? Ketones 1.2 Emergency Vet wait

Sarah & Charlie-cat

Sarah & Charlie-cat

Member Since 2022
Hey all.
During Charlie's curve, I did a blood ketone test and he was 1.1, he went back down with tests at .8 and .5 with some watered food but this afternoon I couldn't get him to eat much and at PMPS he was not eating and ketones were 1.2. long thread on the Facebook group earlier in the day convinced me to take him to the emergency vet.

We have an hour and a half to two hours wait. No food, no water, no insulin on board, missing his evening steroid dose.

Should I stay or should I take him home and try to syringe feed him and try later?

The receptionist knows nothing and there is no triage.
 
Tech: We're going to take his glucose.
Me: It was 316 as of 60 minutes ago, no insulin, it's gonna be mid-300s.
Tech: Blank stares.
Me: Do you want to use my meter so it's more accurate?
Tech: I'll write the numbers down.
Me: starts explaining the differences you might get with an AlphaTrak and the human meter I used all day
Tech: blank stares...uh, ok lady, if it will shut you up, I'll take it.

I swear to dog, this cannot be so fleetingly rare that the ER vet tech is looking at me like I am speaking Martian
 
BG on my meter 302. On theirs 380. Lololol.

Anyway. They said his vitals look good. Gonna do blood work when they can get him in a room.
 
Oh honey my heart breaks for you, an emergency vet visit? every minute can feel like an hour. It's good to know he was checked at least, and not just left with you in the waiting room. :bighug::bighug::bighug::bighug:.
 
Sarah, what others symptoms does Charlie have? Is he lethargic? is he eating?
Is he vomiting or has diarrhoea? Is he dehydrated?
A blood ketone test of 1.2 is normally nothing to worry about if your kitty is otherwise well.
We don’t normally worry until the result is 2.4 as long as there are no other symptoms
 
Dinner didn't get eaten, neither did afternoon snack. Not vomiting. Dunno about diarrhea (too many cats and boxes). He's been fairly subdued today, sleeping a lot. I haven't seen numbers above 1 before.

The chart I have said between .6-1.5 was watch and wait and if it was going up, get there to a vet.
 
Sarah & Charlie-cat said:
Dinner didn't get eaten, neither did afternoon snack. Not vomiting. Dunno about diarrhea (too many cats and boxes). He's been fairly subdued today, sleeping a lot. I haven't seen numbers above 1 before.

The chart I have said between .6-1.5 was watch and wait and if it was going up, get there to a vet.
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I wonder if the chart was for human and not cats.
However if he’s not eating, is subdued and sleeping a lot, I would get him checked out. But don’t leave it too long before he eats and gets his insulin as it is food and insulin and water that will stop the ketones, as long as there are not too many.
 
It did say go to the vet, so I'm guessing not for a human, lolz

Yes, absolutely on food, water, and insulin. I almost went home to syringe feed him! But they have him back there. Just give him some fluids and show me how to do it and some kitty tummy meds and let us go.

He was acting like his tummy hurt, looking at the food, licking his lips and not eating. Eating a tiny bit and walking away.
 
Sarah & Charlie-cat said:
It did say go to the vet, so I'm guessing not for a human, lolz

Yes, absolutely on food, water, and insulin. I almost went home to syringe feed him! But they have him back there. Just give him some fluids and show me how to do it and some kitty tummy meds and let us go.

He was acting like his tummy hurt, looking at the food, licking his lips and not eating. Eating a tiny bit and walking away.
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Sounds like he is nauseated. Are you still at the vets. Ask for an antinausea injection and some tablets to take home.
 
Ask for some ondansetron if possible as it is better for nausea than cerenia. But either way, make sure you get one of them.
Also ask about pain meds if you think he is in pain,…if he has pancreatitis he will have some pain as it is a painful condition.
I’m glad they gave him some sub Q fluids.
 
She said they would do blood work and I was like I have a ketone meter right here and she looked at me like I was speaking gibberish. But you could know in 10 seconds what his ketones are. maybe 12 I'd you count stabbing him in the ear
 
Waiting, waiting. But I wrote recheck ketones ASAP, sub q fluids, and the names of the meds down... Buprenoephine better than gabapentin in this case? He was on gaba and something else when he came home from his pancreatitis and diabetes diagnosis hospital stay
 
He's two hours past his dose, four from food.

They want to do IV fluids and hospitalize him. I asked her to go rerun an estimate with sub q fluids and an anti nausea shot to manage at home.

Although tomorrow is Sunday, so we could just end up here tomorrow.
 
I talked to hubs who said bring him home with sub q fluids and the cerenia injection, keep an eye on him tomorrow and if we have to come back we have to come back. He promised to get him at 7 am Monday since I have to leave at 6:30 to drive to a site visit. Tech said he looks good otherwise. So, I'm hoping this is stopping the ketone train and hopefully get him in to his regular vet soon for a ultrasound to see if there's something else going on and bloodwork.
 
I have been separated from him and they refuse to use my ketone blood meter. The tech seemed to refuse to believe that is actually a thing. She was like well urine is different, I'm sure it is honey but um, I can tell you the concentration of ketones in his blood right now in 12 seconds... I will ask about oral meds and pain meds when she comes back. Apparently, that wasn't on the menu.
 
Sarah & Charlie-cat said:
I have been separated from him and they refuse to use my ketone blood meter. The tech seemed to refuse to believe that is actually a thing. She was like well urine is different, I'm sure it is honey but um, I can tell you the concentration of ketones in his blood right now in 12 seconds... I will ask about oral meds and pain meds when she comes back. Apparently, that wasn't on the menu.
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Honestly I despair at some of the things I hear about vets and vet techs! :banghead:
They are obviously not up to date with all the latest equipment and care of FD kitties and that is a worry…especially an ER.
 
Yeah, she was totally baffled when I told her she should test his glucose with the meter I used all day for his curve.

I'm glad the old vet put him on Lantus, but the other things they were wanting me to do just didn't make sense. And I finally had to thrown down my copy of the AAHA report, well highlighted when the vet was like 91 is a perfectly fine preshot number to give him 2u of insulin.
 
They don't have cerenia tabs to take home. They would give him gaba but don't want to zonk him out and tech is going to check on the antibiotics.
 
Ironically, one of the things I'm working on (I'm an education professor at a research university, lol) how universities can recognize, use, and elevate the knowledge and expertise of lay people. This group and the folks in Germany that developed TR are perfect case studies of the value of people with actual lives experience and what happens when you aggregate it.
 
Sarah & Charlie-cat said:
Ironically, one of the things I'm working on (I'm an education professor at a research university, lol) how universities can recognize, use, and elevate the knowledge and expertise of lay people. This group and the folks in Germany that developed TR are perfect case studies of the value of people with actual lives experience and what happens when you aggregate it.
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I wish that somehow the collective knowledge of this forum could be put to use to educate the many vets about FD because in the main, the up to date knowledge about FD in the vet community is sadly lacking. We get so many cats here that arrive having been given bad advice or not a suitable insulin, or too much insulin or being shamed about wanting to home test….I could go on….
All of us here have looked after a diabetic cat/cats 24/7, often for years and that experience is invaluable.
 
Sarah & Charlie-cat said:
one of the things I'm working on (I'm an education professor at a research university, lol) how universities can recognize, use, and elevate the knowledge and expertise of lay people
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Sooo true, the combined knowledge of those based on experience and the learning based knowledge in the classroom setting, can make for well rounded students. You know this better than I, I can say from personal experience I got a BSc, 4+ years and it was great, and I love the knowledge I got from it. I was keen on doing a PhD... till life changed, working my field changed, and I learned that PhD stood for Pretty Hard Degree! ;) I'm happy to see your mindset change in your texts, it means you are a bit calmer now about Charlie? This group here will surely instill some confidence that combined knowledge is power, it surely has for me :bighug:
 
When you ask for a script of ondansetron ask for 30 4mg tablets. Alot of the pharmacys charge high dollar amount for ondansetron for instance CVS charges $96.73 with the goodrx coupon. Not sure what pharmacies you have around you. I get my ondansetron at Meijer pharmacy with the goodrx coupon for $10.81. I always keep ondansetron, Cerenia & gabepentin, mirtaz(appetite stimulant) on hand because my boy has chronic pancreatitis. You may also want to ask for fluids to take home. I've never given fluids to my boy but if it came down to it I would. I always put 3 tablespoons of water in his wet food so I know he's getting some water & it has worked for us. My boy has never had ketones so I can't really speak on that. Just wanted to help you out by telling you about getting ondansetron & mirtaz. They've both been a savior for my boy. Good luck & I hope Charlie gets better soon :bighug:
 
They didn't have tablet of anything to send home.

I'm hoping this isn't the start of a pancreatitis flair, but it might be.

The only thing they gave me to take home was amoxicillin. Uh, ok
 
Sarah & Charlie-cat said:
Ironically, one of the things I'm working on (I'm an education professor at a research university, lol) how universities can recognize, use, and elevate the knowledge and expertise of lay people. This group and the folks in Germany that developed TR are perfect case studies of the value of people with actual lives experience and what happens when you aggregate it.
Click to expand...
I'm also at a research university and would love, love, love to read this research. I usually refer to myself as a "civilian" when talking to the group of folks you mention.

Hoping all goes well with Charlie! :bighug::bighug::bighug::cat::bighug::bighug::bighug:
 
Sarah, I would increase the dose of insulin to 0.5 U at the next dose.
Maybe ask your usually vet for a script for ondansetron or some cerenia. I’m really surprised they didn’t have any serenity tablets.
And I’m not sure why they gave you amoxicillin.
 
Sarah to address the ketones I would:
  • Try and get Charlie to eat 1 and a 1/2 times as many calories as he normally would. At the moment let him eat what he will eat even if it is not low carb…although low carb is best…eating any food is more important at the moment. Lots of small snacks.
  • Try and source some antinausea medications tomorrow incase they are needed. It did sound as if he was nauseated the way he licked his lips, ate a bit then walked away..
  • Test daily for ketones and document in the remarks column of the SS please
  • Add warm water to the food if he will let you. A teaspoon in each snack can make a difference
  • Don’t skip any doses of insulin. If the preshot is lower than normal…stall, dont feed and test in 20 mi utes to see if the BG is rising.. and post and ask for assistance.
  • I would post daily at the moment for advice and support
 
I haven't retested ketones. I need to. In like scared to now.

I have offered him all haha favorite foods to ni avail. Offered, shoved in his face, wipes on his face, he will not eat He ate a few dried liver treats. He hasn't had his insulin either. He's 12 hours without food now and his last insulin was 22 hours ago.

I really thought we would get home and he'd eat for me.

Back to ER vet?
 
Sarah & Charlie-cat said:
I haven't retested ketones. I need to. In like scared to now.

I have offered him all haha favorite foods to ni avail. Offered, shoved in his face, wipes on his face, he will not eat He ate a few dried liver treats. He hasn't had his insulin either. He's 12 hours without food now and his last insulin was 22 hours ago.

I really thought we would get home and he'd eat for me.

Back to ER vet?
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Even if he won’t eat, I would give him a half dose of insulin…insulin does more than just lower the BG in the body.
Can you offer him some forbidden food? He must eat. Try anything at this point.
Did they give him a cerenia injection at the ER..?
Can you test for ketones now please as we need to know where things are up to
 
They said they gave him cerenia. And that it would work in about an hour.

Since the yard fox just woke us all up...
Ketones .7
BG 317

I can try some regular kibble and giving him his insulin at 6 am ish so we're back where I need him to be for work this week. I told the vet and the tech I didn't think his small dose and his high numbers was going to tank him but they were adamant I not. That is one area where there's conflicting info on the pages here.
 
That is reassuring the ketones are 0.7
How many hours til 6 am?
Yes feed him whatever he will eat during the night and at 6 am. He needs to eat. It is the insulin and the food that will keep the ketones away and it is the lack of both those that invites ketones back in, so the plan has to be food as much as he will eat and regular insulin.
Will your husband be able to test him during the day tomorrow and feed him extra food while you are at work?
Would appreciate a quick response from you as I am inAustralia and need to head off to bed very shortly. Thanks
 
It's 5:45 here now.
He hasn't eat anything offered. The world's best food TM, his normal food, his favorite sardine cutlets (warmed even), Dr. Elsey's, not even the regular kibble.

I managed to syringe about 4mls of Tiki mouse mixed with broth into him but that's hardly anything and he was not having it.
 
Sarah & Charlie-cat said:
It's 5:45 here now.
He hasn't eat anything offered. The world's best food TM, his normal food, his favorite sardine cutlets (warmed even), Dr. Elsey's, not even the regular kibble.

I managed to syringe about 4mls of Tiki mouse mixed with broth into him but that's hardly anything and he was not having it.
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What about some cheese? Parmesan ?
Or regular chicken lightly cooked?
Can your husband go to the regular vet today and get some ondansetron for the nausea? It can be given up to three time a a day and at the same time as cerenia as it works on a different pathway.
You you have honey at home in case it is needed ?
Will your husband be home with him today? And be able to testThe BG?
.
 
My husband is useless in this department. I'm home today (it's only Sunday morning in the US). Gone tomorrow. He will not be home. He hasn't learned to test or inject. He refuses to.

Our new vet has no weekend hours. Our old vet is not open on Sunday. Our old old old vet might be.

We have Karo in the house.

He's never had any interest in cheese. I do have some cooked chicken I could thaw. He seems to like it but he's turned his nose up at everything he normally likes so I don't have high hopes.
 
Sarah & Charlie-cat said:
My husband is useless in this department. I'm home today (it's only Sunday morning in the US). Gone tomorrow. He will not be home. He hasn't learned to test or inject. He refuses to.

Our new vet has no weekend hours. Our old vet is not open on Sunday. Our old old old vet might be.

We have Karo in the house.

He's never had any interest in cheese. I do have some cooked chicken I could thaw. He seems to like it but he's turned his nose up at everything he normally likes so I don't have high hopes.
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I was forgetting the time difference! It is almost Monday morning here.
SUGGESTIONS TO STIMULATE KITTIES APPETITE
Can you go out and buy a roast chicken?

I’m sorry none of your vets are open on a Sunday…try your old old old vet. It’s important that Charlie starts eating and that he gets his doses of insulin.
 
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