HELP REQUESTED - ketoacidosis recovery

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JoeyBoy

JoeyBoy

Member Since 2010
Hello friends,

I need some urgent help. My 6 year old Himalayan cat has been diagnosed with diabetes for over 2 years. He was on Lantus, but we stopped that about 6 months ago -- hoping his body would adjust. His diabetes was under control eating just diabetic food.

2 days ago, he started going into a diabetic crisis. His diet wasn't as strict as it should have been. In hindsight, I am so mad at myself for not spotting this problem 12 hours sooner, as soon as he didn't wake me at 6:30am to eat. This boy LOVES to eat and drink, obviously.

Concerned, I called the vet at 5:30pm on Monday and they set me up with an 8:20am appt the following day. I felt this was critical, and went to get emergency care for Joey Boy.

He has spent 2 nights in under vet care getting extensive treatment, re-nourishment, fluid replenishment, and insulin. This is his first night home, and his first night off an IV -- and I am concerned about my boy.

When I took him home his blood sugar was 300... They managed to get it as low as 195....
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I am especially concerned because he isn't voluntarily eating or drinking. I have been forcing water on him with an eye dropper, and I feel as though he really want my help in giving him water. But he's not eating.... and it's heartbreaking.

I'm new to this... Can someone please tell me what to expect with a cat in recovery from ketoacidosis. I understand the severity of the situation -- but it is normal for them to be depressed after 48 hours of treatment? How can I force feed him? Should I continue to force water on him ever few hours?

This is his first night home, and I gave him 1 unit of Lantus at 6pm... and was advised to give another 1 unit at 6am, and then 1 unit every 24 hours until his vet appointment on Saturday morning.

Any comments or suggestions would be so appreciated.
 
sorry to read your post...i am not an expert so i can't give advise on ketoacidosis.
Was he tested for CRF (chronic renal failure)? did the vet say?
When Rocket stops eating (due to his CRF and NOT diabetes related) i syringe feed him....i wouldn't consider it force feeding...as your aim is to aid them...i buy and keep on stock the clinicare milk which i then add a little of his regular food...pure it enough so it can go thru a syringe (not the insulin type) and i take time giving him the food this way...it is time consuming but worth the effort...
sorry i can't be of no further help
hope this bumps your post to the top
 
Was the only diagnosis DKA? Did they test for hepatic lipidosis and pancreatitis?

Does your cat act like he's nauseated? Was he eating voluntarily at the ER?

Can you get an appetite stimulant from the ER vet? Food trumps pretty much everything. Please monitor his BG carefully if you've given insulin and he's not eating.

I would also try something like babyfood (any type that's just meat and broth -- no garlic or onions).
 
I am so appreciative to have replies so quickly. Thank you!

- The doctors confirmed that it was a diabetic crisis and suggested that it was DKA: "Serum ketones ++"

- I am not aware of the renal failure, but perhaps the results below will mean something to you. They indicated his organs appear healthy, which is good - but his body was in shock/crashing.

- Your suggestion on feeding through a syringe is good.... but he loves dry food. I will take your advice, dilute his wet diabetic food with water (which is stored in the closet because he hates it) and will try to make him eat some of it - thank you

- A metabolic profile test was performed upon admission (48 hours ago)
Na+ : 143
K+ : 3.2
Cl- : 116
BUN : 22
Gluc : 442 (reduced to 290)
HCT : 35
Hb : 11.9
pH : 7.251
HCO3: 9.3
TCO2: 10
PCO2: 21.1
B.E : -18

- I read that recovery can take days to weeks... but would feel so much better if Joey even picked at his food..

- He did vomit once today which clearly contained his dry food... this was at 7pm. He doesn't act nauseated necessarily, however. He is still very depressed, wants to sleep all the time, and even struggled to walk straight earlier without stumbling. I do believe his coordination is slightly better now -- I was very happy to see him climb up to one of his favorite sleeping spots instead of staying on the floor. I was concerned he didn't even have enough energy to do that.

I will inquire about appetite stimulant FIRST THING in the morning, and will immediately take your advise on baby food / wet diabetic food through a syringe.



Any other advice -- or insight on the typical recovery from ketoacidosis -- is appreciated.
 
just want to lend my support...
you've got some really knowledgeable people here that can give you lots of information.

celi & binks
 
There is a yahoo group dedicated to assist feeding called Feline Assisted Feeding. I wouldn't use an appetite stimulant unless you know you have any nausea addressed. It would be like giving you an appetite stimulant with the flu and can lead to long term food aversion. Most likely you'd only have to assist feed to get him settled - a short period. The best appetite stimulant is often just a bit of food itself. Assist feeding will help keep his liver healthy and avoid a second crisis (feline hepatic lipidosis/fatty liver).

I don't have experience with ketoacidosis - just assist feeding. My cat had a feeding tube to get him through his health crisis. But if you join the yahoo group you get sent an auto file on how to syringe feed safely and some tips on going about it.

Hugs.
 
I'm sorry you are going through this. My cat is a DKA survivor and it is really, really rough. My experience after 48 hours was that my cat was still hospitalized (she was there for 6 days and didn't really start to turn a corner until day 4). I would think at this point that you should still be on high alert.

I would post on the Health forum on this board for help with syringe feeding. Did the vet say anything about subcutaneous fluids? That would help keep him hydrated more easily than syringing water, unless he has a medical reason that he can't have them (and he might, so don't give them without the advice of your vet). Do you know how to test for ketones?

What I know is that you HAVE to get food and fluids into him. Water down some high calorie canned food (I used A/D from the vet because it is easy to water down) and syringe it into him every couple of hours. Meanwhile try everything you can think of to try to tempt him to eat. Baby food, real chicken breast, tuna, lots of people swear by KFC for inappetant cats (my cat is different, she loves Chick-Fil-A). Warm his wet food and mix in some low sodium chicken broth to see if that makes it taste better to him. Test for ketones every chance you get, and if you see anything other than negative on the ketone test strip, back to the vet you go. Please do post on the Health forum, though. You'll get lots of good help there.
 
I'm fairly new to this board. I didn't realize this board dealt with assisted feeding and had knowledge of it which is great to hear! I will know for next time.

I hope people know about appetite stimulants not being used on a nauseated cat.
 
My baby also was dx with DKA, along with Hepatic Lipidosis (HL), and pancreatitis.

HL and P-itis can result in inappetance.

ALL of these conditions are treated with fluids. You might ask your vet if you can get a bag of SQ fluids to administer to your cat. And have them show you how to do it.

in the blood panel, was there anything for bilirubin? (that's how we monitored the HL)

There are at least two appetite stimulants that I know of
cyproheptadine- give every 12 hrs, i believe.

remeron or mirtazapine: given every 72 hrs

Personally, I liked the mirtz. it's also an anti-depressant.

good luck to your baby!
 
from the blood panel did they give you a range for the BUN and CREA? if they're above range by a lot...did the vet mention CRF to you? different labs give diff ranges but you will know if something is wrong based on whether he is within normal range or way above...
pancreatitis can lead to lack of appetite and so is CRF...wobbly hindlegs would mean K+ deficiency but i don't see that from your post....sorry i'm trying to help in regards of the CRF issue more than the diabetes...
and i agree...food and water are key
 
i'm sorry to hear about your kitty. you've already received some good suggestions. was he released ketone free? are you testing his urine for ketones at home? it *sounds* like he might still be throwing ketones. if you don't have them, you can buy ketostix at any pharmacy to test for ketones.
 
Great tips -- from clearly great people. Thank you, again.

I have given him food through an oral syringe and think this tip might end up being the one that might save Joey's life. It worked very well -- and reminded Joey how much he likes the taste of the wet food I gave him. After giving it to him, he bends his head to eat/drink from the bowl -- but always stops right before.

He's not indicating any pain when he does this -- but I'm almost inclined to think that something is bothering him... because I do believe he likes the water/food from an eye dropper / oral syringe.

You have given me excellent things to follow up on FIRST THING in the morning with my vets. I'm very appreciative.

---------

Last question --
My boy is still very weak. When walking, he is clumsy, and trips. Slow moving, and still looks skinnier than normal. I understand the urgency in him having food in his system so that his body muscle is not used for emergency nourishment ... clearly VERY important.

However, is lack or orientation common with this condition?

When I first had my concerns on Monday afternoon -- I noticed Joey had a constant "hunch", and couldn't sit down comfortably... instead, he was hunched with his bum a few inches off the ground. Clearly, he still is uncomfortable.

Thank you
Alex
 
<previous message that didnt post>
So grateful for your support and suggestions. Off to the store I go to get a syringe and tempting food. I truly feel I need to get this in him now, and every couple hours overnight. I feel it can be the difference. Tonight could make the difference between life and death.

Thank you.

Is there a such thing as giving him too much water? I'm assuming not -- but I'm not familiar with these keytones, nor the process of excreting them out --

The more water, and the more urine passes the better, correct?
 
the symptoms you're describing... very weak, when walking he is clumsy, trips, slow moving... have me concerned. i'd be calling my vet or the nearest ER to ask for advice. i'd want to know if he's still throwing ketones. he may need more treatment.

edited to add: if you're going out buy some ketostix if you don't have any. test his urine for ketones.
more info here: http://petdiabetes.wikia.com/wiki/Ketoacidosis
 
Water is a good thing when trying to combat ketones. If you don't have them, please pick up Ketostix at your local pharmacy. You dip the stick into your kitty's urine stream (you have to stalk him to the litter box). It's the best way to know whether ketones are still present. If he is still throwing ketones and you notice an acetone smell, please get him back to your vet or ER. If he is wobbly on his feet, it may be that ketones are still present. Like others here, Gabby survived DKA, HL, and pancreatitis. She was at an ICU for 3 nights.
 
JoeyBoy said:
Off to the store I go to get a syringe and tempting food.

Is there a such thing as giving him too much water? I'm assuming not -- but I'm not familiar with these keytones, nor the process of excreting them out --

The more water, and the more urine passes the better, correct?
Click to expand...


tempting food: rotisserie chickens, KFC, get some stinky parmesan cheese,

Water: the more the better for HL, p-itis, DKA, and kidney issues. (Cosmo had all of these). Better ingested orally (via syringe if it's not too stressfull) than by subcutaneous IV.
 
I bought one of those Precision Xtra meters at Wal-Mart that also monitors ketones by testing blood just as a glucose meter does. It was on the expensive side and the strips are about $40 a box for only 10. However, one day when Chester was really high and vomiting, not feeling well at all, I caught a pee sample on a ketostix just as he produced it and it showed a definite trace of ketones. When I tested with my meter, however, the number was 0.1 (basically normal). I wonder if Ketostix can go bad...maybe they were older or were exposed too much air? My vet said that the Ketostix can throw false positives.

I would definitely use them, of course, but good thing you're getting a new bottle. The Precision Xtra gave me that little extra (expensive) peace of mind, however (not to mention adding to my meter collection!) Just a thought.

Your boy is gorgeous. Best of luck to both of you.
 
JoeyBoy said:
Some pictures of the prince : )


healthy Joey-boy
http://yfrog.com/jcjosephcj

Joey at ER check in
Click to expand...
Joey is a very beautiful cat. :-D
I hope that last line you wrote means you got him to the ER. I don't like the sound of his weakness and stumbling.
My cat was hospitalized for 8 days with DKA and came home with a feeding tube and special high nutritian sp? liquid food to give him via the tube. I ended up only having to use the feeding tube or a day or so.
I wish the best of luck to you, and am sending get all better vines to your Joey-boy.
 
I didn't see that last note. I'm glad Joey is at ER. It sounds like he could use some more support. I hope everything is better this morning. Please update when you can.
 
i'm concerned he didn't stay longer with the vet. i'd bring him in. DKA treatment takes a lot of time and attention. it's constant care. any chance you can get him back to the vet and they'll take him til his numbers are better and he's eating more consistently?
very concerned if vet didn't have you give subQ fluids at home. i gave them for months after my cat recovered from DKA.
 
I am glad you brought him to the ER too! We are thinking of you and Joey this morning....
and looking for an update when you can. You did the best thing by bringing him in....
 
happy to hear you took him to an ER. any update?

ps - i'm going to remove the 911 icon from your first post since he's at the ER.
 
Update:

Thank you, all.

I contacted the ER last night and was also able to speak to someone at my vet directly. The ER recommended I bring him in if concerned, but the vet felt Joey was stable late in the afternoon, and it's important to see how he does this evening -- but praised my vigilance in keeping him nourished. The vet is very eager to see if Joey now takes steps to eat on his own today.... if he doesn't, then bring him in immediately.... Thankfully, Joey has started to eat on his own!

When Joey is asleep, he is still pretty out of it.... but when he is awake now, he is MUCH more alert -- eyes wide open ... now is eating on his own (though I still use the oral syringe because he's not eating enough to have me feeling comfortable). He just passed urine for the first time since last night, and bagged it and am taking it to the vet momentarily.

His coordination/slowness/staggering is definitely improving, which is a relief. I've been forcing him to walk short distances, and notice a definite improvement with each time he walks. The vet assured me that for Joey, this was expected, and that we should see slow improvements in his coordination. I'm not seeing him "trip" like he did yesterday -- and he's moving faster, though still cautiously. Poor boy doesn't know what's wrong with him.

Also - I'm able to get him to purr now, when I bring him to my bed for extra TLC. I couldn't get him to be happy at all yesterday -- and that concerned me so much.

I will be taking all of your advice, speaking to the vet after lunch with Joe's urine sample, and we will be bringing him in if his ketones are still a critical concern. Likewise, I have purchased a new glucose meter, and will be monitoring him closely.

I see improvements in quite a few regards, though small..... No matter how small, though, I feel much better... because I truly think he is feeling better.

I will update this once I hear from the vets.
Thank you, all.
 
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