Nutrition questions for Sprocket, in hospital.

[Darnell & Sprocket (GA)]

Sprocket is in hospital again. Vets diagnosed him with cholangiohepatitis, ketones & mild metabolic lipidosis a few weeks ago. He has been on antibiotic (Marboflaxin) , anti- vomiting, anti nausea (cerenia), appetite stim (cyproheptadine), anti- nausea (famotidine) , liver meds (ursodiol), liver support (Denamarin), besides his insulin & sub q fluids to help flush toxins out. And probiotic. He was doing better now for two weeks. Eating well until today. See his spreadsheet. His bg (humam meter) have been in 300s & low 400s. 2.5 units 2xday.
Vets are giving me issues on food. They want him on DM dry & wet food. I said no, I have Young Again Zero for dry (if needed), and have been giving him fancy feast pates with some proplan low carb. Under 5% carb wet. Only feeding him dry when he won't eat wet. When he feels better he starts eating all wet. They also think he may have underlying pancreatitis not seen on tests. If I were to feed him if he had issues with his liver and pancreatitis what food would be best? He is so delicate with ketones. 3rd time now he has ketones. I want to stop that cycle. They are putting up his insulin already.
Help me with vets with some of this food. They are looking into my wants of food at least.
Thank you.

 

[Nan & Amber (GA)]

Hi Darnell--

I'm not sure if there are any general agreed-upon rules for food with pancreatitis (I don't know about liver issues), people usually just go with trial-and-error just finding something their cat will eat reliably.

To be honest, at this point I wouldn't worry about the carb content of the food. The ketones are the major issue, and for that, the #1 priority is just getting him to eat anything. Beyond that, it's important to get enough insulin into him to keep the ketones down (regulating blood glucose is not the only job of insulin), and for that you might need to increase the carbs he's eating.

Once you get past the crisis point, hopefully you'll be able to get him to a better balance of food+insulin to avoid ketones and (importantly) address whatever underlying concern that caused him to stop eating and triggered this latest attack. Pancreatitis is manageable, but tricky-- all you can do is deal with symptoms, but that does seem to help reduce the frequency and severity of attacks.

Hope little Sprocket is doing better today. Sending healing vines and head scritches his way.

 

[Tuxedo Mom]

They also think he may have underlying pancreatitis not seen on tests.

What tests have they done to check for pancreatitis. The best test is the Specific fPLI test which needs to be sent to an outside lab (IDEXX). This is one of the "gold standard" tests for determining pancreatitis and will give a reading that shows the degree of pancreatitis present. They can also do a snap fPLI test at the clinic, which will give an immediate Yes or No result. If it is positive it will not tell how serious, but can still give a negative or positive. If the right tests are done they will be able to determine if pancreatitis is actually present.

 

[Darnell & Sprocket (GA)]

Well his bg has been too high. Thats why I have been trying to control his food intake. He was on gravy fancy feast & proplan foods before. Now just ff pate. & zero carb dry.
He had a test when in hospital 1st time that was sent out to a gastro lab.
Cobalamin fasting- 815 ng/L control range of 290-1499.
Folate Fasting - 8.2ug/L control range 9.7- 21.6
TLI fasting - 10.8 ug/L control range 12- 21.6
Pancreatic Lipase Immunoreactivity Fasting - 0.9 ug/L control range <_ 3.5.

His potassium was low last night so they added that. His liver values are 166 now. They were in 600s at hospital 1st time.

I am showing them difference in DM than fancy feast & zero. I told vet the 1st ingredient was liver with DM cause she said that is bad for him n the phone was silent. She was shocked. She is pushing food she hasnt looked at.
His numbers now are:
344 yesterday at 4pm.
397 at 6pm they gave 3.5 units
10pm was 371. He started eating
2am 283
6am 285. They gave 3.5 units
Then at 8am gave 1 unit of fast acting insulin.
Thats all I got now.

 

[Nan & Amber (GA)]

Very glad to hear that he started eating! That is a huge part of the battle, and shows he might be feeling a bit better. Numbers in the 200's are better than in the 300's so that's going in the right direction, too. Not out of the woods, but encouraging.

Don't know what to say about the vet's food recommendations.

 

[Darnell & Sprocket (GA)]

His bg during day was 75-90. At 6pm he was 56. They gave dextrose. They had given him wrong appetite stim so now its not working & won't give again till morning. I knew that would happen. 3.5 units is too much.