9/28 Yemala update

Hroswitha

Hroswitha

Member Since 2011
https://www.felinediabetes.com/FDMB/threads/9-27-yemala-honeymoon-over.236012/

Mala went to the ER vet last night. Too dehydrated to get all the blood work done. Strong suspicion of keto, but no labs to prove it last night. They wanted to hospitalize her, put her on IV fluids and nutrients, start insulin. As that would require sedation, I turned it down.

Mala is 21 now. She's ornery and a fighter, but I don't know if she's going to bounce back from this. Palliative care may be our best option for her at this point.

As she's not eating, I'm hesitant to give her insulin. I'm getting a prescription for Lantus today, and if she'll eat, we can get a good BG and start administration. Her BGs have been mostly in the high 200 - 300 range, with one outlier of 373 yesterday evening. I will need dosing advice tonight and anyone with experience treating a diabetic kitty with keto, I would love to hear it.

My regular vet saw her today, labs taken, no results until tonight. She also wants to hospitalize Mala, and were she only 15 or so, I might agree. I'm not sure at this point.
 
(((Renee))) I am so sorry Yemala is not doing well. Are you able to test her urine for ketones? Would today's vet be willing to keep her just for the day to get some fluids in if she's dehydrated? If there are ketones, fluids will help flush them out, provided her heart is up to it.

She does need to eat. Cats who don't eat can still get at least a half dose. Insulin is very important if there are any ketones present. Can you syringe feed her, higher carb if needed? Might be good to have some Royal Canin Recovery or A/D around as they are easy to syringe. Neko would actually eat a bit of the Recovery after I'd given her a syringe or two. I see she topped out at 1 unit last time on the juice, so looks like she's just need a small dose to start.

Tagging @Sienne and Gabby (GA) and @AliceMeowliss&Cassandra who have both had DKA kitties. DKA is what we are trying to prevent. The basic recipe for developing DKA = an insufficient supply of insulin + inappetance + infection OR other systemic stresses.
 
We suspect infection. Possible return of pancreatitis, but also maybe a UTI. She has had chronic UTIs in the last two years, but nothing since last winter. On Saturday, her regular vet suspected pancreatitis, and gave her a shot of cerenia. We were not able to confirm the diagnosis with labs, as she was too dehydrated to get sufficient blood last night or Saturday morning. She got the SNAP test today, and I'll get results this evening.

I can find some higher carb food - her weruva is only 2% carbs - but right now, she'll only voluntarily eat either raw chicken liver or, if it's warm and fresh, chicken. I got her to eat a few bites of roast chicken last night, but she was otherwise fed by hand.

I can continue to hand feed her. No syringes - she just doesn't do well with that. However, she had gotten about 2 ounces of weruva today in two separate doses. She normally eats around 3 ounces 2x daily, with incremental feedings as demanded throughout the day. She's often hungry, which is why this has us so freaked out.

You mentioned fluids. Do you mean IV or sub-q? We increased her lactated ringers last night from her usual dose of around 100 - 125ml to around 250 ml in two separate hydration sessions. The first disappeared almost immediately - she normally gets a fat front leg. The second hung around a little longer, and is fully absorbed today. Will sub-q be enough to flush ketones, or will this require IV?
 
You need to find out what her ketones reading is first. The vet could to IV fluids, but if you are giving subq at home, that will help.
 
I'll update with labs after I receive them and speak with the vet. She suspects keto, but I suspect pancreatitis as well.
 
Pancreatitis could be one of the contributors to DKA (systemic stress), so it could be both. Paws crossed it's not and "just' p'titis.
 
Pancreatitis confirmed. Mala is back on Cerenia tonight. We will begin with insulin but only a microdose.

The liver readings are alarming, of course, and we may be looking at hepatic lipadosis. She doesn't fit the profile - no recent weight loss, no obesity, and the condition came on suddenly Friday night with no precursors at all.

I would like to think this is pancreatitis with possible UTI (some blood in the urine). We're getting some mirtazapine to help with appetite, but also a micro-dose. 0.5 mg maximum. She had it once before, and she was up all night howling. Not acceptable.

My vet will call me later tonight to talk about long-term prognosis and treatment options.
 
My husband picked up the pen of basaglar for Mala. We start treating her in earnest tonight.

I'm getting ingredients for the kitty liver shake to help with feeding. She's back on cerenia for the confirmed pancreatitis. No reading on the liver from blood work, but the vet noticed a coloration change that indicates liver failure.

I'm preparing to grieve, but not yet. I'm hoping to squeeze out a few more good days, though I know she's 21 and she's had an amazing, well-loved, pampered life.
 
Do you have any pain meds for the pancreatitis? That's usually part of the solution too. P'titis is supposed to be incredibly painful. As for mirtazapine - there is a transdermal version out now called Miritaz, that you rub on their ears. It's a lot more slowly absorbed and supposed to have a lot less of the meowzipane howling effects.

Sending healing vines for miss Mala to get over this. :bighug:
 
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