Bandit has Ketones

[Mary & Snowy]

I posted this on the wrong forum, so I am re-posting it here. Sorry for the duplicate.

Bandit is a 9 year old Maine Coon. We got him a year ago when he was abandoned by his owners after becoming completely blocked and having THE. operation. He was recently diagnosed with asthma. My vet gave him a long lasting steroid shot which unfortunately did not last as he was coughing again a little more than a month later. Just this past Sat. we took him back and he was put on pills (steroid). Yesterday I smelled his breath which was very acetone. Took him to the emergency vet and sure enough, ketones and blood sugar of 311. He is now in the hospital for the next several days until the ketones are gone. He has already lost a couple of pounds.

My question is for anyone else who has gone through this. What are his chances? I have already dealt with diabetes with my Snowy who died back in 2008. So I know all about the testing and shooting and even the food. But I have never dealt with ketones. I know it is very serious. Also, since he has had UTI's in the past and even been blocked, I know he is more susceptible now, although at least I never have to worry about him being completely blocked.

The emergency doctor told us that 85% to 90% of cats recover from ketones. Bandit still seemed pretty alert and responsive when we left him, so I'm hopeful he will pull through this. I am also hopeful that once the steroids are out of his body that the diabetes will disappear.

Any words of wisdom? Thanks so much.

 

[Carl & Polly & Bob (GA)]

Bandit is right where he needs to be right now, and I'm very happy you got him to the vet. I agree with your vet. They have the tools needed to deal with ketones so his odds are very good. Bob was diagnosed with diabetic ketoacidosis, spent three night at the vet, and came home with diabetes but no ketones. And was much worse off than Bandit when I left him there.

It is possible that the steroids "triggered" the diabetes. I am sure your vet will come up with a plan to treat the asthma and balance that with the possibility of it raising Bandit's blood glucose in the future. Right now the issue is making the ketones go away and getting his numbers regulated short term.

By the way, Bob survived the DKA, was on PZI for ten weeks, went into remission, and stayed that way for 2 1/2 years. The ER care saved his life.

 

[Vyktors Mum]

Vyktor's another survivor, diagnosed with diabetes that his vet at the time thought we shouldn't treat with insulin due to his being 15. Rushed off to emergency a couple of weeks later when he was staggering around like a drunk - got sent home and told to see his regular vet the next day without a diagnosis. Took him into his new vet where he stayed for a few days and got onto the insulin. On the TR protocol with lantus for the next 3 months. It's now three years after remission and my 18 year old boy is still going strong the odds are on your side especially since you were onto it so quickly

 

[phlika29]

I think bandit has a great chance of recovering.

I wanted to address the asthma part of the issue. My remi has asthma and so a few others on here. Ideally you want to get bandit onto inhaled asthma medication and then off the oral steroids as the inhaled steroids aren't systemic and therefore won't affect the diabetes.

There are some great websites and groups than can help you. When I get back to the office I will link them up.

My remi uses a flixotide steroid puffer, an aerokat spacer and has an emergency ventolin. Will post more in abit.

 

[BJM]

See Fritz The Brave for feline asthma resources

 

[phlika29]

I know your first aim is getting rid of the ketones issue but if you get a chance have a look around these websites for advice on treating asthma in felines

http://www.fritzthebrave.com
http://felineasthma.org/overview/index.htm

I am a member of this yahoo group and would recommend that you join this one or the other main one. The set up is different from the diabetes forum but the groups knowledge is fantastic
https://groups.yahoo.com/neo/groups/felineasthma/info

This is the set up you will need to buy

http://www.trudellmed.com/animal-health/aerokat

It is used like a spacer for a baby. Once a cat gets used to it most take to it readily. The recommended way is to start by just leaving it near the cat and then putting a treat in it for them to eat. Then after a day or two try placing it quickly over their mouth, just for a second or two. Then give a treat. Then try a little longer and more treats. Etc

The steroid puffer that we use for cats is cheapest if you buy it from the online pharmacy called inhouse pharmacy. Initially you need to send them a prescription but after you have ordered from them once you don't need to do that again. All the members of the yahoo group buy their inhalers from this company. The minimum dose a cat should be put on is one puff of flixotide 125 mcg twice a day (twelve hours apart). Remi is on a larger dose than that but he started off on the lower dose and it worked well for a couple of years. Once under control there should be no coughing or wheezing.

https://www.inhousepharmacy.vu/p-398-flixotide-cfc-free-125mcg-inhaler-fluticasone.aspx

You should also order a ventolin inhaler at the same time, in case of emergencies.

https://www.inhousepharmacy.vu/p-526-ventolin-inhaler-salbutamol.aspx

With the flixotide you puff once into the spacer and then they have to breath into the mask for at least 10 breaths. Once this is happening It takes about 10 days to fully get into their system and the oral steroid can be slowly reduced and then stopped. I just sit remi on my lap and he happily does it.

In addition to the medication you should find that by trying to remove triggers can help a little. I attempt to Hoover every day, I don't use hairspray or perfume or any aerosol near remi. I try to air the bedrooms each morning and have anti allergy bedding on the bed.

 

[Squeaky and KT (GA)]

Dakota went ketonic almost a year ago now so yes, he can pull out of this. The key is lots of fluids, insulin support to handle glucose and food. I can't tell for sure from your post whether he's just ketonic or has progressed to ketoacidosis (DKA). It's a bit easier to get rid of just ketones than also needing to adjust his ph balance from acidosis. He's where he needs to be to handle either one!

Lots of thoughts and prayers for both of you!

 

[Mary & Snowy]

Thank you all so much for your replies. You are all so helpful.

Bandit is doing better. He does have DKA, but the doctor seem to think he will recover. His blood sugar was down to around 164 this afternoon, and the ketones are starting to lessen. I went to see him, and they brought a can of Fancy Feast in with him, and he really chowed down, which was so good to see since he wasn't eating at all yesterday. I put him on the floor and he could walk normally again. Yesterday he was walking like he was a little drunk.

The DH came by when I was there, and Bandit was sitting on my lap and purring while my husband petted him. It was hard to let him go.

The hospital did all kinds of tests - x-rays and an ultrasound. All of his organs are in good shape except for his heart. They say he has arrhythmia, which is an irregular heartbeat. The heart specialist is in tomorrow, so they are going to do an EKG ($400). I called my regular vet as soon as I got home, and he had already talked to the vet at the hospital. He said he doesn't remember ever hearing any irregular heartbeats from Bandit. I really think this is also related to the diabetes, but we're going with the EKG anyway just to see what the specialist has to say.

As far as the asthma is concerned, the hospital vet told me that unless Bandit has trouble breathing, there may be no reason to treat him with any medications. We got the air filter (I plan to get another one as well), we'll get a humidifier, we changed litters. He hasn't coughed at all at the hospital. They have noted the asthma on his x-rays and the ultrasound, but they said it is not very advanced. So at this point, we aren't even concentrating on that.

It's possible Bandit may come home as early as Friday. It all depends on getting rid of the ketones. But he is definitely much better today.

Again, thanks to all of you for your responses and support. I will keep you posted.

I had forgotten what good people are on this board. Thank you all!

 

[BJM]

DKA disrupts a number of the electrolytes necessary for nerve transmission to happen, including that in the heart. Do ask the vet if any of those are out of range and if that could be contributing to the arrhythmia.