911 DKA Kasie diagnosed on Wednesday, still in hospital, need advice :(

Hello,

This is my first post on the forum. I'm in the UK. I really need your advice and to hear from you if you've experienced something similar. I don't know what to do! I'm devastated and scared I might lose my baby

On Wednesday morning (25-10-17) around 1am, we noticed our cat Kasie looked very unwell: lethargic, glazed look, off her food and seemed very uncomfortable. We called the emergency vets who told us it wasn't an emergency and could wait till morning. At the time, not knowing any better, we trusted them and took Kasie in as soon as they opened at 9am. Sure enough, it was an emergency, not only was Kasie diagnosed with diabetes but she was in diabetic crisis, which I understand means DKA, and very dehydrated.

They started her on fluids and insulin straight away. By the afternoon, they had brought her glucose levels under control but said other things needed to be sorted. From research I've done online, I assume they were talking about the ketones, though I'm not entirely sure.

Yesterday (Thursday 26-10-17), they called to say she had had a good night, was stable and had started eating, and that we could most likely take her home that day. We were so relieved. We had previously been told they couldn't promise she'd even make it. We thought she was out of the woods and we'd just need to learn to care for a diabetic cat, something which we're more than happy to do as we love her so much!
Unfortunately, shortly before we were due to go and pick her up, they told us they'd rather keep her overnight to continue rehydrating her, and to phone in the morning to arrange a time to pick her up.

When we called this morning (Friday 27-10-17) we were told she had stopped eating again and that they needed to run further tests to figure out whether she has problems with her liver, has Fiv or leukaemia. As far as I know, as it stands right now, they've ruled out leukaemia but haven't found the cause either. They said they're having trouble keeping her hydrated, which worries us greatly. How could this be if her glucose levels are under control? She's been on IV fluids since Wednesday morning. (It's now 9pm Friday in the UK) How long should it take for her to get better on IV fluids?

They're already talking about possibly withdrawing treatment and putting her to sleep and we're so not ready to let her go!! We want to give her every chance we possibly can! I'm very upset and really am at a loss. We didn't even know she had diabetes before all this happened. A lot of information to take in... We don't want to let the vets put her down if there's any chance she can survive and have a decent quality of life.

Will we be able to help Kasie if we decide to bring her home? Or is there no hope of her recovering?
I work from home so caring for her isn't an issue.

I probably have more questions, but can't really think right now. Any help, advice, experience with this would be greatly appreciated. Thank you.

 

DKA is a scary, life threatening illness. I’m so glad you got Kasie in on time! I have no experience with it, so I’ll tag @Meya14 to help you. All I know of DKA is it’s important for kitty to eat, get enough fluids and enough insulin. If she’s not eating, maybe a feeding tube would be an option? To get more eyes on your situation, add DKA to you thread title.

 

Hi!

First

Second - Diabetes is very manageable! Once Kasie is over the DKA episode!

Third - DKA - is very serious as Sharon indicated. I have no experience with it but my understanding is this is not an over night fix either. Fluids are important, getting enough insulin, eating and understanding if there is any underlying infection going on.

I know there have been a few people that have brought their cat home for care and this can be fairly intensive. I hope some experienced members pop in soon. Maybe change your title to include DKA advice needed? And add the blue ?

 

Thank you for your understanding and your prompt, informative replies. Very much appreciated. I've taken your advice and amended the title to include DKA and the blue question mark, to hopefully get more responses. So thanks again.

 

Have they given you any details about her current ketones status? If the ketones are gone and the problems are hydration and not eating, then things get much easier to deal with at home if that's what you are hoping to do. Not easy by any means, but not as difficult as caring for a cat still throwing ketones. I'll just throw out a couple of things that come to my mind hearing this story:

1) Usually with DKA there's some triggering event-- often an infection, but could also just be anything that makes the cat feel unwell (pancreatitis and dental problems are two common triggers). One thing for the vets to be looking for while she's there is any possible trigger-- if there's something going on that isn't being addressed, she's more likely to go back into crisis.

2) Not eating: I agree with the feeding tube suggestion-- in really ill cats, it can literally be a lifesaver. Two caregivers with experience with feeding tubes and/or DKA are @Kris & Teasel and @Tanya and Ducia , so I'm tagging them, too. Another less invasive option is syringe feeding until she gets back on her feet.

3) That said, sometimes cats don't eat at the vets just because they are stressed and uncomfortable in the vet environment. Have you been able to visit? Sometimes stressed cats are more willing to eat at the vets when their owner is there feeding them and comforting them.

I hope there are no other big underlying health issues and that things work out for you and Kasie.

 

My cat had a bout of DKA 2 months after being diagnosed with diabetes. He was in the vet clinic's ER ICU for three days to get fluids, insulin, electrolyte balance under control and to make sure he would eat. He was very ill and I don't think I could have managed his treatment at home.

Many years ago I had a cat who stopped eating and needed a feeding tube for three weeks. I syringed a thin soup of food into the tube multiple times a day until she began to eat on her own. She tolerated the tube very well and it was much less daunting than I had imagined. As you likely know, cats are at risk of developing hepatic lipidosis if they don't eat for more than a couple of days. It's possible your kitty's liver values are showing the start of this.

 

Thanks, Kris. Yes, I hope I didn't paint too rosy a picture above-- no matter what, Kasie is a very very sick kitty. A lot of her prognosis will depend on exactly what is going on with her and if there are other underlying issues. All we can really offer advice on is the diabetes part of the equation, and while diabetes itself is very manageable, DKAs are very very serious.

 

I'm so sorry you're going through this. It is scary. My experience echos what has been said above.

Felix was hospitalized for 5 days with DKA; he was diagnosed with diabetes at that time. I believe 3-7 days hospitalization is typical for DKA. Felix's seemed to come on suddenly, and the hospitalization (fluids, glucose) got his vital signs better pretty quickly but he still had ketones for a few days, and they said his prognosis wasn't better until they got rid of the ketones. Also, it took a while to get him eating on his own, and they couldn't send him home before that. They were probably a few hours from putting in a feeding tube when he did start eating on his own. (I've fed a couple cats via feeding tube in the past; it's really not so bad.) It did help when I took in some food he was used to, including some treats, and hand-fed him. He also ate better when their staff hand-fed him than when they just left him food in a bowl.

A doctor would call at the end of their shift and say Felix might be ready to go home in a few hours, and then the next doctor would want to keep him through their shift. It kept scaring me, thinking there were setbacks, but really they just wanted him as stable as possible: after all the effort and the suffering and the money, you really want them set up for success at home. Basically, Felix did well on their quick-acting insulin, but not on the slow-acting one I'd be using at home; it turned out he needed more than they could get their heads around, like they just couldn't fathom that 2 units of Lantus wasn't enough so they kept retrying 1 unit and then needed several hours to observe. But it was good that they didn't prescribe too much too soon, and we worked our way up gradually.

I don't know what to say about their not being able to keep Kasie hydrated. It does seem, however, if they haven't found the cause that triggered the DKA, that there's every reason to keep up supportive care at the hospital and keep looking for the cause instead of giving up. In Felix, they looked for cancers and liver issues, and finally found mild pancreatitis, which responded well to antibiotics in the hospital (he wasn't sent home with any). Now that I realize how many diabetic cats have pancreatitis issues, I'm surprised they didn't identify that more quickly.

After he got home, Felix improved steadily but very gradually. It took about three months before he really seemed like himself again. If I'd found this website earlier, it probably would've gone more quickly, because I'd have gotten more help learning to get his diabetes regulated. He's still not regulated yet, but he's happy and looks good again and seems to feel good, and it appears that his health will continue to improve.

I'll be thinking of you and Kasie and am wishing for you an outcome at least as successful as Felix's has been.

 

DKA is a very serious illness that can happen with diabetics. It's usually due to not enough insulin to prevent the body from using fat as a fuel source. It can also occur due to not enough food or other stressors like infection. In newly diagnosed diabetic cats, however, the prognosis of DKA is better because usually it's the insulin alone as the cause, and not other illnesses contributing. Once DKA is treated appropriately, and the kitty starts eating many cats recover without any lingering issues.

Home care will include home blood sugar testing and close monitoring/changes as needed of insulin doses. Oral or subQ rehydration which you can be taught to do at home. Feeding (syringe feeding is usually needed at home at least for a few days). Treatment of nausea - DKA causes severe nausea, this is a major barrier to eating. Insist that you get anti-nausea medications when she's sent home.

Ask for recovery high calorie food if they have any at the vet. She will need to be eating at least one 5.5oz can per day, more is better. If she wants dry food, then that's fine to feed as well. Her insulin needs may go up as she starts eating more at home - that is normal and preferred - the extra insulin will help drive out the ketones.

Please find out if they did a test for potassium level before she leaves. Low potassium is common in DKA and can affect that heart.

 

Any update? So sorry your family is going through this

 

Thank you very much for all the information, support and advice. Kasie has now been in hospital for exactly three days. We're expecting a call from the vet any minute now and are hoping to go and visit her today. We'll ask them if we can bring her something that smells like home to hopefully comfort her, as well as some wet food to try and feed her ourselves. Any wet food you recommend? Up until now, we thought dry food was better for cats, so we only gave ours wet food as treats... So would the wet food we occasionally gave her be good enough as she might be more likely to eat it, it being more familiar, or would we need to get her something else due to diabetes? We would have liked to have visited her sooner, but we kept being told she was about to come home, by the time we were told she wasn't ready, it was already night time. Wish we could bring her sister Lexie to visit her as well, (of course we realise this isn't possible), but she's been so stressed since Kasie's been in hospital that she's started taking some of her fur off around her tail. She tends to do that when she's worried

Anyway, we'll be sure to ask everything you've suggested when we visit her later today. I've hardly slept last night, I'm very scared of what they might say, but we're definitely prepared to do all we can at home, even if it's intensive. I'll keep you posted.

 

Please keep us posted! As for food, look for a high calorie food, if you need to syringe feed I think A/D is easy to use. Hopefully others with more experience will chime in.

 

Finally heard from the vet. Kasie has jaundice which means she's got problems with her liver. I don't think her prognosis looks too good
Going to visit her in a few hours.

 

Maybe hepatic lipidosis is from not eating enough? If so, it’s treatable
http://www.pethealthnetwork.com/cat...iver-disease-cats-not-eating-can-quickly-kill

 

My kitty had DKA over a decade ago, so it is hard for me to remember exactly, but I remember his pee was very dark and he had yellow stains all over him. It was about the 3rd day that he was in hospital that I noticed it. He had to be in the hospital for over a week and would not eat at all for the vet. I would visit and bring food, but he only ate a couple bites for me that entire time. They put a feeding tube in, because he had to eat. Cats can not go very long without eating before it affects their liver.
I'm keeping Kasie and you in my prayers.

 

Hopefully this is all related to not eating and just need to get some food on board in a consistent manner to help turn the tide.

Go for a visit and I would take the food she is used as a treat that maybe just inciting enough to get her started. Definitely see about the nausea medications.

I would not give up yet. Go see Kasie, give her some love and see what she tells you.

Jones was not doing good on his last ER visit until I brought my nightshirt for him to sleep on, his own food and I spent 20 minutes with him. The next day he was allowed out of the oxygen cage, he ate on his own and generally started to do better.

ETA: Our thoughts are with you and Kasie.

 

Hello Cindy,

I am so very sorry about the diagnose but wanted to let you know that my cat survived her DKA and although she is still being regulated 7 months later she is doing fine. There is hope.

Great info and advice for you is given above. I wanted to add that Ducia bloodwork and prognosis were not good at all when we picked her up (electrolytes out of balance, low potassium, jaundice, liver problems, suspected pancreatitis, etc.) but she pulled thru. The home care consisted of daily insulin, daily SQ fluids, some meds, and food. The most important was enough food and consistent insulin injections. Whatever the diagnose – the treatment is just about the same.

Ducia was fit with esophageal tube for feeding and I believe it was essential for her recovery - we were hopeless with syringe feeding. I’ll be happy to share any info I have or answer any home care question if you like.

You wrote that the vet wasn’t able to keep her hydrated. There are several things to explain it:

the easy one is that her blood glucose level is very high and sugar in her blood “sucks up” all of the fluids from every cell in the body, it can be fixed with proper insulin dosage;

the easiest one is that (sorry) the vet is not very experienced;

and the most complicated to fix (but doable) is the presence of liver condition called Cushing’s – the organism is unable to keep electrolytes in balance. It can be detected with specific blood test.

When caring for Ducia at home the most invaluable help and tool was posting and communicating via this Board. I was online basically 24/7 seeking dosage advise and her blood glucose level interpretation. I was frequently home testing and did not know what the results meant. I made sure my spread sheet was updated hourly. I was coached thru the entire process by experienced members of the Board (thank you again SO much guys!).

I understand very well how stressed and frightened you are right now. I was devastated… but we made it. Please do not despair. Hang in there and keep us posted. I attach Ducia “before and after” pics to cheer you up – see how miserable she was? And she is just fine now. There is hope.

PS. We are in the US.

 

Thank you so much for your support and encouraging posts. We went to see Kasie this afternoon, stayed with her, stroking and cuddling her for over an hour, telling her how much we love her. It was absolutely heart breaking. I still can't stop crying. I'm so not ready to lose her!!!

We were armed with many questions, based on all your comments above, but unfortunately, as it turns out, she doesn't have diabetes, even though she displays many symptoms of the condition including high ketones! They managed to stabilise her glucose levels on day 1, and these have been stable since without the need for insulin. However, they still can't keep her hydrated despite being on fluids, she has now also developed jaundice and she won't eat at all. We brought her favourite food which she normally goes crazy for, and she literally turned her head away every time we tried to give it to her
Before visiting Kasie, I rubbed her favourite toy against her sister's cheeks, and then brought the toy with us, hoping the smell of her sister, home and us would comfort her when we're away. I really hope it helps her feel better, if only a little bit.

Despite doing many tests, the vets haven't found the cause of her illness. She doesn't have fiv nor leukaemia. She must have some sort of liver or kidney issue, causing the jaundice, but what exactly, no-one knows. The vet suggested referring her for emergency testing to a specialist, which would be able to carry more in depth tests, and hopefully find exactly what is wrong and treat her. However, they said this would cost at least £2000 (approx $2600) which we don't have! They said that without treatment, she will pass away within about a week, maybe less. For this reason, I have created a GoFundMe page. I don't know if I'm allowed to share the link here, but I'm so desperate, and so out of time, that I'm prepared to take the risk. Here's the link if you want to check it out: https://www.gofundme.com/urgent-kasies-lifeline-vet-bill Again, thank you very very much for your kind words and support, and if you can spare a few dollars, we would be ever so grateful. Even though Kasie doesn't have diabetes, I will still keep you updated. Thanks again.
Cindy.

This was Kasie at the vet's today.


This is Kasie and her twin sister Lexie when Kasie was still healthy.

Please help us if you can, by clicking on the link above.
Thank you.

 

Many prayers Cindy, prayers and healing vines for your beautiful girl!
Best of luck with funding!

 

Healing vines for you and your pretty kitteh. I hope she gets better. Sometimes we just have to get them thru the tough spots. I hope they can keep her hydrated. And with luck, maybe she will eat something tomorrow.

 

I'm so sorry she's so sick.

 

Sending prayers for sweet Kasie

 

I'm pretty sure it's okay to post a GoFundMe link, we're all in this together. Money always gets in the way, it's just a fact of life.
I hope Kasie comes home soon. She is obviously loved and cared for. Sending you lots of love and hugs.

 

Thank you all for your kind words and support these past few days. Unfortunately the outcome is not what we hoped for. Kasie passed away this afternoon before we had time to take her to the specialist. Her vet called us to tell us she was dying just as we were making arrangements with the specialists. We managed to get to the hospital before she passed and she spent her last moments surrounded by her family.
We were given plenty of time with her before and after she passed, which I am very thankful for. We eventually agreed to have her put to sleep as she was really struggling to breathe and could no longer lift her head up. There was absolutely no way she could recover from this and we didn't want her to suffer needlessly. To be fair, I think she would have passed naturally within half an hour max. She was so poorly.

Only last week I would have told you she was fit and healthy. I really don't understand what happened.
I miss her so very much already, everything at home reminds me of her. It's so difficult having to do things for one cat, when you should be doing it for two!! Everything and everywhere I look is just a cruel reminder. It really hurts so much!! She was only 9, we should have had a few more years with her yet! I'm a total mess and I really don't know what to do to feel better...

 

I'm so so sorry to hear this. On one hand it's good she didn't suffer long, but it's so hard on us when it's sudden and unexpected. I lost my Zimmy in April, and up until 4 days before his death we thought he was doing great and had years ahead of him... so I know what you're feeling.

 

Kasie was loved and cared for. Many cats never get even a portion of the care you gave her. I am sorry for your loss of your fur-kid.

May she fly free and land safely at the Bridge.

 

I am so sorry. We have had between 5 and 7 cats for the last decade, but whenever we lose one, it still takes a long time to get used to the "count being wrong". It always feels like you are one bowl, or one bed, or one _whatever_ too short. I know exactly how you feel. It just takes time.

The only advice that I can give is to pour your love into Lexie. It will help you, and it is likely also what she will need during this time.

Sending strength to you and your family,
Sandi & Whisper.

 

Sorry to hear about Kasie. Every word you said is how we have felt over and over again, you're not alone. Try and get some sleep, cry your eyes out, remember your friends here and your family there. There is no answer but Kasie really did know you loved her.

 

Thank you so so much for your kind words and support. It really helps hearing your stories and being able to talk about her. Believe me, I loved Kasie very much and I know she loved me too. She didn't like going out much, but whenever I went out to walk the dog, she always wanted to come along. She'd follow me as if I was walking her too! It was like she felt safe going out with me and I'll always treasure that. But god will I also miss it!!

We have been giving Lexie many extra cuddles since this all started. Strangely enough, if she hears any one of us being upset, she'll come over from wherever she is in the house, to jump on our lap and give us a cuddle. She has changed so much over the last week! She's always been cuddly, but never anywhere near as much as this. I believe that just as much as we can see she needs more attention and affection, she can see we need the same too. But this is all bitter sweet though, while it helps to pour our love into her and try to comfort her, just looking at her is a reminder we've just lost her sister, and it really hurts too.

The vet told us that very often the illness has been there for some time, years even, but that the body over compensates until it cannot cope anymore, then it starts shutting down. Maybe she was unwell for a long time and we just didn't know it. We asked if her condition, whatever it was, could be genetic or contagious... He couldn't really tell us, but advised us that the best way to keep Lexie healthy, is to have a complete blood count / test done fairly regularly, to check the function of her organs. That way, if anything was untoward, we'd stand a much better chance of treating it in time. We have decided that this is what we're going to do with money that was kindly donated to us, as unfortunately, we were unable to use it for Kasie's specialist's referral. Her time came too soon.

I really hope this isn't goodbye, but merely, see you later.
I'd like to think we'll be reunited one day.

 

I’m so very sorry to read this. Fly Free Sweet Kasie, Land Softly, you are loved

 

I am soo sorry! Give those extra hugs to her sister. Hugs to you too!

 

I'm so sorry you've lost your precious kitty.

 

I am so sorry that this was the outcome.

 

I was deeply saddened to see this. Sending comfort to you and your family, including your sweet Lexie.