In hospital with DKA/CKD/IBD/etc (title change)

Hi all. This is my first post, my cat Eddy (14 yrs, usually 12-13 lbs but is now 10.5 lbs) was just diagnosed two days ago, and I am super overwhelmed. His BG was 392 on 9/3, 253 on 9/4, (prior to any insulin starting), and 410 on 9/5 (today 4 hours after I have him .25u)
The problem is he isn't eating. I gave him his dose of .5u this evening after he ate a few small bites because my vet told me to but he's hardly eaten anything all day or this week. He's lost weight. I'm concerned about giving him insulin if he hasn't eaten (I'm buying a glucometer tomorrow).

He's been eating Hills z/d due to his IBD but since that is high carb I plan to switch him. Bought him some fancy feast pate today but he's still not interested. He's not interested in treats, the tiki gravy stuff, has never liked any human food (no tuna or yogurt or anything). The vet gave him mirtazapine yesterday.
The only thing I can think of is giving him Cerenia and seeing if that helps. He just won't eat. I'm concerned about dosing him tomorrow AM prior to having the glucometer but I just want him to feel relief.

I'm just happy this group exists.

 

Hi there Britt and Eddy!

Is Eddy nauseous? Licking his lips/turning away to eat? Cerenia will help.
I think it'd be best if Eddy went to the ER to be checked for ketones. Cats not eating are at risk of fatty liver as well.

 

Thanks! I haven't given him his Cerenia because he stopped eating pills but the vet showed me how to administer orally. I plan to give that to him tomorrow AM but i guess I could do it now? I have heard about ketones and testing for ketones. Sounds like this could potentially be an emergency situation? Thank you for the advice!

 

Hi

Britt hang in there I’m sure much more experienced members will reply but from my experience Eddy could very well have nausea. Giving him mirtazapine without Cerenia or Zofran would do no good at all . Think of it like this if you felt nauseous and someone gave you an appetite stimulant as hungry as you may be you still wouldn’t feel like eating because you feel sick to you stomach So I’m surprised at your Vet for giving Eddy the stimulant without telling to to give him the anti nausea meds .
My cat also was not eating and a member on here suggested I try human baby food meat purée just any meat chicken etc No onions or garlic . I thought no way ,well I tried it I had to hand feed it to my cat off a spoon and to my shock she ate it lol ...... Britt wait for the other replies and hey if you just need to talk or vent I’m here this is all Overwhelming at first and so much to process

 

Yes ketones can form within hours. The fact that he's not eating puts him at risk.
You can give the Cerenia now I believe. I'm not 100% sure but I think you need to wait 1-2 hours after pilling to offer food, Roe do you remember?

Make sure you chase the pill down with some water too.

 

Elizabeth don’t quote me but I didn’t think it took that long

 

@Chris & China (GA) @Red & Rover (GA)

 

What was the reason your cat was given cerenia? Was it for the current bout of vomiting or something else?
I think a trip to the vet may be in order.
Is your cat drinking water?
Can you do a tent test? You pick up the scruff and then let go. It the scruff takes any time at all to return to its regular shape, the cat is dehydrated. You can also check his gums. They should feel moist, not tacky.

I'm sorry but I cannot stay online. It has been a very long day.

 

Thank you Kel

 

Just wanted to say a quick thank you to all - he's being seen at the pet hospital tonight. Will write more later. Thanks for the advice and support!

 

Please keep us posted

 

Welcome, Britt and Eddy.

I'm sorry to hear Eddy's off his food.

There are claims that mirtazapine, in addition to appetite stimulation, offers an anti-nausea benefit. This might be true but based on my experience and also on what I've read here any such claims are grossly exaggerated. Maybe if the cat had very mild nausea it might do the necessary, but I don't think it can touch ondansetron or Cerenia. I've found ondansetron to be superior to Cerenia in terms of effect. Other members may have different experiences to report.

There are many, many helpful resources here to help you learn how to manage Eddy's diabetes but they take a while to wade through. Below are some links to the information which may be the most helpful to you in your current situation, and which might give you a bit of a leg-up with testing and monitoring. There are also helpful suggestions about what supplies to get in.

IDEXX Pancreatitis Guidelines (Lists all anti-nausea and appy stimulant meds that are good for cats in any case of nausea, not just pancreatitis. Good doc to use when negotiating treatment with vets.)

Nausea, Vomiting, Inappetence - Symptoms and Treatments

Persuading Your Cat To Eat (Includes suggestions on baby foods suitable for cats - ideas for your shopping list.)

Testing Your Cat for Ketones (You can get urine test strips in Walmart or anywhere that sells diabetic supplies.)

Tips for Collecting Pee Samples

Home Testing Links and Tips

Home Testing and Injection Tips (Includes helpful diagram of where to test on the ear.)

How to Treat Hypos (Familiarise yourself with this and print it out ASAP.)

Hypo Toolkit (See the list of suggested higher carb foods and treats used to raise low numbers and add them to your shopping list! )

Hope Eddy's feeling and eating much better today. Please keep us posted with developments. Be sure to ask the vets to give you a good supply of the right meds to bring home with you [ETA: including pain meds if he's having a pancreatitis flare].



Mogs
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Sending prayers for Eddy

 

So glad to hear he's being looked after! Do keep us updated. With a history of pancreatitis it's possible he's having a flare up.

 

Thank you!! I'm definitely going to try the baby food once he comes home from the hospital!

 

He was given Cerenia due to nausea from IBD. He's at the hospital now so I'm sure they're giving him fluids and hopefully a shot of anti nausea meds. Thanks for the info on the tent test, now I know how to do that in the future!

 

Thank you so much! I have no idea how people manage this without this group. It's been so helpful already.

 

Still waiting to hear back from the doctor, they should be calling within a few hours. He was seeing an internal medicine doc today

 

Waaaaaitng...

 

No news is good news! Fingers crossed!

 

I just got an update from the vet. Apparently he was very critical when I brought him in last night and his potassium was dangerously low. He is in DKA. They are rehydrating him, giving him potassium, and intermittent insulin to get rid of the ketones. Sounds like he will be there for a few days still. The vet is going to call back in a few hours to discuss further.

I just have to say I am so frustrated with my vet. I called her several weeks ago about his excessive thirst and urination and she passed it off as his thyroid issues. I knew something was off and have called a few times since then. Finally I called this week again and he went in for x-rays and bloodwork which is how the diabetes was diagnosed.
They sent me home with insulin and no glucometer because there werent any in stock. They didn't talk about ketones, dka, or hypo. I informed them be wasn't eating so how was I supposed to give him insulin? I told them he has been lethargic for the last few days. He went in the next day (Saturday) for a blood sugar check, it was 410, and the vet just said to give him insulin even if he doesn't eat. They didn't test his urine for ketones (but they did test for UTI). They didn't give him fluids. The vet gave him an anti stimulant on Thurs but not an anti nausea. She didn't mention how his Rx food (hills z/d) is high carb and to try switching it.

If it weren't for advice from this group, I may not have brought him in last and that could have resulted in tragedy. I'm so mad at my vet and so thankful for this group.

 

Really glad you took him in last night - I know no one's wallet is prepared for those overnight ER visits.

DKA is rough to recover from. @AliceMeowliss&Cassandra had to nurse Alice back to health for a long time after she came home. Please keep us updated and when he's almost ready to come home make a new thread asking for at-home care assistance. He will need a lot of TLC.

If I had a nickle for every time I heard this I'd be rich. My vet didn't warn me of ketones or anything either so it's not unusual, though extremely disappointing. I highly suggest shopping around for someone new. There are unfortunately no feline diabetes specialists but you want a vet who is going to recognize the signs of common FD issues that you can't tackle at home on your own like pancreatitis, ketones, and DKA.

Do let us know whenever you hear news! We're rooting for you two and prayers that Eddy recovers and is back to himself soon.

 

DITTO

i'M OVER the frustration point its boiled over into full blown ANGER

 

Britt I’m so Glad to hear Eddy is being taking care of my cat was also DKA . Ahhhh I can’t believe your Vet and Iam so frustrated hearing these Vets suggesting Hills when they Know better . Britt just wanted to say you are doing GREAT Eddy is a lucky kitty to have such good mom and be so loved

 

I will definitely post a new thread for in home care assistance when he hopefully comes home! Thank you!

 

Just talked to the vet for 47 min! I love this vet. My little guy has so much going on.

To summarize: they are trying to work on the DKA. He is getting IV potassium, phosphorus, insulin, fluids, and electrolytes. He is still dehydrated, his BG is still high, he still has the ketones, and his liver enzymes are elevated. I knew he had early stage CKD but she informed me it is stage 2. She informed me he has anemia. She said she did not hear a murmur but heard an arrhythmia. He is improving in some areas, still shows no interest in eating.

She is going to place an NG feeding tube today, doing a 3 way x-ray to place and check for other things. She wants to do an abdominal ultrasound. She is concerned about GI lymphoma/potential cancer. She wants a cardio consult and ECG - is concerned about heart disease.

Whew. She said when he is able to come home, the care will be insulin, sub c fluids, and diet (which has yet to be determined for his diabetes/CKD/IBD).

This is a lot. She's going to call again this evening with another update. He is a trooper for hanging in there and showing some improvement. I just hope they can determine if there is anything else going on (more?!), stabilize him, and we can figure out a good plan to give him the best quality of life. I do not want him to suffer.

Thank you all so much for reading and offering support or advice.

 

I believe @Wendy&Neko has experience with IBD/CKD, sorry for the tag if I'm remembering wrong. Also @Aleluia Grugru & Minnie

Feeding tubes are a blessing when a cat can't eat.

It might benefit you to change the title of your thread now to get more eyes on the current issue - In hospital with DKA, CKD/IBD, other potential issues. Sorry I can't help with any of that personally but thank you for the update. Fingers crossed!

 

Thanks, will do!

 

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WTH? I just tried to "Like" the last post.

 

Weird! What would make that happen?

 

I think that happens when the post gets updated - titles, new posts, etc. It's happened to me a few times.

Great job in the title change! Hopefully we'll get some good experienced eyes on the matter for Eddy.

 

hahahah well its resolved itself. All is well sorry for the interruption

 

Plus acromegaly plus heart issues, ... Hmm, am I forgetting something else on the list? Wait yes, it was probably not IBD but likely small cell lymphoma - couldn't diagnose due to her heart issues (hcm, chf, heart block) which were diagnosed at the same time as the SCL. Acromegaly added on a few issues such as arthritis, soft tissue and bony growths.

Britt - first these You got a lot going on with Eddy. I was "lucky" in that other than the heart block/CHF and SCL, the rest of the issues got slowly added so I had time to adjust and learn. I never had to have a feeding tube, though the vet did offer it as a suggestion. With a couple days of assist feeding, and the new meds for her heart and bowels, her appetite came back. Not 100%, but enough. And by the way, if a cat is off their food, you can always give at least 50% of the insulin. A full dose with higher carb food is a better solution for a cat who has DKA. One of our members posted this link on What is Feline Diabetes in someone else's post yesterday and it reminded me what a good read it is to help you understand the basics, including ketones and DKA. This post on assist feeding is also a good one. Often getting a bit of food in will help settle their tummy and make them willing to eat more. Sort of like priming the pump.

Run, don't walk to your local Walmart and pick up one of the Relion meters if you are in the US. The Prime has very cheap test strips and that's what you'll go through most. The majority of us use human blood glucose meters, they were used for ages before Abbott started marketing their AT. I know some of the other peeps here can provide you with a complete shopping list.

 

You're just a jack of all trades, Wendy!

 

Thank you so much for the info! There is so much to learn and I appreciate any and all info.

 

(((Brit)))
A few deep breaths and please know that we have your back. There is an overwhelming amount of information to learn. It will take a couple of weeks and it will all seem routine.

When Gabby was diagnosed, she was in DKA and had liver issues (hepatic lipidosis). She spent a few days in the ICU with my vet and the ICU vet trying to warn me that she was in rough shape. She pulled through. The vets will be checking on Eddy's potassium and phosphorus levels along with other electrolytes to get the DKA. under control. Chances are your kitty will be on 2 types of insulin -- a faster acting (bolus) insulin and a longer acting (basal) insulin. this gives the vet a good deal of control over managing the BG levels. Fundamentally, DKA results if there's an infection or inflammation + not enough calories + not enough insulin. Just stay in touch with the vets -- and I suspect it's OK for you to call to check on Eddy.

If you're going to be following up with Wendy's suggestion about getting a glucometer, you may also want to pick up Ketostix. You'll want to be getting a reading on Eddy's ketones once he's home. The Ketostix are a strip you dip into the urine stream. If Eddy is shy about the litter box, there are also blood ketone meters. The strips are expensive but you don't do ketone tests as frequently as blood glucose tests. If you check on Amazon or ADW (American Diabetes Warehouse) they both have meters and strips.

I hate suggesting this but you may want to ask around about other vets. The information you were giving your vet should have set off alarms and the vet should have been running labs. You could even ask the vets at the hospital if there is someone in your area they would recommend.

 

Thanks for the advice and support ♥️ trying to remember to breathe and slow down!

The vet mentioned something about hepatic lipidosis; I don't recall if she said Eddy has it or if it's just a risk. I do plan to go to Walmart and buy the Relion. I will definitely buy Ketostix as well.

I definitely plan to find a different vet. I will ask for recommendations from the ICU vet (really wish she could just be his vet) and have gotten a few recs for vets nearby. It alarms me that so much was seemingly missed.

Thank you all so much for your advice and support!

 

Sometimes, the vets at an ICU/ER may be there part-time and have practices. Tell her how much you like her and ask if she has a practice. You never know! She may also have some vets/classmates that she really likes.

Unfortunately, a good amount was overlooked. Anytime someone here says their cat is lethargic and not eating, I suggest a vet visit. We're not vets but those of us who have been here a while have our own rules of thumb when it's time to go see the vet or get a kitty to the ER. It sounds like your gut is pretty good at knowing your cat, as well.

 

Minnie has IBD and had a feeding tube for 2 weeks. Will he come home with it then? It is a blessing to make sure they eat and get all their meds without any issues. It’s not as bad or complicated as it may sound. It may be a bit intimidating at first, but there are a few tips I can give you that I picked up along the way. Blending the food well is key and alway flushing lots of water before and after each feeding. Also cleaning the area once a day to avoid infections. I sure missed it when it was gone!!!

 

I'm so thankful that you took her in last night.

 

Hi! I was tagged earlier and just want to say I’ve been through a lot of this. Do make sure you get extra rest while kitty is in the hospital, because post-DKA at home you may be awake a lot of nights. It took me about 5-6 weeks of intensive nursing at home to get Alice back to a good balance. Her history includes mammary cancer, IBD, DKA, low potassium episodes causing neck ventroflexion, constipation, infections, and most recently chronic renal failure. So we have been through a lot!

I like this ER vet you’re seeing and it sounds like your cat is getting a great work up currently, something that Alice actually have never had to the same extent. I hope you’re able to get a good regular vet referral from them.

If your cat’s back legs are weak from muscle loss you may want a box with low sides or you can even use the cardboard that food cans come on as disposable litter pans. Alice couldn’t crouch down for awhile so I lined the area around her litter with towels and pee pads.

Tag me in your post when kitty is back home, I can’t give a lot of my attention right now as I need to go do Alice’s stuff, but I’ll check back.

hugs!

 

The vet said she may send him home on the ng tube. Thank you so much for the tips! I can understand the relief. That's how I felt when I switched his thyroid meds to transdermal and didn't have to fight with him over a pill. I will keep all of these tips in mind ♥️

 

Thank you! Will do!

 

Mirtazapine for appetite stimulant comes in a transdermal! we are using it pretty much daily. I like it because you can give a lower dose more easily. My girl has some mild overdose issues if given a quarter tab dose of the pill.

 

The vet called with another update tonight and he actually ate some fancy feast! What a relief! Hopefully he will keep it up. The Ng tube is still in and he's getting oral potassium. His BG was mid 90s earlier today and was 191 this evening. She thinks as he's rehydrating, he is absorbing the insulin better. His potassium is still low but hasnt decreased. His blood PH is almost normal. She thinks he may have GI disease and wants to start B12. Next is more testing....GI and heart. I'm just glad he's doing a little better.

 

Oh that is so helpful to know!

 

Small victories! HOORAY!

 

B12!!!! Yes!!! My girl always perks up when she gets a shot of IM B12. It seems common for a lot of IBD kitties to need or at least do better with B12.
(Note this isn’t the same B12 as what we talk about using for neuropathy.)

 

Glad to hear positive updates form the vet! Whoo!

 

Feel free to message me when that happens and I can go over the cleaning part and a few other tips too. The main thing I learned the hard way is that sometimes air gets in and they burp making the food come back up through the tube a little. So, always hold it high and wait after you’re done with the feeding to make sure nothing comes back up before putting the tube away. The tube is pretty resistant. Minnie would drag it sometimes or lay on top of it, but it never got damaged

 

You GO Ale! I was hoping you'd find this thread.

Britt Ale just went through all this. Shes an excellent source....as are all the others here.
Gosh I love this place!
j

 

How's Eddy doing today, Britt?


Mogs
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Thanks! Sounds like he will be coming home on the NG tube so I will definitely reach out if needed!

 

He's doing better today! Hopefully he will get to come home tomorrow. No longer in DKA. He is such a trooper! Blood PH is normal, potassium is normal, no more arrythmia, he's eating, he's gained a little bit of weight. Im so happy! Thanks for checking in.

 

Oh that's wonderful news!!

In that case I would go ahead and make a new thread asking about at-home care when you're ready so you can be prepared before he's home. Link it here so we can follow along ^-^

 

Great news about Eddy!


(Make sure the vets send you home with plenty of anti-nausea and appetite stimulant meds. Hopefully Eddy won't need them, but it's much better to have a supply at home in case he might.)

(((Britt)))




Mogs
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So very glad for the good prognosis!
There are days I wish Alice could have a feeding tube.

 

Thank you! I hope Alice is doing well!

 

Been meaning to tell you love your Avatar squeeeeeeeeeeeeeeeeeeee

 

Thank you! The vet said he is laying on a circle bed in the ICU like he is "laying on his throne." He loves his circle beds. Waldo is beautiful!

 

Very Royal!
Waldo was the funniest bestest kitty. He was magic.

 

Thank you! She is now, and I am relieved (as I imagine you must be for Eddy). We had a bad 36 hours or so then she turned it around because she got taken back to the vet. That straightened her right up!



Re: circle cats... my moderate cerebellar hypoplasia cat will curl up in these tiny little round cat beds. He’s pretty big but he makes himself into a nice artisan loaf, a boule perhaps....