DKA without symptoms. HELP.

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Mnyc

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Cat didn't eat yesterday so I thought something might be wrong. Just got home for the vet, who found moderate ketones. I tested last night and they were trace (same as always). BG was not extreme at all.

I have a consult at the hospital in and hour and a half. They are going to tell me to hospitalize him again. He is only a month out from the first DKA episode.

I don't think I can put him through the stress of the hospital again. Is this something that might make the unthinkable appropriate? Outwardly he seems to be doing well, but now I'm worried that I am just delaying the inevitable. In the month he has been home he has been eating like a champ but not gaining weight.

I can't be home with him any more than I have been so home-care isn't an option.

Any thoughts are appreciated.
 
I should add that while money is a consideration (the hospital is brutally expensive) I am more concerned about whether I am doing right by him
 
Looking over the spreadsheet, what I think I see (and I could be wrong) is that
1) he reacts strongly to the very low doses of insulin which are difficult to measure
2) if you're late shooting or skip, he pops up high again, thus risking DKA
3) if he goes low, then he bounces up high

For the not drinking and eating, it is possible to use an oral syringe to get some fluid and food in?

If you cannot be home, is it possible to find someone who could come and monitor him?

Are there any signs of infection, such as dental disease, bladder infection, or respiratory infection? Treating those may help regulate the diabetes.
 
BJM said:
Looking over the spreadsheet, what I think I see (and I could be wrong) is that
1) he reacts strongly to the very low doses of insulin which are difficult to measure
2) if you're late shooting or skip, he pops up high again, thus risking DKA
3) if he goes low, then he bounces up high

For the not drinking and eating, it is possible to use an oral syringe to get some fluid and food in?

If you cannot be home, is it possible to find someone who could come and monitor him?

Are there any signs of infection, such as dental disease, bladder infection, or respiratory infection? Treating those may help regulate the diabetes.
Click to expand...

There is no option to have someone else monitor him, unfortunately. And he has been drinking a good amount of water so food is really the issue. I don't think I could ever get him enough food with a syringe.

There do not seem to be any infections.

I'm hoping the doctor at the hospital has some ideas.
 
Ok. So, this was a long day. Just got home from the hospital where their test showed only trace ketones. The rest of his levels were all on the low end of normal. He also has some gum disease going on but the doctor didnt think that was the cause of the ketone results.

Leo came home with me and I need to get food/water into him at all costs tonight. We are also going back to the initial (.5 unit) dose for the time being. I'm going to monitor him every few hours through the morning and depending on how he does I will either bring him back tomorrow or Saturday to repeat the blood work.

Hopefully we dodged a bullet here.

Thanks everyone for the support.
 
Sorry, I should have clarified... If he doesn't eat then he gets a half dose. But I gave him an appetite stimulant and am going to go grab some baby food shortly. He didnt get a shot this morning so I'm sure he will be pretty high by shot time. If I have to shoot baby food into him with an oral syringe I'll do it. I need to get the ketones cleared before things get worse. He at some at the hospital, so at least there's that.

I'll also monitor closely through the night/day tomorrow.
 
It is feasible to treat trace ketones at home. There are a few things to consider. The basic recipe for ketones is not enough food, not enough insulin, and an infection/inflammation.

First, food is essential. It doesn't matter if you feed high carb. Frankly, if you have to give your kitty ice cream to get calories in, so be it. (I'm only half kidding here.) Calories are critical. Feed Leo whatever he will eat. If he's being picky, there are ways to help perk up his appetite.
Cheryl & Winnie said:
Enticing a Cat to Eat

Here are some things you can do do entice your cat to eat:

-sometimes in order to get a cat to eat you even have to resort to dry it is more important that they eat. there are a couple low carb / grain free brands -- EVO and wellness core.

-making a buffet to give him choices
- heating food

sprinkle food with :
  • forta flora -- a probiotic you can get at vets or online. is very smelly and cats love the taste of it.
  • parmesean cheese
  • smashed crumbles of dry food
  • bonito/tuna flakes (Can be found at Asian markets or sometimes in the Asian food section of a large grocery store.)
  • halo chicken treats (freeze dried chicken) -- crumble into dust over food -- my Wolfie loves this stuff.
  • pour a little water from tuna in water over food (I use low sodium/no sodium added as other kinds in water has veg. broth in it and I assume that means onions, which are toxic to cats and it shouldn't contain soy -- check labels)
  • powdered oregano. yep sounds weird . but some cats like it and it will entice them to eat.

other ideas of foods to offer your kitty to stim appy:
  • trader joe tuna for cats
  • baby food -- beechnut or Gerber Stage 2 -- you want a baby food that is only a protein + broth (although the Gerber contains cornstarch). It should have no onions or other additives. some babyfoods have onions . please read labels if you can't find beechnut.
  • kentucky fried chicken
  • deli turkey /chicken
  • plain cooked ( boiled or baked ) chicken breast
  • canned chicken for people (watch the label that their are no onions)
  • chicken broth -- low sodium

If enticements don't work, you should consider:
-assist feeding ( syringe or make little meatballs and place in mouth)
-and/or talking to your vet about appetite stimulents ( mirtazapine or cyproheptidine)
Click to expand...
Second, getting insulin in is critical. Don't skip shots. If Leo will only eat high carb and needs more insulin, adjust the dose to compensate for the carbs.

Third, infection: If Leo's experiencing gum disease, it means that his gums are inflamed. I'd encourage you to discuss an antibiotic until the ketone issue is history and then discuss getting Leo a dental.

Another issue to discuss with your vet is whether giving subcutaneous fluids will help to flush the ketones. This can be done at home. Marje/Gracie put together a video on how to administer fluids at home. She can walk you through the process if the vet will give you a prescription for fluids and the paraphernalia.
 
So I've been up with him all night. He won't eat. At all. I have tried everything from baby food to tuna to 9 different kinds of cat food. This is with the appetite stimulant. He won't even eat deli turkey, which has always been a "treat" that he couldn't get enough of.

Not sure what today is going to bring when he goes back in for the bloodwork, but thanks everyone. I will certainly update this with whatever happens but a part of me thinks this may be a bad day.
 
Have you tried assist feeding him by putting blended food in a larger food syringe and slowly giving it to him in his mouth?

I will send an email to Karrie and Maverick. Karrie knows a lot about assist feeding.

When J.D. had DKA, he came home with a feeding tube because he would not eat at all while hospitalized.

I am praying for you. Ask the vet about a feeding tube. Hopefully, Karrie will have time to stop by this morning.
 
Cats not eating are not a sign they are giving up. Cats are unique and they will stop eating for a myriad of reasons. Heck even changing brands of cat litter in some cases. I almost lost maverick to liver failure in 2008 and a friend of mine told me about an amazing yahoo group called Feline Assisted Feeding. It is a very active group that as woes thousands of cars over ten years. You need to join now. You will get emotional support on assist feeding also. Assist feeding is often by syringe but can be finger feeding and often by feeding tubes which maverick needed The important thing is to find a way to get enough calories in to clear the ketones and keep the liver happy.

Iams Max cal is worth it's weight in gold calorie wise for a dka cat. 330 calories a can and low carb.

When you join FAF you will be sent five files automatically. One is how to syringe feed safely and effectively. On the home page there is an amazing video of someone syringe feeding their kitty.

Dka cats are very nauseous I would recommend ondansetron for nausea. There is a file on nausea on the site. I will send it to you when you join. Only members have access.

Cats survive dka. You will get amazing advice and support on diabetes here. I lost maverick in 2008 to a blood clot but I still pop in to help cats and especially their owners with assist feeding. It is an emotionally draining thing but once a week goes by with enough calories you will see it was worth every tear and it gets easier. You aren't in this alone. And it's only temporary. Cats start eating again when they are feeling better you can't race them to do this. Be patient and see it as part of the bond you have. I got an amazing two and a half cuddle meow filled years with my beautiful boy. I'd still pay anything to have him back for one more day.

Mavericks story is in my signature.

You hang in there!
 
It looks like Karrie's auto correct went on in her 5th sentence :lol:
She asked me to give you the link to the Feline Assisted Feeding Group on Yahoo and to let you know it's time to start assist feeding, when all the tempting doesn't work.

J.D. gets Ondansetron for nausea, and if he is off his feed, I always give him 1/4 Ondansetron for nausea along with 1/4 Cyproheptadine for appetite stimulant. I don't know why it is, but a lot of vets respond that the cat is not nauseas if they are not throwing up. If there is no food in the belly there is nothing to throw up, but they can still feel nauseas and not eat because of it. If you vet is like that, I would tell him I would like to try Ondansetron, so see if it helps.

Best of luck to you and Mnyc, today, in your vet visit. Prayers for answers and help from your vet.
 
I appreciate all the responses. Last night was just terrible. I would do anything for him but I won't put him through another round of the ICU. So we will see what the blood work says.
 
We've had alot of cats in very dire situations with DKA, feline hepatic lipidosis, and other problems who have pulled through. We have many members who can help you with suggestions on things to ask your vet and also with implementing what your vet indicates.

I wanted to provide you with two, very important links. One, which the FAF group might also have, is how to assist feed a cat. This is a really great video made by one of the members of the Feline CRF group. Notice how she puts the food in at the side of the kitty's mouth and lets the kitty "deal" with the food. You don't want to shoot food down a cat's throat.

[youtube]U6o17wH6ujk[/youtube]

Here is the video I made (to which Sienne referred) showing how to give subq fluids at home.

[youtube]TtSzMuDgx78[/youtube]

Please let me know if I can help with either of these. While I didn't make the first video, all my cats know how to be assist fed and I've done it many, many times through the years. BTW, the "no O-ring" syringes are really nice.
 
I have a note that he has always been a picky eater. At this point I would try him with anything including his original food or high carb dry - if you havent already.

Is he licking his lips and walking away?
 
No, he is at the point of not even really reacting to food or me.

I appreciate the links but he doesn't even want treats or smoked deli turkey (which he has always scarfed down in a millisecond).

His BG isn't even going down despite a shot and no food.

We are heading to the doc at 3 to repeat the blood work and see what it shows. This is the doc who got him out of DKA the first time so I trust her opinion. If there is more I can do that doesn't involve the ICU I will weigh the options.
 
Once the nausea is addressed if he has it, would you be opposed to syringe (or tube) feeding him at home, until he feels better, if the doctor says that is an option? I am sitting here, hoping the best for you and your kitty.
 
Dka is extremely nauseating. A nauseated cat will not eat on their own. They still need assist feeding after starting ondansetron because they associate food with feeling yucky. You have to get in calories you have to start assist feeding. Not licks or picks of food but a 5.5 oz can of food or more a day. Assist feeding saves lives. I wish I had known about it before maverick was almost dead. E-tube feeding tubes are great for getting through a crisis.
 
Just got home. All the test results made it obvious that it was time to say goodbye, which I did.

I don't know any of you personally but I would never have gotten as far as I did without this site, so I thank you all. The last month with him was great, and I know he was happy. But it was clear that even if I got him through this episode there were other problems lurking which would reduce his quality of life more than I would allow.

Thank you for all of the advice and support. It meant a great deal.
 
OH NO!!! I'm so sorry it was time to say goodbye to your Leo. That is one of the hardest decisions we can make for one of our fur children.

Crying tears of sympathy on your loss.

No matter how long or short their stay with us, it hurts so much to lose one of our fur babies.
 

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