Cat in DKA but vet refusing to treat

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manxcat419

manxcat419

Member Since 2015
I've been trying to help in a Facebook group, but would appreciate input from here too.

Kitty (named Inka) is currently being treated for hepatic lipidosis with fluids, Cerenia, a/d syringe fed, rx vitamins and milk thistle (not Denamarin). However, glucose has been very high on blood work and when I queried that, I was told that the vet confirms she is diabetic and in DKA but is refusing to treat with insulin unless the cat is hospitalized which is unaffordable currently. DCIN have been contacted to see if there's any help possible there. Mom has Lantus on hand for another cat but vet will not advise on dosing as they say it's "risking a crash" to give insulin without hospitalization. I've covered the written starting dose protocol for Lantus (1 unit as Inka weighs 9.6 lbs currently). Home testing is possible. Ondansetron instead of Cerenia is an option and is available.
 
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@SharonKurtz - hopefully you will be able to follow the post even though you had trouble creating a new post. If I've missed anything (and I'm sure I have) please feel free to add details.

@Kris & Teasel @Meya14 - I know you both have experience with DKA. If you can think of anyone else to tag, please do as although I know it in theory, I haven't dealt with it in my own diabetics.
 
When your crisis is over, have you considered changing vets? Some vets are great with diabetes, others not so much. Frequent home blood glucose is a vital part of best-practice feline diabetes management, and I dont hear from you that your vet is down with this. Best luck!
 
Not sure who is around at the moment. I haven’t seen Meya online for ages and I think Kris may be taking a break.
Can you create a spreadsheet for Inka’s Mom to fill in the numbers? That would be very helpful for anyone giving advice.
It’s most important that Inka is getting enough insulin, enough food and fluids, and is having any infection or inflammation treated. Any food at all is ok at this point as long as kitty is eating. Higher carb food can be given if necessary to make sure that enough insulin can be given.
Another anti nausea med which can be given at the same time as cerenia is ondansetron.
Are they monitoring for ketones as well? Ketostix is available at Walmart and pharmacies.
I’ll try and find a thread that kris has answered about DKA and post it for added info.
 
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As far as I know right now, there are only 2 numbers - 504 on May 29th and 405 of May 31st - both readings done in-clinic as part of blood work. My personal feeling is that there may not be full-blown DKA at this point. Electrolytes are a little off, but not massively deranged - slightly low potassium, all else within range. And the cat is still alive despite not receiving any insulin as yet. However, definitely ketotic and clearly headed in the wrong direction without insulin and a total lack of appetite.
 
Amina&M'row said:
When your crisis is over, have you considered changing vets? Some vets are great with diabetes, others not so much. Frequent home blood glucose is a vital part of best-practice feline diabetes management, and I dont hear from you that your vet is down with this. Best luck!
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I agree - my immediate response to the lack of treatment was "don't walk away from this vet...run!"
 
Absolutely willing, yes. She already has one other diabetic cat and has all the supplies ready to go - including Lantus even though the vet refuses to a prescribe a dose for this cat. I'm sure she will update when she's able - as we all know, for people more used to Facebook, this site can take a little bit of figuring out initially.
 
I agree with 1 unit start. Has she got some higher carb food to give to keep the BSLs up if necessary.
We’ve had several DKA cases here lately.
 
She has syrup that she could mix with the A/D and syringe if necessary as Inka currently isn't eating on her own at all. I know it's a risk with a cat that isn't eating to start insulin, but it sounds as though she does pretty well assist-feeding, so I'm not sure there's a lot of choice but to start and be ready to boost the numbers if necessary.
 
Bron and Sheba said:
Yes it’s a different situation. I wish her well. She will get a lot of support and help if she posts here. She’s lucky to have you.
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Thank you. I'm just really grateful I knew where to recommend for more help. I can help with the lack of appetite and the HL, but there's nothing quite like some hands-on experience with DKA for being able to advise someone else...and that's something I just don't have.
 
manxcat419 said:
Thank you. I'm just really grateful I knew where to recommend for more help. I can help with the lack of appetite and the HL, but there's nothing quite like some hands-on experience with DKA for being able to advise someone else...and that's something I just don't have.
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I have never looked after a DKA kitty either but we seem to get a lot here needing help. Both Bobbie and squeaky and KT have
 
I nursed Alice post DKA. Keep up fluids!!! I hope DCIN can help. If not, if this person sets up a donation page or something, I can share it in some of my crazy cat groups.

Fluids, any wet food that will be accepted, start a low dose of insulin, test test test, treat for infection, check for ketones. And if kitty acts like they are in shock, GO to ER vet ASAP. (I have a disturbing picture of Alice in severe DKA shock.)

I don’t know anything about hepatic lipidosis though. My advice could be off, with that in mind.
 
I'm sorry, just now getting online and seeing this tag.

At this point, there's almost too much happening in Inka's body to not be hospitalized...but with this vet, that concerns me too. I fully agree insulin needs to be started - start at 1u for now. My instinct tells me it may need to go up to 1.5 fairly quickly tho. Lantus isn't the best insulin to start with but if that's what's available, then the sooner it's started, the sooner the depot starts building and a bit starts precipitating.

Hepatic Lipidosis aka 'Fatty Liver' - this is from not being able to get any nutrition from food or not enough food or not eating at all. This causes the body to burn stored fat - nasty 'fuel'. If a cat is ketonic for very long, it causes the ph balance to become more and more acidic. When you hit that ph acidic point along with the ketones, you have 'Diabetic Ketoacidosis'. FLUIDS - LOTS OF FLUIDS. Lactated Ringers SubQ's at 100ml/day if no heart problems, water added to food, no dry whatsoever. Lactated Ringers will help rebalance the electrolytes too. FOOD - ALL you can syringe feed....all day long.

I'm really concerned this baby is too far into this to be able to be pulled thru at home... :(
 
@manxcat419 - after spending a bit more time thinking about this, this kitty REALLY needs a fully working insulin dose NOW. Lantus isn't going to give you that. I would suggest that she go to Walmart and get a $25 vial of 'Novolin N' (NPH). Start that at 1u altho' that's not going to be enough. The liver's trying to feed/save the body without insulin, when you give any type, it's going to still panic BUT some will still start working. You MUST have that key to unlock the cells to get that glucose and potassium into those cells QUICKLY right now....that key is insulin.
 
There is a full tie between glucose and potassium....they must combine at the molecular level to enter a cell. Without insulin to unlock the ion channel to feed that cell (each cell), the glucose and potassium combine then 'fail' at the door. Glucose numbers go up, potassium goes down - potassium must have an external 'feed' such as food while glucose is somewhat stored within the body. The lower the potassium goes, the weaker the body gets. The weaker the body, the less it can 'do' to continue. There's a whole lot more scientifically required surrounding this but this hopefully gives you enough of an idea of the requirements to help you understand.
 
manxcat419 said:
Inka) is currently being treated for hepatic lipidosis with fluids, Cerenia, a/d syringe fed, rx vitamins and milk thistle (not Denamarin).
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that's what we did for Ducia past her DKA - with Lantus BID and the the SQF was Lactated Ringer's Solution to replenish K, and she had short course of Metranidazol AB.

But I wanted to stress that food - up to 300Kcal/24h via E-tube - was the main medicine.
It was fed as a slurry in about 1/4 can of 5.5 oz Friskie Pate a session x 3 - times each cycle.
Orally taken water - in addition to SQF - up to 300 ml a day mixed to the wet food.

I do hope the kitty pulls thru. very best wishes!

I'd start insulin right now, vet doesn't need to know.
 
Thank you all. @Squeaky and KT (GA) - my concern was that Lantus isn't the ideal insulin for this too unless it's being given IV which can only safely be done in the hospital where they can IV dextrose at the same time. Of course when it's all there is, it's better than nothing. Fluids are already being given at 100 ml/day. Novolin N, much as I don't like it for general use, might just be the answer temporarily until she's more stable. @SharonKurtz - I know you're having trouble with the site, but hopefully you can read everyone's comments even if you can't reply at this point.
 
manxcat419 said:
Novolin N, much as I don't like it for general use, might just be the answer temporarily until she's more stable.
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This type of situation is the only time I do suggest NPH. It's single cycle, the working method will give more available insulin. A good vet in a hospital setting would use a faster acting insulin while providing glucose support and test more often. I would go back to Lantus as soon as this medical crisis is averted remembering the depot has to build before it's capable of providing a 'full dose'.
 
manxcat419 said:
I've been trying to help in a Facebook group, but would appreciate input from here too.

Kitty (named Inka) is currently being treated for hepatic lipidosis with fluids, Cerenia, a/d syringe fed, rx vitamins and milk thistle (not Denamarin). However, glucose has been very high on blood work and when I queried that, I was told that the vet confirms she is diabetic and in DKA but is refusing to treat with insulin unless the cat is hospitalized which is unaffordable currently. DCIN have been contacted to see if there's any help possible there. Mom has Lantus on hand for another cat but vet will not advise on dosing as they say it's "risking a crash" to give insulin without hospitalization. I've covered the written starting dose protocol for Lantus (1 unit as Inka weighs 9.6 lbs currently). Home testing is possible. Ondansetron instead of Cerenia is an option and is available.
Click to expand...
manxcat419 said:
I've been trying to help in a Facebook group, but would appreciate input from here too.

Kitty (named Inka) is currently being treated for hepatic lipidosis with fluids, Cerenia, a/d syringe fed, rx vitamins and milk thistle (not Denamarin). However, glucose has been very high on blood work and when I queried that, I was told that the vet confirms she is diabetic and in DKA but is refusing to treat with insulin unless the cat is hospitalized which is unaffordable currently. DCIN have been contacted to see if there's any help possible there. Mom has Lantus on hand for another cat but vet will not advise on dosing as they say it's "risking a crash" to give insulin without hospitalization. I've covered the written starting dose protocol for Lantus (1 unit as Inka weighs 9.6 lbs currently). Home testing is possible. Ondansetron instead of Cerenia is an option and is available.
Click to expand...
 
Hi All,
I think I found out how to get in here. (at least for today, by tomorrow I'll be scratching my head again)
Tested Inka's glucose this morning at 10:30 and got 206. That is down quite a bit from 504 the other day so I did not give the insulin because I was afraid. I followed April's advice and upped her feedings. I give her 20cc of A/D as a slurry every 2.5 hours during the day. She tolerates it well. No vomiting. I am not sure about her bowel movements as I have 9 rescue kitties here so it is hard to know who does what. I actually sleep downstairs on a couch to watch my other newly diagnosed diabetic kitty (Mookie) and my 19 year old CKD kitty (Mushka)I am planning on checking her BS again in an hour ith her last feeding for the day. She is getting 100cc of Lactated Ringers daily. I did give her a B12 injection and 0.45cc of Cerenia. She is getting the Rx Vitamin Hepato Support which is milk thistle and B vitamins. She seems more alert today. Grooms herself after I syringe feed her. Still not eating on her own but I think I'm giving her plenty of food so maybe she is just not hungry when I put the plate in front of her. Her jaundice seems less severe than it was but she is still yellow. Just so you know her background....I was asked in 2011 to help with placing cats that were in the home of an elderly woman. Someone else was going to NYC and taking cats from the shelter, collecting $200 a cat and bringing them to this lady's barn. The elderly woman had money and had people coming twice a day to feed the cats. If someone said they needed veterinary care (as long as the stepchildren didn't know), she would pay for the vet. When I walked in, there were 200 cats. The place was disgustingly dirty. Some cats were visibly ill. My husband gutted the place, put up new sheetrock and laid linoleum floors to be able to keep it clean. My then vet (who was good) came to the barn, did FELV/FIV testing and vaccinated them all. Some were so ill that they had to be euthanized and the woman that brought them there brought in FELV cats too that were in the general population without isolation. Some FELV cats went to a sanctuary in New York and I placed all but 65 by May 2012. The elderly woman fell, broke her hip and the stepkids came in and gave me until July 31st to place them all or they would be euthanized. All were place except 11 and I brought them home with me. I had one cat at home already (the one that is 19 and CKD). Inka and Mookie, the newly diagnosed diabetic are from that barn situation. I never expected or wanted this many cats but I couldn't let them be put down.
In the past month I have spent close to $7,000 on the two cats and when Inka got sick, I never expected this. I just moved three years ago to Ocean County, NJ and finding a good vet has been a chore. I had one that was good but she went out on a sabbatical. Her husband has his own practice elsewhere so I tried him. Another one that looked at the age of my cat and didn't seem interested. Plus she needed a medication that he said was too expensive for him to carry in hos office. So I went back to the place that the vet left on sabbatical and got this new vet. She is a year out of school and I thought originally was very thorough. She told me that Inka should be hospitalized on Friday. Inka was there on Wednesday and she didn't even do a urine then. When I asked she said it wasn't necessary. Turns out Inka also has a UTI. Inka stopped eating last Saturday and I couldn't get an appt with the vet until Wednesday due to the holiday.Vet gave her a shot of convenia on Wednesday. She told me to only give Cerenia every other day because of Inka's high liver enzymes and that daily may make her have seizures. She said their hospital wasn't equipped to handle anything serious. I'm an RN and my old vet would have sent me home with an IV and a pump for the cat. This vet won't. I can't afford the specialty hospital after having spent the $7,000 already. I'm a senior, out of work for a bit due to a health issue and I'm scheduled to have surgery.
Sorry to be so long with this post but I want you to understand that I am not a bad pet owner and will do whatever I can to help her. I have a total of 14 animals here and will never have this number again because I can't afford all the vet bills. All of my critters are old. 3 dogs, 9 cats and 2 parrots.
Anyway, just so you have background on the situation. I appreciate any and all suggestions offered. The vet gave me two options...hospital or euthanasia. I, in my heart, do not think Inka is ready to go yet so I want to be able to help however I can.
And if anyone knows a good vet in NJ, please let me know. Or what questions should I ask when I start calling around tomorrow for another vet?
Thank you so much! God bless you all
Going to feed now. Hopefully I can find this page again :-)
 
BS 241. It’s down so much. Not sure that damned vet knew what she was talking about. What should I do? Insulin or no?
She is very fiesty when getting her feedings. Eyes look much brighter. She grooms herself after each feeding. She’s resting a lot but she always did that. No clue as to her age but the vet said 12 or better but I don’t trust her guess on age either.
Forgot to mention before that she gets Mirataz cream on her ears for appetite stimulant. My other cat gets ciproheptadine and I think that works better. Opinions on that?
She will not eat on her own. She sniffs the food and walks away. She drinks water. Tolerated syringe feeding well. No vomiting.
Thank you again for your suggestions and support. It is appreciated more than you will ever know. Inka says thank you too!
 
IMHO she needs insulin ETA: if she is DKA, the number is ok to shoot but you may need to stay up a bit later, not too late, and take another test and perhaps feed again. What do you think? Can you stay up?
@SharonKurtz

if you bookmark the page it'll be easier to find later.
 
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Are you giving her anything for nausea ?ETA I see above you gave cerenia injection. She could have some ondansetron as well as the cerenia. They work on different parts of the brain and may help the nausea.
Have you done a recent urine test for ketones?
Is it the Lantus insulin you will be giving or did you get a shorter acting one?
If it’s lantus maybe start off with a smaller dose seeing the BSL is not as high as first thought. Maybe 0.5 or 0.75 units. See what others think.
 
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I am afraid there maybe some site navigating difficulties....

Bron and Sheba said:
Are you giving her anything for nausea ?
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I think 0.45cc Cerenia was administered. Vet suggested this dose every other day.
I did not see anything re: ketones but if vet confirmed DKA...

@Bron and Sheba If no R is available would you start with the smaller dose or 1 U?
Ducia was 6.5 lb when had DKA and her dose was 1U to start.
ETA: Inka is 9.6 lb.
 
Tanya and Ducia said:
I am afraid there maybe some site navigating difficulties....


I think 0.45cc Cerenia was administered. Vet suggested this dose every other day.
I did not see anything re: ketones but if vet confirmed DKA...

@Bron and Sheba If no R is available would you start with the smaller dose or 1 U?
Ducia was 6.5 lb when had DKA and her dose was 1U to start.
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Yes I read back and saw that cerenia had been given and added an ETA to my post.:)
I unit is the correct amount for kitty’s weight. I just thought if Sharon was anxious about giving the insulin with the BSL lower than it was at the vet ( in the low to mid 200s) she might be more comfortable starting with a lower dose. I do think it needs to be started ASAP and if Sharon can test frequently the 1 unit would be better. She can add syrup to the syringe @manxcat419 said if needed.
 
@SharonKurtz
Sharon,
I hope you will figure out your way here to post.
It was extremely confusing for me in the beginning to navigate this Board but then I got used to it.
I am going to bed but I will check in for what I hope would be a happy update on Inka tomorrow.
Very best wishes to both of you.
 
Ketones were +2 on Friday. I’m not trusting anything this vet is saying. BS was 504 on Wednesday, 350 on Friday and today at 10:30 am was 206 and tonight at 10:15 pm 241. All with NO insulin
To make it more concise:
Mirataz transdermal— every day to alternating ears
Lactated Ringers—100 ccs every day
Cerenia—0.45 every other day or she said 0.22 every day
B12–injection 0.4 weekly
Syringe feeding 20ccs of A/D every few hours with water added to make a slurry
Rx Vitamins Hepato Support 1 ml twice a day
She is not eating on her own. Walks away from bowl when offered. Bowls of everything out both dry and wet. No vomiting. Urinating in litter box ok. Do not know about bowel movement. Still jaundiced. Was 9.6 lbs on Friday. Will reweigh on baby scale in the morning.
I will follow your suggestions and will be looking for new vet in morning.
I contacted DCIN as April suggested. I know they have read my message but no one has responded back to me.
I have Lantus here now for my other newly diagnosed diabetic kitty. I can buy any other insulin if that’s what is best
I have a glucometer to test
I have bags of fluids
Think this is everything in short form
Thank you all again!!
 
Do you have a bottle of Ketostix to test the urine for ketones? If ketones are in the picture it is really important to test for them at least once a day so you know which way things are heading. It is an easy test. Just dip the test strip
In the collected urine and read exactly 15 seconds later against the side of the bottle.
 
Bron and Sheba said:
Do you have a bottle of Ketostix to test the urine for ketones? If ketones are in the picture it is really important to test for them at least once a day so you know which way things are heading. It is an easy test. Just dip the test strip
In the collected urine and read exactly 15 seconds later against the side of the bottle.
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How do you collect the urine?
I have 9 cats
 
SharonKurtz said:
How do you collect the urine?
I have 9 cats
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Will she let you pop a small container under her while she pees? Or a large spoon? Otherwise I think you would need to isolate her and put some crumpled plastic in the litter, or a container where she likes to pee most. And wait for her to pee. You only need enough pee to stick a strip in.
The other option is to buy a blood ketone meter which I think would be too hard for you at the moment financially.
 
I can’t help you with giving R insulin or NPH insulin as I have never used them, but I do think you need to start something.
Not knowing what the ketone level is clouding the picture really as we don’t quite know what is going on. But if her BSL is over 200 with a human meter or 240 approximately (with an alphatrak meter) then I think you should start insulin. The longer you leave it the riskier it is for Inka.
 
@SharonKurtz
Good morning Sharon,
how things are this morning with Inka?

I want to second @Bron and Sheba about starting insulin.
Inka's BG in 200s is really good but presence of ketones is worrying.
Having even small dose of insulin should help it.

What are your thoughts on starting insulin, Sharon?
Please let us know.
ETA: a few more BG tests prior to insulin can help making the decision.
If she had eaten then a test 2 or 3 hours after would be good data.

SharonKurtz said:
How do you collect the urine?
I have 9 cats
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I use old large table spoon to collect a little urine and then dip the stick into it.
(make sure you don't take that spoon back into the kitchen ;))
Read instructions on the vial of strips - if you wait longer than needed the testing pads turns darker and reads "positive" which in fact maybe false read.
With so many cats testing one in particular is certainly a challenge.
Will Inka pee for you if you put her in the Litter Box(LB)?
She is having enough liquids to want to pee 2 or 3 times a day,it might be possible she'll pee if you put her in LB.
Knowing where ketones are has huge bearing on the treatment (insulin dosage in particular).
 
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Hi all,
First let me thank you all for your guidance with Inka.
Update:
— she ate a bit on her own this morning. I went into the cabinet, picked up a can and thought to myself that she would never eat it. Weruva Green eggs and Chicken. Well, low and behold she ate it. If anyone saw me doing the happy dance I did, I’m sure they would have called the funny farm for me. But that was short lived. Refused everything else, so syringe feeding it was.
—I saw a reply that had asked if maybe her BS was lower because she was not eating. I think she is getting enough food. I give her 20ccs of A/D slurry every 2-2.5 hours. It ends up being a can and a half by the end of the day. Is that enough?
—I weighed her and she is exactly the same as she was in the vet’s on Friday. I looked at the sheet from there and it said 9.1 lbs. My baby scale weighed her at 9 lbs 11ozs
—the “vet” called to see how she was. I Gave her the update. Her BS was 204 this morning. Asked her about mirataz as opposed to cyproheptadine for an appetite stimulant and was told that the practice there used mirataz and she couldn’t comment on the other. I asked about Cerenia as opposed to ondasteron and again she said that that practice used Cerenia and couldn’t comment on the other. She tried to talk very fast, using a lot of medical terms ( didn’t lose me, I’m a nurse). I decided not to ask anymore questions and try to be as pleasant as I could until she said I was always welcome to get a second opinion from another vet in that practice. Then she said maybe it wasn’t DKA, maybe it was pancreatitis or gallbladder. That’s when I lost it. I’m not a person to argue but I will make my point very clear. I told her that I had every intention of getting another opinion and it would not be with that practice as it seems they are limited in using different medications so another vet wouldn’t change what she has done, and what she hasn’t done. She became annoyed ( poor baby) and said she wanted to examine Inka again. Told her I would pass on her offer.
—made a bunch of phone calls to a few vets offices and asked some questions but I was only speaking to the receptionist and really wanted to pose these questions to the vet. I have an appointment tomorrow (Tuesday) at 3:00 with a vet. He is alone in his practice. 20 years a vet. I’ll try him and if he is another jerk, I have another one lined up.
—Inka seems stronger today. A little less yellow. Tonight I noticed a little clear discharge from her left eye and nose. Great. That’s all we need
—I haven’t seen her in the litter box except for once. I will try putting her in it to see if she goes. On Friday they used fine needle aspirate to get urine and she said it was +2 ketones
“Vet” told me not to give Cerenia 0.45 every day because of her liver issue. She said to either give it every other day or every day at half the dose. What do you think?
“Vet” said mirataz transdermal was their practice drug of choice. I said I read on manufacturers website it said it can take up to 1-2 weeks to be effective. She responded that should it take that long to work they would have to look into why the cat was not eating ( ya think, donkey?) Do any of you use Cyproheptadine? I use it on my 19 year old CKD kitty and within an hour she is looking for food
I will let you know about this new vet tomorrow. Say prayers that he is good!
Thanks again!!
 
Sharon, I am so glad Inka ate for you this morning. I'd have been doing a happy dance as well!
I'm sorry she didn't eat again, but that is definitely a step forward.
I would certainly ditch your vet. I would have lost it too. She is very rigid in her thinking and is not open to new ideas or discussions at all.......
Areyou able to get a copy of the blood tests that were run? We have someone here who is very knowledgeable about cat pathology tests and may be able to give you some insight into what may be happening. I'd also want to take them along to the new vet. They should email them to you as they are yours....you paid for them.

Did you say earlier that you had ondansetron? If not I'd ask the new vet for some. It often works when cerenia doesn't, and if you can only give the cerenia every other day, the ondansetron would be good for the others days.
I've had no experience with appetite stimulants so can't really comment, except to say that they shouldn't be given if the cat is nauseated and that is why they won't eat.
If the vet has the blood work in front of her, she should be able to make a diagnosis, or an educated guess at least. To now say that it might not be DKA but pancreatitis or gallbladder is troubling. Where does she think the ketones came from?

Really you need most of all to get a urine sample to test for ketones. Otherwise it is all a bit in the dark.
Good luck with the new vet. I hope he has some answers and is willing to work with you as part of team Inka.
 
Sharon, best wishes with Inka. A sick cat can be grueling.

As for the a/d ... that sounds like a reasonable daily amount. If Inka is handling 20cc fine, you might be able to bump up the amount a little at each feeding and spread out the feedings a little farther to give you some sleep.

As for cyproheptadine ... Yes, I have used it with much success. It was first prescribed years ago for one of my cats and then seemed to fall off the radar of the newer generations of vets in lieu of mirtazapine. I have had a couple if cats have dramatic reactions to mirtz -- pacing, yowling, dilated eyes, restlessness and distress -- and it was dramatic enough that it even made me a little on edge (I used to do quite a bit of rescue so have seen a lot and don't panic easily). It wore off in hours and they settled back down, but I hate to risk putting a cat through that. Some do fine with it but I still tend to ask for cypro.

Liver issues can be daunting but at least the liver has hop for healing. I just took a cat through liver problems last winter and had to syringe feed and give subq fluids for quite some time. I didn't catch it but are you using liver supplements such as SAM-e and milk thistle (e.g., Denamarin)?

I'm surprised the vet wasn't clear about ketones vs DKA vs liver vs gallbladder. Hmmm ...

I'm glad you're getting a second opinion.

Edited to add: another medication that seems to be used less these days is famotidine (Pepcid AC). Regardless of what recent studies might have shown, that was a GO TO drug that made a huge difference in many of my cats. At his sickest, Charlie would eat like clockwork 20 min after his dose and never otherwise. I've seen it with other sick cats too. Dosage is 1/4 of a 10 mg pill. Note that this is Pepcid AC and NOT Pepcid Complete.
 
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SharonKurtz said:
Asked her about mirataz as opposed to cyproheptadine for an appetite stimulant and was told that the practice there used mirataz and she couldn’t comment on the other. I asked about Cerenia as opposed to ondasteron and again she said that that practice used Cerenia and couldn’t comment on the other. She tried to talk very fast, using a lot of medical terms ( didn’t lose me, I’m a nurse). I decided not to ask anymore questions and try to be as pleasant as I could until she said I was always welcome to get a second opinion from another vet in that practice. Then she said maybe it wasn’t DKA, maybe it was pancreatitis or gallbladder. That’s when I lost it. I’m not a person to argue but I will make my point very clear. I told her that I had every intention of getting another opinion and it would not be with that practice as it seems they are limited in using different medications so another vet wouldn’t change what she has done, and what she hasn’t done. She became annoyed ( poor baby) and said she wanted to examine Inka again. Told her I would pass on her offer.
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I think that seals the deal - you definitely need a different vet. She may not use ondansetron or cyproheptadine all that often, but she absolutely should be aware of what they are, what they do, and the indications for using them. That's basic knowledge - as you've seen, many of us know what they're for and when you might want to try one instead of the other without being vets!

And seriously - NOW she says it might not be DKA? So why put you through the diagnosis of it and her refusal to treat if she's just going to change her mind later? Presumably she wasn't that sure to begin with - maybe she was hoping you'd hospitalize and it would give her a chance to do more tests and figure out what's really going on.

ETA - the electrolytes are the big clue as to whether or not there's true DKA or simply ketones. I think I mentioned to you in the FB group that her electrolytes weren't off enough to really indicate DKA although she might be heading in that direction if you couldn't get her turned around.

We actually do use mirtz currently on an as-needed basis for our Roxi. She seems to handle it pretty well and it does turn her into an eating machine...we put food right in front of her, she eats the food, no questions asked. Then again, she's not all that yowly in the general course of things, so if she is ever so slightly noisier, it's not so much that we really see much change.

JL and Chip said:
Edited to add: another medication that seems to be used less these days is famotidine (Pepcid AC). Regardless of what recent studies might have shown, that was a GO TO drug that made a huge difference in many of my cats. At his sickest, Charlie would eat like clockwork 20 min after his dose and never otherwise. I've seen it with other sick cats too. Dosage is 1/4 of a 10 mg pill. Note that this is Pepcid AC and NOT Pepcid Complete.
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Agree - I've had a few discussions about this with people. Research aside, so many people absolutely do see a difference in their cats with it. I would say, it's pretty safe as meds go - if you want to try it and your vet's OK with you trying it, it isn't likely to hurt. If it works, great - stick with it. If it doesn't, there are other options you can try instead. If our cats were so straightforward that every med worked the same way for every cat, we wouldn't need more choices. But we all know that isn't the case.
 
manxcat419 said:
And seriously - NOW she says it might not be DKA? So why put you through the diagnosis of it and her refusal to treat if she's just going to change her mind later? Presumably she wasn't that sure to begin with - maybe she was hoping you'd hospitalize and it would give her a chance to do more tests and figure out what's really going on.
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Any vet that can't spot the signs of DKA in a cat not only shouldn't be a licensed vet, they should be under a rock somewhere. DKA is very simple to diagnose - you have ketones, you have a ph acidic base and the electrolytes are WAY off.
 
Met the new vet today. At first I didn’t like him because of his mannerisms but the more we talked, I think he knows what he is doing.
He wants her fluids upped to twice a day. Gave me two antibiotics Amoxicillin and Metronidazole. Said she needs that for her liver. Gave me oral mirtazapine instead of transdermal. Said they work better. B Vitamins. Syringe feed 20ccs every two hours while awake and once during the night. He wants me to keep checking blood sugars. Hers was 204 on my meter this morning but 290 on his after a few meals. He was annoyed the other Vet didn’t run a whole urinalysis or thyroid levels. He isn’t a believer in the liver support herbs but said he would be more than happy to get them for me since the group suggested them. Asked about the ondansetron and he looked it up in the vet site on the computer. It states that it is more toxic to the liver than Cerenia. He doesn’t use it routinely but wanted to check if it was ok for Inka. Don’t forget... we have the liver issues with her and gave to be careful. She is still yellow. He gave her a 50/50 chance. Wants to study the bloodwork because he is confused why her BS dropped so low and she is being fed. Will also have the urine to check ketones. We’ll talk tomorrow morning about the results. One thing I didn’t like was that he will not order stock meds for me. Bring in rescueI have always had injectables on hand.
The other vet I would have gone to if I didn’t like him is out of the question. I was talking to one one who found out after months of going to this other vet, she found out her dog had been in kidney failure and didn’t even know. The dog died at 5 years old. She now swears by the one I saw today. She said at first she was taken back by his mannerisms too. But he’s from Brooklyn (and so am I) so he talks a little rough.
And his bill was a quarter of the cost. He gave me rescue prices. Only charge $15 for the office visit and $10 for each bag of fluids with the lines. Medication was discounted too. It’s always hard to start a new vet but I had to walk away from the other one (although she was really good with my CKD cat)
What do you guys think?
 
Just with the amount of time that's passed since this thread started and Inka isn't getting worse, she wasn'/isn't in DKA. Bluntly, she'd have crossed by now due to no insulin. If she's ketonic, it's most probably from the liver issues. If the ketones were increasing since this thread started, she'd probably be DKA now but many things say she may be tetering on the edge but she's not.
I think I like this vet
 
DCIN got back to me today. I sent them a message on Saturday and I know it was seen. All they offered was a suggestion for liver support. I know it was suggested so I thought you should know the result
 
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