Ernest in ICU for high ketones, hoping he comes home today

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LJ and Ernest

LJ and Ernest

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Hi Everyone,

I joined in April and got the details on home BG testing and I've been lurking since then, hoping that we could get Ernest's BG down without insulin. My vet has been great, checking in with me on the BG readings I was getting and with canned food from Binky's Page we were able to get Ernest's BG down from over 400 in the initial DX in April to 250 this week. At that point the vet said we should continue to monitor his BG and weight but not start him on insulin as long as he hovered around 250 and hopefully continued to inch lower. I thought we had won!

Apparently not. Thursday he was fine, had a reading of 261 and then Friday afternoon he starting vomiting, would not eat, and was very sluggish. We got him into the vet Saturday morning, his BG was just over 300 and they found ketones. So we took him to the vet hospital where he has been since Saturday night. He is in ICU and they put him on fluids and an insulin IV. So far I have not heard a diagnosis that he is DKA, just that he has ketones. But it was clear that if we had no gotten him into ICU when we did, he would have died by Saturday night. By the time we said goodbye to him in ICU he was not doing well at all.

Yesterday I talked to the vet at 10am and she said he is off the insulin IV, just on fluids, eating well and acting like his affectionate goofy self. She said if all continues to go well, we can bring him home on Monday (today) and she would call me back after 2pm with details on how the insulin shots and regulations is going. That is actually the only time I have talked to the vet since he has been in. She never called back. I have spoken to the vet techs twice. The vets call once a day between 10-3 and that is all you get. I talked to the vet tech last night and she says Ernest's BG is all over the place. Too low at one point, then up to 500, then down to 360 at the time I talked to her. The tech says this is normal, but could not say whether that meant he is coming home today or not.

So what I am trying to figure out now is if he is actually doing well enough to come home tonight. And even if he isn't, what questions should I be asking to figure out what is happening with him?

Thanks so much everyone. Just reading through the board has been very helpful.
 
Re: Ernest in ICU for high ketones, hoping he comes home tod

Hi,

I'm sorry you're having to go through this with Ernest. Ketones are a scary time, but many cats have come back from even DKA and done well. I hope that's reassuring. I'm sure you're anxious since you're not hearing from the vet very often.

Do you know what insulin they are currently giving him? Most likely it is a faster acting insulin than most of us use, Humulin R or N. Those are given because his blood glucose needs to come down faster than it would on a slower acting insulin like Lantus or Levemir. It is possible it came down very fast and that is why they got a 500+ reading. That is not unusual, despite what you were told.

Please find out what insulin they want to send you home with. We have members here familiar with each kind and we can help you. He really needs to be on insulin. Diet change alone only works for some cats.

Have they indicated that he may have an infection somewhere? Ketones usually are a cocktail of not enough insulin, not enough food, + infection. You are entitled to see his bloodwork values. If you can see those and have the vet explain to you what the too high or too low values mean, that might help you understand what his condition is. Or get a copy of the bloodwork and report those values here. Some of us might be able to explain them when you are less stressed and we can help you understand. Just like with human doctors, sometimes vets speak a little over our heads.

Other members here have gone through the same thing with their kitties and their experience is invaluable! Ask all the questions you can think of, especially after he is home. I hope he can come home today, but if they don't think so, then he is where he needs to be. :YMHUG:
 
Re: Ernest in ICU for high ketones, hoping he comes home tod

I am so sorry you are dealing with this, it does sound like DKA .... I would sit someone down, your vet or vet tech. and find out what is really going on. My Payne has lived through DKA 4x and is doing really well now.

Once a cat starts throwing off ketones, you will need to check those when he comes home. I agree you will need a long lasting insulin, one of the L's or ProZinc.

Don't give up hope and I would not be happy with a vet that is not user friendly .... I believe Payne would not have had two of the DKA's if the vet had communicated what was going on and why.

I hope everything works out well.

Nancy and Payne
(not liking DKA talk, esp. on a holiday :)
 
Re: Ernest in ICU for high ketones, hoping he comes home tod

Thanks Vicky and Nancy.

From the treatment, it sounds like DKA based on what I have read on FDMB. I called the hospital to get a status over an hour ago and they couldn't connect me with a vet tech or a vet. They said they would have someone call me back. I am so unhappy not knowing what is up. I fear the worst. And also, not to be a jerk about it, but we are already in this for $2500 so far and they have been very efficient about charging us, so I feel like they should be a little more organized about feedback as well. I will ask for all the records when I finally get Ernest or have some sort of discussion with someone in charge.

My understanding is that the IV insulin was a fast acting insulin. Our regular vet prescribed Lantus for us on Saturday when it was not yet clear that he had ketones and we thought we might just be able to get him insulin as a solution -- we dropped that off with Ernest when he was admitted to ICU. I think they are giving him the Lantus via "normal" injections now that he is off IV insulin. But I don't really know for sure.
 
Re: Ernest in ICU for high ketones, hoping he comes home tod

Again, I'm sorry for the rough time you are having communicating with the hospital. Is it an ER facility? Perhaps your regular vet might be able to get through a little easier. But then with it being the holiday, the ER is probably the only place taking cases and they might be busier than usual. Perhaps try back this evening if they haven't called you by then.

Lantus is a very good insulin, but works best in conjunction with home-testing, which you have already been doing, so you are ahead of a lot of newbies. Once you get him home I highly recommend introducing yourself in the Lantus Insulin Support Group section of the message board. They can help with dosing and understanding how Lantus works.

Best of luck to you and Ernest. It gets easier.
 
Re: Ernest in ICU for high ketones, hoping he comes home tod

Is he close to you? Even if he is in ER, they should keep you up-dated and if they don't, go down until someone explains what is going on. In the beginning I made several costly errors based on communication. DKA is VERY expensive and very, very hard on the cat .... some of the reasons those of us that have survived it, do a lot of testing, especially ketones.

Lantus is a good insulin but when he comes home you are going to need to be sure he gets enough insulin, relapses happen frequently and watch his ketones. My, this is a problem alert, is when she quits eating .... regardless of anything else. The last DKA was avoidable but I misread the signs. ohmygod_smile

I agree to go to the Lantus forum and they will guide you, good luck and keep us updated.

Nancy and Payne
(who is finally being a pain again ..... sleeping on top lovebirds cage :)
 
Re: Ernest in ICU for high ketones, hoping he comes home tod

Sorry about Ernest.

I wanted to send you and Ernest well wishes. My Kitty survived DKA one month after being dx with DM. It was very hard on her and the treatment was expensive, but she is 3 months out from the DKA and doing well. We test for Ketones a lot now!

She is still unregulated, and on a pretty high dose of PZI-- but, we enjoy each day together. She is 15.5 years old!!

Good Luck-- I just wanted to send you well wishes from someone that has lived it!
 
Re: Ernest home from ICU !

I just brought Ernest home. He is not quite himself still, but getting there, I hope. He will be on 2 "servings" of Lantus twice daily. Also, he is on Clavamox. Turns out he had a UTI and that is what led to the dramatic decline and the DKA. I did get that confirmed from the vet tech who discharged Ernest. I also got her to write out all his BG readings. She did not give me any sort of printout or official record. I am disappointed in the human service at the hospital, but very pleased with the animal service. Ernest is alive and home and I am happy.

We have to give him his first home dose tonight. I am worried about getting him to eat enough to safely give him insulin. He is not that hungry and has only eaten a few kibbles so far. He will not touch the canned food.

Thanks so much for everyone's support so far on this.
 
Re: Ernest in ICU for high ketones, hoping he comes home tod

Glad to hear that he is home and safe in your arms now!!! What dose of lantus did they put him on twice a day?
 
Re: Ernest home from ICU !

LJ and Ernest said:
I just brought Ernest home. He is not quite himself still, but getting there, I hope. He will be on 2 "servings" of Lantus twice daily. Also, he is on Clavamox. Turns out he had a UTI and that is what led to the dramatic decline and the DKA. I did get that confirmed from the vet tech who discharged Ernest. I also got her to write out all his BG readings. She did not give me any sort of printout or official record. I am disappointed in the human service at the hospital, but very pleased with the animal service. Ernest is alive and home and I am happy.

We have to give him his first home dose tonight. I am worried about getting him to eat enough to safely give him insulin. He is not that hungry and has only eaten a few kibbles so far. He will not touch the canned food.

Thanks so much for everyone's support so far on this.
Click to expand...

Also glad to see he's home. Did they recommend any follow-up treatment like testing for ketones at home? That is a necessity for a kitty who's been ketonic.

Do you mean 2U of Lantus? That is higher than our recommended starting dose of 1U, but it may be fine for right now. Please continue home testing - test before every shot and then periodically every few hours, every 3 if you can.

What canned food have you tried for him? At this point he needs to eat, so the dry is fine. We recommend low carb food, which is primarily wet food in varieties without gravy. You can determine the carb content of any pet food from the %'s on the label. Add up the "guaranteed analysis" percentages on the label for protein, fat, fiber and moisture. Subtract that number from 100 to get the percent of carbs on a wet matter basis. Divide that by .25 to get the kcal % or dry matter basis of carbs. It should be less than 10.

Hope Ernest continues to improve.
 
Re: Ernest in ICU for high ketones, hoping he comes home tod

I would be concerned if he is not eating because it can start the whole thing over again .... I would make sure he is eating even if you have to syringe feed him, it is important. Also you want to check for ketones now religiously! Not eating and ketones will be a trip back to ER, so you want to make sure there are none.

I'm glad he's home and hope he heals well, but now is a critical time, right after a DKA.

Nancy and Payne
 
Re: Ernest in ICU for high ketones, hoping he comes home tod

Ernest is home and eating. We got him to eat some dry food last night, thank goodness. I felt like 2U Lantus was too high also. At the hospital his BG was as high as almost 600 so I can see why they recommended 2U, but before I gave him the Lantus last night it was 369. And our vet originally was recommending 1U once a day, so I gave him just 1U and plan to give him 1U this morning and see how he does. He is supposed to get insulin twice day.

He has been eating Wellness Salmon and Turkey canned food from Binkyspage, but he is not feeling that right now. We also have some Friskies canned as backup. Right now I am just trying to get food into him so I can give him some insulin.

They did not give me any particular instructions for testing ketones, but did mention we would want to monitor keytones in the discharge papers. They also recommended I visit this website. :)
 
Re: Ernest in ICU for high ketones, hoping he comes home tod

Good to hear Ernest is eating something!

It will take Ernest awhile before he starts back acting normal. DKA is so hard on the body. I think it is fair to say, it took Kitty a good 4 to 6 weeks before she began acting like herself. She never quit eating, but I will never forget the ride to the ER-- I thought she was going to die before I could get her there. Kitty also had a UTI lead to her DKA.

Here's wishing you and Mr. Ernest the best. Please continue to post the updates, I love keeping up with our DKA survivors!

Kim
 
Re: Ernest in ICU for high ketones, hoping he comes home tod

LJ and Ernest said:
They did not give me any particular instructions for testing ketones, but did mention we would want to monitor keytones in the discharge papers. . :)
Click to expand...

My cat was hospitalized with DKA in April so I bought some test strips and test her urine periodically when I see her heading to the box. I retired a long handled spoon from kitchen duty and I keep it near the litter box along with the test strips so I can quickly hold the spoon under her and get a sample. She hasn't protested so far. I also bought the special litter box to collect urine but haven't used it yet...I've got 3 cats and would have to keep Gracie separated from them in order to know it was her urine.

I'm so glad that Ernest is home!
 
Re: Ernest in ICU for high ketones, hoping he comes home tod

I'm glad you are getting food in him, very important and you can test for ketones as mentioned with strips. I can just put Payne in a litter box and she will go, usually ..... I'm glad you lowered the insulin. Just remember, lack of insulin and infections are probably #1 & #2 reasons for DKA. I hope you have gone/will go to the Lantus forum for guidance.

As Kim said, it will take time for Ernest to bounce back .... but you will need to watch and monitor him tightly for some time.

Nancy and Payne
(who is trying to figure out how to get the raindrops on her side of the window :)
 
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