HELP! 18 year old diabetic cat has cold and anemic

So I had to take my 18 year old diabetic kitty Boots back to the vet today because he has a cold and has been having problems breathing out of his nose and wasn't eating - the starting last night, he wasn't drinking. They gave him some fluids and a B12 shot and informed me he's anemic (he was just diagnosed 2 weeks ago being diabetic) and when I took him when he was diagnosed he was dehydrated and this time he's dehydrated. Well his RBC was 25 2 weeks ago and today it's 15. He's concerned about it dropping so much in 2 weeks. Could the infection and dehydration cause his RBC to drop? And considering both times he had blood work he was dehydrated could the RBC be off? I asked the vet and he said it was a possibility but he wouldn't really know unless I got a bone marrow biopsy. I just need some guidance . Update: he's home now and the vet prescribed him Mirtazapine for a appetite stimulant. I gave it to him about 2 hours ago and he still won't eat or drink. I don't know what to do. I'm so worried his RBC is going to go even lower if he doesn't eat - and him not drinking is just as worrisome. I haven't given him any insulin because he's not eating (and hasn't for 48 hours now) and I tried to check his glucose but he fought me and ran and hid. I'm so overwhelmed and at a loss. I'm trying so hard to help him.

 

I am not a expert on RBC but I can offer some things that may help.
First I would not give a appetite stimulate unless I give ondansetron (for nausea) with it--the last thing a cat wants to do is eat if he or she has nausea.
You could still give ondansetron even if the mirtz was already given.

I would also use cyproheptadine in your case instead of mirtz. just because of the history you have shared. If he begins to bounce back I may go to mirtz.
(just my 2 cents)

Many cats have strange reactions to mirtz like yowling and serotonin syndrome (the antidote is cyproheptadine) I do not think mirtz is bad and I have used it but depending on the situation. My 20 year old Rico gets crypro 2x a day.

It is true a cat will not eat if it cannot smell. Warming the food will enhance smell. Often a cat will eat baby food off your finger warmed up (Gerber stage 2 meat only). Also if a stuffy nose is hindering sense of smell you can turn your shower on as hot as it will go and get it steamy and put Boots in the bathroom with the door shut. They also make humidifiers with warm mist and you can use the Vicks stuff that comes with it in it or I use peppermint.

A very warm washrag rung out and rubbed over Boots eyes and face often feels good if sinuses are hurting. (a little pressure on bridge of nose and eyes)

If Boots heart is ok I personally would be giving SQ fluids probably daily until he stayed hydrated for a bit. If he is hiding he sure seems to not feel good.

Fluids can do amazing things to make them feel better but you should talk to your vet to be sure it is ok for Boots to have fluids. I also would syringe feed enough to keep his liver happy. I personally like AD which you get from your vet. It is high calorie and mostly organ meat and syringes easily. Gerber stage 2 meat only is good to syringe too. Chewy has treat sticks called Inaba that Boots may be tempted by.
Whatever you offer for food I would warm and try to get a teeny bit in his mouth so he can taste it and if sniffing bring it right to his nose....Some like to eat off your finger some a spoon some on a plate that is right at his height (I stack paper plates so they don't have to bend down to eat)

If the anemia is severe enough I would think your vet may suggest epogen to help create RBC.
prayers...

 

@Chris & China

 

15 is dangerously low. Do you have most recent labs? My bet is kidney disease and it could be advanced requiring Aranesp or epogen. A transfusion might be necessary. If dehydrated the HCT could even be inflated. If you gave the labs or can get them quickly post here. Look especially at creatinine, bun, and phosphorus.

 

I agree about giving meds for nausea. Also you may need to syringe feed him for a few days to help him get his appetite back. Puree the food with water to make it soupy. Use a syringe with a wide hole for the food to go through. Afterwards leave any extra soupy food out for him to eat if he wants it. You can sprinkle parmasean cheese or freeze dried tuna flakes on top. They are smelly and may attract him to the food.

 

It's complicated what's the vet giving him for the cold? He needs antibiotics for that did the vet mention him having any complications in his lungs because of the cold did he take an X-ray to make sure there is not fluids in his lungs?

If is only the cold besides the antibiotics you could spray his nose with some nasal sea water spray like sterimar that helps them a lot to clear the airways and helps them breath, you just put the diffuser close to his nostril and shoot, do it in each nostril ( you may have to wrap him in a towel or something burrito style for this but is really quick)

I also think he should get some subq fluids at least for a few days to help him with his dehydration, and you will probably need to assist feed him (syringe feed him) because is VERY VERY important that he eats as soon as possible if you want to avoid liver problems there's this recipe that could help of a liver shake for sick cats http://www.felinediabetes.com/FDMB/threads/the-liver-shake-for-sick-cats.30432/ also you could use hill's a/d almost all cats like it neither of this is good for a long period but right now you need to get food into him asap

Did the vet mentioned anything about how are his kidneys?