911 Not drinking water, high BG

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Amanda and Button

Amanda and Button

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Today Button has stopped drinking water. Her blood sugar has been very high all night and has not come down with insulin. I increased her insulin by .2 units for a total of 1.2 units Prozinc to see if this would help because her PMPS was above 600. It has not come down a bit and I am worried that perhaps her not drinking water and the elevated BG could be because of ketoacidosis. I am going to try to get her to pee for me to do a test. It may also be due to constipation? She has not had a bowel movement since last night and her nephropathy is very bad tonight. I have never had trouble with keytones before, but Button is very thin, anemic and her appetite has been low lately. I have been monitoring her food intake closely, but she has taken another turn downward tonight. If anyone else has some idea of what these new symptoms may indicate please respond. My typical vet is not in the office today and I have had better results from them when I bring in some ideas of what we might be dealing with to suggest certain tests. She had blood work done very recently so I will attach these results as well for those who have experience interpreting these.

https://drive.google.com/file/d/0B1fj6CcK7TPBblN0eVJicmFteEE/view?usp=sharing
 

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I'm not good at reading labs, I do note that kidney values are up. I'll tag @Marje and Gracie
I think Button needs to be seen by a vet (whether your regular vet or a different one).
Check for dehydration and nausea. I'm honestly too tired and fuzzy to suggest anything else. The people on the east coast should be awake soon. Good luck with Buttons.
 
Amanda and Button said:
Today Button has stopped drinking water. Her blood sugar has been very high all night and has not come down with insulin. I increased her insulin by .2 units for a total of 1.2 units Prozinc to see if this would help because her PMPS was above 600. It has not come down a bit and I am worried that perhaps her not drinking water and the elevated BG could be because of ketoacidosis. I am going to try to get her to pee for me to do a test. It may also be due to constipation? She has not had a bowel movement since last night and her nephropathy is very bad tonight. I have never had trouble with keytones before, but Button is very thin, anemic and her appetite has been low lately. I have been monitoring her food intake closely, but she has taken another turn downward tonight. If anyone else has some idea of what these new symptoms may indicate please respond. My typical vet is not in the office today and I have had better results from them when I bring in some ideas of what we might be dealing with to suggest certain tests. She had blood work done very recently so I will attach these results as well for those who have experience interpreting these.

https://drive.google.com/file/d/0B1fj6CcK7TPBblN0eVJicmFteEE/view?usp=sharing
Click to expand...
Hi Amanda, I cannot offer any significant advice other than to test for ketones and seek veterinary advice asap. We have previously managed to get food into a cat by putting some on your fingers and offering it that way, perhaps some fluids on fingers may help a tiny bit. Hope someone else here can advise too with more specific advice than I can. Fingers crossed you can get good veterinary advice soon.
 
Thank you! No keytones present. It seems like perhaps it is constipation which we've been dealing with on and off. And her neuropathy is bad making it harder for her to stand in the box. I have seen high numbers in the past that seemed to be due to stress when she was constipated which dropped after she had a bowel movement. She drank a small amount of water just now with me encouraging her but seemed too tired to keep drinking. She wasn't drinking even when I offered before though so that is better. She gets subQ fluids each night and plenty of water mixed in with her food so she is not severely dehydrated. She is always somewhat dehydrated because of her other conditions.
 
Your cat is stage 3 kidney failure and SEVERLY anemic. He needs to be on sub q fluids at least every other day. He needs injectable b12. He needs an aluminum hydroxide phosphorus binder as the phosphorus is high (which causes them to feel very yucky). As you said the snap test indicates possible pancratitis.... Very common in cats with kidney failure. Cerenia, and a pain killer will help with that. If you are on Facebook please join the group Cats with Chronic Renal Failure. There are many helpful people there.
 
JanetNJ said:
Your cat is stage 3 kidney failure and SEVERLY anemic. He needs to be on sub q fluids at least every other day. He needs injectable b12. He needs an aluminum hydroxide phosphorus binder as the phosphorus is high (which causes them to feel very yucky). As you said the snap test indicates possible pancratitis.... Very common in cats with kidney failure. Cerenia, and a pain killer will help with that. If you are on Facebook please join the group Cats with Chronic Renal Failure. There are many helpful people there.
Click to expand...

Thank you Janet. These results came back while my vet was out of the office and I have not had the ability to discuss more with her. She did get a b12 injection on Thursday, her last appointment. I have switched her to Weruva to try to get her phos down and have been wondering about a phosphorus binder. She is on Cerenia and 100 mL subQs daily. I will post these results to the renal failure group for additional guidance. I will take her in today to get a pain medication to see if this helps.
 
Amanda and Button said:
Thank you Janet. These results came back while my vet was out of the office and I have not had the ability to discuss more with her. She did get a b12 injection on Thursday, her last appointment. I have switched her to Weruva to try to get her phos down and have been wondering about a phosphorus binder. She is on Cerenia and 100 mL subQs daily. I will post these results to the renal failure group for additional guidance. I will take her in today to get a pain medication to see if this helps.
Click to expand...
Bff is good for helping with phosphorous... My cat had 4.7 phosphorus and switching foods brought him down to 3.9 in a few weeks. My cat was also borderline anemic and we gave b12 methylcobalamin in his food along with nutrived b complex with iron. Within a few weeks he went from hct of 21 to an hct of 42.... The anemia completely resolved itself.

This is my cats lab results of you want to compare. He has held at stage 2 for a year now.

https://docs.google.com/spreadsheets/d/1tIt9u2HSuUbzUKUXvcbHTDld9Y2JyNSkZUZfgt8003s
 
JanetNJ said:
Bff is good for helping with phosphorous... My cat had 4.7 phosphorus and switching foods brought him down to 3.9 in a few weeks. My cat was also borderline anemic and we gave b12 methylcobalamin in his food along with nutrived b complex with iron. Within a few weeks he went from hct of 21 to an hct of 42.... The anemia completely resolved itself.

This is my cats lab results of you want to compare. He has held at stage 2 for a year now.

https://docs.google.com/spreadsheets/d/1tIt9u2HSuUbzUKUXvcbHTDld9Y2JyNSkZUZfgt8003s
Click to expand...
Thank you, I will compare these. I think that would be helpful for me. We are getting Button on regular B vitamins added to her subQ fluids as well. She has definitely taken well to the Weruva, something I noticed when she lost interest in the Fancy Feast which seemed to make her feel worse. I will keep the bff food in mind as I have seen that in the store.
 
Amanda and Button said:
Thank you, I will compare these. I think that would be helpful for me. We are getting Button on regular B vitamins added to her subQ fluids as well. She has definitely taken well to the Weruva, something I noticed when she lost interest in the Fancy Feast which seemed to make her feel worse. I will keep the bff food in mind as I have seen that in the store.
Click to expand...
Bff is made by weruva.
 
I will have to disagree with Janet about a couple things.

One is that her phosphorus is only 5.2; that ismhigher than we'd like but phosphorus binders are not usually started until numbers get over 6. I would focus on feeding low phosphorus, low carb foods. Try to feed foods with less than 1.00% P on a dry matter basis or less than 200 mgP/100 kcal. Those aren't "low" P foods as the renal diets AE but they are lower.

Second, fluids are not typically started until the creatinine goes over 3.5. You want to get as much oral fluid in her as you can by adding water ...and lots of it...to her food. Perhaps by a fountain and see if she would rather drink out of that. I see you are giving them to her already but, IMHO, I would get her through the hump of pancreatitis (see below) and then talk to your vet about the need to continue.

Three, I do agree that she is very anemic and she is also low on iron. She is to the point where she actually needs your vet to proscribe an erythropoietin stimulating agent like Aranasp (darbopetin) as soon as possible. Has your vet mentioned this? You might also want to discuss whether she should be having iron supplements.

Four, she likely has pancreatitis according to her specfPL. You might want to read the info in the Primer on Pancreatitis.

Sending many vines for your sweet girl.
 
Marje and Gracie said:
I will have to disagree with Janet about a couple things.

One is that her phosphorus is only 5.2; that ismhigher than we'd like but phosphorus binders are not usually started until numbers get over 6. I would focus on feeding low phosphorus, low carb foods. Try to feed foods with less than 1.00% P on a dry matter basis or less than 200 mgP/100 kcal. Those aren't "low" P foods as the renal diets AE but they are lower.

Second, fluids are not typically started until the creatinine goes over 3.5. You want to get as much oral fluid in her as you can by adding water ...and lots of it...to her food. Perhaps by a fountain and see if she would rather drink out of that. I see you are giving them to her already but, IMHO, I would get her through the hump of pancreatitis (see below) and then talk to your vet about the need to continue.

Three, I do agree that she is very anemic and she is also low on iron. She is to the point where she actually needs your vet to proscribe an erythropoietin stimulating agent like Aranasp (darbopetin) as soon as possible. Has your vet mentioned this? You might also want to discuss whether she should be having iron supplements.

Four, she likely has pancreatitis according to her specfPL. You might want to read the info in the Primer on Pancreatitis.

Sending many vines for your sweet girl.
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The sooner sub q's are started the more it slows the progression.
I started doing them when my cats creatnine level was only 2.7. It has helped keep him in stage 2 for over a year. It also made him more comfortable as he doesn't make 20 trips a day to the water bowl.

I agree the binder can be delayed and lowered with lower phosphorus food... Unless of course the cat decides it no longer likes the lower phosphorus food, or starts to rise despite the lower phosphorous food.
 
THe low HCT indicates anemia as already discussed. However, the reticulate count indicates the RBCa are being produced in response to the anemia. That could indicate internal bleeding as the cause of the anemia.
 
JanetNJ said:
The sooner sub q's are started the more it slows the progression.
I started doing them when my cats creatnine level was only 2.7. It has helped keep him in stage 2 for over a year. It also made him more comfortable as he doesn't make 20 trips a day to the water bowl.

I agree the binder can be delayed and lowered with lower phosphorus food... Unless of course the cat decides it no longer likes the lower phosphorus food, or starts to rise despite the lower phosphorous food.
Click to expand...
I'm sorry....I just disagree based on having had four cats with CKD and three of the four stayed stable for many years (the one that didnt actually had PKD). I never started fluids before 3.5 on the creatinine.

You might want to read more about hydration on Tanya's website. There are even vets who believe starting fluids when the creatinine is 3.5 is too soon. You can overhydrate a cat.

I'd rather have my cat drinking water on his/her own as long as he/she is able to keep up and stay fairly hydrated.

One of the things that slows the progression of CKD is phosphorus control. So, again, I'd focus on feeding lower P foods and g t to the source of the anemia.

Non regenerative anemia is more common in cats than regenerative but GI bleeding can definitely cause regenerative anemia, as Larry stated. Are her stools black and/or tarry? I would absolutely be all over this with my vet because it can be a lot more limiting for her health and longevity right now than the CKD. Cats with anemia feel horrible and have no energy to move or do anything.
 
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