Ketoacidosis

My 3yr old diabetic cat was diagnosed with keotacidosis yesterday. He was just recently diagnosed with diabetes, and we have yet to control it. The vet that we saw yesterday (ours didn’t have an opening) made it sound like even with treatment, prognosis was poor. So after a day of IV fluids and monitoring, we brought him home to spend our last night with him. Then I came to this forum and read so many hopeful posts! Pluto, my kitty, still isn’t eating, but we are admiting him to a 24hr hospital for treatment. Please help! What should I expect?

 

Get him into 24 hour hospital treatment RIGHT NOW!!!!!! If he is not eating, he will worsen rapidly.

My baby had ketoacidosis 5 times over the past year (3 years after his diagnosis of diabetes and trouble getting him regulated) before finally succumbing recently. The 2 events last year he recovered well from. The 3 in rapid succession late last month...sadly no.

Many cats don't make it, true. But IV fluids and brief monitoring is for mild, mild ketones, NOT for full blown ketoacidosis.

Your baby needs 24 hour IV fluids to get his levels back UNTIL he eats on his own. He needs IV insulin and then hourly intra-muscular insulin to get his blood glucose down so the ketosis process can stop. Then he needs continued monitoring to find his right insulin dose.

THEN he can come home and NOT just for one last night.

Your story sounds like where I was 2 weeks ago when we had to make the devastating decision to let our boy go as he just could not fight the recurrent ketones anymore. But you are nowhere near that stage here.

Get him to that hospital. Get insulin into him. Get his PH and electrolytes back to normal. Then go from there.

You are not alone. Many, many kitties recover perfectly fine from this, even despite its seriousness.

 

DKA (diabetic ketoacidosis) is very serious but can be treated. If funds permit the best place for your kitty is in a 24 hour ER clinic with knowledgeable vets and 24/7 care. My kitty had a bout 2 months after his diagnosis and he spent 3 days in the ER ICU and recovered. It took him weeks after coming home to feel normal again.

The ER vets will give fast acting insulin to get his BG down, they'll give fluids to rebalance his electrolytes that get out of kilter with DKA and they'll want to have him eating properly on his own before discharge. You might need to give antinausea and/or appetite stimulant meds when he's back home. I didn't with my kitty. It'll be very expensive - $2K +.

 

Oh, you poor thing! And your poor kitty!

I don't have personal experience with DKA, but here's what I've picked up here:

The "recipe" for ketones is: not enough insulin + not enough food + an infection/inflammation or other "triggering" stress

In the 24hr hospital, they should be treating with fast-acting insulin, fluids to help flush out ketones, and food (assist feeding if necessary). If possible, they should also be trying to figure out what the trigger was and addressing it with antibiotics or other treatment.

This intensive treatment can last several days before the DKA/ketones are resolved. Recovery is possible and we've seen lots and lots of cats do very well after a DKA, but I don't want to sugarcoat things, it's a very very serious condition and not all kitties recover. The prognosis depends in part on how far advanced the DKA is, as well as the overall health of the cat pre-DKA. Not knowing anything about Pluto, I'd hazard a guess that his youth is a very strong point in his favor.

Other folks who have had their kitties go through this (sometimes multiple times) can give you a more detailed view of what to expect at the various stages, including (fingers crossed) home care after getting out of the hospital, this is just the basics.

Hoping for a good outcome for your little boy! Hang in there!

 

Thank you all! He's been admitted to a 24/hr vet hospital and they're treating the DKA aggressively. He's also a little bit jaundice, so they're examining his liver and I'm anxiously awaiting a phone call to see how he is doing. I'm hopeful!

 

Good luck! Praying for Pluto

 

thank you!

 

Cecily. My sprocket had dka also when diagnosed. He almost didnt make it. 8 days in ER hospital. He also had kidney issues as well. Was put on denamarin which is a pill with pill pockets 1xday then usodiol medicine which i got compounded into liquid. He took the denamarin until he figured out the pill pockets had medicine in them. He also took urodiol for about 2 months.
3 years later he is doing good.
When you get him home you will need to learn how to test and change his food to low carb canned good. There are alot of stickies here with great info.

Healing prayers being sent to your baby.
Tell him he is a warrior! He can do it! He is courageous!!!

 

Thank you all! Pluto has been at the 24hr vet since Saturday and he is doing a lot better! They have finally removed his insulin IV and are working on transitioning him back onto his Lantus insulin. I'm praying that his electrolytes and proteins (and everything..i'm still learning what all this entails) remains steady! All of the doctors and vet techs have been raving about how sweet he is. Now that he's feeling better he won't stop purring, head butting, and loving on them! <3

Does anyone have advice on what to expect when I bring him home? I desperately want to avoid this happening again!

 

Awwww! He knows that they're helping him feel better!

I'll let others who have dealt with this themselves give the lowdown on what to expect, but I just wanted to jump in to say, yay!!!!! What a great update!

 

My suggestion would be if you aren't already doing daily bg testing at home you should star. If you want a shopping list we can let you know what to get. Also go to the pharmacy and pick up ketone test strips so you can make sure the ketones aren't coming back.

 

Photo from our visit today!!

A shopping list would be SO incredibly helpful! We are hoping to bring him home tomorrow! We are also closing on a new home and moving this week, so I want to make him as comfortable as possible. I’m afraid to stress him out too much with the move, but then again he has spent 3 days in an ER vet and is doing okay.

 

Wow you do have a lot on your plate.

1. If you have a Walmart nearby, many use the Walmart Relion Micro or confirm meter. You can get a different meter but look for one that only requires a 0.3 size sample

2. Box of 100 extra test strips

3. Box of 26 or 28 gauge lancets (the 30 gauge lancets that come with human meters are too thin)

4. Cotton cosmetic rounds to go behind the ear

5. Neosporin ointment with pain relief

6. Ketone testing strips

7. Fancy feast classic or Friskies pate foods

8. A treat for yourself


I have a video in my signature showing how I test my cat CC at home. Now I use an Alphatrak pet meter, which is most likely the one your vet uses (available on amazon) but most on here use a human meter because the strips are 1/3 the price of the alpha.

 

Sweet photo!

 

Here are some other suggestions for you:

• add extra water to all his wet food meals to hydrate him well and flush out any residual ketones
• ask the ER vet about antinausea and appetite stimulant meds if he's showing the slightest sign of not eating heartily before discharge
• make a plan to test for urine ketones daily for a while
• have a supply of higher carb wet food in case he doesn't eat as much as he should - more carbs mean you can give a full insulin dose.

It can take a while before he's looking and acting more normal. A DKA episode is very hard on him. He'll be vulnerable to developing ketones again quite easily if he goes into a period of vomiting, not wanting to eat, etc. That's why the daily urine ketone test is so important.
Here are some ways to do it:

• put the end of the test strip right in his urine stream as he's peeing
• slip a shallow, long handled spoon under his backside to catch a little pee - you don't need much
• put a double layer of plastic wrap over his favourite part of the litter box and poke some depressions in it too catch pee.

Most test strips have to be dipped and allowed to develop for 15 seconds before viewing the colour change in very good light.

If you get a "trace" reading from a ketone test, call the vet for advice. Anything higher than "trace" ("small" and up) requires immediate vet attention. NOTE: The negative and trace colours on ketone strips are really close so view the strip in bright light.

 

OMG - what a cute photo. You're making us all jealous.

You are getting some great advice from some very experienced people. Home testing is critical to ensure your kitteh stays safe and gets the correct insulin doses.

Leo had DKA twice. Make sure you continue testing for it, since it is a hard beast to conquer.

 

Excellent advice here. Repeated DKA ended up taking my dear baby Dweezil so thank goodness your beautiful fluffy is doing well now. ALWAYS test for ketones.

 

Hi. Glad he is coming home!!
Relion Confirm uses the tiniest amount of blood. I use it too.
Also its good to have famotidine and ondansetron on hand in case he needs them for awhile. I use Famotidine when my boy vomits at all. Ondansetron is antinausea and works fast. I take it myself if needed.
There is also a ketone meter available from ADW Diabetes. Strips are expensive but you only use when needed. It shows if ketones before it hits the urine strips.
All great ideas above. I did those too.
And a spreadsheet to keep tract of it all.
Big hugs!

 

How does one know if their diabetic has Ketones or Ketoacidosis? I don't know what this is. Don't want to take away from the original post either but am curious and want to make sure Oliver doesn't have or get this. I'm thrilled Pluto is doing well!!

 

Ketones will show up in urine once they reach a high enough level. You can test for them as I outlined in my post #15 above. Ketoacidosis is a potentially life threatening complication of diabetes and your kitty would be very ill - extremely lethargic, nauseated, no appetite, etc.

 

Thank you! Ill read the post above for more info. Appreciate it.

 

Some great info from Kris (and others) in these postings. Note that you can get a small plastic bottle of Ketone test strips from Walgreens or a similar pharmacy. They are off the shelf - no prescription. I think they are $11-$13 (in Austin TX).

 

This is a wonderful heart warming story.
I am so pleased that the wonderful gorgeous looking Pluto is doing so much better.