? Pulmonary edema. Acute abdominal pain, bloating, exacerbation of pancreatitis

[Alisia Evans]

I noticed a strange bloating, rapid breathing in the abdomen. I took the cat to the hospital, they checked it with an ultrasound, there is no ascites, but the intestine is full of gases and there is a lot of food in the stomach.
In the general blood test, everything is fine. In the biochemical test, there is an increase in pancreolipase - 38, with a normal value of up to 4. Increased urea - 14, with a normal value of up to 9.
In the diagnosis, they wrote - intestinal overfilling, bloating. But they did not write about exacerbation of pancreatitis.
The following medications were given:
hyoscine butylbromide to relieve intestinal spasm
metoclopramide for vomiting, which is absent
simethicone for bloating
And no pain relief for pancreatitis.
What should I do? I am already afraid to trust this clinic, but it is the only 24-hour clinic in my city.
They also told me that this could have happened because of the transition from Levemir to Lantus.
Please help with advice on what to do. I'm worried that pancreatitis is not being treated. They only prescribed enzymes twice a day for a month.

 

[Sienne and Gabby (GA)]

The switch from Levemir to Lantus should not cause these symptoms.

I would contact the clinic and ask for pain meds. Buprenophine is often prescribed for pancreatitis.

This is information on pancreatitis in case you've not seen it previously.

 

[Alisia Evans]

The switch from Levemir to Lantus should not cause these symptoms.

I would contact the clinic and ask for pain meds. Buprenophine is often prescribed for pancreatitis.

This is information on pancreatitis in case you've not seen it previously.

Thank you very much for such a comprehensive answer!
Our doctor refused to inject buprenorphine, arguing that the pain is probably more related to gas and that we need to observe him for at least 8 more hours. I will contact them in the morning and we will go to the clinic again. The cat is breathing frequently, usually 16 breaths per minute, but now it is over 30. I am very worried about him.

 

[Lara & Luciole (Lu)]

Regarding, "Please help with advice on what to do. I'm worried that pancreatitis is not being treated. They only prescribed enzymes twice a day for a month."

Are these pancreatic enzymes? Was this confirmed as needed by bloodwork? I have seen this mentioned her several times, here quoting @Christie & Maverick "They can be very damaging to the pancreas, unless required so not recommended without positive diagnosis via GI blood panel. Here is some more information EPI - IBDKitties original web page is EPI – IBDKitties"

So if mis-prescribed, the enzymes could be the problem.

In any case, these vets should give some pain relief. Buprenorphine can be injected or administered orally in the cheek, and they should send you home with some to give every 6-8 hours as needed. Pain is pain.

 

[Alisia Evans]

Regarding, "Please help with advice on what to do. I'm worried that pancreatitis is not being treated. They only prescribed enzymes twice a day for a month."

Are these pancreatic enzymes? Was this confirmed as needed by bloodwork? I have seen this mentioned her several times, here quoting @Christie & Maverick "They can be very damaging to the pancreas, unless required so not recommended without positive diagnosis via GI blood panel. Here is some more information EPI - IBDKitties original web page is EPI – IBDKitties"

So if mis-prescribed, the enzymes could be the problem.

The tests only revealed an increase in pancreolipase.
in the drug that was prescribed 1 tablet contains:
amylase - 4470 Ph.Eur.u.;
lipase - 3070 Ph.Eur.u.;
protease - 320 Ph.Eur.u.

 

[Christie & Maverick]

I believe simethicone is a digestive product to help with excessive gas, which is different than pancreatic enzymes.

 

[Alisia Evans]

I believe simethicone is a digestive enzyme to help with excessive gas, which is different than pancreatic enzymes.

Yes, it was prescribed specifically for bloating.

 

[Christie & Maverick]

The tests only revealed an increase in pancreolipase.
in the drug that was prescribed 1 tablet contains:
amylase - 4470 Ph.Eur.u.;
lipase - 3070 Ph.Eur.u.;
protease - 320 Ph.Eur.u.

Which drug is that? My understanding is that they would have run a GI panel to confirm issues with EPI. Sorry this is a bit out of my depth, I’ve not had direct experience with EPI in cats.

For pancreatitis, Sienne has posted the info link. I found for my cat that I needed pain meds and anti-nausea meds, as well as appetite stimulant.

All that is to say, Exocrine Pancreatic Insufficiency is a different condition than pancreatitis.

 

[Alisia Evans]

Which drug is that? My understanding is that they would have run a GI panel to confirm issues with EPI. Sorry this is a bit out of my depth, I’ve not had direct experience with EPI in cats.

For pancreatitis, Sienne has posted the info link. I found for my cat that I needed pain meds and anti-nausea meds, as well as appetite stimulant.

All that is to say, Exocrine Pancreatic Insufficiency is a different condition than pancreatitis.

We were at the clinic again today. He has pulmonary edema and heart failure. It's making it so hard to breathe. It's not just gas.

 

[Christie & Maverick]

Oh my dear, I’m very sorry, I hope for the best, sending healing light

 

[Lara & Luciole (Lu)]

Are the doctors able to treat Asik? My cat had the same conditions, and had the fluid drained and daily heart medications. He was very elderly when this happened, but he lived another 1.5 years.

I hope for good things for you!

 

[Sienne and Gabby (GA)]

I'm glad they caught what the problem is. Please keep us posted on how Asik is doing. Heart failure is a treatable condition.

 

[Alisia Evans]

Are the doctors able to treat Asik? My cat had the same conditions, and had the fluid drained and daily heart medications. He was very elderly when this happened, but he lived another 1.5 years.

I hope for good things for you!

Now they only give him diuretics, oxygen, sedatives, but no heart medication. But I'll call the doctor this evening, I'll ask

 

[Lara & Luciole (Lu)]

Sounds like you really need to advocate and keep advocating for Asik, which you are doing. It must be so stressful, but keep it up.
There are medications for this, apart from diuretics. Is there a cardio specialist you can speak with?

 

[Alisia Evans]

Sounds like you really need to advocate and keep advocating for Asik, which you are doing. It must be so stressful, but keep it up.
There are medications for this, apart from diuretics. Is there a cardio specialist you can speak with?

Yes, if I hadn't insisted, he would have continued to be treated for bloating.
There is no cardio specialist, but I will ask them to contact their colleagues and consult
We have a very poor level of veterinary medicine. I do everything I can, but it is not enough. There is no hospital in the clinics where there are narrow specialists

 

[Sienne and Gabby (GA)]

Diuretics are a part of HF treatment -- an important part. Also, check the sodium content of the food you're using. I can give you sodium levels and fluid intake for humans with HF but I don't know what's appropriate for cats!

They may want to get baseline levels before prescribing anything like a beta blocker or ACE inhibitor.

If you need a consult, the Cornell Feline Health Center offers a consultation service. Cornell is one of the leading veterinary schools in the US.

 

[Lara & Luciole (Lu)]

Hi @Alisia Evans I hope Asik is feeling at least a bit better today, his lungs are less congested and his breathing is better.
Wishing Asika full recovery!

 

[Alisia Evans]

Hi @Alisia Evans I hope Asik is feeling at least a bit better today, his lungs are less congested and his breathing is better.
Wishing Asika full recovery!

Hello, dear friend. Unfortunately, there are no visible improvements. He is very worried in the clinic because of the manipulations, including glucose and insulin measurements. After the procedures, he breathes with his mouth open and his tongue turns blue, but after 20 minutes under oxygen, this goes away. So far, they are giving him diuretics and oxygen for 8-12 hours a day, urine is coming out actively. Saturation 85-92. Today, an X-ray will be done in the evening to assess the state of pulmonary edema. They cannot do an ultrasound of the heart yet, because it is a very strong stress for him and sedatives are not taken. The doctor said that the main goal now is to remove the edema and then he will have the strength to endure other examinations to find the cause of the edema. I hope that this is not just a money-making scam and that I will not waste my last days with him.

 

[Lara & Luciole (Lu)]

Oh I am so sorry for the worry and stress this is causing you and poor Asik!
When my cat had this, they drained the fluid from his lungs, however this was done by a very skilled vet.

However, this is treatable, and looks like the vets are doing the right thing. Pulmonary Edema in Cats: 7 Vital Treatment Options to Know - The Pet Vet
According to the article cats need 24-48 hours of oxygen, so please make sure they're giving him enough.

And the diuretic is also key. My vet also made sure my cat got medications to support his heart, which this article also mentions.

 

[Alisia Evans]

Oh I am so sorry for the worry and stress this is causing you and poor Asik!
When my cat had this, they drained the fluid from his lungs, however this was done by a very skilled vet.

However, this is treatable, and looks like the vets are doing the right thing. Pulmonary Edema in Cats: 7 Vital Treatment Options to Know - The Pet Vet
According to the article cats need 24-48 hours of oxygen, so please make sure they're giving him enough.

And the diuretic is also key. My vet also made sure my cat got medications to support his heart, which this article also mentions.

Oh, thank you. Finally I read a well-structured and understandable article. In fact, now I think they are doing everything right. At least the beginning is right. Thank you for your support and for worrying about us. You have no idea how valuable this is for our family

 

[Lara & Luciole (Lu)]

It looks like, according to his needs, he could need oxygen for several days, so please make sure the vets are doing that.

Oxygen and diuretics seem to be key and hopefully Asik will improve. But also ask the vets for medication to support his heart.

I'm hoping & praying for you every minute.

 

[Lara & Luciole (Lu)]

I hope Asik is having an easier day today. I don't want to be nosy, so don't respond if you don't want to. Just wanted to say that I am hoping he is continuing to get good help.

 

[Alisia Evans]

I hope Asik is having an easier day today. I don't want to be nosy, so don't respond if you don't want to. Just wanted to say that I am hoping he is continuing to get good help.

I am so grateful to you for your care and support. I would never have thought that someone on the other side of the ocean could be with us on such difficult days.
Today Asik is really a little better. The prognosis is cautious, but we have shifts.
Blood saturation - yesterday 86%, this morning 92% during periods without oxygen. With oxygen it was 94-98% yesterday. They give oxygen on a 4/4 schedule and additionally, if SpO2 drops below 85%, for example after manipulations. He is very afraid of measuring glucose, his nose and tongue turn blue, he breathes with his mouth open and his tongue sticking out. In 10 minutes with oxygen it passes.
Yesterday the pressure was 180/120, today 130/82.
Glucose has also stabilized today. He eats himself, poops every day.
Ultrasound diagnostics were performed at night, but I don’t know the results, because the doctor has a day off. He knows about the results, the treatment has not been adjusted yet. I don’t know what this indicates. I hope they will give me answers soon.
I also asked to monitor the level of Potassium. Before hospitalization, it was at the upper limit of normal, but diuretics greatly reduce the level of potassium in the blood.
Glucose was high yesterday, today it is more stable, which we are very happy about.
I will attach X-rays

 

[Lara & Luciole (Lu)]

Thank you for this and I'm hoping Asik continues to improve.

They should never let him get to the point where his tongue is turning blue. That's very concerning.

I'm hoping that somebody who understands feline medicine a bit better can perhaps comment.

Apologies to all - I don't know who to tag. @Suzanne & Darcy , @Sienne and Gabby (GA) do you have any insight into how Asik is doing overall?

 

[Suzanne & Darcy]

Anti-nausea medication such as Ondansetron, pain control, daily subcutaneous fluids given at home — all these should be used to help manage pancreatitis.

Also, unless he has Exocrine Pancreatic Insufficiency, I do not believe he needs the enzymes. Did they also diagnose EPI with the blood test? Anyway, they probably can’t hurt.

 

[Alisia Evans]

Anti-nausea medication such as Ondansetron, pain control, daily subcutaneous fluids given at home — all these should be used to help manage pancreatitis.

Also, unless he has Exocrine Pancreatic Insufficiency, I do not believe he needs the enzymes. Did they also diagnose EPI with the blood test? Anyway, they probably can’t hurt.

Amylase is normal, pancreolipase is 38 with a normal range of up to 4. We don't check any other pancreatic parameters.

 

[Suzanne & Darcy]

I am really sorry for everything you are going through with Asik. I see he has been re-hospitalized? I am very concerned about his open mouth breathing and his tongue turning blue. My heart just goes out to you because I understand what it’s like having a beloved cat under critical care and not knowing what is really happening. It’s very frightening and painful. I hope they will be able to find the cause of his pulmonary edema. I have had cats with pleural effusion before and the fluid was drawn off. My cat had only minimal pulmonary edema. Is Asik on diuretics to help remove the fluid (Furosemide, Torsemide or Spiromolactone perhaps?). How is he now? I am going to say a prayer for him to recover. Much love and support is going out to you now!

 

[Alisia Evans]

I am really sorry for everything you are going through with Asik. I see he has been re-hospitalized? I am very concerned about his open mouth breathing and his tongue turning blue. My heart just goes out to you because I understand what it’s like having a beloved cat under critical care and not knowing what is really happening. It’s very frightening and painful. I hope they will be able to find the cause of his pulmonary edema. I have had cats with pleural effusion before and the fluid was drawn off. My cat had only minimal pulmonary edema. Is Asik on diuretics to help remove the fluid (Furosemide, Torsemide or Spiromolactone perhaps?). How is he now? I am going to say a prayer for him to recover. Much love and support is going out to you now!

He has been in intensive care for the third day. I am very worried about him.
He is currently being given furosemide and oxygen

 

[Suzanne & Darcy]

If he has heart failure, there are medications that can really help him— depending upon the specific heart condition. Pimobendan is one that comes to mind — it helps with heart contractility. I hope he will get help.

 

[Alisia Evans]

If he has heart failure, there are medications that can really help him— depending upon the specific heart condition. Pimobendan is one that comes to mind — it helps with heart contractility. I hope he will get help.

I'm really worried about his glucose levels right now. Last night they determined the lowest level for the entire treatment period. We just switched to Lantus on day 5, could you please look at the table? They gave him the full dose, now I'm really afraid of hypoglycemia

 

[Suzanne & Darcy]

The Lantus depot has been building for several days now so you are beginning to see the full effect of this dose. Make sure they will be monitoring his blood glucose carefully. They will be able to administer glucose intravenously if needed.

 

[Suzanne & Darcy]

I see that he was on a smaller dose with the Levemir.

 

[Suzanne & Darcy]

Are you allowed to see him?

 

[Alisia Evans]

The Lantus depot has been building for several days now so you are beginning to see the full effect of this dose. Make sure they will be monitoring his blood glucose carefully. They will be able to administer glucose intravenously if needed.

How often should I check my glucose tonight? Are +3 and +6 enough?

I see that he was on a smaller dose with the Levemir.

Yes, but his doctor said that was too low a dose for him and increased it to 0.5

Are you allowed to see him?

No, unfortunately. I was at the clinic today and they wanted to take him out, but he started to get agitated and breathe with his mouth open, so they didn't. I hope I can try again tomorrow.

 

[Lara & Luciole (Lu)]

Pimobendan (Vetmedin), as Suzanne has mentioned, is a great medication for this. My cat took it and it helped enormously.
This is a standard medication. Hopefully these vets have it.

 

[Suzanne & Darcy]

How often should I check my glucose tonight? Are +3 and +6 enough?

Are you checking it yourself or are they doing it in the hospital?

 

[Suzanne & Darcy]

What kind of glucometer are you using? Human or pet meter?

 

[Alisia Evans]

Are you checking it yourself or are they doing it in the hospital?

They doing it in the hospital. I told the doctor that this was the lowest glucose level in 4 months of taking insulin, and asked him to monitor his condition. I will call the clinic again at +3 and +6 to make sure everything is fine.

What kind of glucometer are you using? Human or pet meter?

Human

 

[Suzanne & Darcy]

Yes, but his doctor said that was too low a dose for him and increased it to 0.5

Given his recent numbers from the end of 2025 with the Levemir, I am inclined to agree with the vet, although he needs to be monitored carefully — there are just so many variables involved at this time with his care. I would test at +3, yes, and decide at that time whether to test again sooner than +6. If his +3 is similar to the PMPS then you can probably wait. But honestly I don’t understand why you are having to do all of the glucose testing when he is hospitalized.

 

[Suzanne & Darcy]

Okay. I understand now

 

[Suzanne & Darcy]

I would call them at +3 and ask what his BG is. If it’s much lower than PMPS you can have them check it more frequently, but definitely check again at +6. I doubt you will get much sleep tonight.

He was having some lovely green nadirs back in early November. Why did you switch from Levemir. I really liked Levemir, but it’s my understanding it is being discontinued by the manufacturer. Lantus is an excellent insulin for cats.

 

[Alisia Evans]

But honestly I don’t understand why you are having to do all of the glucose testing when he is hospitalized.

I probably expressed myself incorrectly, English is not my native language. They conduct all glucose tests in the hospital themselves. I only call and clarify the indicators to monitor his condition, because they themselves told me that they are not very well versed in diabetes issues and among colleagues from other clinics in our city they have not met such specialists. Therefore, all these months I have been alone with his diabetes.

Given his recent numbers from the end of 2025 with the Levemir, I am inclined to agree with the vet

I was also inclined to agree that 0.25 units is not enough for him. That's why I agreed to such an early dose increase. In addition, he got sick, was under constant stress and glucose was rising. So it seemed quite reasonable. Now I'm in a panic because of the risk of hypoglycemia.

 

[Suzanne & Darcy]

I probably expressed myself incorrectly, English is not my native language. They conduct all glucose tests in the hospital themselves. I only call and clarify the indicators to monitor his condition, because they themselves told me that they are not very well versed in diabetes issues and among colleagues from other clinics in our city they have not met such specialists. Therefore, all these months I have been alone with his diabetes.


I was also inclined to agree that 0.25 units is not enough for him. That's why I agreed to such an early dose increase. In addition, he got sick, was under constant stress and glucose was rising. So it seemed quite reasonable. Now I'm in a panic because of the risk of hypoglycemia.

They would be very capable of bringing up his blood glucose quickly if it drops too low — more quickly even than you could do at home. The important thing is for you to make sure it is being monitored because sometimes they get busy with emergencies in those ER clinics. I do understand how you feel. It’s so much out of your control, and you must feel quite helpless. You are doing a wonderful job of keeping up with everything that is going on with him.

Asik is very beautiful in his photo.

 

[Lara & Luciole (Lu)]

You're such a good, caring person, Alisia. This must be so very tough. And Asik is indeed very beautiful.
Thank you so much for your wisdom here, Suzanne.

 

[Alisia Evans]

They would be very capable of bringing up his blood glucose quickly if it drops too low — more quickly even than you could do at home. The important thing is for you to make sure it is being monitored because sometimes they get busy with emergencies in those ER clinics. I do understand how you feel. It’s so much out of your control, and you must feel quite helpless. You are doing a wonderful job of keeping up with everything that is going on with him.

Asik is very beautiful in his photo.

Yes, they regularly monitor glucose levels now. Thank you for your support

 

[Lara & Luciole (Lu)]

Please keep us updated, and sending you healing vines! (A FDMB saying with magical powers )

 

[Suzanne & Darcy]

I have been thinking about you and Asik. I just checked his spreadsheet, and I see very stable glucose in good blue numbers. I am very happy about that. Please let us know how he is doing as soon as you can. I will be on the road tomorrow quite a bit of the time— taking a cat to a University Veterinary Hospital, but I will check in on your thread here. Saying a prayer for Asik tonight.

 

[Alisia Evans]

I have been thinking about you and Asik. I just checked his spreadsheet, and I see very stable glucose in good blue numbers. I am very happy about that. Please let us know how he is doing as soon as you can. I will be on the road tomorrow quite a bit of the time— taking a cat to a University Veterinary Hospital, but I will check in on your thread here. Saying a prayer for Asik tonight

Of course, I will definitely report the news

 

[Lara & Luciole (Lu)]

Alisia, can you please ask your vets about Vetmedin (pimobendanane)?
It was developed for dogs but is commonly used for cats as well in a variety of forms. My cat took 1 capsule two times daily.

Although the diuretic is great and necessary, Vetmedin helps the heart and "American College of Veterinary Internal Medicine (ACVIM) consensus guidelines recommend as a first-line therapy for dogs in heart failure due to MMVD or DCM.*3 " but it's widely used for cats with heart failure as well.

"VETMEDIN products have a dual mode of action, relaxing the blood vessels carrying blood to and from the heart, and improving heart muscle function to help the heart work more efficiently.

In a clinical study, dogs treated with VETMEDIN products at the onset of clinical signs survived almost twice as long from the start of treatment as those treated with an ACE inhibitor.2

Dogs treated with VETMEDIN products from the onset of clinical signs also required less therapy to maintain quality of life as those treated with an ACE inhibitor.2"

 

[Suzanne & Darcy]

Pimobendan (Vetmedin) literally saved my cat’s life. It was like night and day … and no more pleural effusions for years (until the end.) It was one of the medications which gave us two more good years with Ginger.