Ketones = 1.0 on meter -- what do I do now?

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wombat88

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I just tested Shaikha with a blood ketone meter and she's showing trace ketones, at 0.9 and then 1.0 on the meter. She has chronic pancreatitis and had a very bad acute flareup recently. She's been on buprenorphine, anzemet, and IV or subQ fluids. She was running a fever early on (that's not uncommon for her in very bad flareups), so she's been on antibiotics as well. She's got about four more days left of those. Most of her acute symptoms have gone at this point other than some nausea and inappetance.

Up until this flareup, she never threw ketones -- always 0.0 on the meter. She started throwing tiny amounts during this one, though, and today showed 0.9 and then 1.0 on the blood ketone meter (Precision). Her appetite has been fairly poor but that's always the case when her pancreatitis flares up. The past two days she's actually been eating better though, so the reading at her mid-day shot shocked me. She was hungry for food and is acting normally, so I don't know if I should worry about the ketones or not. Her glucose levels have been fairly decent the past few days too, mostly in the yellows and blues. Her mid-day reading was 189, tested at the same time I tested ketones.

One change the past two days was not giving her subQ fluids. She had developed an irritated area that we thought was from the fluids, so I stopped her fluids to try to give it a chance to heal. The area doesn't hurt, just is a little puffy (it isn't a fluid pocket or a lymph node; my vet has examined it). I'm guessing stopping the fluids wasn't a good idea given her ketones now. I'm about to give her 100ml of fluids, which is the usual amount she gets. She isn't dehydrated and is drinking fine, but the fluids always help when she's got a flareup.

I have urine ketone strips but have not been successful in using them. She is really private in the box and runs away or jumps out if I get close, so I've just been using the ketone meter once per day during this flareup to keep tabs on them. I can try to set up a box with hydrophobic sand but don't know if I'll be able to get her to use it.

Is there anything else I should be doing? When should I check her ketones again?

PS: Shaikha does have fairly severe anemia, so I don't know if that can make the ketone meter read off or not. She was down to 15% PCV so we sent out blood work to check reticulocytes for regeneration and also test her clotting, as that's been a problem. We were planning on doing a plasma transfusion this week and/or whole blood transfusion depending on what the tests show.
 
At 0.5 I call the ER and ask what to do. She gave you a 1.0 now, which is awfully close to 1.6 - so that she is ketonic is clear but you can't know what her electrolytes and blood PH value are unless going to the ER for those blood tests.

Do you have an ER nearby you can call?
 
Unfortunately, the nearest ER is 1.5 hours away. I can call my vet though on his mobile. Should she go in for tests today then? The reading really surprised me because she is acting fairly normally. She was eager to eat but does need some encouragement to finish, but I haven't had to assist feed the past two days like I have been.
 
Take another test and if still in the 1.0's call your vets mobile, and ask whether you should come in.

I don't know your vets procedure, but my hospital take ketoacidosis very seriously and I have made a three step action plan.

At 0.3- 0.5 I test again
At 0.5 I call the hospital
At 0.7 I go straight to ER
 
Okay, I just talked to a vet hospital nurse who then relayed the info to their doctor on call. They felt that it was not an emergency given that she's eating and is acting normally, but they did want me to give subQ fluids and suggested I bring her in to my vet tomorrow morning.

My regular vet then called me back (I'd left a message on his mobile previously, which is why I called the vet hospital as well). Since she's eating and acting normally, he also thought she'd be okay but wants me to retest her ketones at 6pm my time. If they are still high, then we'll take her in for blood tests and fluids tonight if he doesn't like what he sees. He thought that the subQ fluilds would make a big difference as would the food and insulin she got mid-day.

She's been laying in the sun and acts like nothing is wrong, so I'm hoping that continues. Will post again after I check ketones in a little over an hour from now.
 
Thanks so much for your help, Ann. Ketones are something new to me so I wasn't sure what to think. Until this attack she'd been blissfully ketone-free, even when she spiked a high fever. Guess that has changed and I'll need to keep monitoring her levels more closely than I'd been. I'm also not going to skip giving her fluids again after this, that's for sure.

Based on your signature, it sounds like your Simba has been through the mill with problems related to pancreatitis and a DKA. I'm so sorry you've had to deal with all of that. :sad:
 
One more suggestion for you... in addition to the squids, you're going to want to encourage your kitty to get as much liquid intake as possible to help flush the ketones. If you're feeding canned food, soup it up as much as your cat will tolerate. If you cat simply won't tolerate wet, try to make a gravy with the kibble and make the water bowl as attractive as possible (for example, my extremely spoiled boy prefers his water have ice cubes in it. seriously. :roll: :roll: :roll: ).

Fingers and paws crossed that your efforts do the trick and a trip to the vet tonight is unnecessary.
 
Christie & Willie said:
One more suggestion for you... in addition to the squids, you're going to want to encourage your kitty to get as much liquid intake as possible to help flush the ketones. If you're feeding canned food, soup it up as much as your cat will tolerate. If you cat simply won't tolerate wet, try to make a gravy with the kibble and make the water bowl as attractive as possible (for example, my extremely spoiled boy prefers his water have ice cubes in it. seriously. :roll: :roll: :roll: ).

Fingers and paws crossed that your efforts do the trick and a trip to the vet tonight is unnecessary.


Ice cubes - excellent advise. Always works for Bob. He'll drink till they are melted. Like he's ticked off something had the nerve to get in his water bowl.

Carl
 
Just retested her and she's back to 0.0 ketones on the meter! So perhaps the subQ fluid, mid-day food and insulin all worked together as my vet suggested they might. Would ketones disappear that quickly? I am sure they existed though because I'd retested with a new box of strips and the reading was virtually the same (0.9 then 1.0). She's drank water a few times since the fluids, but I'll be sure to put extra water into her canned food tonight (she likes soupy food anyway) too.

I will definitely NOT skip her fluids again, that's for sure. My vet wants to see her tomorrow even if her levels dropped just to be safe. I'll leave her at the clinic so he can monitor her throughout the day, but hopefully if I keep up the subQs she'll not throw them again. Thanks for all the suggestions!
 
That was for sure magic ketones disappearing that fast. ............ But good.

Ketones are basically fatty chains, and when in starving, low fat, low carb diets, the body naturally releases fatty chains from its stored body fat, and these fatty chains have biochemical names but we just call them b-ketones ... which are the longest fatty chains before breaking down to shorter, and a-ketones which are the shorter fatty chains. The b-ketones, which are those we measure with the b-ketone meter, are so long chains, that they can't cross the renal barrier and enter into the urine, so they keep circulating in the blood until they body have processed them and broken them down into shorter chains. So your vet might be right that the formula food, insulin, and sub q fluids, took care of that breaking down process. Good that he wants to see her though so everything else is okay. I know from Simba just how painful pancreatitits are but not sure how much it affects ketones.


There are these, IMO :razz: , loony humans without any medical conditions that does this ketone-dieting to lose weight, they eat just as our diabetics does, high protein, high fat and no carbs. These persons constantly has positive b- and a-ketones when tested, but they aren't in ketoacidosis because their blood pH value and electrolytes are okay. But they report the same thing, that all the high ketone levels they have, makes their brain go dizzy, and one I read about in the paper was taken by the police for drunk driving, since the a-ketones are the ones creating the acetonic in the system and in the lungs, he was totally sober but when he blew in that alco meter, it turned red as if he was drunk. So he was "drunk" on ketones and others get dizzy in their brain. I like to think that must happen to our kitties too when their ketones are too high.
 
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