TIFIL DKA advice please

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Re: TIFIL DKA

Isil --

We didn't forget about you and Tifil!! We're trying to get in touch with a few people who are experienced with interpreting lab values. We want to make sure we give you reasonable suggestions that make sense.

We'll be back!!
 
Re: TIFIL DKA

Hello,
It's morning now,
After 2 hours I will shoot and take tıfıl back to the vet...Tıfıl is nor looking good, she is hidding.
Today at the vet I must be sure that he is giving the right ıv fluids...
I feel terrible, it's so bad not to have a vet to depend on :(


Marjorie and Gracie said:
We know she has some of these but how many of the below symptoms does she exhibit? These are all associated with hypokalemia:

twitching, trembling or shaking
weakness and muscle wasting
stilted gait in the front legs
stiff neck or inability to hold up head
hoarseness
increased night time urination
lethargy
trouble breathing
appetite loss
constipation

She is not trembling or shaking but she has weaness, lethargey, appetite loss and constipation (I must say she made her toilet after the ıv fluids.

Occasionally, if the blood is hemolyzed, the potassium can be low. I'm sure it would be difficult to get that info out of the vet but in the US, it usually states on the lab work if the blood was hemolyzed. Cnversely as I said above when we thought the potassium was high, if she is getting lactated ringers IV, then that is supplemented with potassium.
Click to expand...

Today I will want the potassium value from him...


After I leave tıfıl to the vet, I will go to work, I have only 3 lessons today to give, after I'll come back to the vet and ı'll stay next to tıfıl all day...

The vet wanted me to bring her as hungry but I remember that feading was important on DKA, should I feed?
 
Re: TIFIL DKA

i want to make sure people see your answer there in the quote - I missed it at first.

She is not trembling or shaking but she has weaness, lethargey, appetite loss and constipation (I must say she made her toilet after the ıv fluids.
Click to expand...

so you need to know within 2 hours if you can feed her, is that right? just want to make sure we have the information here for when someone gets online. the east coast people have all headed for bed, i think.
 
Re: TIFIL DKA

isil, did the vet say why he didn't want you to feed after midnight tonight? that's usually an instruction that you get if the vet is planning to use an anesthesia, say for a surgery or some kind of invasive medical procedure that would need the cat to be unconscious.

was there any talk of something like that?

or did the vet give any reason for not wanting tifil to eat?
 
Re: TIFIL DKA

Hi Isil

A few people asked me to look at your thread. I think the test results are strange; I'm sure the potassium isn't too low to read because that would cause death. Even cats have such low potassium that they can't raise their own heads, still have a readable potassium. It's weird that the amylase below normal ... I don't know, it's strange. For the blood gas results (HCO2 etc), they are not as valid with blood sample from a vein so these are often all over the place when you use blood from veins.

I do agree that something is going on with your cat. I assume you don't have the option of another vet? If you are in Istanbul, can you take her to the veterinary college for treatment? Wherever you go, I would get some x-rays of her abdomen, or an abdominal ultrasound (sonogram) to make sure there isn't something in her intestines that is causing her to feel poorly and not eat.

It's possible that she's on her way to DKA and she is just a cat who can't tolerate any ketones without feeling poorly. I think that would be a diagnosis you can only make once you have tried to rule out everything else though. If you can get her to the veterinary college or another vet whom you trust, that is best as she may need to be hospitalized to clear her ketones and make sure she's eating.

Please keep us posted.
 
Re: TIFIL DKA

Sending good vet vines, today. You and Tifil will be close in my thoughts all day.
 
Re: TIFIL DKA

Isil:

Jess is a veterinary technician. She is very smart and one of the people we were trying to contact because we were confused by the lab results from your vet. I think Jess' suggestion of seeing if you can get an appointment at the vet school is a good one.
 
Re: TIFIL DKA

Isil, I hope that you can get Tifil to the other vet today. We are thinking of you, sending healing vines to Tifil, and sending you and Tifil lots of strength.

Many hugs,

Ella & Rusty
 
Re: TIFIL DKA

You have the A Team here! I'll just add healing thoughts and positive energy for Tifil's recovery. Hang in there, Isil.
 
Re: TIFIL DKA

Still sending many healing thoughts and snowflakes that Tifil will be ok and you can get her to the veterinary hospital. Keeping you all in our prayers.
 
Re: TIFIL DKA

Hello,
Today was a strange day, I took tıfıl to the vet and I lied about not giving the insulin. Tıfıl started to take ıv fluids with electrolytes in it (it's strange that in the ingredients there isn't potassium). I asked the vet to add potassium in it but he said it isn't necessary :(
Then I went out of the clinic and my father called, he told me that he arranged an apointment with a proffesor at the vet faculty...
we took tıfıl and went to vet faculty...the prof that we met asked me what our story was, I told him that tıfıl was first diagnosed on May with ketoacidosis. He asked "with what", I said ketoacidosis, he asked again with what???? I said diabetic ketoacidosis, he said, I am a surgeon, I can't help you, you must go to bla bla bla :) He called bla bla bla and we went to see him..
He asked me the story, I answered, he said are you a doctor, where do you know all this stuff, I said I love to read, he said, too much reading is not good and added "I don't believe tıfıl is diabetic."..I said, she is, and has been for a long time...
He brought a glucometre and he tested, aaaannnnnndddddd the result was 44
I was on a shock!!!
How can that be,,,
He started to make fun of me on front of his students..."you see, your cat is hypoglysemic NOT hyperglycemic!!!

He said he won't count on the lab results that I had 2 days ago and he will be waiting for me to get a new test tomorrow, annddd he said he doesn't see anything abnormal with the electrolytes levels!

I came home immediately and I tested tıfıl, she was 209...sooo I guess our genius vet took a small amount of blood and got some wrrroonnnggg result OR I guess his glucometre's calibration has gone crazy....

He also said that tıfıl's teeth are not good, but he thinks that this won't effect the BG... :shock:

BLA BLA BLA...another stupid day has passed...I spent my time trying to explain the vet prof. that my cat is really really diabetic and I am not daydreaming!!





I came home, tıfıl was feeling better, I guess the ıv fluids have worked...She ate...she went to sleep....

Mean while, I called my vet Mr.Bla Bla 2, he said " Haven't I told you not to shoot insulin anymore" guess why he said this???? stupid me, by mistake I told him that I shot this morning....He said, he won't continue on giving ıv fluids if I don't obey to what he says...so, I hope my nose won't extend while lying....

I must say, Mr.Bla Bla 1 the vet at the faculty said that tıfıl doesn't need ıv fliuds so this means we ara continuing with Mr.Bla Bla 2.....

Jess & Earl said:
Hi Isil

A few people asked me to look at your thread. I think the test results are strange; I'm sure the potassium isn't too low to read because that would cause death. Even cats have such low potassium that they can't raise their own heads, still have a readable potassium. It's weird that the amylase below normal ... I don't know, it's strange. For the blood gas results (HCO2 etc), they are not as valid with blood sample from a vein so these are often all over the place when you use blood from veins.

I do agree that something is going on with your cat. I assume you don't have the option of another vet? If you are in Istanbul, can you take her to the veterinary college for treatment? Wherever you go, I would get some x-rays of her abdomen, or an abdominal ultrasound (sonogram) to make sure there isn't something in her intestines that is causing her to feel poorly and not eat.

It's possible that she's on her way to DKA and she is just a cat who can't tolerate any ketones without feeling poorly. I think that would be a diagnosis you can only make once you have tried to rule out everything else though. If you can get her to the veterinary college or another vet whom you trust, that is best as she may need to be hospitalized to clear her ketones and make sure she's eating.

Please keep us posted.
Click to expand...

Dear Jess, Thank you for coming and helping us...I went to the faculty today as I mentioned but the result was not good :(
Tomorrow I will go again and I will ask the things that you said and propose for x-ray (which I am sure he is going to get angry) ...

Thanks god tıfıl is eating and today my ketostix came and I will test her urine...
Do you suggest taking somekind of supplement for electrolyds?
 
Re: TIFIL DKA

Please do not give supplements of any kind -- at least not until you know what you are dealing with. Giving things like supplemental potassium could kill your cat. This is why electrolytes, such as potassium, are not in IV solutions. They are added ONLY as needed and are added very slowly. (Potassium, for example, is in balance with sodium. If you give too much of one, the other is effected. They will effect the nervous system and muscle contraction -- like in the heart muscle -- so you have to be very careful.) Many supplements are manufactured or packaged with little regard to product safety. In some cases, you have no idea what's in them. Recently, for example, freeze dried chicken treats from China that were being distributed for animals in the US were found to be contaminated. It's the same for many of the nutritional supplements -- not all of them are made by companies with good product safety regulations. Right now, don't give Tifil anything that could change her lab values.

Also, it's possible that the fluids your usual vet gave lowered Tifil's BG levels. In addition, some cat's BG numbers will go lower when they are stressed. I would print out a copy of your spreadsheet to bring with you if you are going back to the vet at the University. That way he can see what Tifil's numbers have looked like. You might also want to bring your meter so you can compare it with his results. Is he planning on running any lab tests? I would tell the vet that you have very close friends/family in the USA who work with feline diabetics a lot. Just don't tell him your friends are all on the internet!!
 
Re: TIFIL DKA

:) Dear Sienne, taht's a wonderful idea. I can tell him this :)

He is planning to take only two tests which I didn't understand what they are...
Bt the worst part is, he is not planning to give iv fluids, so I must go to my other vet to take it...


I am waiting for tıfıl to go to her litterbox to test for ketons...

Thank you for being there...
 
Re: TIFIL DKA

I hesitate to clutter up your condo with something that is not advice--I know you are trying to work through so much right now. But I just wanted to say that I am so angry at the vets you are dealing with--especially the one who was going to withhold fluids if you gave insulin. How could someone threaten to withhold lifesaving care just out of spite? Makes me so upset.

I guess what I am saying is, I really admire your perseverance and love for your kitty. I don't think I could do all that you have done. Bless you! And I hope Tifil is better soon.
 
Re: TIFIL DKA

If your vet is giving lactated ringers solution (LRS), it does have sodium and potassium in it; I double checked our bags. These, of course, would be in balance in the solutions. If he's giving Normosol, it also has potassium. Both fluids have potassium in the form of potassium chloride. Here is the info on what is in LRS:

One litre of lactated Ringer's solution contains:
130 mEq of sodium ion = 130 mmol/L
109 mEq of chloride ion = 109 mmol/L
28 mEq of lactate = 28 mmol/L
4 mEq of potassium ion = 4 mmol/L
3 mEq of calcium ion = 1.5 mmol/L
Click to expand...

Sienne is correct that you do not want to give any oral supplementation of potassium until we get a reliable reading for potassium and note that it is low (below "4" in US labs) and determine why it is low and if supplementation would be appropriate. As she said, you have to really be careful with the sodium/potassium balance.
 
Re: TIFIL DKA

If your vet is giving lactated ringers solution (LRS), it does have sodium and potassium in it; I double checked our bags. These, of course, would be in balance in the solutions. If he's giving Normosol, it also has potassium. Both fluids have potassium in the form of potassium chloride. Here is the info on what is in LRS:

One litre of lactated Ringer's solution contains:
130 mEq of sodium ion = 130 mmol/L
109 mEq of chloride ion = 109 mmol/L
28 mEq of lactate = 28 mmol/L
4 mEq of potassium ion = 4 mmol/L
3 mEq of calcium ion = 1.5 mmol/L
Click to expand...

Sienne is correct that you do not want to give any oral supplementation of potassium until we get a reliable reading for potassium and note that it is low (below "4" in US labs) and determine why it is low and if supplementation would be appropriate. As she said, you have to really be careful with the sodium/potassium balance.
 
Re: TIFIL DKA

Tomorrow I will look what kind of iv fluids they are giving...today they said that they are adding something inside with minerals and vitamins...
 
Re: TIFIL DKA

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Re: TIFIL DKA

She is sitting on front of the water again :(

Our 6th cycle has finished...
How much should I increase? 0.25 or 0.50?
She looks like she needs more insulin, should I go for 0.5?
 
Re: TIFIL DKA

I think if you change the 911 to a question mark icon, or put "Dose Question" after DKA in the subject line, more people will see your question-
 
Re: TIFIL DKA

How much time do you have before you have to give Tifil her dose? It appears none of the advisors are online.
 
Re: TIFIL DKA

if tifil was given fluids today you might want to hold off on an increase because as you've seen... fluids can sometimes lower BG numbers.

edited to add:
i'm basing my recommendation on the presumption that drop to 44 today *could* have been accurate.
 
Re: TIFIL DKA

It's 11.47 pm here, I will shoot at 10.00 am in the morning...

By the way tıfıl is 324 at +1...she is feeling terrible...
I feel terrible also, tomorrow I must find a way to test tıfıl's potassium...
 
Re: TIFIL DKA

The only way I know to have potassium tested is through blood work.

Also, did you get a ketone reading?

Please be aware that you can give too much fluid. This is called "hypervolemia." It can put a strain on the heart. Fluids are given for medically necessary reasons -- dehydration, ketosis, some kidney issues, etc. It's not something that is routinely done.
 
Re: TIFIL DKA

I waited for tıfıl to go to her litterbox, she didn't so I took her...and sorry to say +++keton :(
what am I going to do
I called my vet, he is still saying that it isn't important, he is saying wait till the morning...should I find a place to give ıv fluids now?

Should I give ıv fluids by myself???
what sgould I do?
she is not eating and she is feeling terrible :(
 
Re: TIFIL DKA

I can find the iv fluid from pharmacy on duty...Tıfıl needs to flush these ketons and I don't have a emergency vet to go to...There are not much in Ankara...
Tıfıl started to lie on the floor (stone). Just like she did when she was first dka... :(
I feel terrible...

Does anybody know how much iv fluids that she has to get for one day?
If she takes the fluids in the vet, do I have to give more fluids during the night at home?
 
Re: TIFIL DKA

Re: TIFIL DKA
by ISIL&TIFIL » Wed Jan 04, 2012 2:44 am

I can find the iv fluid from pharmacy on duty...Tıfıl needs to flush these ketons and I don't have a emergency vet to go to...There are not much in Ankara...
Tıfıl started to lie on the floor (stone). Just like she did when she was first dka... :(
I feel terrible...

Does anybody know how much iv fluids that she has to get for one day?
If she takes the fluids in the vet, do I have to give more fluids during the night at home?
 
Re: TIFIL DKA

Isil, is this test 15 seconds after putting the stick in the urine? My bottle of Keto-Diastix only goes to 160.
 
Re: TIFIL DKA

I have seen subcutaneous fluid doses from 50 ml each day for a 3.5 lb (about 1.5 kg) cat to 100 mL per day for an 8 lb (roughly 3.5-4 kg) cat.

It also may help to add some water to her food, maybe warm it up a bit so it smells good to eat.
 
Re: TIFIL DKA

Yes after 15 minutes....it's Bayer keto-diastix....

What am I going to do, should I give water from her mouth with a syringe?
 
Re: TIFIL DKA

Please do two things: First, check the expiration date on the bottle of Ketostix. Second, test yourself. It's the best way to know if the ketostix are registering properly.

If Tifil is registering large ketones, you cannot treat this at home. Is there an emergency clinic?
 
Re: TIFIL DKA

Those are the same ketones sticks I have. But, the stick is compared to the bottle chart after 15 seconds exactly.
Did you wait 15 minutes?
 
Re: TIFIL DKA

Sorry ı wrote it wrong, yes I waited 15 seconds :(

The expiration date is 06/2013...they are new :(
 
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