911 Positive keytones vets advise??

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Spike's Mom

Spike's Mom

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Since we switched insulin yesterday I decided to test for keytones tonight. As luck would have it I was near Spike when he went to the litter box. Results came back bright pink. In the 80's range. I immediately smelled his breath and it does smell of acetone. I immediately grabbed the carrier while on the phone with the emergency vet. I explained his results loaded his meds and records from his normal vet and head out the door. Since his regular vet has been texting me since the switch yesterday I sent him a text to let him know we are on the way to the ER. He asked for Spikes current glucose reading. It is at 321. He is advising to stay home and increase his AM dose to 2. Should I completley ignore his advise and go to the ER anyway. I am freaking out right now. He is acting completely normal laying next to me wagging his tail. HELP PLEASE!
 
80 is large ketones I think. I've no real experience with ketones in cats, but with them that high I think I'd be taking that trip to the ER vet - I don't think it's worth the risk of waiting until morning.
 
Anything above trace on ketones should be seen by a vet. Better be safe and go to the ER and try to treat this before it gets worse. Good luck!

You might want to test the ketones strips on yourself too - just to verify that the strips are OK.
 
Important notes:
Urine ketones show up within 5 days after blood ketones exceed the renal threshold.
Blood ketones begin appearing within roughly 2 weeks of high glucose/insufficient insulin.

Since you've detected them in your cat, it may be a good idea to get a blood ketone meter for more accurate tracking.
 
No in person vet yet. I am following my vets advise so far. We are keeping in contact every couple of hours via phone & texts. I am monitoring Spike at home and keeping in contact with his vet. I tested the strips on me as advised and they are good. Spike moved the strip on Saran wrap when he urinated this morning. I cleaned the litter box and completely covered the litter with saran wrap so hopefully I can retest very soon. Giving water via syringe. This is beyond frustrating as I really want to trust his vet as Spike's future hanging in the balance. His vet is open until 3pm so I can take him to the office anytime before they close. Spike is having another day of refusing to eat. Once again the vet recommended I give a shot without food to get his tests lower. I hate doing this as I fully understand the consequences. We were at 270 at +2 after injection. I have to go for now time to get the +3 results.
 
High ketones in cats can cause dehydration, nausea, and low potassium. All these can cause the cat not to eat. It's worth going to the vet to get interventions for these issues early, as it will improve his outcome. Your cat might need subQ fluids as well as potassium supplements (blood tests can tell k+ and hydration). Anti-nausea medications are usually the trick to get a cat to eat when they have ketones.

Ketones develop with not enough insulin + not enough food, so both need to be increased. It's better to force-feed than to decrease insulin during this time. Carbs are OK as they provide a substrate for the insulin to work on and allow you to give higher doses of insulin which will decrease ketones. Try to keep BS around 200 to decrease dehydration.

Don't withhold shots, if it is at all possible. Your cat needs insulin! Even if you gotta mix honey with all his food, it's better than no shot. Often, insulin needs will go up with ketones.
 
Since his current vet is not bringing him in for any additional testing do you think I should just go to another vet? As usual Spike is sick on a weekend. I know there is a vet in Petsmart and as always the emergency vet..
The part that is driving me crazy is Spike is in a good mood. Wandering around the house torturing the dogs laying anywhere he pleases gently wagging his tail.
However, he has only eaten 1.25 oz of food today. I am keeping the food available so he can graze. He is normally a pretty scheduled cat eating at 6:30am & 5:30 PM.
I am still giving water in the syringe.
 
It is possible to have ketones without acidosis, in an otherwise well appearing cat. Rare, but possible. Given the inappetance, though, I'd be pushing in some food or going to the vet.
 
BJM said:
It is possible to have ketones without acidosis, in an otherwise well appearing cat. Rare, but possible. Given the inappetance, though, I'd be pushing in some food or going to the vet.
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Go figure I have the abnormal cat. I guess for now I will just try to get him to eat more. If he would just use the litter box maybe it would ease my worry. I hope he is just protesting the saran wrap in the litter box. He has always been super finicky when it comes to his litter. I have tried to buy different varieties in the past and he always refuses to use the box until he is about to bust every time. He only wants Fresh Step litter. No crystal variety He hates that and any other litter I have ever tried.
 
You may want to look into syringe feeding if he's not eating at least a 5.5-6oz can a day. A cat can go from acting normal to not eating, not moving very quickly. It's really worth getting labs drawn and getting this under control BEFORE its a big problem. Inpatient of a DKA cat can cost thousands of dollars.

Normal cat intake is 225-300 cals/day (a little over a 6oz can depending on the food) and about 300ml of fluids a day (which includes fluids in foods), just to give you an idea of what to aim for. Mix water with the food for additional fluids if he is eating anything. Also if he's a dry food junkie type, feed him some kibble or treats, or whatever else he'll eat. Don't worry so much about carbs until the ketones are gone.
 
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We are eating again. Well if you consider baby food. Last weekend when he refused to eat we got his appetite back with a mix of baby food and water drained from a can of tuna. This week I skipped the tuna water. I ran to the grocery and picked up 8 jars of BeachNut chicken in broth. Once again he devoured the entire jar. Now we have a emergency supply of food he doesn't seem to turn away. I am happy to report he ate all 2.5oz.
I am still waiting on him to go to the litter box so I can retest for keytones. I called every Wal-Mart pharmacy within 50 miles looking for the meter & strips to test his blood for keytones and didn't have any luck. Guess I will just have to order it online and pray for now.
 
When max was really sick and not eating well, he would lick the gravy from the canned cat food with gravy. I added extra water to it for the fluids. Later we smashed up kibble, added it to wet pate food, and added enough water for a "soup". Good idea with the baby foods. If your blood sugar doesn't start to go down a bit after 3 days on that new dose, ask your vet about increasing. Under 300 a all times is good to prevent dehydration when there are ketones.

Also ask your vet about an anti nausea medication, and labs for electrolytes when you are able to see him or her. Insulin and dehydration can cause potassium levels to go very low and can make cats weak.
 
BJM said:
Important notes:
Urine ketones show up within 5 days after blood ketones exceed the renal threshold.
Blood ketones begin appearing within roughly 2 weeks of high glucose/insufficient insulin.

Since you've detected them in your cat, it may be a good idea to get a blood ketone meter for more accurate tracking.
Click to expand...
Do you know where I can get a meter that reads the keytones in the blood besides online? I called every Wal-Mart pharmacy and a few CVS and Walgreens within 50 miles of my house and not one had the Precision Xtra in stock. I can buy the meter online from Wal-Mart for $18.23. The problem is they do not carry the keytone test strips. Is this a discontinued meter?
 
Meya14 said:
When max was really sick and not eating well, he would lick the gravy from the canned cat food with gravy. I added extra water to it for the fluids. Later we smashed up kibble, added it to wet pate food, and added enough water for a "soup". Good idea with the baby foods. If your blood sugar doesn't start to go down a bit after 3 days on that new dose, ask your vet about increasing. Under 300 a all times is good to prevent dehydration when there are ketones.

Also ask your vet about an anti nausea medication, and labs for electrolytes when you are able to see him or her. Insulin and dehydration can cause potassium levels to go very low and can make cats weak.
Click to expand...
Yes Spike was mainly licking the food today as well. The good news is when we went through this last weekend I asked the vet for the Fortiflora pro-biotic. He did not carry that variety but did sell me a box of Advita pro-biotic as a replacement. I was able to find the Fortiflora online and it was shipped yesterday.
As far as my vet I already have a list of concerns I am working on. Emotionally I cannot go through this every weekend. I am a giant sobbing confused mess. He MUST do further testing to find out how to help Spike.
 
There is a freestyle meter too - FreeStyle Optium Neo. I'd check CVS (if there is any in your area), walgreens, and other pharmacy stores. CVS website says this meter is in stock at this location:
5972 UNIVERSITY BOULEVARD WEST, JACKSONVILLE, FL 32216
904-419-5670
In Stock
 
Hang in there, I went through it too when Max was first diagnosed. He was limp, had DKA, and I had to force-feed him and give him SubQ fluids for almost 2 weeks. He was pretty sick, and I thought I'd lose him.

After we got the DKA resolved, and found the infection (teeth) that was causing all the problems, it was smooth sailing. Max has been back to his happy self without any recurrence of the ketones/weakness/etc. It does get better.

Getting the blood sugars under control prevents ketones/complications, so that is priority.
 
Meya14 said:
There is a freestyle meter too - FreeStyle Optium Neo. I'd check CVS (if there is any in your area), walgreens, and other pharmacy stores. CVS website says this meter is in stock at this location:
5972 UNIVERSITY BOULEVARD WEST, JACKSONVILLE, FL 32216
904-419-5670
In Stock
Click to expand...
What about the test strips? Do you know?
 
Meya14 said:
There is a freestyle meter too - FreeStyle Optium Neo. I'd check CVS (if there is any in your area), walgreens, and other pharmacy stores. CVS website says this meter is in stock at this location:
5972 UNIVERSITY BOULEVARD WEST, JACKSONVILLE, FL 32216
904-419-5670
In Stock
Click to expand...
Apparently there is a difference between the FreeStyle Optium Neo Blood Glucose and Ketone Monitoring System and the FreeStyle Optium Neo. The location on University Blvd is closed so I called the 24 hour store on Baymeadows Rd. This location is close to my house so I think I am going to go over and read the box myself.
 
When I was calling around for a blood ketone meter and strips, I called WalMart, and CVS, and Walgreens, and Rite Aid. I think it was CVS and Rite Aid said they didn't have them, but when I asked, they said they could order them. If I remember right, CVS said they could have it in two days, and Rite Aid said they would have it in the next day for me to pick up.
Good luck getting them.
I've found that sometimes, you need to press the pharmacies a little. When there was a fluids shortage scare, I called WalMart and they said they didn't have any. I asked if they could order a case for me, and they put me on hold to ask someone, and sure enough, they had it in the next day.
 
Well I went with the online buy and ordered a Nova Max Plus Blood Glucose Monitoring System by Amazon.com. and Nova Max Plus Ketone Test Strips - 10 Ct Guaranteed delivery: Mar. 16, 2015
Order Total: $48.49
 
Spike's Mom said:
Well I went with the online buy and ordered a Nova Max Plus Blood Glucose Monitoring System by Amazon.com. and Nova Max Plus Ketone Test Strips - 10 Ct Guaranteed delivery: Mar. 16, 2015
Order Total: $48.49
Click to expand...

I've seen recommendations for this meter. Nadine, (Tibbs5) uses one.
 
I personally wouldn't leave it any longer to go back to the vets if they are still open.

The vet could give sub q's and anti nausea medication, etc. if you aren't go in to take him can you ask the vet to give you some ondansetron as this may help him to start eating again.

In the meantime I would be giving spike water by oral syringe (carefully from once side of the mouth to the other) this may also help with ketones and nausea. I would also try feeding him a little by syringe. You need him to eat so you can get the insulin into him as am sure others have advised already.
 
Update on Spike we just got home from the emergency vet. It was a good news bad news situation. The vet we saw tonight was very thorough. The problem is he has a large golf ball sized swelling over his right shoulder. They took two x-rays and she said it is not attached to the bone and nothing in the labs that indicated cancer for sure. She stabilized him with fluids and nausea meds and sent us home to follow up with his vet on Monday.
 
Oh, Tammy ...

Saying a little prayer for you both that it's something like a cyst. Please let us know how you get on after seeing your own vet.

:bighug:
 
Thank you. We went to his normal vet this morning. Overall Spike is doing well today. We are in a hold on and wait pattern. He is tentative set for a biopsy 1 week from Wednesday depending on the stability of him glucose readings thus week. As you can imagine my nerves are beyond frazzled. I will not be able to update his chart until this evening when I get off work. Yesterday was a recovery day for both spike and me. I only tested 2 times. The great news is he was at 139 last night at 10:40 PM.
 
Recovery days are very important. I hope you're both feeling the better for having had one. :)

I'm waiting for Saoirse to go in for a liver biopsy next week so I'm in a similar boat to yourself, Tammy. It's not easy.

Will keep you both in my prayers.

:bighug:
 
Thank you our day of rest was very nice. Spike is feeling much better. As you already know as for me I could use a few more days of rest after the past couple of weeks. Thank you for all the advice and support you have given. It is reassuring to talk to someone that understands all the emotions I am going through right now
I was not aware you were going through a similar situation. I will be praying for you and Saoirse as well. Is her biopsy related to the Pancreatitis or something new?
 
Thank you, Tammy. I really appreciate that. It's for her liver. I got the result back from her latest Spec fPL test today and her pancreas is still inflamed. I'm not sure whether or not the liver problem is related. I've not asked the vet to go into too much detail at the moment. I have PTSD and a number of related anxiety disorders so I can't cope with a lot of stressors coming at me, else I get overwhelmed really badly. Next Tuesday will be time enough to discuss particulars. This week I just want some peaceful time for Saoirse and myself, and I need to try to stay as upbeat as I can manage for her sake. She's still a bit glum after having her procedures last week and I'm banjaxed from the worry and the disruption to her feeding schedule. We had to suspend her anti-nausea meds and she needs much coaxing to eat without them. She can't eat big meals, and if she doesn't eat every few hours her blood sugar levels rise. She had to wear an Elizabethan collar over the weekend, too, which meant that she couldn't eat from her timed feeders. It has been a rough oul' few days for both of us.

Spike's Mom said:
It is reassuring to talk to someone that understands all the emotions I am going through right now
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So true. In the early period after Saoirse's diagnosis she had a pancreatitis flare. I remember telling our vet at the time that I would have completely gone under without the emotional support I received here. I'm glad I've been able to help you a little. :)

:bighug:
 
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