? 8/9 Buddy not eating, post DKA

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Chris & China (GA) said:
Did they send you home with fluids and show you how to give subq fluids?

As long as they stay at trace and don't go higher, the best thing you can do is get as much water into her as possible to help flush them out.

Is she still eating OK?
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Yes, we have fluids. We have been giving 100ml every day. Should we be giving a bit more? She is due for more fluids in two hours so I’m praying that will flush the ketones out.

She is still eating- but not as well as yesterday. Saturday she ate well, Sunday she wasn’t eating great. Monday she ate pretty well, and today she has slowed down a bit again. We just gave her a bit of appetite stimulant so hopefully that helps a bit, and she’s gonna get some cerenia soon. If she doesn’t start eating more in then next two hours, we are gonna start offering everything including the high carb so we can get food into her, as I know we really need to.!

She is drinking more today- I’m not sure if that’s a good sign or a bad sign. She hadn’t drank much since coming home (we add water to her food tho) but today she has gone to her water bowl.

@Judy & Fritz aw thank you so much! This is a little bit older photo, but she’s still my beautiful sweet girl- just a little more tired at the moment :)
 
Hello D'Arcey and Buddy, My Laila went to the Emergency vet on August 3 with DKA. She came home this past Sunday the 8th. So I'm following your progress. Currently Laila isn't eating much. She usually eats 4-5 small cans of FF pate a day but now she is getting about 2 a day in. I just gave her Cerenia and Mirtazapine so I'm hoping they help. She has IBD as well. The ER Vet put a Freestyle Libre on her and I have an appointment with my internal medicine vet on Friday.
 
D'Arcey Taylor said:
Yes, we have fluids. We have been giving 100ml every day. Should we be giving a bit more? She is due for more fluids in two hours so I’m praying that will flush the ketones out.

She is still eating- but not as well as yesterday. Saturday she ate well, Sunday she wasn’t eating great. Monday she ate pretty well, and today she has slowed down a bit again. We just gave her a bit of appetite stimulant so hopefully that helps a bit, and she’s gonna get some cerenia soon. If she doesn’t start eating more in then next two hours, we are gonna start offering everything including the high carb so we can get food into her, as I know we really need to.!

She is drinking more today- I’m not sure if that’s a good sign or a bad sign. She hadn’t drank much since coming home (we add water to her food tho) but today she has gone to her water bowl.

@Judy & Fritz aw thank you so much! This is a little bit older photo, but she’s still my beautiful sweet girl- just a little more tired at the moment :)
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She is a precious girl! She and you guys are both in my prayers. You are doing such a great job with her, I am in awe. And you are getting the best advice possible here.
 
D'Arcey Taylor said:
Yes, we have fluids. We have been giving 100ml every day. Should we be giving a bit more? She is due for more fluids in two hours so I’m praying that will flush the ketones out.
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Hi Jess and D’Arcey. I think I would stick with he 100ml a day of sub Q fluids.
Have you retested the urine or the blood for ketones since the trace?
Is Buddy eating any better after the appetite stimulant and Cerenia? It is always better to give the cerenia and give it time to work, before giving the appetite stimulant. Otherwise if the cat is nauseated, the appetite stimulant is making the cat want to eat when she is nauseated.

D'Arcey Taylor said:
Is one (urine or blood) considered to be more accurate than the other?
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The blood ketone test is an up to the minute test and tells you what is happening now. The urine test is what has been happening since the last pee.
Both are accurate, but the blood test is the up to date one.

How long before the PMPS is due?
 
Bron and Sheba (GA) said:
Hi Jess and D’Arcey. I think I would stick with he 100ml a day of sub Q fluids.
Have you retested the urine or the blood for ketones since the trace?
Is Buddy eating any better after the appetite stimulant and Cerenia? It is always better to give the cerenia and give it time to work, before giving the appetite stimulant. Otherwise if the cat is nauseated, the appetite stimulant is making the cat want to eat when she is nauseated.


The blood ketone test is an up to the minute test and tells you what is happening now. The urine test is what has been happening since the last pee.
Both are accurate, but the blood test is the up to date one.

How long before the PMPS is due?
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Hi @Bron and Sheba (GA) , hope you had a good night!

We have gotten another urine ketone test and two blood ketone test. The blood ones were 0.6 two hours ago, and and 0.4 a half hour ago. We got another urine ketone test a half hour ago as well, and it was still showing trace ketones. I guess I’m just panicking thinking, what if the blood ketone meter isn’t accurate, or something. Trying to stay calm but this last 8 days have been soooo stressful that it’s quite hard!

Buddy is only eating okay today. Better than two days ago, and not as well as yesterday. She had cerenia two hours ago. We also gave 100ml of fluids an hour ago.

Her shot time is in an hour and 40 minutes. Should we be giving the same does as usual, or trying to give a bit more to help control the ketones? She did drop down very quickly last night, but didn’t go down too low (last time she was in the green was 5 cycles ago I believe).

@lena7098 oh my gosh, my heart is with you. This is so hard. I’m thinking of you and will be sending positive thoughts and prayers to you and Laila.
 
I’m not sure why the blood ketone meter is reading is OK and the urine is saying trace. Can you do a urine test on yourself to see what it says.
Im just going to see if I can talk to Janet as I am thinking I would like to increase the dose.
Back soon.
 
Bron and Sheba (GA) said:
I’m not sure why the blood ketone meter is reading is OK and the urine is saying trace. Can you do a urine test on yourself to see what it says.
Im just going to see if I can talk to Janet as I am thinking I would like to increase the dose.
Back soon.
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Sure thing. Hubby just did a urine test and it’s negative. All Buddy’s other urine tests since we brought her home have been negative, other than today.

Sounds good, thanks so much, talk to you soon :-)
 
I haven’t been able to get in contact with Janet.
Let’s see what the preshot is.
Have you done any further ketones tests?
How is her appetite?
 
Bron and Sheba (GA) said:
I haven’t been able to get in contact with Janet.
Let’s see what the preshot is.
Have you done any further ketones tests?
How is her appetite?
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PMPS is 369 (20.5).

Her appetite hasn’t been too great today. She was just underfoot while I was getting her food, meowing, but then she didn’t chow down as she normally does. I opened a few cans, and in total she has has eaten about 1/5 to 1/4 of a can of fancy feast.

The last ketone tests were about two hours ago, for both blood and urine. I can take more blood ketone tests anytime; how often should I be taking them? We will test her urine whenever she goes too.
 
I haven’t heard back from Janet but I’d really like to increase the dose to 2 units because of the trace of ketones in the urine.
We might have to increase the amount of carbs in the food to keep the BG high enough, especially if she is reluctant to eat.
Would you be comfortable with increasing the dose and monitoring closely all cycle?
 
Bron and Sheba (GA) said:
I haven’t heard back from Janet but I’d really like to increase the dose to 2 units because of the trace of ketones in the urine.
We might have to increase the amount of carbs in the food to keep the BG high enough, especially if she is reluctant to eat.
Would you be comfortable with increasing the dose and monitoring closely all cycle?
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Yes, we are comfortable with that. I agree that we should increase the dose by .25. We want to fight these ketones! We slept during the day with the knowledge we’d likely be up with her all night. :-) We are prepared to test as much as needed and have loads of food around, including high carb wet, dry, and the beloved honey and corn syrup.

At the moment, she is eating a higher carb food, that was the can she was most interested in, and I wanted her eating. And yesterday after eating some of that, it seemed to jump start her appetite.
 
D'Arcey Taylor said:
Yes, we are comfortable with that. I agree that we should increase the dose by .25. We want to fight these ketones! We slept during the day with the knowledge we’d likely be up with her all night. :) We are prepared to test as much as needed and have loads of food around, including high carb wet, dry, and the beloved honey and corn syrup.

At the moment, she is eating a higher carb food, that was the can she was most interested in, and I wanted her eating. And yesterday after eating some of that, it seemed to jump start her appetite.
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Ok great. Let’s increase the dose then to 2 units. You have plenty of test strips, yes?
I have to duck out and go to your dentist. Be back soon.:)
Message to Buddy from your Auntie Bron………eat!
 
Bron and Sheba (GA) said:
Ok great. Let’s increase the dose then to 2 units. You have plenty of test strips, yes?
I have to duck out and go to your dentist. Be back soon.:)
Message to Buddy from your Auntie Bron………eat!
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At +2 Buddy is at 320 (17.8). Looks like a slower drop that the last few nights, and this slower drop is more typical for Buddy, or was pre-DKA. However, we are also feeding her a buffet of wet foods, some of which are high carb, because she isn’t very keen on her normal low carb food, and we really really want her eating, so that is likely contributing as well.

At +2 she peed & we did another urine ketone test (two actually, to be sure) which stilled showed trace ketones. We did a blood ketone test, and that has gone back down to 0.1 (previous reading 2.5 hours ago was 0.6). Praying that the ketones are indeed going down and praying that we will see the urine ketone strips go back to negative soon too, because that’s so stressful.
 
Glad she is eating well…that’s important!
That is really strange about the urine ketones showing trace and the blood meter 0.1.
Next time can you take a photo of the test result. I used to often struggle to decide whether the result was negative or trace at times with Sheba……she never actually had ketones but I used to test her because she was often high, especially after she fell out of remission when I was struggling to get her into better numbers.
How do you collect the urine specimen….can it be getting contaminated with anything?
 
Bron and Sheba (GA) said:
Glad she is eating well…that’s important!
That is really strange about the urine ketones showing trace and the blood meter 0.1.
Next time can you take a photo of the test result. I used to often struggle to decide whether the result was negative or trace at times with Sheba……she never actually had ketones but I used to test her because she was often high, especially after she fell out of remission when I was struggling to get her into better numbers.
How do you collect the urine specimen….can it be getting contaminated with anything?
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No, I don’t think it could be contaminated. We are using a clean container each time to capture the urine. We will definitely take a picture next time. Hopefully by then it will be lighter and closer to negative haha. I really really hope. But right now it’s the identical colour to the “trace” colour on the box- we have examined them under bright light inside, and raced over to natural light in the 15 seconds to ensure we were seeing it correctly, and it was definitely trace :-(
 
She is down to 248 (13.8) at +3. We are happy with the speed of the drop this evening, as it’s not too quick. We are gonna keep monitoring every hour, unless it starts to speed up or drop low, in which case we will change to more frequently.
 
JanetNJ said:
I like the 2 dose as long as you can watch. Really important that she eat more right now. Will she eat regular chicken or some tuna?
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We have tried everything in terms of food, we have about ten cans open for her. She will eat both tuna and chicken, but only a bit, and only when she’s in the mood. We were able to get her to eat a decent amount between about +5 and + 7 yesterday. If I had to guess, she probably ate about 3 small fancy feast sized food cans worth of food yesterday. I know we should get more into her- according to my calorie calculations, if she needs 150% of the calorie content she normally would for her size, she needs to be eating 4.5 cans worth a day. Should we start syringe feeding her extra food if she isn’t eating that much?
 
D'Arcey Taylor said:
We have tried everything in terms of food, we have about ten cans open for her. She will eat both tuna and chicken, but only a bit, and only when she’s in the mood. We were able to get her to eat a decent amount between about +5 and + 7 yesterday. If I had to guess, she probably ate about 3 small fancy feast sized food cans worth of food yesterday. I know we should get more into her- according to my calorie calculations, if she needs 150% of the calorie content she normally would for her size, she needs to be eating 4.5 cans worth a day. Should we start syringe feeding her extra food if she isn’t eating that much?
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Did you ask the regular vet for some ondansetron? I would try that first before I tried syringe feeding.
 
Bron and Sheba (GA) said:
Did you ask the regular vet for some ondansetron? I would try that first before I tried syringe feeding.
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Perfect, she is at the vet this morning and we will ask for it.

We got another blood ketone test (0.9) and urine ketone test this morning. The urine test is lighter than it was last night. I would say it is in between negative and trace. Here is a photo, we have more if needed. And we can also get a photo next time of the urine strip from her next to an negative strips if that would be helpful for comparison.
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I can see it is slightly pink. Strange.
Not all vets know about ondansetron…hopefully yours does. It is really good for nausea.
It is actually a human medication. In Australia I have to get a script from the vet and get it from a human pharmacy. But it could be different in Canada.
My vet had not heard of it but was happy to prescribe it after he investigated it.
Let us know how the vet thinks Buddy is going.
I think she is recovering well so far.(antijinx)
 
Bron and Sheba (GA) said:
I can see it is slightly pink. Strange.
Not all vets know about ondansetron…hopefully yours does. It is really good for nausea.
It is actually a human medication. In Australia I have to get a script from the vet and get it from a human pharmacy. But it could be different in Canada.
My vet had not heard of it but was happy to prescribe it after he investigated it.
Let us know how the vet thinks Buddy is going.
I think she is recovering well so far.(antijinx)
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Thanks so so much! She was at the vet this morning and she prescribed the ondansetron (a perscription for a human pharmacy as well here!), as well as more cerenia, more appetite stimulant, gabapentin, buprenorphine, weekly B12 shots, and continued daily fluids. The vet seems to think she looks okay! We have two more weeks worth of the meds and then we will go from there. I don’t think I’ll ever be comfortable not having some on hand though, just in case!

Our regular vet who we saw today wasn’t super knowledgeable about ketones. She knows they are bad and they do test for them, but it’s a urine test that gives either a positive or negative result. So she didn’t have much advice on what to make of the trace(ish) urine ketone results. We are just praying they keep going down and back to negative.
 
D’Arcey/Jess, Fritz has had a urinalysis for each if the past two weeks. He has NO ketones, has never had ketones. I use KetoDiastix. After each lab report, I measured the keto in his urine here at home. The color he always gets is the EXACT color of the photo of Buddy’s strip, if that helps,
 
Judy & Fritz said:
D’Arcey/Jess, Fritz has had a urinalysis for each if the past two weeks. He has NO ketones, has never had ketones. I use KetoDiastix. After each lab report, I measured the keto in his urine here at home. The color he always gets is the EXACT color of the photo of Buddy’s strip, if that helps,
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Thanks. She peed again and it is pinker now. She is drinking like crazy suddenly and won’t eat at all. I’m very very worried.

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Call your vet. Just a thought - do you have mobile vets where you live? Nothing wrong with having your regular vet and a mobile one that comes to you. Prayers for Buddy immediately! Can you syringe feed her a little bit of watered down food! Will she eat treats?
 
Judy & Fritz said:
Call your vet. Just a thought - do you have mobile vets where you live? Nothing wrong with having your regular vet and a mobile one that comes to you. Prayers for Buddy immediately! Can you syringe feed her a little bit of watered down food! Will she eat treats?
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Ironically she just got home from our regular vet two hours ago, and that’s when she started drinking like crazy.

The vet didn’t have any concerns in the moment, when she saw her two hours ago.

I will look into a mobile vet as well!

We gave her an appetite stimulant, and the two anti nausea meds. I’m hoping this will help. She has actually eaten a few bite of high carb food in the last fifteen minutes. I’m hoping this means those meds are kicking in.

We have prepared a syringe full of food that we will probably give her within the hour if she doesn’t eat more. Right now she is drinking lots of water and she will eat a very very small amount of food. We have every type of food in the world available- cooked chicken, broth, dry food, treats, high carb, etc. It’s been about an hour since we gave her the appetite stimulant and we gave her the cerenia 20 mins before it, and the other anti nausea 20 mins after, so I’m hoping they’ll all be starting to help soon.
 
Judy & Fritz said:
Fingers crossed. Which appetite stimulant is she on?
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She is on mirtazapine. While in emergency she was getting 3.75mg of it every three days. Since getting home, she had 1mg yesterday and 1mg the day before. Our vet today said she could have 2mg a day, everyday, if she needs it, for the next week or two. I know there can be side effects from it so we want to be careful, but right now we are really desperate for her to eat, so we gave the two anti nausea meds and then the 2mg mirtazapine today.

Tomorrow we will try and just give the cerenia and the ondansetron, and hopefully that will be enough, and then we could hopefully just do the appetite stimulant every second day (as needed). If there are other/better appetite stimulants I would definitely open to suggestions though :-)

In the last half hour, she has eaten over a quarter can of food. It’s still not a lot but it’s definitely progress! Thank you so so much for all the help and support and loving vibes @Judy & Fritz , we are truly so grateful
 
Do you have the transdermal ointment version of mirtazapine? Thinking of requesting some at next vet visit. Yay, Buddy, you’re eating something! I feel invested in Buddy’s recovery, I have such a soft spot for these little golden tabbies. I have two of them, one a female. Did you know that 80% of orange tabbies are male? So your girl is rare and special, and the care you two are giving her is amazing and inspiring. You’re doing great!
 
Judy & Fritz said:
Do you have the transdermal ointment version of mirtazapine? Thinking of requesting some at next vet visit. Yay, Buddy, you’re eating something! I feel invested in Buddy’s recovery, I have such a soft spot for these little golden tabbies. I have two of them, one a female. Did you know that 80% of orange tabbies are male? So your girl is rare and special, and the care you two are giving her is amazing and inspiring. You’re doing great!
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We have a pill of the mirtazapine :)

Yes, I learned that about orange tabbies- but I didn’t know that when I got her! We named her Buddy (Budweiser, lol) because we were told she was a boy! She’s such a special cat. She is so affectionate and loving. She loves to head butt us and be carried around on our shoulders. This is another picture from before she was sick, but this is how she likes to be held:

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Great pic!
I’m glad you were able to get the ondansetron from the vet. Make sure to always give the antinausea medications before the appetite stimulant and give them time to work… I used to find Sheba would eat about 1/2 hour after giving ondansetron.

Most vets seem to still rely on urine testing for ketones. I don’t think I’ve heard of any using the blood meter on the board but I could be wrong.

I’m glad she has started to eat again.
 
Bron and Sheba (GA) said:
Great pic!
I’m glad you were able to get the ondansetron from the vet. Make sure to always give the antinausea medications before the appetite stimulant and give them time to work… I used to find Sheba would eat about 1/2 hour after giving ondansetron.

Most vets seem to still rely on urine testing for ketones. I don’t think I’ve heard of any using the blood meter on the board but I could be wrong.

I’m glad she has started to eat again.
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Thanks! She is definitely eating better than she was this morning, but still very picky and slow.

We were told to give ondansetron 2mg once a day. Is that enough?! I got the sense from the Facebook group that it could/should be given more often, but I could be mistaken.
 
D'Arcey Taylor said:
Thanks! She is definitely eating better than she was this morning, but still very picky and slow.

We were told to give ondansetron 2mg once a day. Is that enough?! I got the sense from the Facebook group that it could/should be given more often, but I could be mistaken.
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You can give the ondansetron 8 hourly if needed. The 2 mg dose sounds correct.
Cerenia is daily
Ondansetron 8 hourly if needed.
They work on different pathways in the body so can be given together.
 
Bron and Sheba (GA) said:
You can give the ondansetron 8 hourly if needed. The 2 mg dose sounds correct.
Cerenia is daily
Ondansetron 8 hourly if needed.
They work on different pathways in the body so can be given together.
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Okay so 2mg, 3 times a day (8 hours apart)? Good to know. We will run out of what the vet prescribed quickly but hopefully she will be willing to renew the prescription if it works well!
 
D'Arcey Taylor said:
We have a pill of the mirtazapine :)

Yes, I learned that about orange tabbies- but I didn’t know that when I got her! We named her Buddy (Budweiser, lol) because we were told she was a boy! She’s such a special cat. She is so affectionate and loving. She loves to head butt us and be carried around on our shoulders. This is another picture from before she was sick, but this is how she likes to be held:

View attachment 62124
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Nothing but pure love in that wonderful pic! 80% of orange tabbies are boys, those little orange tabby girls are rare! She is such a little love bug.
 
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