Kitty at Emergency Vet--DKA

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kse

kse

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My cat, Kitty, is at the emergency vet suffering with DKA.

She has suffered from a UTI since Thursday (maybe longer---first noticed). I took her to the vet on Friday and she stayed overnight. I picked her up yesterday--I was giving her cefadrops for the infection. I gave her 2 units of PZI this morning- as directed (amps 402), along with the cefadrops. I went out for a couple of hours this afternoon, only to return to find her in a stupor. Her eyes were glazed over and she was almost unresponsive. I immediately got the monitor and checked her sugar (487). I put her in the car and headed to the Emergency vet, begging her not to die the entire way.

Diagnosed with--DKA-- 5 hours ago.

I just called to check on her and they said she was responding to the treatment. What am dealing with? I hope she will survive--- I am assuming the UTI is what pushed her over board.

Any thoughts? Assuming she survives the night--I am picking her up in the morning to take her to the vet hospital.

Thanks for the help--what are her chances?.
 
My cat has survived DKA twice and is now in remission. We have another cat who had DKA three times. You are right in that infections, dehydration and other factors besides just high BG can cause ketosis and DKA. The second time my cat had DKA his BG was only 240.

There is life after DKA. I am optimistic about your cat's recovery and then your kitty can join the ex-DKA club.
 
You got your kitty to the ER vet, and treatment was started promptly...these are all very promising signs. Cats can and do survive DKA, and the fact your ER vet reports she is responding to treatment is just more promising news.

Keep us updated on how you and your kitty are doing.
 
Her chances are excellent, you just need to turn into a detective and follow the basics.

Welcome to the list, not so much the ketones .... I think you called it, the infection. Three main things cause DKA .... inadequate insulin, not enough calorie intake and infections.

My Payne was Dx second week of October and immediately went into DKA and spent 10 days in the hospital.
Came home, went DKA second time, spent seven days in the hospital .... then she was home for three days and yes, went DKA again. In the beginning she spent more time at the hospital than with us.

BUT had I found the list earlier and not been in such shock (how can this happen to me?) and not trusted the vet so much, (feed dry, don't test and just trust me ...... ) the 2nd. and 3rd. DKA would have been avoided,
yes avoided. I don't know what you are feeding, if you check her BG #'s before each shot? pzi is a nice, workable insulin. My problem was I concentrated on her high #'s thinking that was the reason for the ketones, I fear Payne also has at least a bad infection .... but we can't find it, so we have been battling ketones for the past month.

Your job when she gets home is to use urine strips and test her ketones religiously. I hope your like your vet because you will need to work with him. (I am in the process of changing to one who treats me like a partner) If you get the infection under control, that should stop the ketones but you need to know what they are. (trace/small/moderate/God forbid high) If you can stay down under moderate, you can stop going into DKA. Talk to your vet about using Regular insulin (short acting knocks the ketones down) and because pzi usually peaks at +6 the regular insulin will be done by the time the pzi takes over, IF given at the same time. Also, SubQ fluids can be used with R insulin to keep the ketones from taking off and turning into DKA. Also, food is very important, make sure she eats a lot! while she's fighting infection/ketones.

I know this all sounds like a lot and it is but if you can manage her diabetes, you can manage the ketones by being proactive while you are clearing up the infection. The down side is once a kitty starts throwing ketones, they will always have to be monitored and you can do that!

Even though my Payne is still showing ketones, she is doing really, really well! she has gained all the weight back, the wet food is making her fur shiney and she is playing and chasing the 100 pound puppy around.
Read, learn and stay with the list and you will do well, good luck!
Nancy
(sorry this is so long but I can't seem to write tonight but wanted you to know there is much hope!)
 
Yes she probably could learn how to use R-insulin or an intermediate insulin such as NPH if she gets the right vet. Some vets, such as her former one who helped contribute to the DKA can't even prescribe PZI correctly. Using a base/bolus system can be used to manage cats that are prone to ketones. I did it with Nomad and you are doing it with Payne.

It can get very complex and with NPH (Hum.-N) you get into having to test four times a day. With Nomad, the NPH lasted about six hours with the nadir at about three to three and a half hours. Then you have the nadir of the base insulin to factor in. I used the NPH to bring his numbers down just below what his threshold was for ketones. Luckly I had a coworker who specializes in diabetic nursing help me set this up.

Nomad's periods of high ketones usually happened when he also had an infection. While DKA happens more often when the BG is above 300, it can happen at lower numbers. Nomad's second DKA episode happened when his BG was only 240. At first even my vet's office didn't believe me because his BG was only alittle above 200 at their office. When they did the serum ketones and ph then they realized I wasn't just being a hysterical kitty
Mom.

Without knowing more about the situation and her new vet, I don't know if I would recommend she try to manage ketones in the moderate range at home.
 
I will be hoping that this is a one time problem, and once the infection is taken care of and insulin dose is adjusted, that further remediation may not be needed. Just on-going ketone testing and monitoring may be enough.

I am a little concerned that giving you worst case scenarios will make this seem overwhelming. Just wanted you to know that sometimes DKA is a one time thing and is resolved. If that is not the case for Kitty, you have resources in Nancy and Janelle for more in depth intervention.

Please let us know how Kitty is doing.
 
Hi Sue. The only reason I went into a lot of detail was to make the point that using a short term insulin to manage ketones is more complex. I didn't want someone going out on their own and trying it. There is a good chance that this cat's DKA was due to the vet's misunderstanding about the insulin and a UTI on top of it.

I once tried to start a think tank discussion on ketones and DKA. This does raise a valid question about when people should try to lower ketone levels on their own and when they should go to the vet. I made my cut off point a serum ketone level of 2.0 or above. At home I didn't have the capacity to measure serum Ph or electrolytes.

There are other members who have DKA once and never had to deal with it again. By chance this post attracted the mutiple DKA veterans. It is kind of like a hurricane victim meeting someone whose house has been blown away two or three times. LOL :-)

She could ask the vet what the serum ketone level and PH was. This would give us some idea how severe it was. The vet should do an electrolyte panel and also screen for thyroid issues. Besides the UTI untreated dental issues can also cause infections.

You can always look at a crisis as an opportunity. They may be able to diagnosis any other disorders this kitty has. It will also hopefully prompt this cat's mom never to deal with the vet who prescribed the PZI once a day again. It may also be a learning experience for this vet if she or she is receptive to feedback. Last but not least, the kitty will hopefully leave with a reasonable BG and the right insulin schedule.

Sorry for my rambling. When I hear about DKA or ketones it triggers my DKA stories. My story had a happy ending and I am also pulling for this kitty.
 
Thanks for the response---I have the urinalysis and blood work from Kitty's emergency vet---maybe this will tell you something:

Please tell me if you can tell the degree of her DKA from this.

Thanks!


UA analyzer
PH 6.5
Pro 500 mg/dl
GLu 1000mg/dl
KET 50 mg/dl
UBG norm
BIL neg
BLD 250 Ery

Blood
GLU 576
BUN 51
CREA 1.7
TP 8
ALT 42
ALKP 66

ph 7.26
HCO3 13.6 low
PCO2 33.00 low
AnGap 29.5
tCO2 14.6 low
Na154
K 3.2 low
CI 114
WBC 19.39
LYM 11.71
MON 1.17
GRA 6.5
LY 60.4
MO 6.0
GR 33.5
RBC 9.21
HGB 12.2
HCT 31.11
MCV 34
MCH 13.3
RDWc 25.7
PLT 343
PCT .33
MPV 9.5
PCWc 30.8
 
A PH of 7.26 isn't too bad. A PH below 7 is considered severe. It would expected that blood gases and electrolytes would also be messed up now. Most of those things should stabilize again when the ketones and BG are down.

Nomad's first DKA he had a PH of 6.9 and the second time. 7.2 . So your situation looks better than both of my experiences by comparison.
 
What is the difference in the UA PH of 6.5 and the VetStat PH of 7.26? Are they one in the same? Which one is the "true PH indicator"?
 
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