8/1 -- Miko AMPS 447 + 10 589 -- vomiting ?

Status
Not open for further replies.
S

Sarah & Miko

Member Since 2013
I mistakenly thought Miko was doing better today. We were out of the black for a minute and cruising. Got a negative ketone test in afternoon. Miko seemed to be eating and drinking less -- I was hoping he was feeling better, but in past hour or so he's vomited up probably all the food he ate today. I'm thinking he needs an emergency vet trip this evening.

I can't give him any insulin tonight, correct? Tried to get him some water but the smell of a treat I brought made him throw up again. This is breaking my heart.

I'm not sure if he's passed stool today or yesterday. I've been watching the box like a hawk but I keep missing the whodunnit moments.

Had to create a new profile because I was not able to remember or reset my PW on this site but links to previous condos: http://felinediabetesgroup.freeforums.n ... rollTo=157
viewtopic.php?f=9&t=101205
 
I wish I knew what to tell you Sarah, but I am too new :( Hope Miko is doing ok. When I get freaked out I usually PM someone I know has been doing this for a while if they are online. :)
 
If Miko is repeatedly vomiting, it's a trip to the vet. They will probably give him a shot of an anti-emetic (Cerenia or ondansatron/Zofran). Is there any chance he got into something -- a plant, string, etc?
 
Thank you, Janet and Sienne.

I don't think he got into anything. Maybe the high blood sugar is stressing his poor little body out. I've been at the emergency vet with him and having a mini blood panel and hopefully then some fluids. Still waiting. They were pushing to keep him overnight before even examining him but I think the stress will do more harm than good unless he developed ketones or something in the past few hours.

When I give him insulin tomorrow, will I give him the same dosage even though he's not getting any tonight?
 
Sarah

Yes..stick with your dose. When you get home, post. If he's better, we might still be able to get some insulin in him.

I'm thinking something more like pancreatitis?
 
They are going to keep him overnight :(. They said his mini panel was showing moderate ketones and they show up there before they show up in the urine. They are also going to try a short acting insulin on him to confirm that he's insulin resistant.
 
If he's got ketones, that's the best place for him. He needs fluids and he needs insulin. The R is a fast acting insulin that will, hopefully, bring his numbers down. Think of Lantus as a basal insulin and the R is a bolus to try and get the numbers down as you take up the basal insulin. It's pretty common that they will use R insulin for cats with ketones or DKA to get the BG down.

Ketones left unchecked can result in DKA. The recipe for DKA is infection + not enough insulin + not enough fluid. I'd ask them if they see any apparent source for infection.

This is why I wanted you to start to be more aggressive with the dosing. You were doing fine but we needed to step it up.

Sending prayers and healing vines. Please keep us posted. We are very knowledgable about ketones and DKA and can help you with questions to ask.
 
Thanks, Marje. They are running more bloodwork tonight. All they know now from his mini panel is that he showed trace to moderate ketones (as they described it) in his serum, that he is on the very low normal end of anemic, that he seems slightly lipidemic, and that his white blood cell count was elevated and his protein was high. Hopefully more will unveil. He may need to have some scans done tomorrow. She did say that 2/3 of insulin resistant cats have an underlying infection or issue. My vet had wanted to wait longer on insulin before looking for something underlying, but I'd much rather know now. I hope this helps get him on the road to health. The good news is that his murmur doesn't seem any worse. Thank you so much for explaining the R to me and for all your help. Please send my little Miko bean good juju :)
 
Lots of good juju coming his way.

How is he today? If you can get any labs and post them, we can offer thoughts and things you can ask the vet.
 
Thanks, Janet and Marge! They want to keep him another 24 hours and he's been moved into the care of one of the internists there. Fortunately it is an emergency and specialist hospital, and I was considering making an appointment with one of their internists before this happened anyway.

He's getting pancreas scans done today and more bloodwork and will stay on the short acting insulin. They were able to get his BG down to 334 at last reading which I think is a record low for him since diagnosis. I will definitely report back as I know more and try to get his bloodwork results posted up, too.

Just visited him a little bit ago and he looked terrified but better. They told me that 2/3 of insulin resistant cats have an underlying issue, so thank the great kitty gods in the sky they will help figure out if he does and what it might be.

Hugs and thanks to you.
 
{{hugs}}

That high white count could be infection, but don't let them do Convenia (injectable antibiotic for dermatologic purposes, used off label for anything else). Why? Because if he has a bad reaction to it, it'll be 7 days of h*ll on him.

And if they give him an oral antibiotic, about 2 hours later follow up with a probiotic (Ex FortiFlora, if he likes it) to replace the good bacteria being killed off by the antibiotic. Antibiotics are notorious for upsetting the GI tract and thats the last thing he needs. It may help him eat, too.
 
Jeez -- I just looked up Convenia, and it looks like the most horrific thing ever. Makes me angry it's still in use. They gave him injectable Ampicillin.

Pending blood work will confirm but from ultrasound I'm hearing it looks like pancreatitis, as Marje suspected. That actually makes SO much sense. His voice went hoarse around a year ago, but cleared up on insulin -- apparently hoarseness is really common with pancreatitis and it's common for cats to not exhibit other symptoms. I did notice the hoarseness and also him sleeping more, but I was advised it was likely age-related since all his bloodwork was normal.

If this is the case and it is pancreatitis, what types of treatment can I expect next?

I read sometimes IV fluids and etube feedings in hospital are recommended for up to a week. I will do whatever he needs but am terrified about how much that will cost (kicking myself in the butt yet again for never having gotten the fur kids pet insurance).
 
Sarah:

Insulin resistance is different than what you're referring to. You need a very specific lab test (it's done only at Michigan State) to test for insulin auto-antibodies (IAA). IAA are what causes insulin resistance.

Miko is in high numbers and probably what the vet means is glucose toxicity. This is when Miko's body "forgets" what normal BG is and treats high numbers as the new normal. Alternatively, if Miko's white count is high, there is likely an infection. Once the antibiotic kicks in, the numbers may come down.The infection is also contributing to the development of ketones.

The vet hospital is the best place for Miko given the presence of moderate ketones. You make a very good call bringing Miko in. You might want to ask about the levels of potassium and phosphorus. These electrolyte levels are out of whack when a cat is experiencing ketoacidosis.

Marje put together a primer on pancreatitis. It will probably answer a great number of your questions.
 
I'm glad Sienne linked my post....I was just about to do it. It gives you some info on dx and on treatment.

If they dx pancreatitis, when they release him, be sure they give you the meds; ondansetron for nausea, cerenia for vomiting, bupe for pain, and I'd be sure I have some fluids on hand. Ask for a line and 20/21g needles instead of the 18g harpoons they usually send you home with.

If you've never given fluids, let me know. We made a video using our boy Gus that will walk you through it step by step.

More healing vines and prayers.
 
Sending healing vines and get well soon vines to Miko so he can come back home and not be so scared.
 
Thanks, Sienne! That is really helpful to know. And thank you so much for that link. I will definitely ask about his potassium and phosphorus levels, too, that's so good to know. I think potassium may also get thrown out of whack from pancreatitis, though. It seems he didn't actually have ketoacidosis and all of his urine tests yesterday and today from before and after the blood tests have been negative -- I guess there were moderate ketones in his serum. The vet told me she was surprised that his urine ketone tests were negative because usually by the time the ketones are moderate in the blood, they are being picked up in urine tests. Miko is full of surprises!

And Marje, thank you so much for putting it together -- and for the list of things I should bring home. In my youth I worked at shelters and at a vet's office so I've given quite a lot of fluids in my day, but things are often more challenging for me when it's one of my own. I've given one of my dogs fluids, but never one of my cats, so I suspect that video will come very much in use. Miko doesn't like to stay still and be messed with, but hopefully I can overcome (and figure out a way to make him ingest the medicine he needs). His being very bribe-able right now with food and my recent successes with his insulin injections and ear tests definitely help.

Thanks so much, Deb <3 If he keeps eating and if his BG keeps dropping, I can possibly take him home tomorrow. Paws crossed!

The internist is telling me that she thinks he needs to be on cooked food while his health is so poor. Of course she's recommending prescription foods (which are off the table), but I'm wondering what you all think? I don't know about cats and pancreatitis. But I do know that my dog has pancreatitis as well and nothing helped him except for the raw diet that my now ex-vet told me never to feed him. And I've heard cooked food can actually lead to pancreatitis, although Miko seems to have developed his (and his diabetes) on a raw diet.

What do you all think? Stick with the raw? Move to a canned food while he recovers? If the latter, what brands might help diabetes and pancreatitis?
 
Sarah

I am glad he's doing better. Ihope they will restart his Lantus. They should be giving it as the basal insulin. If they aren't giving It, they are draining his depot and you will have to refill it which will take time. And if you aren't giving R, he will have high numbers unit you fill his depot. I'd really be sure they explain to you if they aren't giving the lantus. I'd be sure they understand he will remain at high numbers while you are refilling the depot.

eta: Jill was just telling me that they don't give the basal insulin in the hospital because they will shoot the R much more often (even every 2 hours) than we would in order to get the numbers down. In order to do that, they can't have the basal insulin on board.

Here is the link to the YouTube video HOw to Give Subcutaneous Fluids to your Cat at Home

From what I've read and also learned when Gus had acute pancreatitis once, it is idiopathic in cats unless the pancreas has suffered some kind of injury trauma. Unlike dogs and humans where diet, especially consumption of high fat meals, is the culprit, it does not appear to be so in cats. However, Jill also said that its not unusual for them to ask that raw diets be removed when there are multiple issues because "the immune system may be compromised".
 
Status
Not open for further replies.
Back
Top