diagnosed with ketoneacidosis

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jesmar

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Hello, I'm writing in because my cat, who has diabetes, was diagnosed with (I hope I spell it right) ketoneacidosis. He spent the night at the vet last night with an IV to get rehydrated and they wanted to keep him over the weekend but they said I could take him home, as long as I gave him IV fluids and fed him with a tube. They said he was doing much better since he's more hydrated but he doesn't act at all like my cat. I managed to get 10 units of canned Merrick cat food in him and he fought it for a good 30 minutes. He hasn't been eating much for the past 4 days. He was acting normal 5 days ago. It literally happened overnight.

He's been diabetic for two years and he was on Lantus for a long time. He hasn't had any insulin for about two weeks because I wanted to see how he'd do without it and it turned out he was doing better off it than on. His blood glucose was actually more consistent off the insulin and he was usually, not always, around 170. Now and then he would be 210. He was getting half of one unit.

I'm wondering if I'm doing the right thing by keeping him at home and also if anyone has other suggestions. The vet said he wouldn't have a constant pump with IV fluids if I kept him at home but he seemed to think the cat would do okay, that he's seen a lot worse cases, and that my cat was responding well (except that they couldn't get him to eat much). He said I should give him 150-200 units of saline, three times a day, over the weekend, and then he wants to call me Monday morning. He wanted to give one unit of Lantus twice a day and I was wondering about that, too. I'd be okay putting him back on the insulin but I'm not sure if I should do it now or wait to get more food in him. The vet said it would be okay so long as he eats but he seemed to be more consistent off the insulin. I have the bloodwork and urine analysis here if anyone has a question. It was the cholesterol and triglycerides that were really, really high. Thanks a lot. I hope I did this right.
 
I'm sorry your cat is sick. Ketoacidosis is very serious and the cat should be in the hospital where he can get IVs and insulin, and maybe tube fed. I think you should consider using an emergency hospital if you can because they can go downhill very quickly with this. Do you test for blood sugar? Donna
 
150mL three times a day is a huge amount of fluids! cats with DKA need fluids but they also need proper electrolytes and insulin depending on their bgs and their electrolyte levels. I really question your vet's advice and the fact that they sent your cat home at all.

As for the cause of DKA, it usually takes a combo of factors to bring ketones on, including insufficient food, insufficient insulin and/or infection....was your cat checked for infection?
 
I'm sorry your sweet kitty is so ill, but he needs to be in a 24/7 emergency hospital. He needs to be where they will force feed the food he needs, monitor bloodwork, administer insulin, check for infection, and monitor the level of ketones.
IV treatment is far superior to sub-q fluids, and at the hospital he will be monitored around the clock.

Please reconsider and take your kitty into the hospital (not just vet's office). He needs critical care.

Cats can recover from DKA but you need aggressive treatment from a professional.

Best,
Pam & Layla
 
I monitor his glucose
I have ketone strips
I just gave 1/2 unit of Lantus insulin (I know how to do it)
I tube-fed him (I don't know that the vet will take the time I'm taking to feed him -it took 45 minutes)
I'm giving the IV's (this is the real difference because they have an intravenous pump and I don't)

*They got a blood panel on him and he does NOT have an infection (I think they meant bladder?) The vet said the urinalysis showed that. But he also said there may be another type of infection and that's what they don't know yet.

Insufficient food --he eats raw food and canned food, mixed. High quality.
Insufficient insulin -that's possible. I took him off of it two weeks ago.

If I bring him back to the vet tomorrow, they can't monitor him 24/7 -they leave at night. I'm worried he'll be alone and what if something happens. I'd have to transfer him to the emergency vet at night and then bring him back to the original vet every morning, just to have him watched 24/7.
 
Is he absorbing all of those fluids?

I do get that you are doing a great job, and if it isn't an overnight facility then definitely have him at home...but please be careful!

And what were his bgs before and after stopping insulin?
 
My cat was diagnosed with DKA which is how I found out she had diabetes. This is a tremendously serious condition fpr which she was hospitalized and under constant observation and care. Many cats do not recover. As others have said, it it not just a matter of providing fluids, which does help. DKA also involves an electrolyte imbalance. These levels need to be carefully monitored and appropriate supplements given in a gradual and measured manner. Your cat really needs to be at an emergency facility where 24/7 monitoring is possible. Blood levels need to be taken more than once a day for electrolytes and ketones.
 
Is he absorbing all of those fluids --good question. How would I know? They taught me to check for a soft ball of fluids and I did feel that at the vet. They said it would end up going into his body, spreading around. They said not to give fluids until tonight because he was on a pump all morning and most of the afternoon and then we gave a little bit to show me how to do it. I just went to give the fluids and I guess you have to hold the needle there? Cuz it fell out. So my plan was to try again soon and just hold it there.

The lady that said 150-200 units of fluid is too much --how would she know that? I asked a second vet about it and they said there was no way to know that unless they were the treating physician because my cat's vet is more in-tune with my cat. But now I'm worried she said that so maybe someone can shed some light. I was going to do it very slowly.

Another emg vet said not to feed him anymore because it might stress him out.

His glucose was 300 half an hour ago. It hasn't been that high in a long time but it has gotten to 270 when he was on the insulin fairly recently. Anyway, he was off Lantus for 14 days and I just gave him half of a unit.

PROS OF TAKING HIM TO VET TOMORROW CONS OF TAKING HIM TO VET TOMORROW
He'll have nonstop, intravenous fluids, which I cannot provide They might not take the time to tube-feed enough
If there's an emg, there will be a vet He's not as relaxed there as he is at home
 
My cat is ketone prone and has had 2 episodes of DKA since he was diagnosed (he gets ketones very quickly if his sugar is high). For one, I agree that 150-200 ml of fluid 3X a day sounds like an awful lot of fluid for one small cat. My cat has usually had 100ml 2X a day. (except for the first 24 hours when he was hospitalized and on a drip). What I've learned is that aside from medical attention.... insulin, food, water and fluids are necessary to get rid of the ketoacidosis. All of these things are necessary. ETA: My cat was in the hospital for the first 24 hours for over 24 hours.

What you decide to do as far as going to the ER is ultimately up to you. Is your cat lucid? Is he walking around? If the answer to either of these is no, he should be with a doctor. If yes and you decide to keep him home you must make sure that he gets food and water even if you have to syringe feed stage one baby food. I syringed that and water into my cat's mouth i don't know how many times a day. He does need insulin and he needs those fluids to flush the ketones out. and of course food to support the insulin as well as for nourishment. I would double check on the amount of fluids because too much fluid can be harmful. I don't by any means recommend NOT going to the ER but suggest that you realize that this is a dangerous situation, things can change quickly and that you must stay on your toes if this is what you choose to do. I have done it at home, but again, it is under a special circumstance of having an ex who is a vet and can/will always be here in 5 minutes if i need him. And I HAVE needed him. That's a big 'crutch' and comfort when you are handling something like this at home.

Please keep us updated.

Good luck to you and your kitty.

caryl
 
"For one, I agree that 150-200 ml of fluid 3X a day sounds like an awful lot of fluid for one small cat"

I've never said how big my cat is or how much he weighs and nobody here knows how dehydrated he is so I'm not understanding these comments on the fluids. I can ask another vet tomorrow to double-check.

It's kind of hard to here the comments about how everyone else's cat reacted to something. I can't really do anything with that information and it makes it a little confusing. My cat is different than everyone else's cat.

I am taking the advice about getting him to a vet very seriously, though. I will keep him with me tonight and call first thing tomorrow. Just checked his glucose and he went down from 300 two hours ago to 275, so that's good. I'm thinking he'll go down more tonight and I've got my alarm set to wake up throughout the night and keep monitoring his glucose.
 
jesmar said:
"For one, I agree that 150-200 ml of fluid 3X a day sounds like an awful lot of fluid for one small cat"

I've never said how big my cat is or how much he weighs and nobody here knows how dehydrated he is so I'm not understanding these comments on the fluids. I can ask another vet tomorrow to double-check.

It's kind of hard to here the comments about how everyone else's cat reacted to something. I can't really do anything with that information and it makes it a little confusing. My cat is different than everyone else's cat.

I am taking the advice about getting him to a vet very seriously, though. I will keep him with me tonight and call first thing tomorrow. Just checked his glucose and he went down from 300 two hours ago to 275, so that's good. I'm thinking he'll go down more tonight and I've got my alarm set to wake up throughout the night and keep monitoring his glucose.
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The fluids have electrolytes in them. your cat can't be more than 20 pounds I'm guessing. You're right, no one does know how dehydrated your cat is but the fluids don't just act to hydrate him, they go to other parts of his body as well. Like to his heart. I don't know how old your cats is or if he has any other problems but believe me when I say that we were all just concerned.♥

And each cat is different. No one knows that better than me. Like I said, I never took my cat to an ER..he was home treated by me with the help of my vet and it worked just fine. For US. THAT TIME. That doesn't mean it's fine for anyone else or even that i would do it again. It would depend on what I saw.
I am sure you'll find something that works fine for you. It's clear that you love your kitty and you'll find a way to make it work. Just know that you have support here and we do care...

You are doing a great job!!!

Will you please let us know how the vet visit went?

Caryl
 
((((hugs)))) I'm so sorry you are having to deal with this crisis. I don't know a lot about it, but I thought that one of the reasons for having a DKA cat at the vets was that they would maintain them in good #s using a fast-acting insulin, as well as working on the fluids and feeding tube if needed. I could be wrong though, that is just what I have assumed. I know that is something one can do at home too, but of course you would need a fast-acting insulin to do that, and to be prepared to do a lot of extra BG testing. You might ask the vets about that tomorrow if they didn't mention it to you already.

Sorry I don't know enough to answer any of your questions, but I just wanted to say hi & send good wishes your way. The board may be a bit slow since it's Saturday night, and although there are plenty of peeps here with DKA experience, I'm not sure how many you will find who feel comfortable giving advice on home treatment. Even if your kitty really is doing well enough that your vet safely sent him home with you, it's such a scary situation that I think you will find that most people (myself included - I would be terrified to attempt all that at home!) will suggest going to the ER. Don't take that to mean that you aren't supported here - you are! - just that people are worried about your kitty, and about you too. :)

If you don't get the answers you need on specific questions, like some of the technicalities of administering fluids, please be sure to repeat them if needed - they may get buried in the mix of things. I don't have fluids experience so can't help you there, but I know there are people around who do & hopefully they can help you out on those questions.
 
I just gave fluids and to be honest, I'm not sure I know how much he got. I know he got at least 100 units. But at one point, the needle fell out and I started over again, not knowing for sure how much got in. He didn't get anywhere near 200.

Trying to figure out the best course of action because I don't live in a town that has emg vet care 24/7. I'd have to bring my cat to the regular vet and then transfer him to the emg vet and keep doing that for however long they need him. It's making me mad that I can't take care of him myself, if that's even true. My vet thought I was okay until Monday and I'm not sure why.

Got him down to 205 glucose
Was at 300 after I stressed him out force-feeding him, then 275, now 205.
He was in perfect condition 5 days ago --seemingly-- nothing was different. I'm praying he's going to cut this out and wake up perfect tomorrow.

Can anyone tell me anything based on the bloodwork/urinalysis I have or is that not necessary at this point?

Thanks for the support
 
I'm so sorry I just don't have the knowledge to give you any help or insight, and it looks like not too many are around tonight (I am going to sign off in a couple minutes myself). I popped over to Lantus and saw that you posted there as well & got a reply from Jojo, who is one of the most knowledgeable people here, she is a really experienced vet tech. If you were able to take him to the ER tonight, could they keep him til Monday morning (if needed) without you needing to transfer him around before that? Here, the ER is open all weekend, and then just nights during the week, but I don't know if that is the same everywhere.

Personally I wouldn't worry too much about wondering whether or not it's ok to take care of him yourself - if there is any doubt at all, I would head to the ER first and ask questions later. My personal philosophy is that a trip to the ER, even if it were to turn out to be unnecessary, is better than the other way around. I really don't know if there is a good reason that your vet sent him home with you - maybe he is actually out of DKA or something and doing really well - but given that a lot of people here who I have a lot of respect for are saying an ER is needed, I'd tend to go with that. If somehow the ER turns you away and says your cat is doing just fine and doesn't need treatment, then you can go back home and sleep well...? Just my way of seeing it. I'm sure all of this is really frustrating to you, I feel for you!
 
Thanks, I just wrote over there. The emg. clinic vet said it was okay to keep him at home for tonight, based on what I told her, and to bring him in if anything changes. I will call my vet in the morning. Thanks.
 
i saw your note that your latest ketone reading was moderate (guessing you used the urine test strip and not a blood ketone monitor? there will probably be a difference between the two readings, and my guess is that a blood ketone test will show a higher ketone level). can't encourage you highly enough to raise the dose to the full unit the vet was recommending. if your cat has ketones he's not getting enough insulin (i realize you stopped the insulin for a while so that contributed to the diabetic ketoacidosis -- no judgements, hon, what happened happened so now we're just concerned with trying to get him better).

the situation is incredibly serious. i still think he needs to be at a 24-hr vet hospital so they can monitor him continuously. they do many things to DKA kitties including alternating short and longer term insulins and fluids and glucose to try to balance them out. even with all that care many ER vets will give you no better than a 50% happy outcome. it's expensive and time-consuming to treat. many cats do recover from it. in fact, many cats on this board have gone through the same thing, some multiple times. with the inappetance you also risk fatty liver disease's entering into the equation, so there's really so much more to do than a layperson is really capable of.

for now it will help to add water to his food as well to keep him hydrated but we can't in all honesty suggest you treat this at home. if it's at all possible can you bring him to the vet ER? they shouldn't release him to your care until the ketones are gone and he's stabilized.
 
I said it sounds like a lot of fluids but of course I don't know, but I raised the caution because it is a lot of fluids. If you give a cat too much fluids it could cause problems for other organs.

I realize you are in a tough place, we are trying to help as best we can.
 
I have two threads now so this can get confusing but I posted one at the ISG for Lantus insulin, plus the one here.

I'll ask my vet when he calls shortly if it was a blood ketone test or a strip but I would think they'd read accurately either way. I wrote an update on the other thread. Sorry I don't have the URL but next time, I'll post it here.

Briefly:
His glucose was 150 before his insulin shot today, then I force-fed him, then it was 140, and one hour late it's 141. I'm monitoring very closely.

*If I raise the insulin dose to 1 unit, I'm worried he could go to low. When he was on 1 unit before, he would get as low as 25. I gave him an eency weency bit less than half a unit this morning but if everyone thinks I should give more, I can give him more. I just don't want to make him go all over the place.

QUESTION: When you say to up the dose amount, wouldn't I know if the dose I gave was working or not based on his glucose readings?
 
If he's running 140-150 then the need for insulin is really questionable. so, if the problem isn't insufficient insulin (or at least doesn't seem to be main problem) then it is really important to try and find out what is the cause. I know that some cats are wayyyyy more prone to ketones than others but this one seems to be a bit problematic. I wish I knew more; we have some vet techs who frequent this board and the lantus group and I really hope they chime in.
 
jesmar said:
I just went to give the fluids and I guess you have to hold the needle there? Cuz it fell out. So my plan was to try again soon and just hold it there.
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Hey there,

I was recently having problems with my cat having ketones, so I have been giving him fluids regularly. A quick tip I've learned: after I put the needle under the skin, I use a piece of medical tape (really any tape that's not super-sticky would work) and I tape it in place. Then I have my hands free for other things.

Hope this helps & that you and your kitty are feeling better soon!

Molly
 
My cat is at the ER getting fluids. They are mostly watching his electrolytes and PH. They are about to give .5 units of insulin because I told them that he has gone too low at numbers higher (he's actually gone to 30 at .5 a while back so it may even be too high). But I'm okay with the .5 units for tonight. What bugs me is they aren't going to feed him until 6 hours after giving insulin and he hasn't eaten except for with me this morning. The vet said he didn't have to eat because his blood glucose was 235 now. DON'T THEY HAVE TO EAT REGARDLESS?

Someone said that the electrolytes take a while to change. Is there a way to know if the cat is doing better or worse with the electrolytes before waiting 12 hours? She said they were going to check 12 hours later. My worry is that they won't know if he's doing worse until it's too late. If they check earlier or do something else, like feed!!, then maybe he would get better easier.
 
jesmar said:
My cat is at the ER getting fluids. They are mostly watching his electrolytes and PH. They are about to give .5 units of insulin because I told them that he has gone too low at numbers higher (he's actually gone to 30 at .5 a while back so it may even be too high). But I'm okay with the .5 units for tonight. What bugs me is they aren't going to feed him until 6 hours after giving insulin and he hasn't eaten except for with me this morning. The vet said he didn't have to eat because his blood glucose was 235 now. DON'T THEY HAVE TO EAT REGARDLESS?

Someone said that the electrolytes take a while to change. Is there a way to know if the cat is doing better or worse with the electrolytes before waiting 12 hours? She said they were going to check 12 hours later. My worry is that they won't know if he's doing worse until it's too late. If they check earlier or do something else, like feed!!, then maybe he would get better easier.
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I would worry about that too. I don't understand. With ketones, one of the keys is to keep them eating!
 
jesmar said:
My cat is at the ER getting fluids. They are mostly watching his electrolytes and PH. They are about to give .5 units of insulin because I told them that he has gone too low at numbers higher (he's actually gone to 30 at .5 a while back so it may even be too high). But I'm okay with the .5 units for tonight. What bugs me is they aren't going to feed him until 6 hours after giving insulin and he hasn't eaten except for with me this morning. The vet said he didn't have to eat because his blood glucose was 235 now. DON'T THEY HAVE TO EAT REGARDLESS?

Someone said that the electrolytes take a while to change. Is there a way to know if the cat is doing better or worse with the electrolytes before waiting 12 hours? She said they were going to check 12 hours later. My worry is that they won't know if he's doing worse until it's too late. If they check earlier or do something else, like feed!!, then maybe he would get better easier.
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When my Stormy Blue was in the hospital last Spring for diabetic complications (not DKA, though), I went to the hospital and fed him myself every 4 hours. Would your vet allow you to do that? Go there and feed your kitty every few hours yourself? It surely cannot hurt to ask - especially if you express your concerns about him not being fed often enough.

~M
 
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