? 4/9/17 Sprocket AMPS 417, 3.25u, +2.5/301, +7/209.PMPS/247, +2/316.Ketones, UTI, ear infection

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I wonder what +2 ketones on the urinalysis means?
I hope it's +2 in mg/dL and not +2 in mmol/L.
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Darnell & Sprocket said:
I didnt know it posted twice.
I syrnged him famotidine then he threw up 5 mins later.
I have cerenia here.
Click to expand...
I would try Cerenia instead.
Does Sprocket vomit white foam/or food liquid with white foam?
If yes, then it is acid related and Fam is appropriate I was told.
If not then I would give Cerenia a try.
I cancelled Fam for Ducia since there was to foam in her vomit.
Please run this by experts on the Forum
Ducia takes 1/4 pill of Cerenia every 24 hours. But don't know the proper dosage for Sprocket.
 
You're home now?

I need to sign off soon, but I'm still questioning the vet's instructions not to feed until 5pm-- I feel like something must have gotten lost in translation, it's really important that Sprocket be eating small meals of whatever you can get him to eat.
 
Also, when you get a chance, please update the spreadsheet-- especially with this starting to be a long thread, it will make it easier for any new people to jump in and see what is going on.

How are you and Sprocket doing?
 
Thanks Nan for remembering what I said.

I'm glad you have confirmation now of the other infection. I suspected there had to be more issues.
Unfortunately the convenia won't really fix that, it is for bacterial skin infections. Vets like the injectable solution especially trying not to pill cats.
Doxycycline would have been a better choice for a uti. Clavamox makes kitties tummys feel worse. ( altho' some cats do tolerate it)


I would call that vet back and ask for a prescription for the ondansetron to address the nausea. ( take the prescription to a human pharmacy)
and while you are out, grab some kitty milk and baby food ( if sprocket likes those)
The other thing that can help with nausea but not bg numbers, is to boil some rice and see if he'll drink a little of the cloudy rice water.
It might help settle his stomach. It's just a carb though and might raise numbers but eating is more important right now.
That's why you need a good nausea medication.
Cats that are nauseous just don't want to eat, even when they are really hungry.
 
Update: he had 1.75oz wet in 2 feedings with probiotic capsule powder & fortiflora. Had a nap.

Usually famotidine is good for him.
What's the difference between the anti nausea meds?

I posted the lab results above.
& vet notes.

He has some bacteria in his urine.
He has had soupy poopy on n off but when not soupy it was soft. He did scoot on rug too to clean up something stuck.
Sure that didn't help.

Now that this has happened. Will his dose change since we are not sure how much he will eat?
Or if his bg will be lower cause he hasn't eaten much today.
And if it is,& I shoot same dose, if he goes low later. What if he won't eat the food?
 
Will he eat treats or even dry food? It's better if you are able to shoot the full dose (within reason - depends on the blood sugars) or just a slightly reduced dose (3/4 or so of normal). Skipping doses like the vet recommend is a sure fire way to end up back at the ER. If he is only eating a little bit at a time, you can add something higher carb (honey, dry food, treats) to each meal so it raises BS so you can give the insulin. It's important that you monitor the sugars really closely, as your kitty likes to give you hypo surprises.

The diarrhea is probably preventing him for absorbing calories as well. And if it was a GI infection from the longer term use of antibiotics, this could also prevent him from recovering. Generally, when they are having issues with diarrhea when getting ABX, they should be getting metronidozole (flagyl) as well to address the GI infection/dysbiosis. +2 ketones is Moderate. Cats usually have a lot of nausea by the time they have moderate ketones. And the ketones have increased since the home test. This is worrisome. You need ondansetron or cerina (anti-nausea) medications to help eating. Anti-acids like famotidine don't help this kind of nausea because it occurs in the brain (not from acid in the GI tract). Cyproheptadine is an appetite stimulant and is more for long-term anorexia, rather than short term nausea.
 
Also his potassium is on the lower side of the range (not dangerously so) you may want to ask about supplementation.
 
When he has not been nauseous, he wants to eat with appetite stim. Before I had cut the dose in half but after last ER we went back up. The cerenia didn't seem like enough with antibiotic for nausea. As soon as I started famotidine he was better to eat. It seems to help with antibiotic but he has to take it.
Antibiotic seems to be causing the issues with diarrhea in first place. I wonder if he really needs that one anymore.
Usually he will eat the zero or evo dry but been trying not to give u less he needs it for keeping bg up or if its most of what he will eat like when he was at ER.

So will I be able to get rid of ketones with fluids every day but more than 100ml?
Or what else?
Bg in a few mins
 
I want to offer some suggestions on the diarrhea/gut concerns that might help Sprocket. There is an excellent post on IBD kitties here that gives directions for giving probiotics to cats. It also has a section on Saccharomyces Boulardii, a beneficial yeast.

The link is good and I'd encourage you to read it. The short version of it is that you can buy S. Boulardii at a local health food store, or a section of a regular store if they have supplements - it's very common - and you can give it every 2 hours to stop diarrhea in a cat. It is a "non-colonizing" yeast, meaning that it works when you give it but it doesn't grow in the cat's gut, so if you stop giving it the effects are over. There are some cats that are sensitive to yeast, so if it increases diarrhea stop giving it. We've had good luck with it, however. You can open the capsule and mix it with food.

Here is a bit on probiotics and S. Boulardii that I just wrote last night for Bronx's Dad here.
I saw your question here in Chuck's condo from yesterday, and rather than bump up the old thread thought I'd answer here. Here are some links below from the "Where Can I Find?" thread about digestive woes. I was the person who told StephG about the S. Boulardii. I have a civvie, McGee, a short-haired tuxedo cat about 4 years old. He was vomiting pretty much daily and I assumed it was hairballs. He was also extremely constipated. Always. Then Wendy and Marje shared the links below about chronic vomiting and probiotics.

I started McGee on probiotics. We bought the Renew Ultimate Colon Care (90,000 colony forming units) - I took 1 capsule and divided it up among my 3 cats each day. I gradually increased the amount, focusing on just McGee and Anya (another civvie who used to have chronic diarrhea) until McGee was getting one capsule alone, each day. I open up the capsules and mix with his food. He got that therapeutic dose (1 capsule per day) for 2 months, then I gradually decreased it. Now he gets 1 30,000 CFU (still Renew Ultimate brand) daily as a maintenance dose. I've noticed if I miss a day or two he'll vomit. If I get it to him daily, no vomit. He must have slow gut motility - causing both the vomiting and the constipation. It's been an amazing transformation.

He also gets a pinch of ground flaxseed (people quality) every day - the amount also was started very small, just a few grains, then increased until it seems to be the right amount to have pretty well eliminated the constipation. It's less than a measurable amount, but I worked up to it and recognize it as the right amount. The amount I can pinch - I'm sure it's less than 1/8 tsp.

I buy the probiotics at a local health-food type store, but I've seen Renew Ultimate at lots of stores and online. I also bought S. Boulardii - as I told Steph, my youngest daughter has been on multiple antibiotics simultaneously for 2 years because she has Lyme disease. She had one bout of C. Diff, but then we discovered S. Boulardii and since then (more than 1 year since the C. Diff) she hasn't had any recurrences of c. diff. Once you've had it you are more likely to have it again, but the S. Boulardii has prevented it. The stuff is a miracle in the Lyme world because it is so hard to be able to take continuous antibiotics. Anyway, there are "stop diarrhea" directions on the link about probiotics in IBD cats. Wish I'd known of it when Punkin got c. diff after taking Clindamycin for a post-dental infection. We buy Jarrow brand.

Digestive Problems:
Constipation, Maggie11 & Ann; Feline Constipation
Hairballs/Chronic Vomiting
Probiotics in IBD (or other) cats
Hairballs/Chronic Vomiting
Probiotics in IBD (or other) cats
Antacids (Pepcid)

Anyway, hope some of that helps answer your question and gives one example of how to use it in a cat. The Probiotics in IBD cats link has directions as well.
Click to expand...

Also, I would reconsider giving Fortiflora - or at least give a look at this link regarding its ingredients. We used to give it a lot but since I read this post I switched to human probiotics. If I wanted to use it as an appetite-stimulant, I'd smash up some dry food (or freeze dried meat) and use those as a topper instead of Fortiflora.

Sending you a lot of virtual support. I sure hope Sprocket feels better soon. We've had good luck with Cerenia.​
 
Just saw your question about dose.

I would stay at 3.25u - my reasoning: he's on the rise from the nadir of this cycle, with ketones present you want to get as much insulin in him as is safely possible, and you are awesome at monitoring him.
 
I didn't see an answer to what to do if he won't eat and his numbers drop.
you can always rub honey on his gums, tongue, or even use your finger with honey on it , and rub it into his anus. ( that's what you would do if you
were on the way to the E.R.)
 
Don't fret about too low of carbs right now. You want to give him enough insulin to keep the ketones down. Getting ketones to go down isn't about getting blood sugar down, it's more about getting insulin in there so he is able to absorb the food and stop burning his fat for fuel. So although it seems counter-intuitive, sometimes, we have to add carbs in order to give the larger doses of insulin without fear of hypo. You can mix dry food with water to make a "soup" and help with hydration. You can even syringe wet food mixed with honey every 1-2 hours if he starts to go low. Because you cat is still having issues with ketones, it indicates that the insulin dose is not quite high enough to normalize the metabolism. I agree give 3.25 if you can monitor closely.

The subQ fluids can help with flushing out the ketones as well and preventing dehydration, however, in a cat with cardiac issues (murmur) I would used carefully per vet recommendation as sometimes you can cause swelling and fluid in the lungs if too much fluids are given and the heart/kidneys can't handle it.
 
Uggg!! I can't win! I am not good at monitoring exactly. I am a mess!! I can do the bg test now but he is getting not so patient with that. After when he goes into 100s it freaks me out!
One doc said years ago he had a heart murmur then she said that for all 5 cats. Other vets listened and agreed to he didn't. This is first vet in 4 years to say it so idk exactly. He was purring at same time too.

I gave 3 units. I am afraid to do 3.25 cause he hasn't eaten alot, has not had appetite stim, no guarantee he will continue eating if his bg goes down early to give more food. Tummy tender. Plus I am not calm to do the balance at under 100 bg.
I know he needs insulin to reduce ketones but if he stayed in mid 100s for a low, wouldn't that still be ok?
I can't syringe him with no help. He won't take it. He freaks out big time! He was abused as baby so he doesn't like to be held down.
So TR is not good for him.
I am alone at home most of time. I have 3 friends that know how to help with subq fluids but 1 he is iffy with.
So I can't just syringe feed him.
This dose decision is so insanely scary to me. I don't want too little or too much.
For 8 days he stayed steady with numbers but he didn't have enough insulin or food so now he has more insulin and food but now has infection.
So ain't I doing something right?
 
(((Darnell))))

You are doing MANY things right! Sprocket is SO lucky to have you helping him!!

You're being given a ton of information and some of us are contradicting others. It can be very difficult in your shoes, to figure out whose advice is best to follow. I can say that if my cat were in Sprocket's place, I would want Meya helping me. She works with adult diabetic patients and has helped many of our DKA/ketone kitties get better. I never dealt with ketones with punkin, so don't have that experience. When a cat develops ketones, they are metabolizing differently than normal. The reason for more insulin is to change that cycle and return it to normal. I'll let others explain that better than I can.

See how he does tonight and you may want to go back to 3.25u in the morning. Don't reshoot anything now - just let it go.
 
Darnell, you're doing great! This is a very stressful situation, and you are hanging in there!

I think we haven't quite figured out where the infection(s) are coming from, although I do think it's possible that something has been hanging out at low levels with occasional flares the whole time. I hope the latest round of antibiotics is effective, but please read Rhiannon's posts above when you get a chance about different antibiotics and their uses. It may be as simple as just that you haven't been prescribed the right antibiotic yet.

I agree with Meya about just feeding him anything he's willing to eat at this point-- find something that he finds tasty even when he's feeling a little yucky, and don't worry about things like carbs. Dry food, baby food, treats, tuna, deli meat-- it's all on the table for the moment! What's really good is that he's still eating something, so you just have to get him to keep it up.

Adding, because Julie+Punkin just posted, I will second the recommendation to follow Meya's advice, 100%. If ever one of the rest of us says something that seems to contradict what she's saying, go with her take.
 
I can't make a decision for myself. This is driving me nuts!
I have never been so stressed in my life. So many opinions. Then I feel guilty when I chose wrong! But I cant handle going so close to low. But he keeps getting something so he won't stay steady.
It takes so long for these posts to go through. Its hard to post, wait, give meds, feed, read& figure out who to listen to. Plus typing that I can barely type proper words so it takes longer.
All within a half hour from bg to shooting.
Fb pm is faster currently. So if someone can do that so it takes away a few steps for the short timeframe would be great.

I am losig my mind. I feel like I am killing him.
 
I know that you are overwhelmed, and I wanted to tell you that you are doing a fine job. It's just a very complicated health situation that you are in right now. For right now, don't stress too much about TR or protocols and all that. Those are really for well cats, not sick cats, so it's not worth stressing about. Also, don't feel bad about going with your gut at times. You know your schedule and abilities best, and you gotta do what you gotta do.

Having DKA resolve and come back is common, and it simply means that something is not right with either the insulin dose, the food situation, or there is an underlying illness that needs to be dealt with. So we can help you work on all those things. DKA happens a lot to diabetic cats unfortunately. We've had many recover and were just fine after they figured out the feeding/insulin/illness issues. It takes a good 2 weeks at least to recover, so hang in there.

As I mentioned in my post on the thread earlier, the more insulin you are able to get in him safely, the better. To do this, you can increase carbs to raise blood sugars. In people with DKA, we actually give them an IV of sugar water, and insulin. We basically put sugar directly into their veins so that we can give larger amounts of insulin. You may have to ask the vet for more anti-nausea and a medication called flagyl if the diarrhea continues. Feed anything that your cat will eat. Doesn't matter what really. What matters is getting the insulin in, trying to increase it slightly if we can, and getting those infections gone.
 
well....
let's breathe.

you are doing great.
as long as his numbers are above 50. He's not too low.

Keep exploring for things he might eat, even if it isn't diabetic friendly.
If he'll eat a piece of bread, that's calories..... and that will also keep him from going low.
 
I would aim for about 12% at the moment, but if he's not eating that well, just give him anything. Set out dishes of all kinds of food, wet, dry, temptations treats (ie. kitty crack), etc.
 
So what do I do for dose in am? I am on eastern standard time. Western Massachusetts.
If I feed higher carb then give what dose?

Everyone is saying feed low carb so why the higher? Just to get more insulin in?
For how long?

Here is where confusion comes in...
Should feed low carb to get right dosage. So I do that now & he keeps getting ketones.
I been feeding him @400-500 calories under 5% carbs. 4-5 cans of fancy feast .
He was eating alot of gravy before this all happened.
So do I just feed med carb for a few weeks to get him out of danger?
Or is that how to regulate for him since he is now so ketone prone?
 
I would test about 2 hours before the test time. If under 250, then feed a highcarb meal at 2 hours before test time. Then check again at test time. If over 250, give 3.25U and monitor closely. If under 250 at test time (200-250), if you are able to feed another round of high carb then give 3.25, if he won't eat more, then continue with 3U. If he is below 200 at test time, ask here what you should do.

Ideally, we want to stick with 3.25 or even get up to 3.5. So use the food to get to a comfortable blood sugar level so that you can give it and not worry.

Low blood sugar is only dangerous when you start to get below 60-80. So you have a lot of wiggle room. Ideally, we want to see DKA kitties in the 150-250 range at all times. The range is different for healthy cats because we need that wiggle room and higher sugars for safety in DKA.

Try to get another ketone test tonight if you can (or did you already?) and get one tomorrow AM if possible.
 
Ya. I just got a ketone test and it says negative. So not sure if the strips are working well.
He peed like a long time too. I wish I had timed him. I swear it was like a minute he was peeing.
Although tonight I noticed he was sitting peeing and last couple of days he was peeing a little vertical. I wonder if that makes a difference?

So this procedure you wrote here. Is that forever? Or just to get him under control for awhile to allow his body to heal from ketones?
 
This is only for your AM dose for tomorrow. There are too many variables going on right now that it's really day by day.
 
Hang in there, Darnell. Things are harder and different now because of the ketones. You're on the right track to getting him better. I'm celebrating the negative ketone test tonight!

We can't give any advice via personal messages, either on Facebook or here on FDMB. It's a rule for the safety of the cat and the protection of the person giving advice. Advice has to be given in public view so that anyone can see it. No one would want to make a mistake and hurt a cat because of it, and one can lose their membership here on FDMB if they violate that rule.

There are a couple of features that might be helpful to you though:

1. On this page, at the top right, there is a little spot that says "Watch Thread." If you click on that, you can choose to get emails whenever anyone replies.

2. Somewhere at the top of the page, near the website address, is an icon that looks like an almost complete circle with an arrow on it. That is a refresh button. It will reload the page you are on and if there are answers, they will show up. I have a little Asus netbook, so if you have an Apple it will no doubt be in a different spot, but I think the symbol will be the same.

Hope you can get a good night's sleep!
 
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