Question for those that have had to hospitalize

[Herdo]

Our cat Bubba was admitted today due to DKA. Apparently our ReliOn glucose monitor is no where near accurate as we are getting readings of mid to high 200s while the doctors calibrated monitor is getting high 400s. It looks like our baby was never actually regulated, because he should have been on a much higher dosage. At his lowest, 6 hours after insulin he was getting down to about 250 according to our monitor, but closer to 400 in reality.

Either way, he was hospitalized today, and they are giving him insulin through an I/V. He has gone for 490 to 422 in 2 hours, which the doctor said was pretty slow going. The problem being, that at 8:00 P.M. the vets office closes for the night and no one is there to monitor him until 7:30 A.M. They said they won't do the insulin drip while no one is there, but he will still be getting fluids through the I/V.

I guess my question is, is this normal? We are going to be taking him home at night because we would rather monitor him all night rather than worry about him sitting at the vet alone. I guess we just assumed someone would be there all night, but even the doctor kind of acted like it was abnormal that no one would be there, and he suggested we take him home and bring him back first thing in the morning.

We are concerned that without the continued insulin over the next 12 hours, he will get worse. They have only had him on the insulin drip for about 3 hours at this point, and we are going to pick him up in about an hour. The doctor said he hasn't really gotten any better because there just wasn't enough time to get his BG down. Right now, the plan is to take him home at about 8:00 P.M. and bring him back at around 7:30 A.M.

So for those of you that had to hospitalize your baby, was someone there all night monitoring them and giving care? Is no one being there all night normal?

 

[Carl & Polly & Bob (GA)]

When Bob was in emergency care for DKA, it was at my vet's clinic. He was there for three nights. My vet either went there a couple times a night, or slept there, and checked on him. Bob's case was sort of unique in that respect. I flat out couldn't afford $1000 a night, and my vet understood that, and she went way above and beyond in order to help him and me. I don't know how ERs normally operate, but you'd think someone would be there to monitor? At least I would (like you).

When Bob was there, he wasn't given PZI (the insulin he eventually was put on). He was given fast acting, short duration insulin (probably what we refer to as Humulin "R"). And he also was on fluids and at least part of that mixture was dextrose or some other type of "sugar". I think the strategy is to give them hefty doses of fast acting insulin on an "as needed" basis while using the "sugar" to stop the numbers from going too low. Someone else would most likely have a better idea.

Once the ketones were gone, and his BGs were under some control, I got to take him home. His BGs when he started PZI at home were still in the 350-450 range for a three or four weeks at preshot time, and his dose went from 1u twice a day to up to 4u twice a day in the first 4 weeks. I also had to give him sub-q fluids twice a day for that first week, and then once a day for another week. I gave him fluids for many weeks, but not so much because of dehydration. He was given potassium supplements via sub-q fluids for a long time before his potassium levels rose to "normal".

Also, it's hard to believe that your meter was that far off. I used a relion micro, and it was about 30 points lower than my vet's meter (I think she used an AlphaTrak). A great way to find out is to do a side-by-side test at the vet. Use the same drop of blood to test both meters, and see how they compare. I did it twice and it was 25-30 points off each time.

 

[Herdo]

When Bob was in emergency care for DKA, it was at my vet's clinic. He was there for three nights. My vet either went there a couple times a night, or slept there, and checked on him. Bob's case was sort of unique in that respect. I flat out couldn't afford $1000 a night, and my vet understood that, and she went way above and beyond in order to help him and me. I don't know how ERs normally operate, but you'd think someone would be there to monitor? At least I would (like you).

When Bob was there, he wasn't given PZI (the insulin he eventually was put on). He was given fast acting, short duration insulin (probably what we refer to as Humulin "R"). And he also was on fluids and at least part of that mixture was dextrose or some other type of "sugar". I think the strategy is to give them hefty doses of fast acting insulin on an "as needed" basis while using the "sugar" to stop the numbers from going too low. Someone else would most likely have a better idea.

Once the ketones were gone, and his BGs were under some control, I got to take him home. His BGs when he started PZI at home were still in the 350-450 range for a three or four weeks at preshot time, and his dose went from 1u twice a day to up to 4u twice a day in the first 4 weeks. I also had to give him sub-q fluids twice a day for that first week, and then once a day for another week. I gave him fluids for many weeks, but not so much because of dehydration. He was given potassium supplements via sub-q fluids for a long time before his potassium levels rose to "normal".

Also, it's hard to believe that your meter was that far off. I used a relion micro, and it was about 30 points lower than my vet's meter (I think she used an AlphaTrak). A great way to find out is to do a side-by-side test at the vet. Use the same drop of blood to test both meters, and see how they compare. I did it twice and it was 25-30 points off each time.

Thank you Carl, you are the best. Yea, the more we think about it, the more it makes sense that usually no one would be there at night unless it is an emergency clinic. We are just really nervous and not looking forward to another night like last night. I got about 2 hours of sleep because I stayed up all night watching him, and I know I probably won't get much more than that tonight. I'm really hoping he does good tonight and tomorrow he gets a good 12 hours of insulin through the I/V.

Thanks again

 

[Sienne and Gabby (GA)]

When my cat needed to be hospitalized with DKA, my vet would not keep Gabby at their offices. They refer to a 24 hour emergency/specialty/ICU for critical care. It is a 24/7 facility where Gabby could be monitored closely around the clock. They were also set up to do the number of necessary labs to monitor electrolytes on a regular basis, tritrate insulin, and do other tests (an ultrasound, for example) that other facilities may not be set up to do if those procedures are necessary. DKA can be life threatening and none of us are set up to administer IV fluids, stay awake around the clock to monitor insulin and give bolus doses of fast acting insulin to pull numbers down, etc. at home. It is expensive but your cat would be getting appropriate attention, monitoring, and care. I'd be concerned that if your vet's practice is busy that Bubba may not be getting a great deal of attention thfoughout the day unless they have staff who are dedicated to caring for the critically ill animals there.