Toonces is Home and, of course more questions

[Janet]

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I just picked Toonces up from the vets. She did have a urinary infection. So she had an antibiotic shot along with iv. She also tested positive for mild ketones in her cbc profile.

Here's my question. At the vet the last meter reading he did was at 11:00 and it was 502. Then he did a blood draw for her profile at 1:00 and it came back at 377. So, when I got her home
at 2:00 I tested her and it was 654..so

11:00 vet's alpha meter 502
1:00 vet's blood draw reading 377
2:00 my alpha meter 654

Isn't that a big discrepancy?

I just have to get her back on her feeding and shot schedule now and see what happens.

 

[Sienne and Gabby (GA)]

That's a huge discrepancy. At the very least, the numbers from the vet's AlphaTrack and his serum chemistry analyzer should be close unless there's some stress-related explanation for the difference. Chances are Toonces numbers are high due to the stress of bringing her back from the vet. Give her a couple of hours to see where her numbers are once she settles down.

What was the injection the vet gave her?

What instructions did the vet give you for managing the ketones? Did he give you fluids and show you how to use them? Was Toonces eating while at the vet? Will she eat for you now? Is she on any meds?

So, here are the basics of dealing with ketones at home:

• Food is a priority. Feed Toonces whatever she will eat. It doesn't matter if she's turning up her nose at her favorite foods. Give her the most carbolicious food she wants and I seriously mean that if the only thing she'll eat is an ice cream sundae, give it to her. Calories are a big issue when it comes to ketones. Hopefully, she'll be happy with her regular food but you never know.
• If she refuses food, you may need to get an appetite stimulant from your vet (i.e., cyproheptadine or mirtazepine). Alternatively, you may need to assist feed (i.e., syringe feed). We can help you with this if it's necessary.
• If she's not eating, does she look nauseated? If so, you may need to get a drug to help with the nausea. Most people here use either Cerenia or ondansatron.
• If numbers are staying high, we can help you learn how to use a bolus insulin (i.e., Humulin R) to help bring numbers down.
• You may need to be more aggressive with Lantus dosing until the numbers start to come down.
• Try to get a ketone test at every single opportunity. Ketones can develop to a critical stage very quickly. You can get a meter that will test for ketones in the blood (vs. the urine ketone strips). The strips are pricey, though -- about $1.00 per strip. They do give a more accurate reading of the ketone levels.
• Add water to whatever food you're giving her. Add as much water as you possibly can. Water helps to flush ketones out of the system.

I know you said you liked your vet and the practice is conveniently located. I was very disappointed that the vet did not run labs the second you brought Toonces through the door. Ketones are dangerous. Not knowing if Toonces was experiencing an episode of DKA with all of the metabolic imbalances that go along with DKA could have put her life in jeopardy. This should not have been an issue with how familiar your vet is with Lantus. It is a matter of knowing whether Toonces needed other supportive therapies (i.e., electrolytes) as part of her treatment. I'm just putting this out there for your consideration. I'd also encourage you to get copies of Toonces lab work. If you look at my spreadsheet, you'll see I have a tab that has all of Gabby's lab work on it. It's a good think to have the labs if ever there's an emergency. We can also help you to understand the lab values.

 

[Janet]

Toonces never did lose her appetite. When I smelled the keystones I called him, he was 3 hrs out of town but had me take her in immediately and his tech put Toonces on an iv with electrolytes. When he got back in town he did an exam and stayed with her until late last night...he never took her off Lantus because the first day her numbers were pretty stable but today they shot up...he had her eating both canned and dry hills WD and as much as she wanted to keep her eating...I attribute that to the high numbers today, but I understand it was what had to be done to keep her eating. She is quite a piggy...to her favor in this situation.

He gave her a shot of convienia...she will have to go back for a urine test to make sure infection has cleared up.

Her numbers were just starting to look like they were improving before this incident so I guess my plan is to stay the course with 4 units tonight and tomorrow.

oh, I forgot to say..I went to Walmart and bought a relion confirm meter...but my brain cannot throw that into the mix right now

 

[Sandy and Black Kitty]

hi Janet

Seinnes recommendations are spot on and all important.
One in particular I want to chime in on:

Try to get a ketone test at every single opportunity. Ketones can develop to a critical stage very quickly.

In one instance, Black Kitty went from, negative ketones to large in exactly 24 hours (testing his urine with Ketostix).
The importance of vigilance can't be overstated.

So happy to hear Toonces has a good appetite and that the infection has been discovered. That right there addresses 2 of the 3 main factors in the ketone equation.

Hang in there!
And continue to hang out here .

 

[Sienne and Gabby (GA)]

Great news on the appetite front. You did phenomenally when you noted the ketones.

Just one thought. Most of us don't let our vets give Convenia. It lasts over 2 weeks. If your cat has an allergic response, there's no way for the drug to wear off quickly. It's primarily used for skin infections. Some vets like it because it's a long lasting injection but the fact that it's long lasting, can be a problem. At this point, Toonces is clearfly fine with it. In the future, you may want to opt for a different antibiotic.

 

[Tara & Buster]

I'm glad Toonces is home and you got some good answers at the vet. I hope she gets over that UTI quickly. Sending some healing & recovery vines your way!