GA New Member- DKA, Pancreatitis and Hepatic Lipadosis

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porchat

porchat

Member Since 2022
Hi all this is my first post so I hope this is the right place to post this. And sorry it’s so long.
(Update at the bottom if you want to skip this portion!)

(This might be unnecessary but just background info on how I got here)
I have an 8 year old female tortie who was diagnosed with diabetes about a year ago and at that time she had pancreatitis, uti, constipated, and of course, DKA. Basically, she was near death but made it through. She is on 3 units of Lantus and eating Purina DM and fancy feast pate. On 10/23 I had to take her to the emergency vet. She had been eating less than normal all week and I took her to the vet on 10/21 and they said her blood work was fine, bg at 380 (which is high but I stopped giving insulin because I wasn’t comfortable with the amount she was eating and the vet said that was a good choice) and suspected a digestive problem so they sent me home with an antibiotic (metronidazole) and an appetite stimulant (the ear gel one). Well, the gel didn’t help really at all she ate a little bit more but not much and she refused the antibiotic.

(The important part)
On Sunday she looked terrible so I took her in. They said she was in DKA and had pancreatitis. She’s been in the hospital for 2 days now and they hoped she’d come home today but I got a call this morning saying she didn’t eat this morning and her electrolytes especially potassium dropped after they switch from one rapid insulin to another because the first one wasn’t working but the second one did work. (Sorry I don’t remember the names I just remember they switched to one with a tube?) They now are saying they might want to transfer her to a place with a critical care specialist because theirs is on medical leave at the moment. I am reluctant to do that however. I have spent $10,000 on the bill from the first DKA and this time will be about $5,000. If they transfer her it will be another bill. Is it possible for them to balance her electrolytes at this place without a specialist? The vet seemed like her potassium dropping after the new insulin was surprising but I thought that was normal because it’s actually working unlike the previous insulin and so she’s peeing it out but I could definitely be wrong about that. I would transfer if absolutely necessary but I really don’t want to start calling her the $20,000 cat but she’s priceless in my opinion.

What are all your opinions? Are there any questions I should be asking the vet when they call? Am I right to be frustrated at my vet for not catching it? Also is 2 bouts of pancreatitis a year apart considered chronic? Any and all answers are welcome, even if it’s just support.
Thank you all for reading this!


Update:
I decided to transfer her as the cost would be the similar to her staying at the same hospital. She ate this afternoon (good sign!) and potassium is slowly rising but unfortunately her calcium is low and isn’t responding to treatment. Does anyone have any experience with that? They aren’t sure why it’s happening. Also have any of you done a transfer before? And were they aware that you were coming and knew all the necessary info? They acted like they had no clue who I was before I made them call the previous hospital and make sure. I’m worried she‘s just sitting in a cage without being given proper fluids and supplements. Thank you for reading if you made it this far.
 
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Hi and welcome to you and Freckles to the forum.
I am sorry no one has answered you before this. And that you are going through this.
I am glad to hear that Freckles is eating some food now…that is a great sign. With DKA the electrolytes can be all over the place and the vets will need to give supplements to correct this.
Is she on a drip now? Are you able to stay with her and visit her?
I would ring and ask for an update. Ask them is she on an IV drip, is she getting continuous insulin, how are her blood glucose levels, what were her last electrolytes results, can you come in and try and get her to eat.
Please give us updates.

I can help you with information on how to look after her once she gets home, but will post that information a bit later.
Hugs, Bron
 
Hi thank you so much for responding! They put a feeding tube in her and is sending her home with me because I can’t afford her to stay any longer. Do you or anyone have any experience with feeding tubes? The internal medicine vet said she isn’t in DKA anymore and her electrolytes are off because she isn’t eating enough and she has hepatic lipadosis.

I’m very confused about this. When they said she ate (yesterday at 1pm) they said she ate enthusiastically. And I transferred her around 2 pm that same day and I got to see her at 9/10pm and it was the front desk lady who went in the room and brought her out immediately in her carrier like she was just sitting back there. So she wasn’t hooked up to anything for 7 hours and when I saw her she was the skinniest she’s ever looked. I asked if they fed her yet and they said no and I told them to ask why and I got a response (from the front desk lady who wasn’t exact giving a proper verbatim response) that it was because her she had some fatty liver numbers and they were trying to recalibrate her electrolytes. So this morning the internal medicine vet calls me and asks when she last ate (?? Why would I know?) and I told her what I was told the previous night and she said she wasn’t sure why they were doing that and that her fatty liver numbers were because she wasn’t eating.
I know how confusing that is to read but it’s because it’s extremely confusing! I’m so frustrated with this hospital. I just got her and her eye was bleeding(I guess it was from when they took the catheter out somehow) and she looked completely out of it and with no pain medication. She’s home now and she peed herself on the way home, they forgot to give me my insulin back (it’s a 2 hour drive there and back) and she’s just staring at nothing. I don’t know what to do. Is it normal for her to be out of it after anesthesia even though that was about 7 hours ago now. I’m so scared and frustrated. Any support is welcome.
 
porchat said:
Hi thank you so much for responding! They put a feeding tube in her and is sending her home with me because I can’t afford her to stay any longer. Do you or anyone have any experience with feeding tubes? The internal medicine vet said she isn’t in DKA anymore and her electrolytes are off because she isn’t eating enough and she has hepatic lipadosis.

I’m very confused about this. When they said she ate (yesterday at 1pm) they said she ate enthusiastically. And I transferred her around 2 pm that same day and I got to see her at 9/10pm and it was the front desk lady who went in the room and brought her out immediately in her carrier like she was just sitting back there. So she wasn’t hooked up to anything for 7 hours and when I saw her she was the skinniest she’s ever looked. I asked if they fed her yet and they said no and I told them to ask why and I got a response (from the front desk lady who wasn’t exact giving a proper verbatim response) that it was because her she had some fatty liver numbers and they were trying to recalibrate her electrolytes. So this morning the internal medicine vet calls me and asks when she last ate (?? Why would I know?) and I told her what I was told the previous night and she said she wasn’t sure why they were doing that and that her fatty liver numbers were because she wasn’t eating.
I know how confusing that is to read but it’s because it’s extremely confusing! I’m so frustrated with this hospital. I just got her and her eye was bleeding(I guess it was from when they took the catheter out somehow) and she looked completely out of it and with no pain medication. She’s home now and she peed herself on the way home, they forgot to give me my insulin back (it’s a 2 hour drive there and back) and she’s just staring at nothing. I don’t know what to do. Is it normal for her to be out of it after anesthesia even though that was about 7 hours ago now. I’m so scared and frustrated. Any support is welcome.
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@Bron and Sheba (GA)

@Wendy&Neko

@Suzanne & Darcy
 
I’m so glad you have posted again.
Do you have any insulin to go on with?
It is extremely important that you give the insulin when it is due as long as the BG is high enough.
It sounds as if the vets were pretty hopeless.
Did they give you any advice about the tube feeding?
Did they give you any antinausea medications such as cerenia or ondansetron?
I would try and offer some food and see if she will eat anything for you. She may do so now that she is home. Let her eat whatever she will eat at the moment. It doesn’t matter if it is not a low carb food. Eating is more important than what it is at this stage.

Do you have a vet near you where you can buy some Hills a/d canned food which is a recovery food which you can use for tube feeding?

Here is a link to some information about tube feeding and hepatic lipidosis. There is also a link within that link which may also help you
https://www.felinediabetes.com/FDMB/threads/discouraged-feeding-tube-for-fatty-liver-disease.102615/

Here is another link to information
https://vcahospitals.com/know-your-pet/tube-feeding-in-cats

You can also whizz up some normal cat food with some water to make it very sloppy so you can put it through the tube.always end the feeding with some water to &lush through the tube.

Here is some information about DKA recovery and hepatic lipidosis for you to follow
  • With both DKA and HL it is really important that you give frequent small meals as a cat recovering from DKA needs 1 and a half times as much food as normal. And with HL food is what is needed the most. I would offer a snack every couple of hours and if she won’t eat I would give her some food via the tube.
  • Don’t skip any doses of insulin…….are you hometesting the blood glucose? If you are not, I would strongly recommend you do it…we can help you …let me know.
  • How much insulin did they say to give her now and what type is it?
  • I would buy a bottle of Ketostix from Walmart or a pharmacy and test her urine every day for ketones at the moment. This is very important as we don’t want any ketones in the urine at all.
  • If you don’t have any antinausea meds, ask the vet for some. Ondansetron is best.
  • If you give an appetite stimulant, you need to give the antinausea medication first because she will be nauseated if she is not eating.
  • Did they send her home on an antibiotic?

I will ask @Bandit's Mom to help set up a spreadsheet for you and ask @Suzanne & Darcy if she can add any more about tube feeding as I am not experienced in that with cats. please post and let us know how she is….there is always someone here who can help you.
 
I feel so lucky to have responses like this from complete strangers. Thank you so much for your kind words. Unfortunately, I have decided to let her cross over the rainbow bridge tomorrow. I hope I’m making the right choice. I took her to the Er again tonight and she was cold (98) and low blood pressure (83) and they got her blood pressure up to “low-normal” but not so much her temperature. She’s miserable. Her eyes are bleeding/ watering for an unknown reason. She won’t stop drinking water despite the insulin. She’s peed on herself multiple times now. And she can’t get out of her pain position and won’t close her eyes and rest despite giving her pain medication. She looks at me with a plea in her eyes. The tech said she growled at her when she tried to remove the catheter and she has never growled before. She’s tired of the poking and prodding.

It’s been 5 days now and she’s only gotten worse. Am I making the right decision? Is this too premature?
 
porchat said:
I feel so lucky to have responses like this from complete strangers. Thank you so much for your kind words. Unfortunately, I have decided to let her cross over the rainbow bridge tomorrow. I hope I’m making the right choice. I took her to the Er again tonight and she was cold (98) and low blood pressure (83) and they got her blood pressure up to “low-normal” but not so much her temperature. She’s miserable. Her eyes are bleeding/ watering for an unknown reason. She won’t stop drinking water despite the insulin. She’s peed on herself multiple times now. And she can’t get out of her pain position and won’t close her eyes and rest despite giving her pain medication. She looks at me with a plea in her eyes. The tech said she growled at her when she tried to remove the catheter and she has never growled before. She’s tired of the poking and prodding.

It’s been 5 days now and she’s only gotten worse. Am I making the right decision? Is this too premature?
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I am so sorry she is not improving. Only you can tell if it is time to help her cross. She is only a young cat so it is sad.
While she is so unwell I would not worry about her peeing on herself. Also the drinking will slow down when the dose of insulin is correct.
Are they giving her pain medications? If she is still in pain, they may need to increase the dose of the pain meds. She is most likely growling because of the pain.
Do they have her on a drip and feeding her via the tube? She needs lots of food.
If her BP is low, it sounds as if she needs to be on a drip to replace fluids.
Have they placed her on a warm bed to increase her temperature.
The first several day of DKA and hepatic lipidosis can be rough and poor Freckles has both.
I am sorry I can’t tell you which decision is the right one. Why don’t you wait until tomorrow and see if there is any improvement. Cats are incredibly resilient.
I would ask them if the DKA is under control now. How are her electrolytes? Most of the things you are mentioning have solutions.
Whatever you decide we will support you.
:bighug::bighug::bighug:
 
Hi sorry I should’ve clarified more. I took her to the er but she went home with me last night. She doesn’t have dka anymore so that’s good. They gave me pain meds to administer so I did that last night when we got home. At some point she finally laid on her side and slept last night but still this morning she isn’t exactly comfortable. She has a very hard time closing her eyes. I have her on a heating pad for her low temperature. From what the er said it sounds like she needs to be hospitalized again and all they were trying to do was get her through the night but I can’t set her up at another hospital again. I’m running out of money and she’s running out of veins for the catheter. Plus her growling for the first time means she’s completely over this. She looks slightly better than she did last night so I’m gonna feed her today and do all the necessary discharge steps and see what she looks like tonight/tomorrow. Thank you so much for your support.
 
I’m so sorry you’re both going through all of this. Just wanted to clarify, does she have a feeding tube on right now? If so, where is it? That’s the best way to feed a cat who doesn’t want to eat. You just have to do water through the tube first then food then end with water again. Let me know and I can give you more info. Good luck
 
porchat said:
She has a very hard time closing her eyes
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My cat had Horner syndrome in one of her eyes when she had Etube inserted past DKA.
I would describe it as you have. It's not uncommon I was told.
The condition resolved after the Etube was removed.

My heart goes out to you both.

Good that she is at home now and I hope you will post soon saying she has eaten well. Being in a clinic does affect their eating.
And food + LRS at home is what saved my cat, not vets.
I have experience with E- tube and DKA.
Can I help?
 
Tanya and Ducia said:
My cat had Horner syndrome in one of her eyes when she had Etube inserted past DKA.
I would describe it as you have. It's not uncommon I was told.
The condition resolved after the Etube was removed.

My heart goes out to you both.

Good that she is at home now and I hope you will post soon saying she has eaten well. Being in a clinic does affect their eating.
And food + LRS at home is what saved my cat, not vets.
I have experience with E- tube and DKA.
Can I help?
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That makes me feel a little bit better thank you. Did your cat have eye drops or anything? I looked it up and it does sound very similar in that I’m not sure she’s blinking at all. It’s like when I look and her she’s asleep mentally but physically her eyes are open and they do react to me moving my finger around her. I don’t want her eyes to get dry (though they don’t look dry at all right now). Is there a way I can get her to close her eyes? Right now she sounds like she’s sleeping but her eyes are open with her third eyelids half covering her eyes.
For the feeding tube how much air would go in when you would give water? I feel like a bunch of air is getting in her and when I pick her up it come out of her mouth. But she is also slightly wheezing when at rest. I’m not sure if that’s common with the feeding tube or not.

One more question: what does LRS stand for?
Thank you all so much. I am so grateful.
 
porchat said:
I’m not sure she’s blinking at all
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porchat said:
I don’t want her eyes to get dry
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Both are very good question for your vet. Can you make a picture of her sleeping with the eyes opened and send it to them for the evaluation?
porchat said:
she is also slightly wheezing when at rest. I’m not sure if that’s common with the feeding tube or not.
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I think it is the tube and will pass once removed.
porchat said:
For the feeding tube how much air would go in when you would give water?
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Not sure I can answer this, don;t remember having any issues with air, sorry.

How much do you feed via tube?
Has she expressed any interest in any food? You know you can feed her anything she really likes - anything at all?
Do you give subcutaneous fluids such as Lactate Ringer's solution?
 
Ale & Minnie (GA) said:
I’m so sorry you’re both going through all of this. Just wanted to clarify, does she have a feeding tube on right now? If so, where is it? That’s the best way to feed a cat who doesn’t want to eat. You just have to do water through the tube first then food then end with water again. Let me know and I can give you more info. Good luck
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yes she does in the neck area. I asked another member this but I will ask you as well: are you aware if wheezing is a common symptom after feeding tube placement? And if her releasing air from her mouth when I pick her up is a bad thing and or from having too much air in the tube when I give her water?
If she isn’t able to drink water on her own how much water should I be giving her? They said she was hydrating at the vet so they didn’t give me any instructions on it. I gave her gabapentin (0.5) last night and this early afternoon and I think that kinda took her out doing anything physical so I will hold off on that tonight so I can see her strength.
Thank you all so much. This information is invaluable and I think I will hold off on putting her to sleep because of this. Thank you again.
 
Tanya and Ducia said:
How much do you feed via tube?
Has she expressed any interest in any food? You know you can feed her anything she really likes - anything at all?
Do you give subcutaneous fluids such as Lactate Ringer's solution?
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I am doing their regimen so yesterday night was 20ml and this morning/afternoon/night is 40ml.
She’s extremely weak/ tired this morning I’m assuming from the gabapentin and just from this whole thing so no interest but last night before I took her in the er she did have interest in food and I think she ate a single nugget. The thing is she hasn’t pooped at all since Monday (occurring to the vets). I can’t imagine wanting to eat while constipated so I’m gonna add miralax to her slurry this afternoon and hope for the best.
I was not provided with Lactate Ringer’s solution. They said her electrolytes were off balance because she wasn’t eating but I would honestly prefer using a solution to make sure she’s getting enough. I wish the internal medicine vet was easier to get ahold of. This hospital wants the front desk people to try to answer the questions first and it’s very frustrating because they are high schoolers.
 
porchat said:
I am doing their regimen so yesterday night was 20ml and this morning/afternoon/night is 40m
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Are these two number the amount of water that you flash down the tube before and after each feeding? Is it total for the day - 60ml?
porchat said:
The thing is she hasn’t pooped at all since Monday
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porchat said:
so I’m gonna add miralax to her slurry this afternoon and hope for the bes
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The extra water will help with constipation.
How much does she eat total?

There is a link to Ducia SS - take a look at 2017 tab - I detailed what was given in the comment section on the right. Ducia was about 4 lbs back then and very weak after DKA.
Although not ideal but what we did worked for our cat. Check it out - it'll give you an idea of what's can be used for Frecles.
porchat said:
I was not provided with Lactate Ringer’s solution. Can I buy that OTC? Is that for electrolytes?
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Rx is necessary but sometimes vets have it in their offices and also train you how to do fluids. It sounds difficult but easy in practice. Talk to them about it.

The electrolytes are the potassium, calcium and sodium levels in the cells that makes everything in the body/organism work together (to put very briefly/simply).
It's essential to get it balanced but it will take time. You can check Ducia's blood tests - in the LABs tab at the bottom of the SS - and see the improvement that being achieved by home nursing.
 
Tanya and Ducia said:
Are these two number the amount of water that you flash down the tube before and after each feeding? Is it total for the day - 60ml?


The extra water will help with constipation.
How much does she eat total?

The electrolytes are the potassium, calcium and sodium levels in the cells that makes everything in the body/organism work together (to put very briefly/simply).
It's essential to get it balanced but it will take time.
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So we are increasing by 25% everyday. 20 ml was what I gave her last night because I only had the final feeding shift as I think they did the other two at the vet. So total yesterday was 60ml. Today I do 40ml three times a day so total is 120ml. The said do at least 5 ml of water before and after each feeding but that’s when she was drinking by herself. She is very tired today and can’t really bring herself to drink so I’m trying to supplement that but I’m unsure the amount I should be giving. I gave her 20ml this morning. And we are working our way through the first feeding of today with water in between so I think 30 ml of water in total for right now? (We aren’t done with the feeding yet). But also that doesn’t account for the added water to the food (hills a/d).

So for the electrolytes my internal medicine vet said that they should even out with the hills a/d slurry I’m giving and that extra supplements aren’t necessary. The first hospital I went to earlier in the week supplied me with a potassium gel however but nothing for sodium or calcium. I think my issue with asking about this stuff is that I really don’t want to come off like I think I’m smarter than the internist and I don’t have any proof that her electrolytes aren’t balancing out you know?

I will check your spreadsheet and start one of my own as well.
I will also provide a comprehensive list of everything I have been given/told to do in a post after this.

One last question about the feeding tube. I’m waiting on my internist to call me back but I’ll ask everyone in the meantime. I can see the air moving the bits of water in the feeding tube while she breathes. Is that normal? It goes back and forth with every breath in and out. The tube is just connected to the esophagus right? So how is air moving in there?

Thank you all!
 
porchat said:
Today I do 40ml three times a day so total is 120ml
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That's sounds better.
When I spoke to the (good) vet in ER she has told me that recommended amount of water for cats is 300 ml which seemed too much at the time.
But 300ml is the total - including water added into the canned food by the manufacturer. Friskie for instance, is bout 78%, the Tiki Cat - over 80% moisture.
I could never calculate how much to add for 4 lbs Ducia so we ended up with LRS 75ml x 2 a day +whatever extra water via tube as recorded in the SS
+1 1/4 to 1 1/2 Friskie pate (5.5oz can) to get about 300+ calories a day. It was more than she ever ate before her diagnosis.

porchat said:
One last question about the feeding tube. I’m waiting on my internist to call me back but I’ll ask everyone in the meantime. I can see the air moving the bits of water in the feeding tube while she breathes. Is that normal? It goes back and forth with every breath in and out. The tube is just connected to the esophagus right? So how is air moving in there?
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Try moving the tube - very cautiously - to make sure it is inserted properly and not about to fall out.

Do you inspect the insertion site?
We were instructed to remove the bandages daily and check for possible infection. We were given a solution to wipe the insertion site.

The other thing I would pay attention to is that food or water is given very slowly via the tube and that it has been flashed with water before and after each feed.
I hope it helps. Ask questions. The tube is fantastic tool for such situations.
porchat said:
I think my issue with asking about this stuff is that I really don’t want to come off like I think I’m smarter than the internist and I don’t have any proof that her electrolytes aren’t balancing out you know?
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I would very respectfully but firmly disagree with you on that one.
We are as the cat parents must advocate for their best interests.
Please do ask you vet about getting LRS - it's really worth it.
I am sure the internist won't take any offense in you trying to help you fur baby or get educated on something totally new to you.

Some info on LRS here.

I'll check your posts for questions later on - gotta go out now.
My best wishes and prayers goes to you and Freckles.

 
Freckles after care:
-Increase food intake 25% everyday. Feed 3 times a day of hills a/d slurry. 5ml of water before and after each feeding
-half a pill of cerenia before meal
-mirataz on ear before meal
-gabapentin 0.5ml every 8-12 hours if necessary
-3-4 units of lantus twice a day (morning and night)

we are at the hospital for the internist to check electrolytes, check vitals, to look at the feeding tube to see why she is wheezing and to check if there is any neurological issue that would be causing her not to shut her eyes. The wheezing became louder from this morning. It really seems that she’s struggling to breathe. She also looks more yellow than yesterday. Hoping for the best but prepared for the worst.
 
porchat said:
we are at the hospital for the internist to check electrolytes, check vitals, to look at the feeding tube to see why she is wheezing and to check if there is any neurological issue that would be causing her not to shut her eyes. The wheezing became louder from this morning. It really seems that she’s struggling to breathe. She also looks more yellow than yesterday. Hoping for the best but prepared for the worst.
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:bighug::bighug::bighug:
praying all turns out well
post if you think I might be able to help
PS. rather post in any case at all - everyone on here will be willing to help
 
I’m glad Tanya has been able to help you. I am only just awake….I live in Australia.
I’d just like to clarify a couple of things please…
  • Are you testing the blood glucose at all or just giving the 3 or 4 units without testing? If you are not testing, I would recommend you ask the vets to put on a freestyle libre which is like a button that is attached to the skin and reads the blood glucose levels for you. That is a much much safer way of doing things than just giving the insulin without testing as you have no idea what it is..
  • I don’t think only feeding three times a day is enough food. What do you think @Wendy&Neko
  • Cerenia is only given once a day.How often ae you giving it and how much. Please check with the vet about this.
  • If you are going to give sub Q fluids…and I agree it is a good thing to do….I would check with the vet first and ask is he happy for you to give them ….we just need to ensure that Freckles heart is ok when giving subQ fluids…the vet will know.
Information about the freestyle libre….it is used for humans as well
https://www.freestylelibre.com.au/discover-freestyle-libre-2

Freckles is very lucky to have looking after her so well. I am sending all my very best to both you and him.
Bron
 
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porchat said:
The wheezing became louder from this morning. It really seems that she’s struggling to breathe.
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That is very worrisome (definitely not something I’ve experienced with feeding tubes). I’m very glad you took her to the vet clinic. Breathing issues are never something to wait on. Please update when you can.
 
Hi everyone,

Thank you all so much for your help. I let Freckles pass away today. She was in a lot of pain and it was only getting worse. She got to sit in her favorite chair. I brought it just in case it went that way. I’m glad she got to sit in something she knew and with familiar smells with me by her side. I will miss her for the rest of my life. The most perfect cat.
Thank you again.
 
I’m so very sorry for your loss. It’s the most selfless decision you could make so that she can be at peace and rest now. I’m sure she’s watching over you from across the Rainbow Bridge :rb_icon:cat_wings>o:rb_icon:
 
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I am sorry for your loss. Freckles knows you love her very much and did everything you could for her.

Fly free sweet Freckles and watch over everyone who loves you.
cat_wings>o
 
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