Recurring Ketones

Mathilda and Maverick

Mathilda and Maverick

Member Since 2020
Maverick has had recurrent ketones pretty much since he was diagnosed, but the past months it's become much worse. We have been home treating with SQF, app stimulant, and cerenia. He's been on the cerenia pretty much daily since nov 2020. We spent a fortune on him (really), and just 10ish days ago $900 on bloodwork. It came back with trace of protein in urine, no ketones, and slightly low potassium and slightly low phosphorus (I tried my hardest to feed CKD/diabetes friendly food and guess it backlashed)-he's now on pohosphorus support. he's been receiving 100mls SQF daily for the past 2 weeks. He just recently started to vomit, and just yesterday didn't want to eat, as this morning. He received app stimulants this morning and I just syringe fed him 3-4oz. I emailed his specialist, but am now very worried. Due to ketones he lost some weight- not super bad, but 1lbs over the past 8ish months, but seem to have lost most of that since January. He acts lethargic today and it really makes me worried, we can't afford another ER visit, but also don't think he's ready to leave us. I do suspect he may have small lymphoma in addition to the diabetes, IBD, CKD, but obviously we can't treat for that unless it's diagnosed but the biopsy needed for that is $2500 and that just does not work. However, he is on Budesonide. I'm sorry this post is messy, I'm just at the point I don't know what to do. If anyone has any suggestions or thoughts, please let me know. Her is his spread sheet. We test ketones with a BG Keto blood meter, and the black in the recent days are HI ketones not BG. TIA
https://docs.google.com/spreadsheet...0M38qxw7XkYRe1oYEpr_b8nK-Y/edit#gid=267420611
 
Now he started to growl when cried, lifted etc. He's not himself. I got about 5oz food down today, lets see if he keeps it down- perhaps the food causes him discomfort?
 
Do you have any odansetron on hand, or can you get if from the vet? It's much better for treating nausea, though Cerenia is better for vomiting. You can give both. I wonder if he's got some pancreatitis. It's a common occurrence in kitties with IBD or SCL. A Primer On Pancreatitis You would need to add pain control (preferably buprenorphine) to the mix.

Was his heart checked before you started fluids? Try counting the number of complete breaths per minute when he's resting. That's in and out breath counting as one. My Neko's heart could not take fluids, which we found out when I started them. :( Her resting respiratory rate (RR) went up indicating the fluids were too much. Normal is 20-30 range.
 
Wendy&Neko said:
Do you have any odansetron on hand, or can you get if from the vet? It's much better for treating nausea, though Cerenia is better for vomiting. You can give both. I wonder if he's got some pancreatitis. It's a common occurrence in kitties with IBD or SCL. A Primer On Pancreatitis You would need to add pain control (preferably buprenorphine) to the mix.

Was his heart checked before you started fluids? Try counting the number of complete breaths per minute when he's resting. That's in and out breath counting as one. My Neko's heart could not take fluids, which we found out when I started them. :( Her resting respiratory rate (RR) went up indicating the fluids were too much. Normal is 20-30 range.
Click to expand...


Thank you for answering! Yes, I forgot the pancreatitis- he also been diagnosed with chronic pancreatitis but his flares has never been like this, and never really needed pain killer- I do have some at home I believe but not sure if it expired or not. His heart was good last time at the vet, about 10-14 days ago, both heart rate and blood pressure normal.
 
I can see you increased the dose to 2.5 U at AMPS. That is good.
At what point does the blood ketone meter give you a Hi reading?
Has the vet or specialist given any reason why Maverick gets such high ketones all the time.?
Have you tested the urine at the same time as getting hi blood ketones to see what the urine is saying? It would be interesting to know… although the urine ketones would be lagging behind the blood.
I think Wendy’s suggestion getting some ondansetron is a good idea.
We needMaverick to eat as much as possible.
 
Bron and Sheba (GA) said:
I can see you increased the dose to 2.5 U at AMPS. That is good.
At what point does the blood ketone meter give you a Hi reading?
Has the vet or specialist given any reason why Maverick gets such high ketones all the time.?
Have you tested the urine at the same time as getting hi blood ketones to see what the urine is saying? It would be interesting to know… although the urine ketones would be lagging behind the blood.
I think Wendy’s suggestion getting some ondansetron is a good idea.
We needMaverick to eat as much as possible.
Click to expand...
The ketone meter gives a HI when it's over 7.9. The specialist has no real answer to it, more than it may be the GI or pancreas. I suspect small lymphoma as well and she is not disagreeing, but I don't have the funds for a biopsy. She says that the ketone meter may confuse us more and want me to check pee instead or go with another kind of blood meter which I think makes no sense. I have tested them both several times and while the pee can be neg, the blood can be small-med. Never been the other way around, and that would make sense. Ive also had HI on blood meter and mod to large on urine- its all in the spread sheet. Maverick has vomited up all food I've given him and he keeps on vomiting foam after food are gone. He started to mjau/growl when lifted which never happened before- he seems to be in pain :( Insulin time is coming up so I'll try to feed more. Ketones are down to 3.5. Just worried he won't be able to keep any food down with the 2.5U.
 
Bron and Sheba (GA) said:
I can see you increased the dose to 2.5 U at AMPS. That is good.
At what point does the blood ketone meter give you a Hi reading?
Has the vet or specialist given any reason why Maverick gets such high ketones all the time.?
Have you tested the urine at the same time as getting hi blood ketones to see what the urine is saying? It would be interesting to know… although the urine ketones would be lagging behind the blood.
I think Wendy’s suggestion getting some ondansetron is a good idea.
We needMaverick to eat as much as possible.
Click to expand...
Wendy&Neko said:
Do you have any odansetron on hand, or can you get if from the vet? It's much better for treating nausea, though Cerenia is better for vomiting. You can give both. I wonder if he's got some pancreatitis. It's a common occurrence in kitties with IBD or SCL. A Primer On Pancreatitis You would need to add pain control (preferably buprenorphine) to the mix.

Was his heart checked before you started fluids? Try counting the number of complete breaths per minute when he's resting. That's in and out breath counting as one. My Neko's heart could not take fluids, which we found out when I started them. :( Her resting respiratory rate (RR) went up indicating the fluids were too much. Normal is 20-30 range.
Click to expand...
I found very little prob 1/4 if that of the buprenorhine we got prescribed in 2021, it expired almost exactly 1 year ago… can I give him that? The dose was 0.2ml but prob not even 1/4 of that left. He seems to be in pain and I will not be able to get him anywhere tonight
 
I am glad to hear the ketones are down to 3.5 but that is still high. I would not reduce the dose of insulin. Were you able to get any Ondansetron?
Are you in a position to take him to an ER if he gets worse?
 
Bron and Sheba (GA) said:
I am glad to hear the ketones are down to 3.5 but that is still high. I would not reduce the dose of insulin. Were you able to get any Ondansetron?
Are you in a position to take him to an ER if he gets worse?
Click to expand...
Yes it is, but as he has been vomiting now and clearly shows pain in tummy area, I would think he’ll most likely won’t be able to keep food down. Would I still dare to give the 2.5u? I’m about 1h past insulin time. I did give Cerenia 1h ago and I redosed app stimulant and he kept that down. I’m just about to get to feed him, will still prob have to syringe feed him. I been in email contact with the specialist and she strongly suggest another ultrasound, the past 2years ultrasounds hasn’t really shown anything…And also says take him in if worsen. But I’m in a tight spot to take him in both with the money and as I’m alone with my 2 small children tonight. I just had $900 worth of blood work done a few days ago and ultrasound is $600 + visit $250 But obviously either way I’d have to figure something out, he’s in pain. Do you think dosing the insulin would still be safe? I’d stay up with him but what would I do if numbers goes down and he keeps on vomiting?
 
Yes I think you have to give him the insulin. Otherwise the ketones will go back up. You may have to keep the BGs up with rubbing honey on his gums.
You may also have to take him to the ER if he is in pain and can’t keep down food and if ketones go back up.
maybe try tiny amounts of food every so often and see if that can stay down.
I can see you are in a very different position. but I don’t know what else I can suggest
 
Bron and Sheba (GA) said:
Yes I think you have to give him the insulin. Otherwise the ketones will go back up. You may have to keep the BGs up with rubbing honey on his gums.
You may also have to take him to the ER if he is in pain and can’t keep down food and if ketones go back up.
maybe try tiny amounts of food every so often and see if that can stay down.
I can see you are in a very different position. but I don’t know what else I can suggest
Click to expand...
He's a mystery for sure, those ketones will go up and down as they please anyways, independent on the insulin dose I'm afraid. His history of ketones just makes no medical sense at all unless there's a cancer or similar in the system. I did give him the 2.5u insulin and will stay up all night feeding little bit every few hours as well as testing BG. He's always so easy to syringe feed and treat, but he acts so very different tonight. At this point I do think it's a pancreatitis flare but obviously don't want him to develop DKA. Gosh, it's so hard. I know the ultimate thing would be that biopsy but we just can't. However, keep on doing bloodwork and ultrasounds that gives no real answers seems like a waste as well. I am worried with this added pain. I may have to haul everyone to spend the night at the ER but am trying to avoid it as I know that will also stress Maverick out greatly to have overtired toddlers in tow. I appreciate your support!
 
Bron and Sheba (GA) said:
How are things today Matilda, with Maverick?
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Maverick seemed to be in less pain this morning. He is still not eating, I syringe fed him all night and today. I did end up taking him for an ultrasound and I'm still waiting for the real report but I was told by the specialist that took a look at it that there's def a pancreatitis flare going on at least. So no real surprise thus far. Hopefully I'll get the full report tomorrow morning. Until then I will continue as we have- I also made sure to get some odansetron and buprenorhineAs far as I know, he has not been vomiting since last night and his poop is somewhat formed now. His ketones has been around 3 and BG went down to 145 this far. So, I'm hoping he'll feel better tonight.
 
That is a better update. I'm sorry he is still not wanting to eat. Have you tried the ondansetron yet?
If it is pancreatitis, nausea is very common and some cats don't want to eat for a while.
When you have a spare moment, can you drag the 2023 SS over to the far left of the page please sp that when we open the SS it is the 2023 one and not the 2022 one. Thanks!
 
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