Tom is DKA

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Tommy2016

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I believe it started yesterday or the day before. I did a urine strip yesterday, dark brown. Took him to the vet yesterday. Vet said to subq ringers lactate, but said no insulin for the rest of the day, really??? I took his BG before the vet, it was 250. He takes Prozinc.

Took Tom home and syringed him food (blended wet food, honey, pedialite) and subQ, and took his BG for the rest of the day, it was 350 by night. I massaged is bladder and got another dark reading on the stick.

This morning at 5am, his BG was about 350, I gave him 1.5 units of prozinc, Tom usually gets 2.5 twice a day, but I wanted to give him more prozinc throughout the day, depending on BG readings. Syringed him, Subq 100Ml and shot of b12 from the vet. 4 hours later, BG is 250, so another round subQ 100ml, 1.5units of prozinc, and syringe fed. 2 hours later, 100ml of subQ. 2 hours later BG is 220, another 1.5units of prozinc, 100ml of Subq. Massaged his bladder, he peed, Keto stick is lighter brown.

Right now, BG is 220. I gave him 1 unit of prozinc, syringe fed him and 100ml of subQ. Tom has now taken twice his normal daily prozinc by now. urine stick is going in the right direction, Tom is lethargic, same as yesterday.

Tonight an hour before bed, if his BG is around 200, I will give him 1.5 unit of prozinc, wait an hour then syringe feed him blended wet food and honey again (since the prozinc is so so slow) and try to take his urine test. Actually I do 100ml of subq an hour before I go to bed, so he'll be ready to pee when I feed him and stick test his urine.

What do you think?

Edit, massaged his bladder and got another stick test 20 minutes after posting the above, it's even a lighter color now, between trace and small about 10mg/ml. But Tom is still very lethargic, I'm assuming that is normal?
 
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If Tom has more than a trace of ketones in his urine you need to take him to either the vet or the ER. I can’t believe the vet sent him home!!
And saying no insulin for the rest of the day is the exact opposite of what Tom needs.
He needs lots of food, insulin, IV fluids, blood tests to see if the electrolytes are out of balance.
Do you have a spreadsheet to share with us?
 
Did the vet say Tom had DKA?
Did he do blood tests?
How much Prozinc are you giving? Are you giving it every 12 hours?
At the moment he needs 1 and a 1/2 times as many calories as he would normally eat.
With ketones or DKA the most important things are food, insulin and fluids.
He is most likely nauseated. Did the vet give you any antinausea medications to give Tom?
Being lethargic when a cat has ketones or DKA is normal but in saying that, that is not a good sign.
I would encourage you to take Tom to the ER for assessment. It sounds as if you are doing a good job with him but DKA is not an illness that can be managed at home. His electrolytes could well be out of balance and they will require the vets to give him supplemts to adjust them.
 
*******How much sub Q fluids are you giving him in 24 hours? You need to be careful you are not overloading him. And you need to make sure the previous subQ fluids have been absorbed before giving him more. From what I can gather reading your post it sounds as if he got at least 400 mls subQFluids in 24 hours which is too much.
 
Hi, No I don't have a spreadsheet. The vet suspected DKA, they did a blood test to see if there is anything else. The problem is, the vet came back and said "we took his blood but then realized we didn't have any blood test kits so were going to try and find some. Take the cat home with subq, 200ml then 100ml, syringe feed, no insulin for the rest of the day". I was told they would call us, but never did. My wife called them twice and never got a call back. They said they would refund the $500 for the blood test if "they couldn't find any" whatever that means. This vet is on emergency basis and also works normal hours, and generally are pretty busy and well known. But I don't know what to think at this point.

Tom usually gets 5 units of prozinc per day, 2.5 morning and 2.5 at night. Today he received about 8 units.

Tom just peed and so I did another urine stick test, it's nearly normal now, just a hair darker then normal. Tomorrow the vet will have normal hours, my wife will call the vet in the morning to see if the blood work came through.

edit, off to bed. BG 220, temp 202.7, syringed fed him a blend of wet, honey and pedalite, gave him 1.5units of prozinc. I'll update in the morning.
 
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Sounds as if the vet is either very disorganised or doesn’t have a clue. Not returning your calls when Tom is possibly in DKA is unforgivable.
I think I would be looking for a new vet if that had happened to me.
But it does sound as if you have managed the situation really well if the ketones are almost back to normal.
If you are having to syringe feed him you will need to get some antinausea medications to help with the nausea. Don’t let them just give you an appetite stimulant. He needs an antinausea med first before getting an appetite stimulant. A good antinausea medication is ondansetron which is better than cerenia for nausea. The vet will need to give you a script for that and then you get it from a human pharmacy.
When managing ketones you need to be feeding 1 and a 1/2 times as many calories as you normally do. And don’t miss any doses of insulin as it is insulin and food that will keep the ketones at bay.
And keep testing for ketones daily once they have gone for several days and then a few times a week to make sure they have definitely gone.
And I would ask the vet if he did manage to get the bloods done, if the white cell count was up. You need to establish if he has an infection which needs treating. Maybe a UTI or his teeth may need checking. Lease let us know how you get on as we are concerned for Tom.

Would you mind taking down the 911 now please that things seem to be improving, thanks :)
 
Hello,
This morning Tom came running down the stairs waiting for his breakfast. I was about to get in the shower so I just told my wife to go ahead and feed him and I'll just do a blood test when I get downstairs. He scarfed down a whole wet patty. BG was 300, I gave him 2 units of prozinc. I'm home today so I will test his pee and BG off and on today. He seems like his usual self, so unless something happens I won't update this thread, but I appreciate everyone's interest and replies.


As to the vet, yes I will have to reconsider this vet, they were the only one open and on emergency walkin, our othr emergency vet said they can't treat DKA, really??? Tom did have DKA years ago which we treated at home, the difference was at that time he was on Vetsulin, so it was easier to figure out the dosage, Prozinc is just so so slow. My wife is so happy Tom is back to his old lazy self and so am I. We have four cats, btw, each has their little quarks, but Tom is our special guy.
 
I am very happy to hear Tom is seeming better. Please continue testing for ketones fir several days to see they have completely gone. If he had twice had DKA he is prone to ketones so you need to keep that in mind any time he seems unwell or not eating well.
And food is very important. Make sure he always eats well. :)
 
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