Hospitalized: Pancreatitis Acute/Chronic Help?

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LovingErlend

LovingErlend

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On Monday we had a visitor stay with us for the first time since Erlend was diagnosed diabetic last August. Erlend hid in our room, mostly under the bed. She was eating half her usual amount of food during the visitor's stay, but we chalked it up to stress and temporary lack of exercise, and were pleased that her BG levels remained safe and stable. It wasn't until today that we learned ketones are still possible even if BGs appear under control :sad: Her drinking & urine output increased Thursday, I scheduled a vet appointment for the weekend, but this morning she refused to eat so we couldn't even give her insulin and we took her in right away. Vet didn't seem urgently concerned, just kept her for the afternoon to collect urine sample and blood analysis. They sent us home and told us results would be available tomorrow morning. Luckily I asked them to test urine for ketones right away, and the test turned up moderate ketones, protein and traces of blood.

We rushed her to emergency vet for hospitalization. There she tested positive for pancreatitis. She is being treated for that and "uncontrolled diabetes" (vet did not call it DKA, but I don't know what the distinction is), likely aggravated by the pancreatitis. I asked the vet whether the pancreatitis was a chronic condition, and she said no, but that it was dangerous in its acute condition. However, later the vet assistant said if she recovers and comes home we will have to adjust her diet to a low-fat one.

1) The vet isn't really clear whether the acute pancreatitis is relatively mild or severe, and won't really offer a prognosis. Maybe she does not have enough info, but I also feel like she - understandably - doesn't want to make any projections that may be incorrrect. Has anyone else had their kitties go through this, and know how long it could take to treat this and the likelihood of recovery? Do you know what specific questions I could ask about Erlend's specific case to glean how life-threatening this is? Besides loss of appetite and mild lethargy, she wasn't exhibiting other acute symptoms like vomiting, diarrhea or visual displays of abdominal pain in the past week.

2) We desperately hope Erlend makes it through this acute case. If she did, but still had chronic pancreatitis, what kind of diet satisfies the low-carb low-fat dual requisites?

confused_cat very confused and concerned... would love to hear your stories/advice
 
I'm so glad you asked them to check for ketones! I'm sorry, I have no experience in this area, so no advice to give, but I pray your sweet girl with get the medical attention she needs to feel better and be back with you SOON!

Libby (and Hershey, too!)
 
1. The emergency facility should have an ultra sound scan, and do a ultra sound of the pancrea - that is the only way to tell how swollen and severe it is. Besides that they should also do the blood test fPLI.

First time my Simba had severe pancreatitis the vet gave me a very bad prognosis, but after 2 weeks in intensive care my guy turned around and the pancrea had started to be reduced in the swelling and the DKA was under control, so my Simba proved the vets wrong, that he DID in fact have a good chance to survive it and get through it.


2. On the food - there isn't any consensus that cats need a low fat diet, and nor do I feed my Simba that. I feed him the ordinary low carb high protein moderate fat food.



I SO do hope Erlend have the same want to live and fighting spirit in her as my Simba did! And that she will be home sooner than you think and will recover well.
 
My cat Shadoe had frequent issues with pancreatitis and the vet had me start giving her B12 shots weekly and she has had only one small issue since starting the shots. You may want to talk to your vet about giving B12 shots.

Chronic pancreatitis (or does my cat have a pepcid deficiency?)
Idexx Treatment for Pancreatitis

To treat at home, be sure that you always have SubQ fluids and pain meds like buprenex as pancreatitis is very painful. You can also give pepcid AC twice a day, the daily max is 5mg, so get the regular strength 10mg and cut into 4.
 
There are many cats here who were diagnosed with pancreatitis at the time they were diagnosed with diabetes and there are also many who have recurrent bouts of pancreatitis. This is a treatable condition. The biggest complication is if your cat won't eat. That raises the issue of hepatic lipidosis.

The ultrasound can be helpful diagnostically. However, the utility of the ultrasound is only as good as the sonographer who is doing the test. This is a clinical roundtable on pancreatitis that is reasonably current.

You'll want to note that a low fat diet is not necessary in cats. Dietary intervention is used in dogs, not cats. This is rather old school thinking.

The link to the post from the old board that Squeem provided is very helpful. For many cats, Pepsid (famotidine) will help to reduce some of the nausea. Pancreatitis is also incredibly painful so a pain medication is usually prescribed. Most of the cats here have been given buprenorphine, which is a narcotic. (Do not let the vet give your cat Metacam. It has an FDA black box warning due to its causing renal failure in cats.) Because most cats are nauseous, vomiting, and in pain, an anti-emetic (for vomiting) may be prescribed (e.g., Cerenia or ondansatron). Likewise, an appetite stimulant may be needed (e.g., mirtazepine or cyproheptadine).

There is a difference between ketones and DKA. The difference is based on lab results. Are levels of potassium and phosphorus abnormal? If they are, your cat will need to be on IVs that will help to titrate those levels back to normal. If they are within normal levels, your vet may have your cat on IV fluids to help flush the ketones. In either case, the vet may use a fast acting insulin (e.g., Humulin R or "regular" insulin) to help bring blood glucose levels under better control.

It may be that your cat has a urinary track infection. Often, blood in the urine can be indicative of a UTI. If this is the case, your cat will need an antibiotic. Often, infection + not enough insulin + not eating = ketones/DKA.

I would definitely ask the vet about the lab results. The more the labs, especially electrolytes, are out of whack, the more life threatening the situation is.
 
Thank you for all the responses, they are very helpful. I'm gathering that "chronic pancreatitis" just means your cat is prone to developing pancreas flares in the future, and if you recognize signs of such a flare up (less appetite, loaf after eating), then we would give her Pepcid, fluids and pain meds? I will ask about B12 injections if/when we get to bring her home.

Hospital update: Erlend's BG is under control at 135. Vet says it could take another day to flush all ketones out, but they will try offering her food tonight, so I think that has to be a good sign? They said they found some kind of bacteria in the urine so they are treating her with an antibiotic, but they're waiting on the actual results from urine culture to see what kind of bacteria it is, which could take up to another 48 hours.
 
Thanks for the update, I was really worried, and my heart sank first when I saw you had responded, because I thought it was bad news, but thankfully! it was better news.


It does take some days for all the ketones to go away, usually gets better and better every day.

But she must start eating so hopefully she will do that now.


Keep us updated on her progresses. We really like to know.
 
Thanks Ann!

Update: Transferred Erlend from emergency vet to our normal vet to continue to get IV fluids, and apparently they'll be starting her back on glargine during the day (how do they administer it with her not eating?). Ketones are reading low-to-minimal, which is great. The plan is to bring her home overnight and encourage her to eat, then bring her back tomorrow again.
 
I bet she will love to come home.

If they start her on Lantus again, ask them to start low and go slow, since it is especially important when she isn't eating that she doesn't get too much insulin.
 
Erlend started eating while being hospitalized today (to the vet's surprise), so they sent her home with us this evening with no meds and said she won't need to be brought back tomorrow morning :RAHCAT

Unfortunately the vet left before we learned about this update, so we didn't get a chance to ask some questions. Apparently they dosed her with 3u glargine before sending her home, and we're instructed to give her 2u in the morning. That seems like a lot, so we hope to do a +3 reading in a couple hours to see where she's at. She did a little eating before we let her in the room and she ran to the comfort of under the bed, just traumatized from the vet visit. I assume if she's not eating a ton of her low-carb wet food in the next few hours it would be okay to try some gravy wet food? We are worried about her not getting enough food since this incident.

Here are some questions we will be asking the vet tomorrow morning. Can you think of any others you might think helpful?
-Do we not need antibiotics (for infection) or potassium (her reading this morning was 2.5, apparently below target range) supplement?
-B12 injections to combat pancreatitis? Should we have other items on hand like fluids, pepcid & pain meds to administer at home if she shows signs of pancreatitis again?
 
LovingErlend said:
Erlend started eating while being hospitalized today (to the vet's surprise), so they sent her home with us this evening with no meds and said she won't need to be brought back tomorrow morning :RAHCAT

Unfortunately the vet left before we learned about this update, so we didn't get a chance to ask some questions. Apparently they dosed her with 3u glargine before sending her home, and we're instructed to give her 2u in the morning. That seems like a lot, so we hope to do a +3 reading in a couple hours to see where she's at. She did a little eating before we let her in the room and she ran to the comfort of under the bed, just traumatized from the vet visit. I assume if she's not eating a ton of her low-carb wet food in the next few hours it would be okay to try some gravy wet food? We are worried about her not getting enough food since this incident.

Here are some questions we will be asking the vet tomorrow morning. Can you think of any others you might think helpful?
-Do we not need antibiotics (for infection) or potassium (her reading this morning was 2.5, apparently below target range) supplement?
-B12 injections to combat pancreatitis? Should we have other items on hand like fluids, pepcid & pain meds to administer at home if she shows signs of pancreatitis again?
Click to expand...

For pancreatitis, I always have fluids pepcid and pain meds (bupe) on hand. Be sure to come home with those 3 items.
The pepcid is a good thing to give twice a day. I gave my Shadoe pepcid at am and pm shot times, 1/4tab which is 2.5mg ... daily max is 5mg.
Ask the vet to show you how to check for dehydration.
Pick up a copy of all the tests results and bloodwork so you have a record at home and can refer to the numbers.
I do know that B12 worked very well for Shadoe's inflammation and lessened her frequent pancreatitis issues. She still gets weekly shots and I don't need to give her the pepcid daily, but only on the off day if she is acting a bit upset and not eating.
Ask about any infection, and if not ruled out, what about an AB?

I am figuring that you are testing for ketones frequently, so maybe ask the vet how to proceed with any ketones you find on testing.

I don't know about the others, but I'd let her eat what she liked .. if she eats a bit of the gravies and her numbers go up, you can always give her more insulin to balance it. She needs to eat; that much is certain.
Are there any things you have that can coax her to eat that you can sprinkle on top of her food? My cats like Forti Flora, so if you don't have any, you can ask at the vet and get some if it's ok with your vet to try.
 
I'm gathering that "chronic pancreatitis" just means your cat is prone to developing pancreas flares in the future, and if you recognize signs of such a flare up (less appetite, loaf after eating), then we would give her Pepcid, fluids and pain meds?
Click to expand...

This is a good question, one I have asked many times because Smokey was diagnosed with chronic pancreatitis. She has never exhibited the signs of acute pancreatitis. She has had periods of vomiting, but that was actually after we brought the fPLI test numbers back down. I question it because I worry she has pain we aren't treating, but the last vet said she could palpate the pancreas so that she felt her fingers on the other side and Smokey didn't react as if she was in discomfort or pain. Her ultrasound showed an inflamed pancreas, her pancreatitis tests came back positive, but she doesn't exhibit the signs. That's what I concluded was chronic pancreatitis. The doc that did the ultrasound said that most cats are found to have a mild for of it if under necroscopy after a cat has died from something else.
 
Update: Since getting home she's been mostly under the bed sleeping and cleaning herself:

-She occasionally comes out to explore and sniff around (good signs), and will stoop in her litter box for longer than usual as if it's taking a while for her to go. Not much (but a little) has come out. Is this maybe due to not eating for a while and/or being hooked up to a catheter?
-We just tested her at +4 (possibly +5, depending when the vet actually administered the 3u glargine), and got a 42 reading. We've let her go to town on some high carb gravy wet, both to prevent possible hypo if that's a threat + get more food in her belly.
 
LovingErlend said:
Update: Since getting home she's been mostly under the bed sleeping and cleaning herself:

-She occasionally comes out to explore and sniff around (good signs), and will stoop in her litter box for longer than usual as if it's taking a while for her to go. Not much (but a little) has come out. Is this maybe due to not eating for a while and/or being hooked up to a catheter?
-We just tested her at +4 (possibly +5, depending when the vet actually administered the 3u glargine), and got a 42 reading. We've let her go to town on some high carb gravy wet, both to prevent possible hypo if that's a threat + get more food in her belly.
Click to expand...

The 42 is pretty low, especially if that's after eating the gravies.... how long ago did she eat and would you be able to get another test to be sure she is not going lower?
 
Yeah we can, though it's sad because she won't willingly test for us so we have to burrito her and she gets mad and hides more :-| She had a few laps of gravy about 10-15 min before testing (trying to stimulate her appetite to get her eating more of her normal wet). After the test we let her eat as much gravy wet as she wanted.. looks like she ate a decent amount.
 
Once she's feeling better, that dose may be too high. Shadoe had higher numbers when having pancreatitis issues.
The gravy may bring her up but it won't last that long. if she eats some of the food with the gravy, it should last longer than just gravy, but will fill her up more.
Hopefully, she'll surf along nicely then rise to ps.
 
So 30 minutes after the 42 test, we tested again and got 93 (+5ish, possibly +5.5). If her previous curves usually nadired at +5 does this mean we should be in the clear on hypo for the night? I feel so bad pulling her out from under the bed, making her threatened & growling.

Thanks for the responses Gayle. She did eat the "chunky bits" along with the gravy.
 
great; the gravy has kicked in and you are in a safer zone now.

I would say that since her nadir is around about this time, and she is on the rise with a belly full of gravy, you should be good to sleep. If you are worried, just leave some more food for her to eat if she needs.

I know if my Shadoe was in a hiding spot and I wanted to be sure she had food if she needed, I'd put a small bowl near her hidy spot. Later on, I would find that she ate some.

I would rather have her eat some extra and be high ... it's safer than too low.
 
We did leave it out and she chomped on some more. She has eaten 2-3 oz of the wet gravy & bits total. She's back to sleeping under the bed and is sleeping DEEP. This seems understandable if she was stressed out not resting for 48 hours of hospitalization... but at the same time we're fearful of signs of extreme lethargy or unresponsiveness. Like her eyes remain shut despite our calls and pets, though she did start purring after rubbing her long enough. nailbite_smile nailbite_smile Where do you draw the line between letting her sleep and being worried about responsiveness?
 
Talked to vet. Apparently they gave a long-acting (2 week) antibiotic injection, that's why they didn't send us home with pills. Ok'd my suggestion of giving Pepcid.

AMPS 258, she wouldn't eat her normal lowcarb wet so we gave her more gravy bits, mostly finger-fed. Gave her 2.5mg Pepcid in the afternoon. PMPS 273. Had to feed her a small handful of dry food just to make sure she had sufficient food in her tummy for insulin. Uncertain whether she's getting enough food... has eaten about 4 oz wet gravy food plus a few all-meat treats and the handful of dry (she's 9.5 lbs). Do we err on the side of caution and let her eat more dry, or does that just destabilize her BG without much benefit? Feels like a lose-lose situation.

She keeps going to use her litter but nothing's really coming out. Then she cleans her bum a lot. Not sure what this indicates?
 
LovingErlend said:
Talked to vet. Apparently they gave a long-acting (2 week) antibiotic injection, that's why they didn't send us home with pills. Ok'd my suggestion of giving Pepcid.

AMPS 258, she wouldn't eat her normal lowcarb wet so we gave her more gravy bits, mostly finger-fed. Gave her 2.5mg Pepcid in the afternoon. PMPS 273. Had to feed her a small handful of dry food just to make sure she had sufficient food in her tummy for insulin. Uncertain whether she's getting enough food... has eaten about 4 oz wet gravy food plus a few all-meat treats and the handful of dry (she's 9.5 lbs). Do we err on the side of caution and let her eat more dry, or does that just destabilize her BG without much benefit? Feels like a lose-lose situation.

She keeps going to use her litter but nothing's really coming out. Then she cleans her bum a lot. Not sure what this indicates?
Click to expand...

Can you ask if the injection was convenia? Please read the attached link
http://www.catinfo.org/?link=convenia
It's important to be aware of the signs of problems. Many people have their pet's files marked No convenia, No Metacam, because of some problems that have happened.

For the dry food, I don't feed it to my two diabetics. One has never eaten dry, and the other is too carb sensitive. if she is eating wet food, hopefully the pepcid will help her start to eat more of it.

If she is having issues in the litter box, you may want to ask the vet. When was the last time she peed, is it less or more than usual and what about her last bowel movement. how much water is she drinking? You can try adding water to her wet food; she can use the extra water. If she is constipated, you can get some miralax and put 1/8 tsp into her wet food, but be sure to add extra water as the miralax draws water from the body into the stool to soften it and make it easier for her to pass.
 
Gayle Shadoe & Oliver said:
LovingErlend said:
Talked to vet. Apparently they gave a long-acting (2 week) antibiotic injection, that's why they didn't send us home with pills. Ok'd my suggestion of giving Pepcid.

AMPS 258, she wouldn't eat her normal lowcarb wet so we gave her more gravy bits, mostly finger-fed. Gave her 2.5mg Pepcid in the afternoon. PMPS 273. Had to feed her a small handful of dry food just to make sure she had sufficient food in her tummy for insulin. Uncertain whether she's getting enough food... has eaten about 4 oz wet gravy food plus a few all-meat treats and the handful of dry (she's 9.5 lbs). Do we err on the side of caution and let her eat more dry, or does that just destabilize her BG without much benefit? Feels like a lose-lose situation.

She keeps going to use her litter but nothing's really coming out. Then she cleans her bum a lot. Not sure what this indicates?
Click to expand...

Can you ask if the injection was convenia? Please read the attached link
http://www.catinfo.org/?link=convenia
It's important to be aware of the signs of problems. Many people have their pet's files marked No convenia, No Metacam, because of some problems that have happened.

For the dry food, I don't feed it to my two diabetics. One has never eaten dry, and the other is too carb sensitive. if she is eating wet food, hopefully the pepcid will help her start to eat more of it.

If she is having issues in the litter box, you may want to ask the vet. When was the last time she peed, is it less or more than usual and what about her last bowel movement. how much water is she drinking? You can try adding water to her wet food; she can use the extra water. If she is constipated, you can get some miralax and put 1/8 tsp into her wet food, but be sure to add extra water as the miralax draws water from the body into the stool to soften it and make it easier for her to pass.
Click to expand...

Thanks for the reply Gayle. Yes, I confirmed it was Convenia. That link is a bit worrying, especially since we could've administered AB pills ourselves.

I called the emergency vet to get results of urine culture from Erlend's stay, and they said they found out the bacteria was E Coli, and suggested we bring her in to regular vet especially because she was having litter box problems. Well, after only peeing drops in the last two days, she went all over as we tried loading her into the carrier ohmygod_smile Vet said she was not dehydrated and that E Coli is sensitive to Convenia, but he sent us home with Clavamox and an appetite stimulant. He also said to give her a constant 2u glargine as long as her preshot is 100+, and that the slow-acting nature of glargine doesn't pose as much of a hypo risk and Erlend exhibits a flat curve. I mention this because today's AMPS was 110 and I only gave her 1u. Indeed, her PMPS today was 325. I know the board sticks to the idea that you don't shoot or reduce if preshot is less than 150. Thoughts?

Erlend is drinking a lot of water. Haven't seen her pee much in litter, and don't smell any around the house. She's only had one BM, and it was a watery stool / diarrhea.
 
Hi Ann,

Erlend seems to be doing pretty well. She is eating consistently, and more willing to eat her low-carb wet... probably a result of the appetite stimulant. Hoping the ABs are going to clear up her bacterial infections. Still really not much stool, which is concerning, but hopefully that picks up as she's eating more.

Read about Gustav in your thread... hope you find out exactly what's wrong with him and that he gets better!
 
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