GA Two DKA Episodes in one day, vet says too hard to regulate. HELP

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Update: he's not doing too great. He ain't eat, and his red blood cell count has dropped. The doctor thought that it would pick back up once he was home, but it hasn't. I am so scared. He might need a blood transfusion.
 
Rusty & Smokey said:
Update: he's not doing too great. He ain't eat, and his red blood cell count has dropped. The doctor thought that it would pick back up once he was home, but it hasn't. I am so scared. He might need a blood transfusion.
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Is he still at the vet or home with you now? Sending healing vines to Smokey, I hope they figure out what is going on, he doesn't need a transfusion and he starts eating on his own. :bighug::bighug::bighug::bighug::bighug:
 
Assuming he's still at the vet, the not eating could just be him being depressed/confused at being back there so soon after coming home. Crossing fingers that there's nothing more serious than that going on. :bighug: :bighug: :bighug: :bighug:
 
Update: I just talked to the doctor myself, and she said as soon as she got off the phone with my mom, Smokey started gobbling his food and wandering around his cage! Happy news!

As for the RBC being low, she believes it's due to the pancreatitis, and that his body is most likely just taking a bit to restore the count. If he needs a transfusion, it would just be to help his body jump start the process a bit.

Mom is still a mess, but it's very good news that he's eating now!
 
ask your vet for a prescription for ondansetron when you bring him home again....
many vets aren't knowledgeable about this drug since it is for humans - it was developed for cancer patients who can't eat.
the dosage is a 4 mg pill divided into 4 pieces ( ask the pharmacy for round pills as they are easier to divide)
you can give it up to 3x a day. Most of us do it before breakfast and before pm shot time.

even without an appy stimulant afterwards, it could very well make a Huge difference in him eating.
if they also give you cyproheptadine, you give that 30 minutes after the ondansetron.


I'm glad he ate for now but this sounds like a recurring problem. Nausea can really make them hesitate to eat like you are
describing.

the other thing mentioned in that primer for pancreatitis article is pain management.
ask the vet for something for his pain, something to knock the edge off.....
bupenorphine is the one most of us use. I gave the smallest dose possible.
 
Max had chronic pancreatitis for several years. Ondansetron started immediately when his appetite was off even a little really helped so I second that suggestion. If you can get it today to have on hand. Once you learn his signs and you treat right away you hopefully won’t need to hospitalize often if ever.
 
Update: he's back in DKA, and his blood cell count dropped to 14. We don't know what to do... How could he go back into DKA so quickly? The doctor said if we treat him, he'll be very difficult to regulate.
 
Rusty & Smokey said:
Update: he's back in DKA, and his blood cell count dropped to 14. We don't know what to do... How could he go back into DKA so quickly? The doctor said if we treat him, he'll be very difficult to regulate.
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I'm so sorry, but at least he's at the vet and they can help him. :bighug::bighug::bighug:For what it's worth, there are many cats here that have had one or more DKA episodes and they can be regulated, it does require you testing at home for ketones and being aggressive to keep them at bay, one that I'm aware of even went OTJ @Sandy and Black Kitty
 
Stacy & Asia said:
I'm so sorry, but at least he's at the vet and they can help him. :bighug::bighug::bighug:For what it's worth, there are many cats here that have had one or more DKA episodes and they can be regulated, it does require you testing at home for ketones and being aggressive to keep them at bay, one that I'm aware of even went OTJ @Sandy and Black Kitty
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Have there been kitties who were sent home and got DKA right back?

We really don't want to make The Decision if this can be treated...
 
Rusty & Smokey said:
Have there been kitties who were sent home and got DKA right back?

We really don't want to make The Decision if this can be treated...
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I have no personal DKA experience, but I put the word out to a few people, hopefully will be by soon. Maybe put a 911 up again and something in your title, DKA twice in 2 days, vet says too hard to regulate after treatment or something like that just to get as many eyes as soon as possible.

@Dyana @Jill & Alex (GA) @Meya14 @Kris & Teasel @Tanya and Ducia @Susan&Felix
 
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Rusty & Smokey said:
Update: he's back in DKA, and his blood cell count dropped to 14. We don't know what to do... How could he go back into DKA so quickly? The doctor said if we treat him, he'll be very difficult to regulate.
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Do you know what lab value this is that dropped to 14? Is it hematocrit?
 
My cat had a bout two years ago and spent 3 days in the vet's ER ICU. By the time he was released, his BG was under better (but not great) control, electrolytes were OK and he was eating on his own. He was tired and weak but recovered slowly over a couple of weeks. I wish I had more to offer but I don't. :(:bighug:
 
How severe is the DKA? Are there trace ketones or large ketones? How is the vet testing? If it's a blood test, what are the numbers? My point here is that DKA is on a continuum. It's not like pregnancy (you are or you're not). Cats can be very sensitive to insulin if their numbers have been low the way Smokey's were (i.e., bhe 21). Cats can easily fall back into developing ketones after an episode of DKA especially if they don't have enough insulin or if they aren't eating. Remember, food and insulin are critical to keeping ketones at bay. Over the years, we've seen any number of cats who were hospitalized for DKA and become ketone-prone after that episode.

I'm going to be stern. You will need to keep on top of Smokey's ketones at home. You are also going to need to get religious about home testing. Pre-shot tests will not be enough to keep Smokey safe and out of dangerous territory and to say nothing about saving you a fortune in vet bills. With the number of times Smokey has been through DKA, you have got to become more rigorous about testing if for no other reason than what you've been doing isn't working right now. I've held too many people's hands with DKA kitties to be polite and tell you this will be OK. You will have to work harder to keep your kitty safe.

Find something Smokey will eat. It doesn't matter if it's a hot fudge sundae (well, without the chocolate since that's not good for kitties). Forget about carbs for the moment. Your cat needs to eat. You can feed higher carb food to offset the insulin. Try baby food (Gerber or Beechnut Stage 2 -- no veggies, just a protein and broth and sometimes cornstarch). Many cats find baby food irresistible. It's not a good permanent diet since it doesn't have all the nutrients a cat needs but it's a good temporary option. Liver shakes which sound disgusting can be a great way to get food into a cat. Ask the vet for the kitty equivalent of Ensure and if Smokey isn't eating, ask for a feeding syringe. You may need to learn how to assist feed your cat.

If Smokey is nauseated, which can happen with pancreatitis, the combination of Cerenia and ondansatron can be very helpful, as others have noted. (Ondansatron -- also known as Zofran -- was developed to help cancer patients overcome the nausea associated with chemotherapy. It's a prescription available at any pharmacy. Cerenia is available for pets only.) Once the nausea is better controlled, an appetite stimulant, either mirtazepine or cyproheptadine should get Smokey eating.

Managing DKA is a big job and it's scary. You HAVE to monitor your cat both for ketones and for BG. It is easiest if you can get a meter that measures both BG and ketones -- either a NovaMax or Precision Xtra. Blood ketone testing is much more accurate than urine testing and you don't need to stalk your cat to the litter box. To keep Smokey out of danger you are going to have to work hard.
 
I like Sienne's advice. It is a continuum and this is probably a resurgence of the same episode because he isn't eating well and has had very low BGs. He's in a very vulnerable state right now. He needs carbs to allow enough insulin to be given and buying a blood ketone meter is a really good idea.
 
Hi there :cool:

Rusty & Smokey said:
How could he go back into DKA so quickly?
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It's a delicate balance.

There have been many kitties here that have had DKA more than once my BK was one of them. I also was told many times by his first vet that it was time for the pink shot.

It can be overcome at home however beating back ketone development requires intensive care on the part of the caregiver - no two ways about it. Close monitoring of BG is a must


The recipe for development of ketones (which can quickly escalate to full blown DKA) is:
not enough calories + not enough insulin + infection or some other systemic stress.


So, Smokey needs to consume something along the lines of 1.5 - 2 times the calories he normally does.
Mix as much water into his food as he will tolerate - dehydration happens quickly when ketones are on the scene .
To get those extra calories converted to energy his cells can use requires more insulin.

Restoration before regulation..
First address the ketone development, and when it''s well behind you, then turn your focus to regulation, always with the knowledge that your kitty is ketone prone.








 
Can you get the range your vet is using for the red cell count? If this is RBC (and not hemoglobin or hematocrit), it is not low -- but it depends on whether the 14 is from your vet's in house lab, Idexx or Antech. Every lab has a different reference range for blood values. For example, Antech's range for RBC is 5.92 - 9.93. This would make a 14 a high value and not a low value.
 
Rusty & Smokey said:
Have there been kitties who were sent home and got DKA right back?

We really don't want to make The Decision if this can be treated...
Click to expand...
It can be treated at home.

My Ducia had full blown DKA with Large ketones - we took her home with Trace amounts, far from perfect electrolytes, suspected Pancreatitis, jaundice, low RBC the whole DKA package - 24 hours later and cared for her at home.
She was fit with E-tube - for feeding and the food + hydration+ some meds - was her medicine.
She was also anemic - very low RBC - resolved with food in 4-6 weeks.
Ketones went from Trace to Negative in 3-6 weeks with SubQ fluids+insulin+she was feed via tube well.
Doing fine now.
She had only 1 episode (touching the wood) - 13 months later I still testing for ketones daily.
It was hard but doable - THANK YOU FDMB!

I strongly support Sienne's post #68.
 
We have decided to send Smokey ahead. He is suffering and we just cannot stand seeing him suffer. Even if the DKA is treated, he likely has something else going on with his blood.

The vet said that he probably won't make it. We just can't do it anymore. We can't let him live like this.

I feel like this is all my fault. I reduced his insulin too sharply...
 
Rusty & Smokey said:
We have decided to send Smokey ahead. He is suffering and we just cannot stand seeing him suffer. Even if the DKA is treated, he likely has something else going on with his blood.

The vet said that he probably won't make it. We just can't do it anymore. We can't let him live like this.

I feel like this is all my fault. I reduced his insulin too sharply...
Click to expand...

I'm so sorry, Rusty, please don't blame yourself, it is not an easy disease to manage, double that with DKA and we all do the best we know how for our kitties. :bighug::bighug::bighug::bighug::bighug:
 
Rusty & Smokey said:
Update: he's not doing too great. He ain't eat, and his red blood cell count has dropped. The doctor thought that it would pick back up once he was home, but it hasn't. I am so scared. He might need a blood transfusion.
Click to expand...

You did all the right things, even if you won't right now believe it.

All I have is to wrap you in hugs.
 
I'm so sorry for your loss (((Rusty))) I know how hard it is :(
Rusty will be waiting for you at The Bridge.
Fly Free Smokey :rb_icon:
I will light a candle for you.
 
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