Kit in hospital with ketones (orig: help please - feeding advice for an increasingly picky eater)

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Just to add a tiny bit to what Marje posted re. the difference between ketones and DKA, with DKA, lab values will change. The cat is usually experiencing metabolic acidosis, bicarbonate and potassium levels are off and magnesium and phosphorus levels may be effected, as well.
 
Going forward, if Kit will be more prone to DKA episodes, do you recommend I get a blood ketone meter? I read the info page on them and I see that the strips are really expensive but I think that might be easier than having the perfect timing to test her urine. She's really good with getting her ear pricked for blood tests. I'm lucky to have enough in my vet savings account for this round of overnight hospital stays but another long hospital stay might clean me out (and I need to keep enough saved for Henry when he eventually has old boy cat issues).
 
egwv said:
Going forward, if Kit will be more prone to DKA episodes, do you recommend I get a blood ketone meter? I read the info page on them and I see that the strips are really expensive but I think that might be easier than having the perfect timing to test her urine. She's really good with getting her ear pricked for blood tests. I'm lucky to have enough in my vet savings account for this round of overnight hospital stays but another long hospital stay might clean me out (and I need to keep enough saved for Henry when he eventually has old boy cat issues).
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If it’s hard to catch her going into the litter box, a blood ketone meter might be better for you.
 
I just talked with the internal medicine specialist and am feeling overwhelmed by it all. I'm just going to list everything that I wrote down from our conversation because I need some time to process it:

Priorities are:
-Identifying what triggered this
-Nutritional therapy

This is what they are initially planning on doing:
-Nasal-gastric tube as syringe feeding does not provide nutrition
-Daily bloodwork
-Ultrasound (they will do a limited one since Kit got a complete one last week at my regular vet)
-Chest xrays to check her lungs and esophagus (check for pneumonia, dilated esophagus)
-GI panel
-Freestyle Libre glucose monitor while she is in recovery
-Hospitalization estimate for 48-96 hours depending on how she does

They are only doing IV insulin while she is there and will wait to restart subQ lantus when she is eating again.

I mentioned that her ultrasound last week showed some enlargement of her liver/pancreas and some thickening of her intestines. He said that the intestines might be a sign of IBD or lymphoma(? I think? I didn't fully write everything down) and that an enlarged pancreas might be pancreatitis which is hard to diagnose the trigger and has a wide range of recovery.

Neuropathy: we will wait for her to come home before starting the B12 since the main priority is getting her appetite back.

He went over feeding tube options:
-Nasal-gastric only while she is in the hospital (I am going ahead with this because she needs nutrition).
-E-tube option if she is still not eating on her own because this can go home with her and stay for months. He said it has to be inserted under general anethesia and that diabetic cats have greater risk of complications such as blood clots and ischemic events (neurological). This is scaring me the most right now.

Her DKA status doesn't have to be perfect for her to go home, just better and regulated (appetite back, insulin levels good).

I asked about high ketones vs DKA and he understood the question. He said the weekend emergency clinic didn't show an acid-base status. Based on her blood ketone level and her electrolytes he's assuming DKA but there is a separate blood test (something to do with glucose/electrolytes/potassium?) but that the initial treatment is the same for ketosis and DKA.

He said that DKA cats have a 50/50 prognosis. With appropriate nutrition and identifying the underlying cause that can go up to 60/40 or 70/30 but it is still very serious.

He did not have her ketone levels for today or her urinalysis report but they will update me every morning and evening.

This has me really rattled. The bill estimate is crazy high but I can't not pay it, but obviously it's hard to think of anything but worst-case scenarios with her needing more than 4 days in the hospital and anesthetic for an e-tube, or that she has pancreatitis/IBD/lymphoma and I'm going to lose her.

Does everything they are doing seem on board with you all? Anything that seems unnecessary, or anything they might have missed or that I should ask about?

I can visit her any time but right now I don't even think I am safe to drive because my whole body is shaking. My parents are picking me up from work and taking my car back to their place (they closer to the hospital than me) but I know they are going to tell me that I'm crazy to spend so much money on a cat. I know that that is my decision to make and that people will judge me for whatever decision I make but Kit is my family and I am responsible for her.
 
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My kitty J.D. was about Kit's age when he got DKA. He was in critical condition when I took him to the ER on a Sunday. Very weak, lethargic, and purring loudly. The ER back then was only open when other vets were closed (in the middle of the night, weekends, and holidays). At 6:00am on that Monday morning, they were giving me the choice of two hospitals to transfer him too, both 1.5 to 2 hours away in commute traffic. At 7:00am, we started our journey to the UPenn Vet Hospital. I was just praying he would make the journey, and he did. He was in Critical Care in the beginning. His electrolytes were all off, and he was turning yellow. He was so weak, he couldn't lift his head. They never could find what was causing the DKA. He had to have a couple of blood transfusions. Lots of around the clock care, and he slowly got better and better, and eventually through the days was transferred to 3 other departments (ICU, Internal Medicine, and then some other that I can't remember). I prayed all day and all night every day. I was obsessed. I LIVED to go visit him after work for the limited 20 minute visits that they allowed. He wouldn't eat for them, and each visit after work I would bring his favorite foods and treats. He wouldn't eat them. He was there for 8 and 1/2 days from before Christmas to New Years Eve. I traveled through snowstorms to get to go see him. They kept saying he could get to go home as soon as he would eat. On New Years Eve they said I could come get him with a feeding tube. He came home, and within the first 24 hours he took that feeding tube out and was eating on his own. He was still weak, but getting better. He lived a happy life to 20 years old (8 more years). The vet bill was a lot for me back then, but I have always felt if it was a human (with insurance and all) it would have been 100 times what I paid.
 
It sounds as if this vet knows what he is doing. I think a feeding tube is a very good idea. It probably sounds scary to you but it will be much easier to get food into her until she can eat on her own. You will be able to manage fine with it and it will be much more pleasant for Kit than syringe feeding. And getting plenty of food into her is so important at this stage.
Don’t worry about what others will say about spending money on a cat. Kit is your family and it is your decision. Many of us have that pressure from family and friends. There is no need for you to justify what you are doing. Just say it is your decision and your money. We all support your decision here. :bighug:
 
Gabby was a DKA survivor. I had my vet and the emergency/internal medicine vet both warn me that she might not survive. She did. The vet hospital got labs twice a day. I would call twice a day to find out what the values were. I'm pretty sure Gabby was eating but it was so long ago I honestly don't remember how her appetite was. I'm pretty sure she came home with an appetite stimulant and I suspect she was given an appetite stimulant in the hospital. She was diagnosed with diabetes at the same time so a lot of what was going on was caught up in the entire process of a just diagnosed diabetic cat who was in the midst of DKA, pancreatitis, and hepatic lipidosis. She was hospitalized for 3 days. I was a wreck. My response to the cost was, "That's what credit cards are for."
 
I agree the vet sounds knowledgeable. Although I don’t get the part about syringe feeding not providing nutrition. Perhaps he thinks it would be difficult to get enough calories in a cat via syringe? I know of people who have syringe fed their cats with chronic kidney disease for years. It takes the right syringe, the right food to go through the syringe, and the right number of calories.

Having said that, it sounds like a feeding tube is warranted in this situation and we’ve seen many DKA cats here come home from the hospital with a feeding tube. Here is some info about feeding tubes. And here is info about living with an e-tube. The person who wrote this makes the Kitty Kollar which is fantastic for cats with e-tubes. You can read about it and order one if it becomes necessary from her website. We have at least one member here who uses a Kitty Kollar to keep the FS Libre on her cat.

When you have time, here is a detailed post on pancreatitis. If she has enlargement of some organs, I wonder if she could have triaditis which is inflammation of the pancreas, liver, and small intestine. I wouldn’t go too far down the IBD or lymphoma rabbit hole right now. To be correctly diagnosed, a biopsy is necessary and that’s not in the cards here. She might just have some inflammation. If, after she is feeling better, she is still showing thickening in her intestines on u/s, you can discuss the options with the IM vet then.

It seems to me he is being very thorough. As I mentioned before, we often see vets pull the kitty off the basal insulin (eg lantus) in favor of a faster acting insulin.

We have had many, many, many cats here survive and thrive after DKA. I can remember one who had it twice and made it through both episodes. We have a lot of info here to help you once you get her home.

And I also agree, don’t let anyone tell you it’s silly to spend the money on her. She’s your baby and you get to decide what’s best for you both. We respect whatever your decision is because she is yours and you know your situation. We are here to support you in any way. Hugs to Kit from all of us and lots of healing light.
 
I just got back from visiting Kit. She was still a bit groggy from being sedated from having her nasal tube put in, but she was alert enough to accept kisses and some gentle snuggles. And she enthusiastically ate two Churu tube treats, though the turned her nose up at some Purina DM wet food. She was going to start nutrition through the NG tube soon so we didn't do syringes of a/d food (or more Churu).

I didn't get too many updates or ask more questions because my brain was too full from the info the doctor told me earlier today. So the only update I have is that they didn't find anything new in her ultrasound (I will clarify tomorrow if "nothing new" means "nothing" or "we saw the same issues with pancreas/liver/intestines and have concerns") and her glucose levels are coming down (I didn't get specific readings/times for today's spreadsheet). I did ask about her ketone level today but the vet tech didn't have that information for me. They are focusing on her appetite.

Just to clarify about the doctor's comment about syringe feeding, in the context of the conversation I think he meant that during the hospital stay when they are really trying to get her appetite up that syringe feeding didn't provide enough nutrition compared to a nasal tube. (This was when he was going over what tube feeding entailed and my first reaction was "oh my god tubes sound invasive and expensive and can we just syringe it instead.")

I'm going to visit again before work tomorrow morning and will post when I get the morning update.

Henry's yelling at me for attention so I should give my other cat some scritches now. Thanks, as always, for the information, questions, and support.
 
That is very good news Kit is eating something, even if she turned her nose up at the Purina DM. Before she comes home I would get a collection of canned food to offer her once she wants to eat again. And she will want to eat again. Most cats after DKA are still nauseated and need an antinausea medication and often an appetite stimulant.
that is good they did not find anything new in the ultrasound and her BGs are coming down.
Make sure the vets give you some ondansetron for nausea to take home.
I am surprised the vet tech didn’t know what the ketone level was now. The number of ketones is very important as well as the appetite.
did they find any infection?
When you bring her home we can help and support you while she recovers. We get a lot of DKA kitties recovering after being in the ER.
We appreciate the updates.
 
egwv said:
I just got back from visiting Kit. She was still a bit groggy from being sedated from having her nasal tube put in, but she was alert enough to accept kisses and some gentle snuggles. And she enthusiastically ate two Churu tube treats, though the turned her nose up at some Purina DM wet food. She was going to start nutrition through the NG tube soon so we didn't do syringes of a/d food (or more Churu).

I didn't get too many updates or ask more questions because my brain was too full from the info the doctor told me earlier today. So the only update I have is that they didn't find anything new in her ultrasound (I will clarify tomorrow if "nothing new" means "nothing" or "we saw the same issues with pancreas/liver/intestines and have concerns") and her glucose levels are coming down (I didn't get specific readings/times for today's spreadsheet). I did ask about her ketone level today but the vet tech didn't have that information for me. They are focusing on her appetite.

Just to clarify about the doctor's comment about syringe feeding, in the context of the conversation I think he meant that during the hospital stay when they are really trying to get her appetite up that syringe feeding didn't provide enough nutrition compared to a nasal tube. (This was when he was going over what tube feeding entailed and my first reaction was "oh my god tubes sound invasive and expensive and can we just syringe it instead.")

I'm going to visit again before work tomorrow morning and will post when I get the morning update.

Henry's yelling at me for attention so I should give my other cat some scritches now. Thanks, as always, for the information, questions, and support.
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All good news and thank you for clarifying the vet’s statement.

Today, when you have a chance, can you please start a new thread? We try to limit thread length to 50 posts and we are past that. Please entitle it something like “Updates on Kit—DKA”. If you can then please copy the link below and paste it in the first post of the new thread, it will be easy for us to come back to this thread if we need to read something. Thank you and I hope you rested and Kit is much better today.

https://www.felinediabetes.com/FDMB...increasingly-picky-eater.278522/#post-3081913
 
egwv said:
Going forward, if Kit will be more prone to DKA episodes, do you recommend I get a blood ketone meter? I read the info page on them and I see that the strips are really expensive but I think that might be easier than having the perfect timing to test her urine. She's really good with getting her ear pricked for blood tests. I'm lucky to have enough in my vet savings account for this round of overnight hospital stays but another long hospital stay might clean me out (and I need to keep enough saved for Henry when he eventually has old boy cat issues).
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I always used a blood ketone meter. Much easier and you don't have to wait for them to pee.
 
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