Ketostix positive but not at vet?

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Priss

Priss

Member Since 2012
Hi,

Priss's showing positive on ketostix last week so we took her to the vet. The urinalysis was negative for Ketones, the vet said that this could be because they are made for humans? Right now she isn't acting well and we increased her dose last week but her BG is still high, and she is drinking a lot. This morning she wouldn't eat and the ketostix were positive again. We'll call the vet today to see if she needs another dose increase - has anyone else experienced the ketostix not matching the vet? Last vet told us to use them.

Thanks,

Elizabeth
 
How high is she reading on the ketostixs? A trace isn't too bad, but moderate or above is serious and she needs to be at a vet pronto, especially if she isn't eating.

Not eating with ketones can quickly turn into DKA..as well as not eating can cause fatty liver disease.

Mel, Maxwell, Autumn & The Fur Gang
 
Just checking: Tests should be done with fresh (<30 min), uncontaminated urine.
 
It is the darkest color in fresh urine. It also was last week when I took her to the vet, and the vet said the urinalysis showed no ketones at all. I asked her about the ketostix and she said it must be because they are for humans.

At her vet visit they gave her fluids, did a blood cbc/chem panel, fructosomine (536) and urinalysis. She was sent home with instructions to increase the insulin by one unit total a day.

I have been having a hard time getting her to eat which is originally why we went to the vet last week, plus the ketostix. Yesterday morning she didn't eat at first but when I came home the food bowl was empty. She did not eat last night, I will call my boyfriend to see if she ate since I went to work. This morning her BG was 208.
 
She hasn't eaten today so we are waiting for a call back from the vet, I'm still confused why the ketostix and the urinalysis would not match. Last week nothing unusual came up besides her elevated liver enzymes, the vet said this may be because her diabetes isn't controlled, so we put her back on Den. liver support and they gave us baytril in case there is an infection.
 
Does her breath smell funny kind of like nail polish remover?...if she has ketones her breath will smell like acetone...DKA can be life threatening

Ketones can spring up very quickly, so there is a chance they weren't there a week ago but are there today. Also timing of the reading is very important with Ketostixs, you need to dip and read within 15 seconds...the longer you wait to read it the darker it will get, but you want that reading right at the 15 second mark.

But if I understand you correctly she is testing at a very dark red/purple...if that was taken within the 15 second mark she is one sick kitty and needs vet care pronto. Any chance you can get a second test just to be sure?

Mel, Maxwell, Autumn & the Fur Gang
 
Ketostix aren't supposed to be exact, they are only a rough indicator. A NovaMax can test for ketones, although the strips are quite pricey.

If Ketostix are stored in poor conditions, they may not work correctly. Moisture and heat are potential agents to break these down. How long has the container been opened?
 
If her breath smells like nail polish remover, go to a vet asap as that is a definite sign of moderate ketones or higher. Maybe a different vet. And ask them to test for blood ketones - the level in the blood is what you're most interested in. The urine collects over several hours, and sometimes, excess water filters back into the body, making the concentrations of anything in the urine higher.

Check for gross dehydration: gently pull up the scruff of the neck and release. If it snaps right down, probably not dehydrated; if it stays pulled up, dehydrated. This level should be seen by a vet.
Check for mild to moderate dehydration: lift the lip and press firmly on the gum above the teeth. When you remove your finger, does it immediately go back to pink, or does it stay whitish and s l o w l y return to pink. The latter indicates dehydration.

If the breath doesn't smell, and she's not dehydrated and is behaving OK, then I'm thinking the strips may have gone bad or be a bad batch.

When in doubt, check it out.
 
I have a ketone prone cat. He smells like acetone before he even has a high ketone reading but it is NOT true that all cats smell like acetone if they are in DKA. Some do not smell at all. I would say that if your kitty is not eating and you are getting a purple reading on the ketostix there is a very good chance that your cat is in or headed toward DKA. Is he lethargic? Acting sick? I find it odd that his BG reading has not been mentioned here. Is it high? If your Vet is insisting that urinalysis is not showing ketones but your test strips are getting a purple reading and your cat is not eating I would go to another vet. This can turn critical very quickly and whether it's your test strips or not it's better to be safe than sorry.This is not something to guess about. High blood glucose, dehydration, not eating and the incorrect dose of insulin PLUS a possible infection are all factors that lead to DKA. And you're giving insulin to a cat that isn't eating which can lead to a hypo situation as well.

There is too much I don't know to really give any advice...and I have a lot of experience with ketones...other than to say...please take your kitty to another vet. Really soon.

Very Sincerely,
Caryl
 
By her spreadsheet looks like Priss is running in the 300s even on 1.5u bid.

My Musette was a ketone prone kitty too, and she went into DKA without extremely high BG readings.

Please if there is any doubt take Priss to a vet...this can be very serious, very quickly and she will need a vet's care to pull through if she is headed for DKA.

Mel, Maxwell, Autumn & The Fur Gang
 
The test strips have been open 2.5 months, they were in the bathroom medicine cabinet so maybe gone bad. Her BG was 208 this morning.

I called the vet office and they said she needs to eat and may be headed to the DKA again which she had before. They want to do an ultrasound earliest tomorrow to see if she has an underlying condition like pancreatitis.

I can go to another vet but there is only one in this area, who treated her before, that is 24 hours I would take her to, she had the DKA in September and it cost a lot so we might not be able to afford her treatment again. We took her to the new vet because it is less expensive.

She ate a little this afternoon, I'm at work now so can't do anything until at home and will try to get something else to check for ketone.

She is lethargic and has been drinking a lot.
 
Lethargic and drinking a lot is worrisome.

When you get home, or if anyone else is at home to help, use an oral syringe to administer canned food with added water blended into it. Go for about a teaspoon worth at a time to see if she'll keep it down.
 
This is why I took her in last week, they said it was just because she needed and increased dose. We didn't take her to the specialist because they charge $130 just for the exam, sort of wish we had gone there first.
 
Also, we have an appetite stimulant and pepcid ac the vet told us to give her when I get off work to see if it helps
 
Ya know what? It doesn't matter what she eats right now. your ketostix are not so old that they have gone bad. There should be an expiration date on the bottle. There is on mine. All eating will do is to keep your kitty from going hypo. He/she (i'm sorry I don't know) needs stuff you can't do at home. Eating alone is not going to solve anything. It has to be in conjunction with subQ fluids to flush the ketones (assuming there are ketones) out of the body and the correct dose of insulin AND knowing whether or not there is an infection she may need antibiotics. Sorry but this is all the truth.Like I said, and you must know this if you've seen it before..... A cat can rapidly go from ketosis to DKA and depending on how bad it is ...well like I also said, it can get critical very quickly.
If those stix are purple...I'd get my cat to a vet instead of worrying about syringe feeding. I am saying this to help not to scare you.

Seriously.

Caryl
 
I still think it is weird the vet urinalysis showed different the same day as the ketostix. Is it possible for the urinalysis to be wrong? We might be able to afford to put her back in the ER but only for one night after last time and after we wasted the money on getting a blood panel and everything done last week.
 
Elizabeth --

Just to be sure, are you using Ketostix or Ketodiastix? The latter has 2 patches on the end. One patch tests for ketones (flesh colored for none to maroon for large) and the other for urinary glucose (aqua to dark brown for high). With where your cat's blood glucose numbers have been, I would expect a high urinary glucose level.

One way to see if your strips are good is to test yourself. If you test your own urine and you are getting a greater than trace response, the strips are likely bad. Humidity can effect their accuracy.

Acetone on the breath, for most cats, occurs when ketones are large and the cat is in metabolic acidosis. If you notice this, scoop your cat and run to the ER. Caryl's Alex is unusual (or she has a super sensitive nose) in that she can notice ketones very early in the process. Most of us aren't so lucky to have that kind of early warning system.

As others have noted, a blood ketone reading is much more to the minute than urinary ketones. It can take hours to get a reading that will tell you whether urinary ketones are present when a quick blood test (just like testing blood glucose) will give you a reading of how high the ketone level is right now. Food has to be processed into waste, the urine has to be collected in the bladder, and they you need to catch your cat in the litter box. It would be best if your vet had tested blood ketones.

Ketones can develop when there is an infection, a cat isn't eating, and there's not enough insulin on board. Blood glucose numbers do not have to be high. A cat can develop ketones even if numbers are in the lower ranges. One of the very experienced members here posted this note over the weekend regarding ketone awareness. If your cat isn't eating, this will add to the problem It also adds to the problem is your cat isn't drinking -- water or any fluid helps to dilute and flush the ketones out.
 
The vet is all likelihood uses a dipstick too but their dipstick has about a dozen pads vice one pad for ketostix.
The dipsticks have both an absolute expiration date and a date like six months after the container was first opened. Humidity getting into the container shortens their shelf life.
 
They are ketone test strips. The brand is CVS pharmacy ketone strips. I have no idea how the strips could turn yet the other vet said there weren't any ketones. I should have trusted my instinct. I just checked her bg and it is 398. She vomited while I was gone with some hair and grass an hour ago, apparently did not eat much at all if anything. I'm taking her to the ER vet tonight, but we can't afford another full 3-4 days in the hospital, after we just paid for the diagnostics at the regular vet. She is lethargic now but not as bad as last time.
 
I'm glad you're taking her to the vet. My cat is a DKA survivor. It is very critical that she be at the vet.
I wish you the very best of luck.
I am sending prayers for your kitty.
 
Glad you are taking her to the ER vet.

Sending prayers for you all...I lost my little girl Musette to DKA.

Mel, Maxwell, Autumn & The Fur Gang
 
Just read this and am glad to hear you went to the vet. All the speculation in the world can't take the place of taking your kitty to the doctor. Please let us know what happened. Hope everything is okay!!!!

Caryl
 
I took her to the vet hospital and they ran her chem panel again and did a dipstick. We took her home last night and put her on fluids, and are syringe feeding. Lunchtime today she will go back to the hospital and may get an ultrasound, her primary doctor will be there and advise. We can't afford to keep her in the hospital for a full day this time since she was hospitalized in September with DKA and an etube for a few days, now she has it again but it wasn't as advanced. This is the same hospital and the doctor feels we need to get the ultrasound to see what keeps causing her to have DKA and if it is treatable, so she can get out of this cycle.
 
Hoping Miss Priss will once again recover fully, so glad you got her in to the ER when you did. ((((((Hugs))))) You might also want to send a PM to Violet and Garland they went through DKA not that long ago and she got Garland over it at home as well due to low funds, Violet might have some wisdom to share, I don't know if she is still on the board but worth a try trying to contact her.

Mel, Maxwell, Autumn & The Fur Gang
 
An ultrasound is an expensive way to diagnose pancreatitis -- if that's what the vet is looking for. It's much cheaper to do a blood test. A Spec fPLI (this is sent out for analysis) or a Snap fPLI (this is an in-house test if the vet has the supplies) are considered the state of the art diagnostic tests.
 
The vet thinks pancreatitis, liver disease, or cancer may be causing her to get DKA again. I asked about the Spec fPLI test and both the hospital and regular vet wanted to do the ultrasound because they think it could also be something else. I'm trying to find a way to get both the ultrasound and put her on supportive care for 12 hours, I'll see what they think is best. Everyone thinks I'm crazy and its the cat's time to go but I'm not convinced unless she has cancer.
 
I was able to find a way to get the ultrasound and have 18 hours of hospitalization. The vet is due to call me after the ultrasound with the results before starting treatment, if there is anything treatable. Thanks Squeem for the links, we already maxed out the care credit last DKA and now reran new charges on it.
 
Just want to send positive thoughts and gardens of vines to Miss Priss! I hope she can recover from all this. She has a wonderful Mamabean looking after her. :YMHUG:
 
The ultrasound results showed no masses and no blight on her liver. The pancreas was unusual, vet said that it was dark and abnormally shaped with the surrounding fat bright. She said Priss could have a low grade cancer or other concurrent disease which would show on a biopsy, but that it was reasonable to assume and treat for pancreatitis. She may also need an increased dose of insulin.
 
If you can get some mid-cycle tests in the +5 to +7 hour range, you can use that data to follow the protocol to increase her dose. Its posted in the Lantus forums.
 
The vet also mentioned her kidneys may have some infection and gave an antibiotic, she wants me to do a curve on Saturday to increase the dose.

Hopefully this won't happen again with her pancreas because I simply can't afford anything after this. I feel like people think I'm crazy for not putting her to sleep.
 
Some people just don't get how much our furbabies mean to us. If it's crazy to love and take care of our babies than I am happy to be crazy.
 
Priss,
Some cats like my Alex throw ketones when any little thing is 'off'. Thank goodness it hasn't happened lately.(Unjinx). After his first big episode with DKA I learned how to treat it at home as well. I would never dream of treating it myself if Alex seemed very sick but my ex boyfriend is also his vet so I have a lot of support which I realize most people don't have. If it happens enough you learn to recognize the difference.

I'm glad you went to the vet. As we all knew, there was no way (almost no way) that you were getting that reading on your sticks without any ketones being present.I hope the vet told you that once you start flushing them out with the fluids the sticks can remain dark for a time even after the ketones have actually left the body so just keep doing what you're doing and if the dose needs to be increased, and kitty starts eating...all should be well. I hope they figure out what causing this....

hugs to you!
Caryl
 
She is coming home today at 1pm. She ate a little and they have syringe fed her, the ER vet wants to keep her another day but we've run out of funds. Most likely she still has ketones but the ER vet said they must be reduced. This time her values were much better than in September so hopefully it is enough.
 
Prayers for you both that at least now you will be able to get her back to a complete recovery. She is such a pretty girl and she has an excellent mom taking care of her.

Everyone here will have their fingers, toes, paws and tails crossed that this is just a bump in the road for her and soon she will be back to health.

Mel, Maxwell, Autumn & The Fur Gang
 
The ER Vet will check her for ketones this afternoon before you pick her up?

Do you have fluids for home use? If not, I would get some and ask the vet to show you how to give them.
 
No, she didn't check again for ketones to save the cost, I have fluids already that they gave us and know how to use them.
We're in California so I think the vet costs are especially high in this area, the vet has actually helped us out a lot trying to keep the cost down.
 
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