? DKA/Pancreatitis Recovery - Advice needed

Marc & Jen

Marc & Jen

Member Since 2018
Hi all,

FA had another flare up of his pancreatitis last Thursday evening - initially we thought he ate a hair tie and was trying to throw it up but were wrong about that. We had him admitted to the ER Friday around noon and he stayed for 3 full days. The ultrasound showed moderate to severe pancreatitis and ketones were high therefore he was DKA again (just like his last stint in the hospital last August).

He came home yesterday around noon, ketones were negative when he left the hospital and they said he had been eating fairly well. When we got home he was initially his regular self, jumping on the counter (which he is not allowed to do) and exploring the house. He did eat at that point too. Since then however he was been incredibly sleepy due to the pain medication that he's on which is also a sedative and has only ate enough of his regular food so I can give him his insulin otherwise he is not too interested in it. Interestingly enough he will still eat all the freeze dried salmon treats whenever I offer them to him.

He is currently fitted with the free style libre sensor between his shoulder blades for bg readings - yesterday morning his AMPS was 350 at the vet, then he dropped to 54 around +9 and since then has climbed all the way up to 450 - the highest that we have ever seen him. He is still not eating much and I'm concerned about ketones again. We have a blood ketone meter but I do question the accuracy of it - had a reading of 3.4 this morning and then a reading of 2.0 around +6. My understanding is that anything under 2.4 is ok.

I am going back to the vet in a couple hours and they are going to teach me how to administer subQ fluids at home and hopefully send me home with an appetite helper to get him eating again.

He is not looking too good - not eating much, not acting like himself and I am really worried. The pain meds/sedative probably doesn't help and when he is a bit more awake he keeps scratching at the bg reader so I bought a little t-shirt to put on him to cover it up which he also seems to hate.

What else can I do for him? Any suggestions on food to try? He usually eats FF classics but I did give him some rachael ray wet food as I also had some in my cupboard but he's not so interested in either. We cannot hospitalize him again so anything we can do at home we will try.

Last time this happened in August, he bounced back really quickly however he was on an appetite helper at that time.
 
I think you're doing all the right things, especially learning how to administer SQ fluids at home.

For now, whatever FA wants to eat, give it to him! After DKA and with pancreatitis, food intake is so important.

What pain medication is he on currently? Is he on any anti-nausea meds?
 
Crista & Ming said:
I think you're doing all the right things, especially learning how to administer SQ fluids at home.

For now, whatever FA wants to eat, give it to him! After DKA and with pancreatitis, food intake is so important.

What pain medication is he on currently? Is he on any anti-nausea meds?
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I'll make a run to the pet store after our appointment to pick up a variety of different foods for him to try then - is dry food ok at this point too? We already have a wide variety of dry food in our pantry from before we completely switched over to wet food.

I can't remember the pain meds that he is on, they're administered by syringe in his mouth and apparently they taste really bad - will have to check when I get home (starts with a g which is all I can remember). He isn't on any anti-nausea at the moment although we do have 2 pills at home - I'll ask at the vet if we should try giving those as well.
 
I'm not too sure about the dry food. Hopefully someone else will give an answer for that. For me, personally, when Ming used to get pancreatitis every month (ugh), I only broke out the dry foods when he wasn't taking ANYTHING else. And it was what he wanted to eat in hospital so they let him have it.

If it starts with a G, it sounds like it might be gabapentin. If it's coloured, then it probably is gabapentin, although, I always thought it tastes better than buprenorphine which is another, more common, pain medication. Buprenorphine tastes bad and is clear. If you think FA is being too sedate on his pain meds, then I would ask your vet to see if reducing the dose can help with getting back his appetite. Or try buprenorphine if it isn't what you're using already. Gaba can be used for pain but it's more commonly used for anxiety.

Yes, it shouldn't hurt to give anti-nausea meds. There's no point in giving appetite stimulants if kitty is nauseas - they won't eat if they're nauseas.
 
If it's an oral pain med, it's likely buprenorphine. It's a narcotic and good for pain. The downside is that it can cause kitties to be zonked. Talk to the vet about lowering the dose. Pancreatitis, as I'm sure. you know, it very painful so it's a balancing act between managing the pain and a zonked kitty.

I would also try baby food -- all meat and broth, no veggies. Lots of cats love baby food. Just keep in mind that it's not nutritionally complete so it's not good for the long term. You might ask the vet for a couple of cans of A/D -- it's a recovery food that's high in calories, which is what you want if FA isn't eating. The higher the calories, the bigger the bang for your buck. You want to try to get about 1.5 times the amount of FAs usual calories into him to keep the ketones at bay. Adding water to his food will also help as well sub-q fluids.

Did the vet give you any meds for nausea? Either ondansetron (Zoran) or Cerenia or both may be helpful You don't want to give a nauseated cat an appetite stimulant until the nausea is under control. (You usually give the anti-nausea med at lease 30 min before the appetite stimulant.)
 
Sienne and Gabby (GA) said:
If it's an oral pain med, it's likely buprenorphine. It's a narcotic and good for pain. The downside is that it can cause kitties to be zonked. Talk to the vet about lowering the dose. Pancreatitis, as I'm sure. you know, it very painful so it's a balancing act between managing the pain and a zonked kitty.

I would also try baby food -- all meat and broth, no veggies. Lots of cats love baby food. Just keep in mind that it's not nutritionally complete so it's not good for the long term. You might ask the vet for a couple of cans of A/D -- it's a recovery food that's high in calories, which is what you want if FA isn't eating. The higher the calories, the bigger the bang for your buck. You want to try to get about 1.5 times the amount of FAs usual calories into him to keep the ketones at bay. Adding water to his food will also help as well sub-q fluids.

Did the vet give you any meds for nausea? Either ondansetron (Zoran) or Cerenia or both may be helpful You don't want to give a nauseated cat an appetite stimulant until the nausea is under control. (You usually give the anti-nausea med at lease 30 min before the appetite stimulant.)
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All good advice! Thank you! I'll ask about lowering the dose of the pain meds - he was on an even higher dose when he was in the hospital as he was quite angry to be there. It's quite alarming how sleepy it makes him and I wonder if it's one of the reasons that he's not eating so much because he's in such a deep sleep.

I'll look into your recommendations on the food - and when you say baby food you mean human baby food? Or kitten food?

I also can't remember the nausea meds that they gave us. This was when we were still under the assumption that he ate a hair tie - he hasn't thrown up since Thursday night but it's possible that he's still feeling nauseous due to the pancreatitis. Will check with the vet once I am there in an hour.
 
Pancreatitis can linger for some time. Ask vet to give you enough meds to last a couple of weeks. IMHO I think Buprenorphine is the better pain med for p'titis, at least for Ollie. Eventually I was able to lower her dose to a small maintenance amount. Keeps her comfortable without being zonked.
 
For Max who had chronic pancreatitis for years, nausea medication was all he needed once I got the dose right. I used mostly ondansetron but sometimes used cerenia. Until one of those worked I used cyproheptadine as an appetite stimulant. I always had buprenorphine around but rarely needed it. Every cat is different as to symptoms and what works best. That’s what makes pancreatitis so difficult. Also feed several small meals as opposed to just a few times a day. As they feel better eating too much at one time can make them feel yucky.
 
Here's what works with Macka when he suffers from pancreatitis, tummy issues, or any other health condition:
- human baby food, turkey or beef with broth
- Tiki cat Velvet mousse
- Recovery by Royal Canin (low carb 3%), syringed if you must
- Dr Elsey dry food 4% carbs

Recovery from DKA and pancreatitis can take a while.
My friend, who has diabetes and had DKA, told me that it took her 2 months to recover from it, and I think she's right. It took about 2 months before Macka acted like a old normal cat again. He was very, very tired all the time, not much appetite, etc. I think he also had nausea so he would take Cerenia daily, it helped.

I hope FA recovers soon and quickly though. :bighug:
 
Thank you all for your replies! They have all been so helpful!

FA had subQ fluids administered at the vet yesterday afternoon when they taught me how to do it - they said to give fluids every 3 days so we will give him more on Friday. He still wasn't quite himself when we got home, we tried to give him the anti nausea pill (cerenia) but he wasn't having it and was quite upset so we left him alone. I did give him the appetite stimulant and he did eat little bits throughout the night - his bg dropped pretty quickly so we did have to wake him up to eat a few times as he was still quite sedated on his pain meds. I may try crushing up the anti nausea pill and putting it in a syringe with some baby food to get him to take it later today.

This morning it took us a while to get him up but he finally did and ran over to his breakfast spot and while didn't eat very much seemed excited for food. We have left out a variety of foods for him including baby food and dry food. He still likes his freeze dried salmon treats best so we have left lots out for him - we could hear him trying to get into the treat bag in the middle of the night which was a good sign that he's still got some spunk.

I only gave him 1/3 of the dose of pain meds today in hopes that he is a little less sleepy. I will go home and check on him at lunch to see if he has eaten. His bg numbers were very good last night and ketones read 1.1 on the blood ketone meter which my understanding is negative (under 2.4).

I honestly think that we were so lucky in August when he was discharged from the hospital, he was back to his normal self in under 12 hrs from getting home. That was my expectation again for this time however that does not seem like the typical recovery from DKA/pancreatitis.
 
Try raising the food bowl about 4 inches. An upside-down cookie tin works (most tins have a small rim on the bottom which stops the food dish from sliding off), or a small stack of books you don't want any more. If you are nauseous, the last thing you want to do is lower your head.
 
These are encouraging news! One thing about Cerenia: it’s very bitter and will probably turn him off his food if crushed. Do you use pill pockets? I put my 1/2 cerenia in a 1/2 pill pocket and my cat gobbles it up. Good luck!
 
Red & Rover (GA) said:
Try raising the food bowl about 4 inches. An upside-down cookie tin works (most tins have a small rim on the bottom which stops the food dish from sliding off), or a small stack of books you don't want any more. If you are nauseous, the last thing you want to do is lower your head.
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Good call! I didn't think of that!
 
Penelope and Mačka said:
These are encouraging news! One thing about Cerenia: it’s very bitter and will probably turn him off his food if crushed. Do you use pill pockets? I put my 1/2 cerenia in a 1/2 pill pocket and my cat gobbles it up. Good luck!
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I tried injecting the crushed up pill with some baby food at lunch into his mouth but missed most of it - I have never tried pill pockets so I will have to pick some up!

When I went home at lunch, he was in his little house in our bedroom, it was hard to tell if he ate anything while I was gone this morning. Still was excited about his freeze dried salmon though and will eat those out of my hands. I couldn't get him to come out of the house so I went to see what other foods we had in our pantry and when he heard me pouring out dry food he came running - apparently he is a big fan of the prescription dry food that we got when he was originally diagnosed as diabetic. He was purring while he was eating it - he didn't eat a ton but did eat some so I have added that to his plethora of foods that he has out and available to him.
 
You can also get blank capsules. Capsuline is a company that has cat sized capsules. Putting the Cerenia in a capsule protects your kitty from the bitter taste and also prevents it from melting in your cat's mouth if you're not able to get the pill down FA's throat the first try.

FYI - pill pockets have a good amount of corn syrup in them. Even if you use a small amount to wrap around a pill, it may raise BG numbers. Some people will use a soft cheese cube instead.
 
Sienne and Gabby (GA) said:
You can also get blank capsules. Capsuline is a company that has cat sized capsules. Putting the Cerenia in a capsule protects your kitty from the bitter taste and also prevents it from melting in your cat's mouth if you're not able to get the pill down FA's throat the first try.

FYI - pill pockets have a good amount of corn syrup in them. Even if you use a small amount to wrap around a pill, it may raise BG numbers. Some people will use a soft cheese cube instead.
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Ok good to know! I'll take a look and see what they have at the petstore this afternoon. Cheese may work though! The second I take any cheese out of the fridge both cats are immediately sitting right behind me waiting for a sample. With tomorrow being Thanksgiving here in the US, and stores being closed, I may pick up some sort of pill pocket/capsule just in case the cheese doesn't work.

Latest update that I received from my husband who is live streaming FA on his phone at work is that he got up to eat again not too long ago! Glad to see that he is beginning to eat without coaxing from us.
 
You can also get gel caps from Amazon. You want size 3 or 4. The larger the number the smaller the capsule. I used to put pill pieces in one and coat with some baby food so it would slide down. If not eating you need to chase it with a syringe of water. That being said I was not successful with my young cat a few months ago so a feisty cat might take perfecting the method. Next time she needs meds I will do it in the bathroom on the counter. I forgot how A strong young cat can be a challenge. ;)Eating is a very good sign. Acting hungry but not eating much is most likely nausea.
 
Marc & Jen said:
I may try crushing up the anti nausea pill and putting it in a syringe with some baby food to get him to take it later today.
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Cerenia is very bitter. Better to put it in a gelcap, and cover that with butter. I could buy small gel caps locally from a compounding pharmacy, and also the specialty/ER vet. Just so you have enough on hand until an online order shows up. Or get ondansetron for nausea. You need to give it more frequently, but it's not bitter. Cerenia can also be given as a shot. My vet said she would pre make up syringes if I wanted to do that. But the shot stings,so glad I didn’t have to do that. A piller or pill gun helps get pills and capsules down too.

The duck and pea pill pocket is FD friendly. But only comes in dog version so you break off a piece to use to wrap the pill.
 
Hi All - just as an update, FA seems to be on the mend! He is venturing out further from his house everyday and is eating well. We successfully gave him fluids at home yesterday and will continue that every 3 days for the rest of the month and probably will continue that once a week beyond that to hopefully prevent another pancreatitis flare up. We also got him to take the anti nausea pill a couple day ago however now we have ran out and he has been off of that and pain meds for a day now and still seems to be doing well.

His BG levels have been quite high as he is now eating dry food again. We increased his insulin dose due to that and ketones remain negative. He is eating the Hill's m/d for glucose/weight management and loves it - and will not touch his fancy feast :banghead:. The only wet food that we have found that he likes is any tuna in broth (already bought the store out of the purebites brand) but I realize that this is not a nutritionally whole food and too much tuna over time can be bad? He does not seem to be interested in chicken which we have also offered to him - funny enough our other cat Molly will also no longer eat the fancy feast and only will eat the Hill's dry food and tuna. Any suggestions to get him back over to wet food? I am going to pick up another bag of the Hill's dry food but hope that we can get him off it again in the next few weeks.
 
The Hill's dry is horribly high in carbs. If you need a dry food, some here use Dr. Elsey's Clean Protein or Young Again Zero Carbs. Another alternative is ZiwiPeak air dried raw. It looks like a jerky-type treat but is an air dried raw food.
 
Sienne and Gabby (GA) said:
The Hill's dry is horribly high in carbs. If you need a dry food, some here use Dr. Elsey's Clean Protein or Young Again Zero Carbs. Another alternative is ZiwiPeak air dried raw. It looks like a jerky-type treat but is an air dried raw food.
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I did offer him a bunch of different dry foods and the Hill’s is the only one that he would eat. I may have found a wellness core canned food that he’ll eat so fingers crossed that he continues and I can transition him away from the dry food over the next week. Of course I have 8 cases of the fancy feast that he will no longer eat in my pantry...
 
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