 
Okay, not in bed yet (!) but going there next. First, wanted to share my talk with the vet.

She said B is doing quite well. She has been eating well tonight and keeping it down and is pretty stable. She said the electrolytes are looking fine. They had to give potassium but not all day, and her phosphorous is actually a bit high (normal for CKD) and they are expecting it may come down a little. But overall, the balance is okay.

They still hadn't got a ketone test because B is defaulting to peeing on her blanket instead of in the litter box. But the vet will either do that bladder compression thing or go in with a needle tonight so they can get a check. If her ketones are gone, the vet said all we need to do is transition B back onto the long acting insulin/Lantus (they only have her on the fast). She has no concerns about transferring B to the regular vet tomorrow -- yay! So unless something dramatically changes overnight we should be good.

There are no signs of an infection, although they didn't do a urine culture and sensitivity. They already have her on an antibiotic in case (Ampacyllin) so it's kind of academic at this point (although they have a sample they could send in if I want, I'm not sure it's worth it). She also said B's teeth could use some work so there could be a mild infection there. That's much trickier, since a dental would require anesthesia and her heart murmur is counterindicative of this. She suggested I speak to my regular vet about options there. Hmm.

Nothing too much to report in bloodwork. Her kidney values are a bit high, which is to be expected -- but her creatinine was actually only 294 (I think in US that's 3.3?), which isn't bad at all. This would also suggest her kidney infection hasn't returned -- her kidney values were much higher at that point (506/5.7). She is still anemic, although I forgot to write down the hemocrit number -- I will get copies of the labs when I pick her up. I need to do a bit more research on the anaemia, as I think it isn't helping things...and if it is contributing to the heart murmur then addressing the anemia would help a lot in general. Anyone have any expertise on this?

But overall things seem pretty good. They're going to call in the morning and the plan is for me to go in and pick B up and bring her to the regular vet's. Then hopefully home tomorrow night!

Sienne, I really appreciate your keen eye, and am awed by the scope of your knowledge. Thanks for helping me understand better, and for the great help with the kinds of questions I should be asking!

As always, suggestions welcome. If anyone would like to see the bloodwork I'd be happy to post it. Whether I can convert it all into US numbers could be another story though! :smile:

I will say it again and again -- I am grateful for your help and support!
 
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