911 Hospitalized Cat, No Clear Diagnosis (blood in urine, newly diagnosed diabletic)

Thank you in advance for reading my post.



My cat went into the vets office for a routine physical/increased drinking and urination on Wednesday. They ran blood work and sent me home with a urine collection kit.



On Thursday, the called back with his lab results indicating he had diabetes (blood sugar of 500) and scheduled him to come in on Friday to begin insulin and create a glucose curve. I was able to get his urine on Thursday and submit that as well. By Friday morning before his first day of insulin, he appetite began to decrease.



We brought him in on Friday, they did a glucose curve, and monitored his insulin all day. His urine results came back that day as well showing blood in his urine, but there was no evidence of bacteria infection in it. They prescribed Zeniquin. He was not eating at all by friday night so I gave him 1/4 tab of pepcid to see if maybe that would help. It did nothing.



By Saturday morning, he was not eating at all. He began his first dose of Zeniquin and I syringe fed him a little food with the medication. I also gave him some cerenia (anti-nausea cat medication) which did nothing. He was back at the vets on Saturday where they gave him fluids, some vitamins, and an appetite stimulant.



Sunday he is not eating at all, his pupils have become very dialated. I brought him back to the vet, they did an x-ray which showed some constipation but nothing more. They gave him an enema and some pain medication with some sub q fluids. His blood pressure was a bit high, but normal range.



Monday he was taken to a veterinary specialty center, still not eating. His liver numbers from last week shot up almost 100 points (most likely onset of fatty liver from not eating). They took a urine sample, there was still blood in the urine and did an abdominal ultrasound. They ruled out ketoacidosis, pancreatitis, urinary blockages or stones. His liver looked enlarged but nothing super out of the ordinary. They admitted him into the ICU where they began giving him fluids, pain medication, anti nausea medication and pain medication.



As of today nothing has changed. He is still not eating, and they are sending him home with a feeding tube. I am really concerned that they do not have any idea why he stopped eating to begin with, and now he is worse than ever with his liver numbers elevating from the anorexia. His blood glucose has been mostly in the mid to upper 100's since being hospitalized. They told me to stop giving him glucose at home. Prior to hospitalization his glucose had been ~300 checked daily.



If anyone has any ideas or help, it would be appreciated more than you know.



On a side note, he is a male cat, under 10 years, but exact age not known.

 

The test for pancreatitis is not foolproof. He might have it anyway.
Discuss with the vet treating "as if" that were the condition - fluids, opined pain relief, appetites stimulant, anti-nausea meds.

 

Sorry I can't help with any suggestions but I wanted to give you these

 

I am very sorry your kitty is so poorly, and I know how frightening it is when a cat stops eating. A number of years ago, I lost one of my little ones to hepatic lipidosis (vet failure). Last year when Saoirse, my diabetic cat, stopped eating. It turned out to be a severe , and my sugar, Saoirse, had a . My cat stopped eating last year (pancreatitis flare) so I know how very worrying it is. Your cat is very fortunate to have you as his person.

I know that you've had the pancreatitis test come back negative, but I found the information at the following links very helpful for advice on appetite issues. I wonder if they might help you:

IDEXX Pancreatitis Treatment Guidelines (covers symptoms and treatments)

Tanya's Site - Nausea and Appetite Page

Tanya's site focuses on CKD kitties but there is an absolute goldmine of cat health information, symptom checkers, etc. (They also have information on pancreatitis.)

Re nausea, some cats do better when treated with ondansetron. (Cerenia seems to be a better med when vomiting is in play.) I've read here that it may take a few days or so for the ondansetron to build up its effect. It helped my Saoirse fairly quickly.

Things that helped my cat when she was struggling to eat were:

Medical:

* ondansetron for nausea (1-2mg BID - Saoirse weighs approx. 4.5kg/10lbs)
* cyproheptadine for appetite (1/8 of 4g tablet BID - any higher of a dose and it had a sedating/depressing effect)
* famotidine (1/8 20g tablet SID)
* weekly B12 cyanocobalamin injections for 6 weeks, then once a month for maintenance.
* ad hoc small doses of buprenorphine for pain relief.
* Stomorgyl 2 (Flagyl is an alternative - she needed this for diarrhoea - I am not sure whether it may also have had other beneficial GI effects).
*Pro-Kolin kaolin paste with probiotic (for diarrhoea).

Practical / Dietary:

* raising her food and water bowls, and warming her food a little.
* feeding frequent, tiny amounts of plain poached chicken (finely minced) with a little water and some of the poaching broth to keep her hydrated. (Timed feeders invaluable.)
* when she started eating a bit better, Liquivite recovery food helped her (UK product - may be similar products available in the US).

(@phlika29 - Sarah: can you add some of the foods that helped Remi, please?)



Did your vets identify what may have caused the pupil dilation?

I hope that your cat feels better soon and that your veterinary team gets to the root of the inappetence. It's good that they were able to deploy the feeding tube. I feel for you.


Mogs
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Hi,

I'm just checking in to see how your little one is doing, and how you're holding up. When things settle down, it would be very good to get a short update. I hope the little fella is eating a bit for you.

Dealing with pancreatitis can be scary; lonely even. I know from personal experience that a wee bit of support and reassurance can help a lot. We're here if you need us.





Mogs
.

 

So sorry to hear your kitty isn't doing well (what's his name?).

Which appetite stimulant did they give him? Mirtazapine makes a lot of cats go spacey and disoriented. I've had better luck with Cyproheptadine, so if they gave you Mirtazapine maybe ask for Cypro instead.

Cerenia also didn't help my cat. Critter Mom made some good recommendations: ondansetron and famotidine can help with nausea and upset stomachs.

When you have a moment, let us know how it's going. Sending healing vibes for kitty.

 

Thank you all for replying. He is home now, resting with a feeding tube in. He has shown some interest in food, but still eating very little on his own. They are still not sure exactly why he is not eating. His urine culture is negative for bacteria, but there is blood in his urine. Abdominal ultrasound indicated no abnormalities except in his liver which is enlarged. His ALT is slightly elevated, 144, but his other numbers are normal. They are contributing that to fatty liver/ diabetic hepatopathy. I am trying to adjust him onto Lantus, so all of this at the same time is a bit overwhelming. He is on an antibiotic and some pepcid as well. I was told to only give him insulin if his BG was over 300 when I went to feed him and have been testing it at home with my meter. Any advice or tips for newly diagnosed diabetic cats is welcome. This is a lot for me to take in at once!

 

Great that you're testing at home.
Take a look at my signature link Secondary Monitoring Tools.
I disagree about waiting until over 300 mg/dL. The fat breakdown is happening because not enough insulin is available to use the glucose from eaten food.
A small dose - 0.25 to 0.5 units - might slow down the fat breakdown and if you are testing at home, you can keep him safe! Plus, by lowering the glucose level, it may stimulate some hunger and interest in eating on his own.

 

The 300 m/l is with the Alpha Track 2 pet glucose monitor. I see from your notes that this monitor is different than the human glucose monitor. At what blood glucose using the Alpha Track do you consider too high? I gave him 1 cc of Lantus at this level yesterday and his 6 hour point was just under 170. Is this good?

 

On the AlphaTrak, we're looking for good numbers to be between 68 and about 160, so if he's above that, he's "too high"....at about 250 they reach renal threshold where glucose spills over into the urine (depending on what study you're looking at, the renal threshold number really varies)

Most of us here use human meters...mostly because the cost of the AT strips is so insanely high...despite what a lot of vets will tell you, we do very well with them!

Also, I think you mean 1 UNIT, not 1cc and a +6 of 170 is promising. It'll really help for you to start using our spreadsheet to keep track of his numbers. Here are some "Instructions on creating the FDMB spreadsheet"

You need to always test before shooting, and then on the AM cycle get a test somewhere mid-cycle (between +5 and +7) and on the PM cycle at least a "before bed" test to make sure you don't need to set an alarm to get more tests in later. Most cats go lower at night so it's important to know how he's doing before going to bed.

What's your "extra sweet" kitty's name? We'd like to know yours too! We become a big family here, and don't want to keep calling "Hey you!"

Sure hope your kitty is feeling better soon.....tube feeding can really be a lifesaver

 

Thank you for updating us. I am very, very glad to hear your little one is safe home from hospital. Hopefully with a little time we can help you more and you will feel less overwhelmed.


Mogs

 

I'm so sorry your kitty is so sick, but I am so glad he's on the feeding tube and eating some on his own. It is very scary when they stop eating and I am sure you are feeling overwhelmed by all of this. Did your vet give you a treatment plan for what he is calling fatty liver/diabetic hepatopathy?