Emergency?

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kextyn

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I'm still new to the site and I put a lot of information about what has happened in the last couple weeks in this thread:

viewtopic.php?f=3&t=12975

Tonight it seems Simba has gotten pretty constipated again. He had an enema about 12 days ago and was pooping a little bit at a time the week after. But he's stopped up again even though I used the stool softener for the last few days. He made several trips to the little box this evening but no poop and I don't think he urinated. He did vomit yesterday and again this morning (vet was aware of this when I brought him in yesterday for testing.) But what really made me worried is I just found that he urinated on one of my old jackets that he's been laying on every day for a while and he was still laying there next to it. I wasn't sure what it was at first because it almost didn't have any scent. I'm worried about his kidneys since he's had high renal numbers on the blood tests but he just received fluids under his skin yesterday. I called the standby English speaking tech (who has been working with Simba) and he didn't advise against emergency but didn't say I should go either. He said if I wait until normal hours in the morning (almost 9 hours from now) to just monitor him and call back if anything out of the ordinary happens again.
 
He had an xray when I took him into the ER on the 16th. Lots of poop in there and it was pretty hard. They had to take it out by hand apparently. He had the same problem twice last year but I don't think they did blood tests like this last time when they found the high glucose and renal numbers.
 
I have two things in mind.

One is hypoglycemia. Is he acting disoriented at all? Do his eyes look funny? Is his walking off balance? Is he acting like he's starving? Lethargy? Head tilt? Strange noises? I am very concerned due to the vomit and the fact that he got fluids yesterday and I'm not really clear on his dose. Fluids can cause hypoglycemia because they flush the body and cause the glucose to be flushed out, for an oversimplified explanation. Without bg numbers we can not guess that though, so we've got to go with symptoms. Please list anything out of the ordinary, either that I've mentioned or anything I've not.

Second, I am concerned about the renal problems. If he's peeing outside the box, that is his way of telling you he's in distress. Could be pain, could be hypoglycemia, could be constipation or blockage, could be a number of things. Oddly the urine had no scent, and I would think it would have a strong scent if he had a urinary tract issue.. but I am not qualified to guess that. With recent doses of stool softener, it's possible he's not blocked but again, that would be a guess. How has his appetite been? Diabetes makes cats VERY hungry. Hypoglycemia will make them almost crazed for food.. more so than normal. If he's been inappetant, I would be very concerned about other issues happening. Diabetic cats do not get inappetant unless they have something else happening.

What diet is he on? Dry food? In the long run, I will assure you that the canned food will help with the constipation, and we use a supplement called Miralax a lot around here to keep things moving. That is not a constipation fix though, so we can not advise that at this time, it's only for maintenance.
 
I'm pretty sure he's constipated, no doubt about that part. I've seen the symptoms in him before so I know how he is when he's getting stopped up. As for the fluids, it was quite a bit...he had a large bulge of fluid around his shoulders which didn't completely go away for at least 8 hours. He's not acting disoriented at all as far as I can tell. He's basically been laying in the closet or walking out to the litter box most of the night but now he's on the bed with my wife like nothing is wrong. His appetite never seems to change. He gets canned food every 12 hours and within an hour before he bugs the hell out of me sometimes (either he bugs me or he's sleeping.) He's mostly eating canned food now. He doesn't touch the dry food I put out for him much.

I just had him walk across the apartment so I could watch and he seems fine. After looking at me like I was an idiot for taking him off the bed he just walked back to the closet where he normally lays (where he peed on the jacket.)
 
Just read some of your old post, I am certain that Lantus is available in Japan (if you could get a Rx any pharmacy can fill it for you, and the military pharmacy can definatly order it if they don't have it in stock) Lantus is Germany's biggest pharmacutical export and after the European Union Japan is the #2 importer of Lantus.

LANTUS® SoloSTAR® and APIDRA® SoloSTAR® were approved by the EMEA in September 2006; LANTUS® SoloSTAR® was approved by the FDA in April 2007. LANTUS® SoloSTAR® and APIDRA® SoloSTAR® are launched in France, UK, Italy, Spain, Germany, Netherlands, Slovakia, Slovenia, Sweden, Norway, Iceland, Poland, Austria, Denmark, Estonia, Finland, Greece, Hungary, Ireland, Latvia, Australia, Lithuania, Lebanon, South Africa, Cyprus, Israel, Jordan, Argentina, Korea, Turkey, Egypt, Tunisia, Romania, Chile, Colombia, Indonesia, Costa Rica, Dominican Rep, Peru, Georgia, Uruguay, Curacao, Nicaragua, Singapore, Guatemala and Switzerland. LANTUS® SoloSTAR® is launched in the US, Canada, Taiwan, Japan, Venezuela, Syria, China, Iran, Thailand, Malaysia, Hong Kong and India. The preparation for launches in other countries is planned during 2008 and 2009.

A much better choice of insulin in my opinion.

Also Nestle/Purina foods are available in Japan sold under the name MonPetite (same as Fancy Feast) Friskies is also available.

product_img03.jpg


If you need me to reasearch further I can try, I seem to be the international advisor here :lol: I can speak 6 languages and read/understand about 10 more at least minimally.

Hope Simba is feeling better soon!
 
kextyn said:
I'm pretty sure he's constipated, no doubt about that part. I've seen the symptoms in him before so I know how he is when he's getting stopped up. As for the fluids, it was quite a bit...he had a large bulge of fluid around his shoulders which didn't completely go away for at least 8 hours. He's not acting disoriented at all as far as I can tell. He's basically been laying in the closet or walking out to the litter box most of the night but now he's on the bed with my wife like nothing is wrong. His appetite never seems to change. He gets canned food every 12 hours and within an hour before he bugs the hell out of me sometimes (either he bugs me or he's sleeping.) He's mostly eating canned food now. He doesn't touch the dry food I put out for him much.

I just had him walk across the apartment so I could watch and he seems fine. After looking at me like I was an idiot for taking him off the bed he just walked back to the closet where he normally lays (where he peed on the jacket.)
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Ok he should be peeing like crazy after those fluids, have you seen him visiting the box much to pee? Fluids will bulge like that and it does take a bit of time for them to be absorbed, and make them look like linebackers, so don't be alarmed by what you saw.

So would you say he was doing poorly in the recent past and now seems a little better? Honestly, I am really concerned about both the insulin action and also potential urinary tract issues. What dose insulin is he on? A change to wet food from dry food can drastically decrease insulin needs, and in some cases reduce need for it permanently, so this is pretty important. A cat at the vet will be very stressed and that will increase bg readings, so if the vet is basing the dose on his numbers there, they may be so inaccurate as to cause serious problems with dosing him in a less stressful environment.

Re: the food, while he's on insulin, I'd recommend you leave food out throughout the day since you guys both work. N is a quicker acting insulin, and he may need food more often than every 12 hours. We do find most diabetic cats do better on 4 smaller feedings per day, or actually grazing on wet food, (regardless of the insulin) than twice a day feedings. Wet food may look ugly and dry after it's sat out for a couple hours, but it's fine to feed. You can also add water to the food to soup it up, that should help both the diabetes (which is a dehydrating factor) and his constipation problems, as well as assist with urinary issues he may be having. I add just about 2oz to every 5.5oz can I feed.
 
He just went to the litter box again to try to poop but ended up just vomiting a very small amount of thick fluid. It sounded like he was puking a lot more than that though. Still no poop and no pee that time either.
 
I'd get him to an ER if this is happening! Please ask them to check for both poop blockages but also urinary blockages; check his urine for ketones (via cytocentisis) and his kidney values. Something is going on here and if he is left for too long it may be too late.

Sending hugs across the ocean

Jen
 
Ok I am glad you have an appointment, he does need to see a vet. I'd hold off on any further insulin at this time until he's seen the vet and try to keep him hydrated. Do you have a needle-less syringe that you can use to get water into him? Vomiting is going to continue to dehydrate him.

My next question is really important. How much has he peed since he had fluids? If not at all, or very little (ie: just on your jacket), this is an emergency situation and you need to get him to the vet as soon as you possibly can.
 
Just got back from the vet. They're keeping him for at least today with an IV. His BG was 504 mg/dl...what are the chances that it's way up because of the constipation and vet stress? His BUN was 50 mg/dl and Creatinine was 2.1 mg/dl. They're still high but lower than yesterday. They were most concerned about his potassium level of 2.6 mEq/l though.

I wish all this would get sorted out...I'm sure he's going through hell with all this vet stuff :cry:
 
Yes, constipation causes stress, pain causes stress, being at the vet.. all 3 of those are a recipe for a 504 bg. Also he might not be getting enough insulin, or might be getting too much insulin, both of which can add to high bg's. Right now, diabetes needs to take a backseat to whatever else is going on, unless he has ketones. The fluids will help that considerably too. Is there any kind of diagnosis, or anything the vet said that might confirm constipation, or urinary blockage of any sort?
 
And do make sure they are giving him potassium supplementation. You may need to give it when he comes home. Too low of a potassium level can cause muscle problems, i.e. not being able to walk, heart arrythmia, not being able to lift his head.
 
Only because potassium has been an issue for Tucker recently, I noticed the potassium number you mentioned.

My vet did tell me that insulin can cause a kitty to lose potassium, she said it draws potassium from cells. I have done much research on that since Tucker has been diabetic since 2005 I don't think his recent potassium loss is insulin related, but now I wonder if yours is.

Tucker takes Tumil-K, a potassium supplement and it helps him tremendously.
 
The only thing he has really been diagnosed with is diabetes and constipation. They showed me the xray from today and from the 16th side by side and todays was worse but he was very constipated both times. When I asked what could be causing the constipation the vet said something about him maybe having pain at the end of his back just above the end of his colon. They really haven't said anything about IBS but on the 16th the vet did show me a page in some book about megacolon but didn't say for sure. I'm hoping that switching to a canned only low carb diet will rid him of the constipation for good.

I'll look into the potassium supplements. Thanks for the info.
 
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