Moderate Ketones - Grayson's 2/23-24 event

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Grayson & Lu

Grayson & Lu

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I just caught Grayson in the box and was able to get a ketostrip partially in his stream of urine. For the first time ever, it came back as "Moderate". So afraid of DKA... wondering what I need to do???

BG 5 minutes ago was 340 - that was at +3.5, (I shot .6u and fed him a full can of FF). I just gave him ANOTHER CAN of FF and he devoured it completely. He's not acting strange - just lounging and grooming - pretty normal.

I know some folks have said they give subQ fluids to keep them hydrated. Should I be doing that? I have access to some lactated ringers - bag spiked 2 months ago. Usable?

Lu-Ann
 
Re: Moderate Ketones - help needed

Lu,
I was told the bag is good for a very long time. I gave 100ml a week for 10 weeks on one bag. Yesterday, if I recall right, Kim said to call her if you saw ketones....have you done that?
Carl
 
Re: Moderate Ketones - help needed

Yes...I have the fluids, but they were spiked 2 months ago and I have not used them lately. One vet in town told me recently that they never go "bad"....... another vet told me not to use after a period of time- less than 2 months. I also have amoxicillin and knowing that infection can lead to DKA, I am wondering if I should give him a ml as prevenative. Lu called the vet and they said not to worry about the ketones...that moderate was okay and to recheck later...sound CRAZY to me.

What do you think?
 
Re: Moderate Ketones - help needed

I think anytime I see "vet said" and "not to worry" in the same sentence, it scares me. What's the sense in waiting for "high" when you can knock them out at moderate? Not sure on the AB, but infection usually is a factor when ketones are found.

My vet (actually a very good tech at the vet) told me that the lactated ringers don't go bad and that a bag will last months if need be.
 
Re: Moderate Ketones - help needed

Carl - would you try to nip this in the bud w/ sub Qs if he was your boy?

So I guess we try them? It certainly can't hurt.
 
Re: Moderate Ketones - help needed

Bob was DKA right after diagnosis. He almost died. I gave him gallons (well, 4000-5000 ml) of sub-q fluids over a three month period for various reasons. But he never showed ketones after his DKA, so I never was faced with your situation.
Has Grayson ever had sub-q fluids? I read months back that there are cases when sub-q fluids are definitely not a good idea, like if a kitty has heart/lung issues maybe? Not sure of the specifics. But if he's had them for any reason before due to your vet saying he needed them, then I would think it's safe.
 
Re: Moderate Ketones - help needed

Not enough insulin + infection + ketones = DKA

I would try to head the off as soon as possible while you still can.
 
Re: Moderate Ketones - help needed

Lu
Can you check to see if Grayson's breath smells odd, like nail polish remover or acetone if you've ever smelled that?
Carl
 
Re: Moderate Ketones - help needed

This might prove useful:
Excerpt from Ketones for Dummies:
What are ketones?

Ketones are a fat by-product (an acid) that is created when the body burns fat for energy. Ketones happen in people as well as cats ("The Zone" diet actually encourages development of ketones to burn stored fat).

The body needs energy to run. It goes to the usual sources but there's not enough insulin to turn glucose/carbs into energy. So to keep the body going it starts to burn stored fat for energy. The ketones are an acid by-product of this process.And if left untreated ketones will continue to develop into a life-threatening situation

What can cause ketones?

The cause of ketones is the body burning stored fat for energy. Here are a couple of situations where this might be more likely to happen:

infection
unregulated/undiagnosed diabetes
high blood glucose numbers for a long period of time
anorexia / not eating regularly
Some cats are more prone to ketones (Some cats will never get ketones - but it seems to me that it is safer to test everyone on a regular basis than to find yourself in a crisis situation ($15 for a bottle of ketone test strips versus $1,000s of dollars in emergency treatment).

Think of ketones like your in-laws. Sometimes they'll just show up out of the blue. Other times, they may hint at stopping by (these will be times when you're busy and tired usually). If you let them in and they make themselves comfortable, its going to be da*n hard to get rid of them !

What are the signs of ketones?

Ketones and their more serious step-sister ketoacidosis will usually show themselves in the following ways:

bad breath - not the normal cat breath, an almost fruity - acetone (nail polish remover) smell
lethargy - you read what ketones are, if your kitty has them they probably feel pretty crappy
vomiting and lack of appetite - again, kitty feels very unwell and will usually refuse to eat after a while
loss of weight - remember, the ketones are burning stored fat so if kitty is losing weight with no other explanation keep your eyes peeled
How can I know if my cat has ketones or ketoacidosis?

Ketones are expelled from the body via the kidneys and the lungs. You can easily test for ketones using ketostix or ketodiastix available at any pharmacy counter.
Click to expand...
 
Re: Moderate Ketones - help needed

Call the vet and tell them that. That might make a bigger impression than the word "moderate" did.
Carl
 
Re: Moderate Ketones - help needed

And ask them if sub-q fluids would be a good first step.
 
Re: Moderate Ketones - help needed

If you smell acetone....Go To The VET now! The only other advice I have is to call NCSU CVM emergency clinic and ask their opinion. They will let you talk to a doctor and they might have different advice than the vet you talke too. I have the number if you need it.

Ketones are BAD news! I know from experience. When Kitty went DKA her values were moderate. I would not mess around. Kitty was negative on Saturday and DKA on Sunday.
 
Re: Moderate Ketones - help needed

It took Bob less than 72 hours to go from mid-300 BG to "HI" and DKA. Form "no scent of ketones on his breath" to the vet saying to me "smell that....that's ketones". Definitely call the vet(s)
 
Re: Moderate Ketones - help needed

carlinsc said:
This might prove useful:
Excerpt from Ketones for Dummies:
Ketones and their more serious step-sister ketoacidosis will usually show themselves in the following ways:

bad breath - not the normal cat breath, an almost fruity - acetone (nail polish remover) smell
lethargy - you read what ketones are, if your kitty has them they probably feel pretty crappy
vomiting and lack of appetite - again, kitty feels very unwell and will usually refuse to eat after a while
loss of weight - remember, the ketones are burning stored fat so if kitty is losing weight with no other explanation keep your eyes peeled
Click to expand...
Click to expand...

So... slight scent of acetone in his breath.
No vomiting
No lack of appetite
He's put some weight on since dropping from 21.6 (June 2011) to 12.2 (Jan 13)... he's about 14.6 and increasing.

just updated his SS - here's the Reader's Digest version:
PMPS 357 shot .6u fed FF
+2 345
+4.5 340 fed another full can FF
+5.5 315

laying on the table looking around, wagging his tail, trying to get some more freeze dried chicken... Doesn't seem to have a care in the world.

Lu-Ann
 
Re: Moderate Ketones - help needed

Lu,

Moderate ketones are not something I would suggest that you try to deal with at home, even if there were no other signs. I would strongly suggest that you take Grayson to the ER now. Don't wait until morning, don't call the vet.....take him to the ER. He needs more than just some fluids and the usual dose of insulin.....ketones are a direct result of not enough insulin. Please....take him to the ER, they have the tools to deal with this. The sooner you get him treatment, the better the chance that he will be ok.

Ketoacidosis

In a diabetic, any urinary ketones above trace, or any increase in urinary ketone level, or trace urinary ketones plus some of the symptoms above, are cause to call an emergency vet immediately, at any hour of the day
Click to expand...

This info can also be found in the sticky at the top of the forum......
 
Re: Moderate Ketones - help needed

Lu
At least call them. Tell them you have access to sub-q fluids and need to know if you should give him some. If it gets worse, it will happen quick, and it will cost you over 1000 dollars to save him, easy. "Standard" price I was quoted was $1000 per night at the ER.

Carl

edit....after Bob was saved, my vet told me that he had, at most one, more day to live if I hadn't brought him in that day.
 
Re: Moderate Ketones - help needed

Carl asked that I copy my post from your Health thread here.

Sienne & Gabby said:
i wouldn't use a bag of squids that's been open that long.

I hate to tell you but I would not try to manage anything above trace ketones at home. The difficulty with urinary ketone testing is that it's not a 'to the minute' test. The level could be less or it could be considerably more on a blood test. Ketones can go critical quickly. If this were my cat, at the very least, I'd call the vet or the ER and get their recommendation. I don't know your cat so if he's prone to ketones, I'd encourage you to err on the side of safety and go to the ER.
Click to expand...

If you are now smelling acetone, scoop your cat into a carrier and get to the ER. There are more than "moderate" ketones. Ketones and the resultant DKA can be life threatening.
 
Re: Moderate Ketones - help needed

I second what Carl said. Don't wait & see; at least call. Don't mess with dka.
 
Re: Moderate Ketones - help needed

Just spoke w/ a vet at NC State Vet school. The doctor I talked to said they'd be glad to see him, but if he's eating and drinking okay, his condition isn't digressing at a rate that he couldn't just see my vet first thing in the morning. She said that most of the cats that come in w/ DKA are REALLY sick, they haven't eaten for several days, are lethargic and throwing up.

Grayson is acting pretty normal, lounging around, wagging his tail, watching the dogs, and napping intermittantly and going in the kitchen so see if he can convince me to give him some freeze dried chicken!

My gut is saying be first in the door at 7:30, spreadsheet in hand. Am I crazy?
 
Re: Moderate Ketones - help needed

Lu
Granted, Bob was in real bad shape, not just smelling like acetone.

Robin posted the "equation for DKA" earlier.

Not enough insulin + infection + ketones = DKA
Click to expand...

I just looked at Grayson's SS. His numbers have been pretty high for the past few days, with not much "dip", which indicates he probably needs a dose increase. So he's got two of the 3 ingredients for DKA right now. We don't know if he's got any infection going on. If he pees tonight, be there with a stick. No matter what, you need a vet to look at him when their door opens or sooner. It troubles me that the vet he'll be seeing is the one that told you "moderate" is not something to worry about. But you're the momma. I won't call anyone crazy.

Carl
 
Re: Moderate Ketones - help needed

My opinion--- the goal is to keep the cat out of DKA. So, Yes... the cats they see that are DKA are REALLY sick, that is what you are trying to avoid by testing for ketones. Most cats that end up in ERs or Vet hospitals with ketones and are DKA, their owners are not testing for ketones. If they were testing, they would probably avoid DKA. Owners that are not testing for ketones, do not recognize their cats are in danger or ketonic until they quit eating and are sick. So, the vet's statement is probably true. But, that is why you are testing for ketones....to avoid being like the cats they "normally see" There is a difference in being ketonic and DKA--- you want to avoid DKA.

Your spreadsheet will be of little help when dealing with DKA--- just tell them Grayson has moderate ketones on the urine strip and his breath is smells like acetone.
 
Re: Moderate Ketones - help needed

I know a LOT about DKA, Payne has had four times .... the last time she seemed fine but had moderate ketones, since I know how to fight ketones I waited. Within six hours she was in full blown DKA.

At this point in my dance with Payne I know she will never DKA again because I will not wait to see how she is doing, we will be in ER finding out. Good luck ....

Nancy and Payne .....
 
Re: Moderate Ketones - help needed

The vet at the vet school, 1 hr away, said he'd probably be okay til the morning when we see my regular vet. The in-the-door was $2-4000.

The local ER vet clinic initially wasn't concerned (that concerned me). I just spoke with the vet just a few minutes ago, and she said that as long as he was eating and drinking, she wouldn't recommend anything at this point. Just see the regular vet in the am.

Just tested BG +6 is 340. He's been in the pink pretty much all day - but hasn't gone into the red, where he lived, just a few days ago. At that point I upped the dose from .2 to .4 to now .6u.
 
Re: Moderate Ketones - help needed

nancy and payne said:
since I know how to fight ketones I waited. Within six hours she was in full blown DKA. .....
Click to expand...

By this, do you mean that you did sub Qs and the other insulin to knock it down?
 
Re: Moderate Ketones - help needed

When you fight ketones you use SQ fluids, R insulin and more of your regular insulin. Ketones are difficult to fight at home but DKA needs "something" else to go with the ketones. Infection, less insulin, not eating or drinking, etc. With Payne's last one we had changed vets and he wanted use to use Lantus. We had been on L for 2 weeks and the ketones started .... it is hard to use R with L but not with pzi. By the time we realized she wasn't getting enough insulin, she was DKA.

I just looked at your SS and you are not giving much insulin, that makes fighting ketones more difficult. It is also near impossible to use R, not impossible but difficult. I do think the SQ fluids help ketones quite a bit. If it were a choice between using an old bag or none, I would use the old.

Nancy and Payne .....
 
Re: Moderate Ketones - help needed

Thanks for staying up with me... I thought I was doing good... numbers coming down, cycles finally ~12 hours, low doses, meaning minimum chance for hypos, testing for ketones... then this!

Don't know if you noticed on his spreadsheet... we had been doing marathon cycles... 20-24 hours on one dose (he's never had more than 1u at a time). We cut him to .75, then .5 and he was still marathoning. Finally tried .2 and he did okay... but then started getting really flat cycles... but they were 9-12 hours long. Not completely sure which is better - a broader/narrower range, lower pre-shots, or cycle length.

So if we make it through to the morning, and see my regular vet, do I shoot & feed before going? If he is going to use the R, did I read that you shoot them separately, but don't want them to nadir at the same time? Given his doses, and I see your guy is a gulper, not a sipper, would you even consider letting the vet do the R?
 
Re: Moderate Ketones - help needed

The vet will use R to fight the ketones in a drip .... I would not withhold insulin which is one of the variables in DKA. Sippers are harder to treat but it is basically the same, insulin is needed. One of the mistakes I made in the beginning was trying to get Payne's insulin as low as possible ohmygod_smile or better OTJ!! Imagine!
I didn't look at the whole Payne and most of my mistakes were made trying to get her to fit in my round peg when she is a square peg :)

Payne is very complex and would get ketones on a regular basis until I quit messing with what works for her. She still gets SQ fluids every other day, pred daily and 12u pzi a day BID. If I see ketones she gets SQ daily and I add R to every shot but she is a big gulper and this would not be good for any other kitties. Also she doesn't go low, thank God!

Don't panic, use common sense and you will be fine. Also some cats that are on the road to DKA with ketones are still eating, Payne did. It is scary in the beginning but it will get better. Also I have found if I keep her food under 5 carbs, it helps her stay healthy. During her DKA's she weighed 7 pounds and today, almost a year from her last one, she is a whopping 15 pounds and I love it! Take a deep breath, it will get better.

Nancy .....
 
Re: Moderate Ketones - help needed

I must not have refreshed, as I didn't see Nancy's last post til just now. Grayson, the dogs and I had a slumber party on the dining room floor - I don't recommend this for middle-aged folks, but I was able to get a few hours of sleep.

We're about 2 hours out of being able to go to the vet, just checked his BG and it's only 313 - which is GREAT for him. Didn't get a ketone check... him in the litter box is what woke me up. Hopefully it's no more than where it was - moderate. He looks like himself... laying belly-up under the table, tail wagging, staring at me... would probably try to get a can of food open on his own if given the opportunity, although he's not quite his normal ravenous self.

I'm about one hour out from his AMPS... Don't want to taunt him with some food, but I suspect he wouldn't mind having it sooner rather than later.

He does seem a slight bit congested... maybe that's the infection that's starting to kick in. Will keep us all tuned in...
 
Re: Moderate Ketones - help needed

Denise - we must've been posting simultaneously. See previous post - and thanks for checking!
 
Re: Moderate Ketones - help needed

Good morning Lu,
Sorry to bail last nite but had to wake up @4:30 this morning. Keep us posted!
Carl
 
Re: Moderate Ketones - help needed

Late to the party but sending good vibes nonetheless. Hope you got some answers and solutions at the vet.
 
THANKS TO ALL for your support last night!!!

We (yep, me AND Grayson!) just returned from the vet. He did not go DKA, last night, but did have ketones in his urine. Bloodwork showed no sign of infection, however he did have a slightly snotty noise... so after 100 units of sub Q fluids (no R), he came home w/ liquid Clavamox and a REALLY REALLY GRATEFUL mom! Per my discussion w/ my vet, I'll up his insulin from .6 to .75 tonight. Hopefully we'll be able to see some blues WITHOUT it turning into the 13th dance marathon... we can hope, at least!!! And I am well past the age of "all-niters"!

Grayson is VERY fortunate (although he may feel otherwise!) that I've been as retentive about testing him and checking for ketones as I have. The ER vets that I spoke with last night said that usually, by the time they see a patient, he hasn't eaten in several days, resulting in BG all over the place cuz you can't shoot them if they aren't eating, and their condition is critical. Auntie Kim encouraged me repeatedly to check him for ketones, and because hard-headed me actually listened for a change, it made the difference between treating a slight ketone issue and full blown case of DKA.

I'm lucky it wasn't further along; although I was prepared to go to the ER vet last night if his condition had worsened. Fortunately, he kept eating and otherwise acting normal! I guess I shouldn't be surprised, he didn't get to his former [nearly] 22 pounds by passing up an opportunity to eat! Instead, I got to see the vet who's known him since birth and works with me on ALL my "special needs" and healthy kids. And Grayson didn't seem the least bit traumatized by the vet experience... despite the fact that most of his vet visits have been the annual tune-up for everyone in the form of a house call!

SO, relief! Yes, I am breathing again. I just ate breakfast - about 5 hours later than usual, Gray seems pretty content, so as soon as I check him ONE MORE TIME, I think I'm gonna call it a night and get a little rest!

Thank you again to everyone that helped me by being here and sharing your wisdom!

Lu-Ann
 
What great news this morning, Lu Ann. So lucky you have a resident (neighborhood) helper and that everyone was around last night. I hope his numbers with ketones and bg both improve!
 
I stalked him when he went to the litter box... no such thing as "going" by yourself in my household! Anyways, the ketone stip registered about halfway between none and trace. The sub Qs appear to have flushed the ketones out of his system. Thank God!!!

NOTE TO SELF: Test for keytones REGULARLY and if there's the slightest little increase... feed & get him some Sub Qs!
 
Good morning all! (I used to say it wasn't morning til you went to sleep and woke up again!)

Grayson just flushed out a volume of his sub Qs - sounded like a race horse! I think he's feeling REALLY GOOD right now. I tested the puddle in the box, and it's showing just a small trace of ketones... but you know I'll be running after him with a stick for quite a while!!!

He's about 2.5 hours from preshot, and is usually hungry by this point, and his +9 reading was 312,m so he's getting 1/2 can FF. Hate that I slept through his nadir, but it probably was something really low like 289 (based on the past several days)!

Again, thanks for all the support, and I'll keep you tuned in to his progress.

Lu
 
Awesome news on the lack of ketones! You needed the nap more than the nadir test, so not a big deal. :smile:
Carl
 
carlinsc said:
You needed the nap more than the nadir test, so not a big deal. :smile:
Carl
Click to expand...

Yes, I did, but being somewhat of a control freak, and spreadsheet geek, I really wanted the nadir too!!! :-D
 
Lu - I am so happy Grayson did not go into DKA. Grayson is very lucky to have you looking after him and staying up throughout the night to make sure he is eating. I hope Grayson's numbers start to lower so that he isn't running the risk of those nasty ketones.
 
Thank you!

Not that I'm a good housekeeper by any stretch of the imagination, but I never thought I'd be sleeping on the [HARD] dining room floor or would have a coathanger w/ a bag of fluids hanging from the dining room mantel! But I have to be selective of where I hang it, as SOME of my children might be inclined to poke the bag or play tug w/ the drip lines! My little angels! :lol:
 
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