Throwing up 14 times but bloodwork 100% normal???

Hey y'all! Thankfully, I haven't had to post in this MB for a while. My kitty's BG and insulin values are checked daily and she has been doing very well, and I'm getting her fructosamine checked soon! Yesterday morning, I think I accidentally gave her some of her insulin IM instead of SC, and her BG dropped (52) before dinner and she vomited a lot overnight (~9 times). Of course, this worried me, so I immediately called her vet and brought her in as soon as they could see me, which was 2pm. Brought her in, did full blood work, and everything was perfectly in range. Her liver, kidney, blood sugar, etc were all good, which rules out DKA (also, she's had 3 before and I know what that looks like for her). Her temperature, lymph nodes, and heartrate were good, and the only issue seemed to be dehydration (which is understandable, considering she threw up about 12 times before going to the vet). Vet prescribed Mirtazapine for the nausea, and she had it with her dinner. She just had dinner about 3-4 hours ago, and kept it down very well, until just now. She just threw up an excessive amount of water, with very little food mixed in. Seems like she was able to hold the food down, but a little bit came up with an excessive amount of water. She was looking better this morning but seems to be a bit frail from the loss of water now. After coming home from the vet at 3 she spent a lot of the time sleeping, which I expected since throwing up and traveling to the vet can be very taxing. Her BG is still within range, PMPS ~200 and she got a little bit less insulin with dinner, since she seems to be a little bit more insulin sensitive now. Earlier today, she seemed totally fine temperament-wise, but I think the vomiting is getting to her more, as she seems a little bit more sickly.

Better written schedule of vomiting, food, and treat amounts for yesterday and today. For reference, her meals have water added to make the texture softer and so she is adequately hydrated. This is not new and has been her diet for about 6 months with no issue. Also, none of the throw-up has blood in it.

[BG]
Yesterday morning-
8:45am AMPS [110] 1.5units (lowest amount that I currently give her)
1/2 can Friskies Pate + water
Finished all of her food, seemed fine

Yesterday night-
At 6pm (2hrs before dinner), she swiped at my roommate which made me think she was low. Tested her at 6pm [58] - 1 Cat squeeze treat.
7:45pm PMPS [112] 1.5 units
Dinner time, 1/2 can Friskies Pate + water
Finished all of her food.

12:30am- threw up a mix of food and water, mostly water.
[52] - 2 cat squeeze treats and some dry treats.

4:00am- threw up again.
[119] - Honey on gums
by 5:00am- [216]

This morning-
9:16am AMPS [408] ~1.9 units
1/2 can Friskies Pate + water
Only ate about 2/3 of the food, seemed energetic though.

1:50pm- [184] Threw up again at around 1pm, but was busy calling vet so didn't get BG till 1:50p. still mostly water with a little bit of food in it.

Vet visit 2-3pm

This night-
7:00pm PMPS [202] 1.5 units (gave dinner early because she was running on a mostly empty stomach)
1/2 can Friskies Pate + water
Ate about 90% of food, took Mirtazapine with dinner, started drooling. Food was given in intervals to avoid more vomiting. I noticed she was drinking water, which was good. She might have just drunk too much which caused her to throw up, but I was trying to also monitor her water consumption.

10:45pm- [231]

11:10pm- threw up again, a LOT of water. Like a full cup of water.

12:00am- [254]

To be fair, seems like she's keeping food + water down in a longer interval at least, but I'm concerned she's continuing to throw up at all.

TLDR: I'm concerned about the constant vomiting, but I'm not sure what else can be done, since we got a full panel of bloodwork and legitimately everything was in range. The only thing I can imagine right now is pancreatitis, but I figured that would show up somewhere on the blood tests as well. Any advice? Anyone dealt with something similar?

 

Routine blood tests do not show if a cat is suffering from pancreatitis. You need an fPLsnap or an fPLspec for pancreatitis.
I would ask the vet for some ondansetron or cerenia for the vomiting instead of the mirtazapine; mirtazapine can make some cats hypersalivate.
I can’t see the 2024 SS anywhere? Do you have one?
With 3 lots of DKA in the past history, I would continue to check for ketones and try and get the vomiting sorted out quickly.

 

I don’t currently have a 2024 SS, but I check her BG 2x a day and it’s been very consistent. I need to make a new SS and update it for sure. I was also thinking pancreatitis, since the blood panel didn’t have that test. 7:30am is when the vet opens, and I will immediately be calling again.
As for the ketones and DKA possibility- vet said liver and kidney values were normal so no DKA. Also, given her recent numbers for past couple of days, I highly doubt it. If she’s not low, she’s usually 100-200 and happy and stuff.

thank you for your quick advice on the pancreatitis! I was thinking the same thing and am definitely going to talk to my vet tomorrow about getting her tested and treated. She also has a history of pancreatitis triggering her DKAs so I want this handled ASAP, and I think it’s a good theory! A little peeved my vet didn’t recommend it as an option during the $250 visit today…

 

I would definitely get your SS for this year up and running in case you need dosing advice. It’s is also very good for you to keep track of things. Much better than just writing it down.
Did the vet actually do a ketone test or do you check regularly? . Can’t stress enough how important this is especially when your kitty is unwell. let us know how you get on.
Remember it is not enough food, not enough insulin and an infection or inflammation that is the recipe for DKA.

 

No actual ketone test, but I don’t think that’s what it is here. She still has an appetite and is not weak. Overall this morning she’s looking much more active, walking around and looking alert. I called the vet and am waiting for him to give me a call back. I’m gonna make and start updating her 2024 SS immediately today. Thanks for the advice! I’ll update when I can

 

The other issue could be inflammatory bowel. Cats will vomit and/or have diarrhea. There isn't a lab test that tells you if your cat has IBD. This is a website that discusses IBD. It has an emphasis on a raw diet however, the information on supplements, especially for treating vomiting and diarrhea is very helpful

If you are testing only twice a day, there's a good chance you may be missing what's happening at nadir. You have no idea if numbers are low. Would you be able to test at least one additional time during both the AM and PM cycles? You also don't know if you need to make a dose change based on pre-shot numbers.

 

This is another good web site for IBD, if your cat has that: https://www.ibdkitties.net/

My diabetic also has IBD. The IBD came first and the steroid he was taking caused the diabetes Novel protein food works for for the sensitive tummy IBD cats have. I personally feed raw but there are some commercial canned foods that are suitable for IBD and may be low enough in carbs for the diabetes. Look into Koha and Rawz.

What does the vomit look like? I've found that my cat will vomit clear foamy liquid if he goes too long without food. This happened before the diabetes diagnosis and still occasionally now.

 

Thank you both! I'll talk to her vet and see if he thinks she has IBD as well. Still waiting on a call back from him, unfortunately.
Just looking at the website though, it doesn't really look like her symptoms. Her stool is regular and of regular consistency, and her hairballs are infrequent, maybe once every 3 months. This vomiting spell is abnormal for her.

Also, the steroid causing diabetes is so frustrating! I'm sorry to hear that. I was talking to my vet yesterday and heard him mention we absolutely cannot give her a steroid because of her diabetes, so that checks out!

As for the BG, I do glucose curves, so I know what her nadir is with her PS values and dosages. I think her insulin resistance is also decreasing due to the consistent feeding and dosing. I think overall her diabetes has been getting better, save for this one instance. It's also why I'm getting her fructosamine checked soon, since I want to see how her BG has been doing on avg. I can't typically test more than twice a day, since I'm a college student and don't get back to my dorm until about 5-6pm most days, and dinner is around 8pm. During the weekends when I do glucose checks, I do BG checks about once every hour and make sure the dosages are good.
For the throw-up- No foam, just a lot of water with a little bit of her wet food mixed in. No blood at all but is overall a pink color because her wet food is pink-ish. The color is very consistent with her food and I've been triple checking as I clean it up that there's no hairballs or blood.

Again, thanks everyone for the feedback and suggestions! I really appreciate the help

 

My cat still takes a steroid to manage the IBD. The vet switched him from prednisolone to budesonide. Budesoinde is supposed to not affect bgs too much but ECID. My cat gets his pill at night and I find that results in bgs not really moving too much from whatever the PMPS is. Occasionally bgs drop for some reason.

Clear yellow-ish liquid vomit is stomach acid. There may be loose hair or some food mixed in. Small meals spread out during the day may help keep the tummy happy.

 

That's the best plan I can come up with. Thankfully no vomit overnight, so I think she may be doing a bit better. She got a teensy bit of food this morning, but overall seems uninterested.

 

Both of my cats had IBD and diarrhea is not always a symptom. The main ones are vomiting and not wanting to eat.

 

hm, did it start suddenly? This isn't something normal for her. Honestly all of this behavior is abnormal for her

 

My cat's only IBD symptom was vomiting stomach acid and not feeling well after eating certain proteins. It kind of just started one day and the vet and I kept tabs on it to see if it was a one off thing or something that needed to be looked into more thoroughly. I think it took a few months of being on steroids and trying different novel protein foods to see what worked to control symptoms.

It wouldn't hurt to put your cat on a novel protein diet to see if that helps. A lot of IBD cats can't eat poultry and beef. Novel protein like rabbit is best.

Does your cat seem nauseous?

 

If you want to see the discussion on this topic, it is over on the ProZinc forum. We had a long talk yesterday and hopefully Ginger is doing better this morning.

 

Hey everyone! So far so good, Gingy is slowly recovering. She doesn’t seem nauseous anymore, but was quite averse to food last night. She got some (3) kitty treat squeeze tubes, since it’s the only thing she’d eat and I want to make sure her BG was regulated. Also, she hadn’t eaten all day and I wanted something in her system. The last time she threw up was about 36 hrs ago (Friday at 11:30pm), and she hasn’t thrown up since. I’m about to try some fresh breakfast, but this morning she was purring and is currently sleeping on my legs looking out the window. I’ll let y’all know how she gets on today, but I’m hopeful about food! Seems like she ate a couple bites last night.
If anyone has a suggestion for getting cats to eat powered gabapentin, I’m all ears, by the way! Gingy does not like the flavor.

 

The standard powdered gabapentin that comes in capsules tastes terribleA while ago one of my cats bit into a capsules. When I later took the capsule my self the taste was terrible.
For my cats when I need less than a full 100 mg that is in the smallest human capsule I put it in a #3 or smaller #4 gelcap and use a pill popper same for a full 100 mg capsule. You may be aple to get it compounded as a flavored liquid but not sure that will be accepted.

 

Wedgewood Pharmacy has a bunch of different compounded forms of gabapetin available: https://www.wedgewoodpharmacy.com/medications/gabapentin/?pageindex=1

Ask the vet if the transdermal option will work for your cat. You apply the medicine to the ear using a q tip or gloved finger (to prevent your skin from absorbing the medicine). Or maybe the flavored chew treat or tiny tab option will work.

 

Just wanted to give everyone a quick update! Thanks again for all the suggestions and support. It means a lot to have such an amazing and helpful community!
Gingy is feeling much better today. She absolutely loves some salami, so I got some from the dining hall to give to her. I know flavored food is ill-advised, but she seemed to be hungry but avoiding the wet food (im assuming it left a bad taste in her mouth after she threw it up so much). She went ravenous for the salami, as she usually does, and I figured the salt would help her get some more water down. Plus, we didn’t do any sub-q so I figured she could use some electrolytes. She ate some that I put in her food, so I tricked her into eating some food as well! I also checked her BG, which made her wake up and (completely of her own volition!) eat some of her normal wet food! She’s eaten about 3-4 times in small bites, and has only eaten probably 1/3-1/2 of her normal breakfast portion, but she ate literally nothing yesterday. Her temperament is much better today as well. She’s purring, following me, and looks a lot like her normal self. I’ll update again if something changes or if I feel like she’s in the clear. Thanks y’all!

 

Mini update! Gingy is doing slightly better. Still no more vomiting. Last night she ate her whole meal from that morning. Usually she gets that amount 2x per day, but I'm happy she even ate it once. Got her a new brand and type of food and she is ravenously eating currently! I think she doesnt like her old cans anymore, it reminds her of the vomiting, I assume. I gave her some pate of fancy feast and she has been eating for about 10 minutes straight and is making her way through the can! Hopeful this is something to stay, and I can find another low-carb brand of food thats yummy to her as well.

 

Or maybe the old cans are from a "yucky batch". Do the cans have the same batch / lot number printed on them? Sometimes pet food companies change ingredients or the source of ingredients or tweak formulas which then causes tummy issues in some cats.

Glad your cat is eating and keeping it down

 

I have found this to be true as well!

 

I hope she continues to improve!

 

hm. very possible! I get the cans when they go clearance and I buy like 4 boxes of 40 cans at a time. Cans say they're fine before Dec 2025... still not a bad theory. Opened one of these cans once and found mold! Definitely possible. I will be thinking on this!

 

Also! She just finished the entire can of fancy feast!

 

She’s making up for lost time (food.)

 

Definitely true. Started sniffing at the other food from today that she was previously not interested in! Progress!

 

When ours vomits it usually means she is low so I give her two Churu tubes and the vomiting stops right away. If she throws up twice that is when we give her a Churu. Churu has tapioca in it and it will cause BG to spike and get her out of the hypo fast. Plus it is a liquid and get absorb quicker than feeding a high carb food that can take a bit of time to a get into their system. Try that if she does it again. I would get a few tubes and keep on hand just encase. ANd when she is sick like this I have never had her turn her nose up the a Churu like she would with high carb canned food. She devours the tube.

 

I already tried that. Usually that is what works for me when she goes low, and she's happy to enjoy them. I gave her 1 tube the first time she went low, then she went low after throwing up so she got 2 more, then she threw those up a couple hours later.

 

Great news everyone! Ginger is back to ravenously consuming all the food I offer her! She's meowing at me when I take too long, and purring incredibly loud when we snuggle. Last night, she ate a full can of fancy feast which I was happy for. Without realizing it, I left out the other 1 1/2 cans I opened and prepared for her, and I woke up to everything licked clean, and her going back trying to lick the bowls and meowing at me for breakfast. I'm so grateful she's back to her normal energy and appetite levels. Thanks so much for everyone's suggestions! I hope you all have an amazing week

 

Great news! I know you are relieved.

 

Genuinely a relief like you couldnt believe. I keep picking her up and hugging her and kissing her. She's meowing at me and upset with me for bothering her, but I genuinely couldnt care less!