911 - DKA?

Hi there. Totally new to the forum and in a bit of distress. My nearly 15 year old lady has been acting a bit off for the past week or so. At first I thought it was a URI, but her symptoms didn't seem to quite match. Minimal food intake, weight loss, very lethargic, strange smelling breath (not acetone or fruity, but not normal for her), not grooming herself, no BMs for 4 days... I contacted a friend who is a vet tech when I first noticed the off behavior (I watched her cat decline and pass before the holidays & was worried that I saw the same signs from mine) to have her come over to check her out for me. She administered subq fluids and Tannin seemed to bounce back a bit, but really only enough to eat a few bites of chicken and get comfortable. My friend wound up taking some blood yesterday and ran it as a courtesy with her vet reading the results - she believes that Tannin may be in DKA and so we have the next available appointment to bring her in to find out for sure. Her blood sugar is elevated, pancreatic enzyme levels are "extremely elevated", her electrolytes are low, and the vet said something about ketones that I didn't fully understand. I've done a ton of reading about feline diabetes and DKA in the past 24 hours, but I am terrified of a few things, the first being that I have no idea if my little poof is going to make it through today; the second is that I'm terrified that I can't afford to save her life. I'm a full-time caretaker for my terminally ill father and I don't have a job with an actual income. I'm using everything I have saved to pay for the testing and hospitalization today, but I don't know if it's enough. Would it be kinder of me to euthanize my best friend, knowing that I likely can't adequately provide a level of care befitting her? I don't want her to suffer (and thankfully if she is, she's suffering sweetly with a constant purr), but I also absolutely don't want to give her up if I don't have to. I want to do what's best for Tannin, whatever that may be, and regardless of how hard it is for me. I guess my question is, is there a good chance that a 15 year old cat could survive DKA with a decent life expectancy or would it be kinder of me to let her pass today? Everything I've read about DKA seems split down the middle with some older cats bouncing back to live perfectly happy lives for years and others passing away days after treatment. Any advice, information, tips, suggestions, or anything really would be greatly appreciated. Thank you so much <3

 

Hi--

I'm so sorry your Tannin is so sick... I don't have any experience with DKA other than knowing of many here on the board whose DKA kitties pulled through, and hearing tales of some who didn't. I can offer a couple of comments and suggestions, though.

For Tannin's prognosis (and cost of treatment), a lot depends on how early you have caught things. It is an excellent sign that Tannin is still willing to eat and perked up upon being given fluids, but a cat with ketones can decline very very quickly. She needs vet evaluation and care ASAP, but in the meantime, the more fluids and food you can get into her, the better. How long until your vet appointment?

With regards to cost, we here can offer a lot of tips for saving money (while not sacrificing quality of care!) on diabetic cats in general, so we can definitely help in the long term. A lot will depend on the vet's evaluation of Tannin's current condition and prognosis, so you may not yet be thinking long term, but if it comes to that if the vet gives you a big price tag for dealing with feline diabetes, please come to us for a second opinion before making any decisions!

Hoping you get some good news from the vet, and that Tannin is feeling better soon!

 

Just adding after re-reading your message: it's not 100% clear from your message that your friend thinks Tannin is in DKA right now, or if she's just likely headed in that direction given the high BG and the lack of eating. I'm crossing everything I've got that it's the second! The sooner she gets to a vet to get fully checked out, the better.

In your original message, you mention constipation and elevated pancreatic enzymes (i.e., possible pancreatitis). Either one can make a cat feel yucky/stop eating/get into further distress, which may be how you got where you are now. The good news is that we also have lots of tips for dealing with those two problems, and if they are not complicated by other major medical issues, they can often be dealt without major vet bills.

 

If your vet gives you a dx of diabetes you can contact Diabetic Cats in Need and see if they can help you with some of the costs. They are a wonderful organisation. There is also the Care Credit option, you can ask your vet about it. Whatever is ailing your kitty is best treated sooner rather than later; if it was my kitty I would push my regular vet for an emergency appointment today. Prayers that your kitty gets well soon!

ETS: Please let us know what your vet says - we will worry!

 

Hi,

I'm sorry to hear that Tannin is throwing ketones and may be in DKA. If Tannin is producing ketones then she needs to see the vet today; it's a medical emergency. If you're not already booked to see the vets today please ring them and ask them to see Tannin as an emergency case today - it's not something that can wait.

A cat can get very, very poorly with DKA but with appropriate treatment and aftercare it can be survivable and, other conditions permitting, it is possible for a recovered cat to have a good life afterwards.

First up, as Lucy suggests above if the vet confirms Tannin is diabetic and needs insulin (which is typically expected if she is throwing ketones) then try applying to Diabetic Cats in Need (DCIN) as soon as possible to see if they might be able to help you with the financial side of things. They are on Facebook and this, I believe, is the email to contact:

amy@dcin.info

Tannin will need food, insulin and IV treatment to rebalance her metabolism. If it is ketosis but not DKA then if the vets can flush the ketones out of Tannin's system and get the right treatments in place quickly then it could prevent her going into DKA. If it is DKA then it may need several days of treatment by the vets. (Note: while it is potentially possible to try to nurse a cat through DKA at home, it is difficult and can be gruelling. If the vet can stabilise Tannin then with the right supportive meds and fluids it is possible to carry on nursing care in the home thereafter; not necessarily that easy but do-able if no other option exists).

Getting Tannin to eat is key and, assuming that her blood glucose levels are off, she will need insulin treatment. Ketones, dehydration and out-of-balance electrolytes will all be making her feel nauseated. Anti-nausea meds and an appetite stimulant can help. NB: An appetite stimulant on its own will not work! Also if Tannin is constipated then that needs to be addressed urgently as the regular anti-nausea meds won't help until things 'get moving' again. The vet will need to make sure there's no obstruction and treat the constipation ASAP if it is present. (Constipation alone can make a cat nauseated and may also cause vomiting.)

A Cerenia injection may help fastest with nausea but ondansetron may be a better med overall; it can take a little time to start helping but the cover from the Cerenia should provide bridging support. (NB: if the vet prescribes ondansetron ask for the generic; the branded version, Zofran, is very expensive.)

Ondansetron can be used in conjuction with appetite stimulant cyproheptadine. (NB: there is another commonly-used appetite stimulant, mirtazapine, but there is a major drug interaction between ondansetron and mirtazapine; if used at the same time it can increase risk of inducing serotonin syndrome.) Cyproheptadine is gentler in action than mirtazapine but it can be given up to three times a day and therefore gives much more control over stimulus than the mirt.

Ondansetron and cyproheptadine are both human medications. If your vet doesn't carry them you should be able to fill a written Rx at a human pharmacy.

Our vet prescribed the following for Saoirse's pancreatitis (dosing for a 10lb cat):

Ondansetron 4mg: 1/4 tablet every 12 hours for mild nausea; 1/2 tablet every 12 hours for more severe nausea.

(The larger dose can make a real difference.)

Cyproheptadine 4mg: 1/8 tablet every 8-12 hours.

If appetite doesn't come back quickly you could ask if Tannin would be a candidate for a temporary feeding tube: they can save lives.

http://catinfo.org/feeding-tubes-for-cats/

Ketosis and DKA are usually the product of three conditions: insufficient food + insufficient insulin + underlying infection/inflammation/systemic stressor.

In addition to the treatments outlined above your vet will need to treat for any underlying condition which may have triggered the ketosis/DKA. If it should prove to be pancreatitis then the anti-nausea and fluid therapies will help with the pancreatitis, too. Pain meds may also be needed (buprenorphine). (NB: buprenorphine and ondansetron can be constipating so ask the vet about managing the side effects.)

Here is a very helpful resource with details of the best anti-nausea, appetite stimulant and pain management treatments for pancreatitis:

https://www.idexx.com/files/small-a...pec-fpl-treatment-for-feline-pancreatitis.pdf

The anti-nausea/appetite meds section is also applicable to management of nausea for ketosis/DKA.

Sending prayers and positive thoughts for Tannin. Please let us know how you get on at the vets.


Mogs
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Other potential sources of financial assistance:

http://www.felinediabetes.com/FDMB/threads/financial-help-links.131190/

You could also try setting up a crowdfunding campaign on the internet.


Mogs
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PS:

I don't know whether this is possible in DKA situations but if pancreatitis is the root problem then an injection of B12 (preferably followed by a full course) can give an inappetent kitty a bit of a boost and it may help with appetite, too. (ETA: a pancreatitis flare can also make a cat very debilitated but again food, hydration and the right supportive meds (and insulin, if indicated) can make a huge difference.)


Mogs
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Thank all of you SO much for your replies - doing a blanket reply rather than respond individually as we're getting closer to her appointment time and I want to make sure we get out the door when we need to. She has an appointment today for 4 - it was the earliest they could see her, though they said if she starts declining to bring her in ASAP, so thankfully not too much longer to wait. The vet who analyzed the blood results was concerned that it was DKA or pancreatic failure, but leaning towards DKA based on the ketones and blood sugar level. I'll be sure to come back and update as soon as we know more, crossing my fingers that she pulls through and I can figure out the next steps. Thank you all so much for the incredibly helpful links - if she pulls through, I'll try for financial assistance.

 

BTW if the vet thinks chronic pancreatitis might be an underlying issue then that, too, can be managed going forward with the right supportive meds (typically ongoing anti-nausea treatment, B12, sometimes pain meds and fluids if there's another flare).

FYI: If SNAP fPL test is available at your vets it should give a yes/no 'on the spot' indication of likelihood that the pancreas is inflamed. Spec fPL test gives a numeric result but it needs to be sent to an external lab and results may take a couple of days.

Sending more prayers and positive thoughts for Tannin.


Mogs
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NB - it may be necessary to assist feed to get some food into Tannin while waiting for the effects of supportive meds to kick in. It's critical to get enough calories on board. IAMS Max Cal is a calorie-dense food (given that appetite is poor then the more calories packed into the volume of food Tannin gets down the better - but if push comes to shove anything she will eat is the 'right' food right now). Your vet may also be able to provide/recommend a suitable calorie-dense food.


Mogs
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I'm so glad you got her in at the vet's today, instead of waiting for tomorrow! Praying all goes well. Let us know.

 

Thank you all so much for the advice, links, and well wishes. It was invaluable information and I greatly appreciate it. Unfortunately it wound up being pancreatic cancer and there wasn't anything that the vet could do for her. We put her to sleep a little over an hour ago and I'm beside myself, but I feel that we made the right choice for her. She wasn't in pain and she passed with us by her side, so I can try and take some comfort in that, I suppose.

 

So sorry.

 

Oh, I am so sorry to hear that! I know how heartbreaking it is. Cherish all your memories of her and she will live in your heart until the day you are reunited at The Rainbow Bridge.

Fly free, beloved Tannin, safe travels to your new life at the Bridge

 

Oh, I am so, so, sorry. I'm glad that her passing was peaceful and with those who loved and cared for her so deeply. You gave her the final gift of your love for her, there was no more that you could do.

 

I'm so very sorry for your loss.

Fly free, sweet Tannin ...



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Oh no... I am so very sorry. You obviously loved her so very much, and you should be at peace knowing that you made the right decision for your little poof

The bridge has a new little angel tonight. She'll have plenty of company to show her the ropes.

Sandi.

 

I'm so sorry you lost your beloved kitty.

 

Thinking of you ...




Mogs
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So sorry for your loss

 

First I'd to says that I'm very sorry for what happen,

If this can be ''reassuring'', no to find better word, the symptoms you were describing
are very suffering to a kitty. Mine went through a DKA and it was a pain to look at him.
After 2 days he turned into a walking skeleton, stopped eating, drinking and was, I was
sure to be given his final dose. It proved to be DKA and I saved him but barely. ER was
not a possibility due to financial limitation. Had to do the impossible to save him but
it was no small task with no warranty of success.

Once you recover from the pain of loosing your furry friend you might want to read the
help we got from the forum on the link in my signature. Small Kitty was recoverable,
but with lots of suffering. Unfortunately yours wasn't but there was no suffering.

There is time where crossing the bridge is better then extreme pain.
You made the right choice.

Sorry for this sad ending.
.

 

So sorry for your loss.