911 Emergency Ketoacidosis, game over ?

Hi all....

Dont know what to think right now, so sad and angry at the same time. I think I've
been fouled by my vet and victim of his passivity.

This is my second post on the forum, posted this week asking if diabetes in cat was faithless.
I was reassured by many and thanks to all.

Right after the diagnostic came I changed my life beat to wake up at 6, feed, wait 1h, test and
inject, this is back in early March. Two weeks after, I performed a glucose curve (testing every 2h. for 12h.),
numbers were all in the mid 300. I send the results to the vet with no reply. This was with Lantus 100 U/ml, one unit morning .5 12h later. Homeworks were made, switch to diabetic diet, monitoring... Like said in my previous post, I could never reach the Vet, just technician telling me that numbers were normal that it will eventually go down. But they never did, always between 300 - 400.

A second opinion with a vet being more available was required and still, I did my home works and did that.
Urinary infection was detected last week then Small Kitty almost stopped eating and drinking, barely eating and drinking a little drop of water. I started feeding him and it seemed he was in not that bad of a shape.

The vet asked for a Ketone test ASAP two days ago. No matter how hard I was trying, I could not get a single drop of urine. Squeezing a full bladder, massaging.. no avail. so I took the day off today to visit my new vet and the a new diagnostic came by.

KETONE, on the roof, sugar over flood having been to high for too many days. It's now a full scale hospitalization with intravenous water, fast acting insulin; test every 2 h., adjustment and so on... 800 to 1200$ min and at 75% chance the cat would start eating and drinking again.

I will meet the thief lazy vet at 4pm. Not sure of my strategy, might put him the result of his action straight in the face or implore an emergency action with reasonable expense, will see. No matter what, I'm almost sure my budget will not allow any action plan.

Meanwhile the cat seems to be in not of a bad shape, numbers are were encouraging yesterday and this morning. By raising the dose to 1 at the morning and 1 at night blood sugar was getting lower, 300.

Question now is : Is there something that can be done at home, anything ? Will not let this vet kill my cat, if there is no plan the final fate will be done with me holding him in a way that he will not suffer. I know of a place where I go in a small valley where nobody goes (I grew up illicit herb there a few years back there), I'll dig him a nice hole, built a nice cross, puchase concrete and make a tombstone. I'll know he's going to be in a happy place with maybe some trace of weed I had fun enjoying and helping my epilepsy.

Should I prepare this tombstone or something can be done ? No faith but... feeling so sad..

Meanwhile I'll start reading about at home euthanasia

Thanks.

 

Ketoacidosis is serious. HOWEVER we have had members who went through a bad DKA episode (or even two) and their kitties are still doing fine. If your kitty responds well to the ER treatment then you would have to be much more vigelant about testing both glucose and ketones.

Unfortunately the best place for your kitty when in DKA is at the ER being treated with IVs to restore the electrolyte balances and flush out the ketones and fast acting insulins ( with dextrose drips available if the numbers go too low). He needs to be monitored and treated as shown by testing.

Sending prayers that your kitty will be okay. Everything else can wait to be discussed once you kitty is out of danger.

 

Keeping you and your kitty in my prayers.

 

So even if Small Kitty seems to be alright feeding him of food and water manually and whatever fast acting insulin injection and monitoring is impossible ? I'm pretty sure ER cost will be just too much money. Anything I can do at home with small chance of getting out of this ?

 

Trying to treat a DKA kitty at home is very difficult. It can be done but you need to be able to a lot of glucose and ketone testing. Using fast acting insulin at home is NOT recommended since if it drops the numbers too low there is a good chance of your kitty going into hypo which can be just as dangerous.

You mentioned that Small Kitty had a UTI. Is she on antibiotic for it? DKA is most often due to 1. Infection 2. Too high of a glucose 3. Not eating enough . Any of those 3 things or a combination of them can cause DKA

ETA Are you home testing and do you have ketodiastix for testing ketones in the urine?

 

I am so sorry small kitty is in the ER, sending purrs and prayers your way. What you have gone through with the first vet is totally unforgiveable, there is no reason he should have ignored your questions and obvious pleas for help.... i am sorry you have had to deal with this, and wish I had some advice

 

Please don't lose hope, Sébastien: Small Kitty is in the right place to get help now. Once the vets restabilise him there are several treatments to help with nausea and to stimulate Small Kitty's appetite to help him to keep eating when you're able to bring him home again. You'll be able to get help and support here while he's recovering, too.

For a cat in DKA, that's rather an encouraging status update.

Sending prayers and positive, healing thoughts for Small Kitty to feel much better really soon.




Mogs
.

 

I'm not sure whether @Meya14 is checking in regularly now but she helped someone else nurse their DKA kitty back to health at home so I have tagged her hoping she will see this and offer some input and suggestions.

 

QUESTION - is SmallKitty just 'ketonic' or actually 'ketonic AND acidic' (DKA). With lots of work, just ketonic can be handled at home IF you can give subq fluids yourself as well as syringe feed water and food AND test bg's at home often because you're going to have to be sure to push enough insulin and food to give his body energy to fight this. If he's definitely DKA, he does need to be at the vet...

 

Thanks for this precious information Texudo Mom.

1 : Yes, Small Kitty is treated for unitary infection. He's on Clavaseptin 62.5mg antibiotic twice daly.
2 : Yes GL is high but down a bit this morning.
3 : Yes the cat has stopped eating
4 : Yes I have ketone test but has had hard time getting pee this morning. The vet did it in 1 min but said it was very
hard to do (he squeezed the bladder and urine sprayed out).
I tried massaging the bladder and flatting the organ without any result. Worst the cat would not urinate, I was
ready to test but no pee... The litter is ready with senrenrap on top of the litter with little holes.. but no pee...

5 : See next post

 

All I know is that Keto Strick was to the roof, above 160mg dl.
See next post

 

Can you do subq fluids at home? And test every 1-3 hours day and night? Treating at home would be tough unless you have lots of experience. But it is possible.

 

Yes I Will ! I bought the subq kit 30$ at the vet + hoses and syringes. I have the timer set every 3h, no problem.

My problem is that I've a very hard time to let things go, limits are pretty high no matter what.

Hope I'm not only prolonging the pain of Little Kitty, witch BTW, seems not to be that
concern about the situation. He's not the one who will have to wake-up every 3h. tonight

 

Hi there! Sorry to hear about your kitty, and that you both are going through this. DKA is a very serious -acute- issue. Once you get it under control, the cat usually is no worse for the wear and will live a normal life. Its expensive to treat, but if treated properly, it's actually pretty likely that your cat will be fine. That said, home treatment requires almost 24hour care.

Home care consists of:
SubQ fluids per vet recommendation (lactated ringers)
Syringe feeding every 1-2 hours, at least 1-5.5oz can/day
Oral fluids once able to tolerate (can use plain pedialyte)
Supplementation of potassium and other electrolytes based on labs.
Nausea control - anti-nausea medication (cerinia or ondansetron) NOT mirtazapine
4-5+ times a day glucose checks.
adjusting insulin to BS levels (goal is 150-200 - higher than normal for a "buffer")
1-2X per day ketone checks.

You will need to have the vet show you how to do the subQ fluids. You will also need to have the vet draw potassium and electrolyte labs prior to discharge, and probably after about 4-5 days of home care. Low potassium can be fatal and is common in dka. You will have to learn how to syringe feed and be diligent in feeding so that he's able to take in at least 1 large can of food a day. Insulin needs to be increased rather quickly, so lots of blood sugar checks are important.

Most cats with proper intensive care will start to improve in around a week, with the DKA resolving completely in about 2-3 weeks. The sooner your cat starts eating on it's own, the better.

If you have trouble getting urine ketones, there are blood ketone meters available that you use like a glucometer.

Also, what insulin was your cat on initially prior to the DKA?

 

Thank you for chiming in here Meya!

 

Small Kitty has a couple of threads going. On the other thread he was tested for ketones this morning and had only a trace.

http://www.felinediabetes.com/FDMB/threads/never-give-up.157045/#post-1666881

I think this other thread is more up to date.

 

Thanks Mary Ann!