GA Need help with ketones recovery

Sam seems a little off this afternoon. Not bad but kinda lethargic and a little less than normal appetite. She just wants to sit on my lap. She ate her dinner and got her 1.5 units of Prozinc. I have been trying to catch her at the litter box to test for ketones and I can' catch it from her stream.
I dipped the ketone strip in some urine that had not soaked into the litter yet and it read positive for ketones. I tested the stick with just water in the litter to make sure it wasn't the litter giving a false reading.

She isn't showing any sympotoms of DKA just a little off. She seems to be drinking from her fountain normally and peeing twice a day. I did the gum check and pinched her skin to test for dehydration and it seems ok.

Her numbers have not been over 215 for quite some time and usually lower than that. Can she have ketones while eating and getting her normal injection?

 

I have no experience with this but I can tag a few that do....
@Bobbie And Bubba
@Wendy&Neko

 

@Tricia Cinco(GA) & Harvey

 

Thanks

 

@rhiannon and shadow (GA)

 

Yes, they can have ketones while getting insulin and having relatively low numbers. It's not the usual scenario but it happens. There are various levels of ketones indicated on the strip from negative to trace to small and so on. Where did the test result fall? We usually say that anything higher than trace warrants vet attention.

 

I was just about to tag you Kris!

 

The test said "large" which is pretty high. I haven't been able to test her because she always sneaks to the box while I am gone or sleeping. This test was the second time I tried and the first one said trace but I had to dip it into the litter.

She doesn't seem to have any symptoms and is wanting to play now. I called the only emergency vet nearby and they said as long as she isn't showing any signs just wait until tomorrow to bring her in. They have 3 critical cases currently and it would be about a 2 hour wait anyway.

 

Large is a worrying result. They can go from OK to very ill quickly so watch her like a hawk. Get as much water into her as possible even if you have to syringe it in. Feed her small snacks made soupy with added water. I think they're being a little cavalier in telling you to wait until tomorrow. I've been through a bout of DKA with my guy and it developed very fast, resulted in 3 days spent in the vet's ICU and an enormous bill at the end of it all.

 

Yea, I'm not 100% on their suggestion either.

I know humans when doing the keto diet enter ketosis after restricting their carbs aggressively. Is it possible that her diet of just FF Classic chicken being such low carb, she is entering ketosis because of that?

 

No I don't think the food you are feeding would cause the ketones.
I agree that large ketones is very worrying, and I think I would be going to the ER.
Tagging @Meya14

 

How old was the "sample" when you tested it?

The urine needs to be fresh to get an accurate result

 

Question: when you got the "large" result, was it from a strip that was properly dipped into fresh urine and timed for 15 seconds? Timing is important. The strip will continue to darken.

 

I dipped it into urine on top of the litter and it instantly turned dark red and didn't
seem to darken any more.. I wonder if the strips are good. All of them have a light tan color but I thought they were pretty much completely white when I first opened them.

 

Use one on yourself (or a willing volunteer)

 

I tested one of the sticks on myself and it showed negative.

 

Try giving her extra water as I described above. See if you can get another urine ketone test in a few hours.

 

Usually it's not the low carb per-se that causes the ketones with the cats around here, but an overall lack of calories. She may not be intaking enough calories on the FF - which could be why the BS is relatively low yet you are seeing ketones. Increasing amount of food (and sometimes carbs) and increasing insulin to match can help clear the ketones. And add as much water to her diet as she'll tolerate.

However, if she does have large ketones (as opposed to small or trace) and is still eating, go to the vet as early intervention can save a ton of time and $.

 

@Meya14 knows a lot about DKA, so her advice is worth it's weight in gold. The usual recipe for ketones is not enough insulin + not enough calories + some kind of infection. But you don't always know if there is infection. You've gotten good advice. Watch Sam closely, and if you feel like her condition is deteriorating, take her to the ER. Otherwise, call your regular vet in the morning.

 

I took Sam to the vet last night. She did have ketones but the vet on duty seemed like it wasn't alot. I had brought a print out of Sam's spreadsheet and he also thought her numbers were "tolerable" and she was "well regulated". I wasn't too crazy about the vet but it was the only option. They had to sedate her because she won't let them draw blood or anything every time she goes. Her BG was 320 there which I expected with the stress etc. I had tested her about an hour before I brought her and she was at 211 on a human meter. They said her Potassium was low and one other thing I can't remember right now and that her urine was fairly concentrated so she may be a little dehydrated.

They kept her overnight and did the IV with fluids and B12 etc. I got home about 1 am and I'm at work now at 6 am. Hoping she doesn't need to stay more than 24 hours and I can talk to her normal vet there when I pick her up. I asked that they give her only wet food and adminster 1.5 units of Prozinc at 5:30 am. Hopefully all of that takes place.

Thanks to everyone for the help. I knew what I should do once I thought she had ketones just was hoping she didn't have them. lol I will keep everyone updated. I'm curious to see what her liver levels look like also since they were high last time we were there.

 

I'm glad you got her to the vet. Don't mess with ketones. I like Meya14's advice about upping her calories. Something to consider.

Fingers crossed she's much improved later today. Good luck powering through a work day on too little sleep!

 

Thanks for the help and positivity. Sam is eating 2-2.5 cans of FF classic chicken a day. According to their website she should be eating 2.8-3 cans. I know all cats are different but does this seem correct? She lost 3 pounds when she had the episode a few months ago and has stayed at exactly 10 pounds since.

 

Does she generally have a good appetite? Is 10 pounds a good weight for her? Some people have fed canned kitten food to get some weight on their kitty. I think there are versions that aren't too high in carbs. You could post a thread to ask about that.

Maybe an automatic feeder the dispenses small meals multiple times day and night would encourage her to eat more.

 

Yes, she seems to eat the whole can in the morning in 2-3 sittings and the same thing for dinner. 10 pounds seems a little skinny but we have seen her at 13 and obviously overweight for years. lol According to the weight charts I have seen she seems to be a healthy weight which is where you can't see bones but can feel her spine and she looks skinnier from above. I have it in a timed feeder so she can't eat 2 hours before testing since I am not home or sleeping at that time.

 

Hard to say. She might be a kitty that does a little better physiologically on slightly higher carb food and/or with a little extra weight on her. Fat tissue is metabolically very active as you probably know.

 

Sorry I am just now seeing my tag. So glad that you took her to the vet as a precaution. Bubba had moderate ketones back at the end of 2015. I was able to handle it at home by giving lots of water in his food and watching him like a hawk. The ketones came and went and with the help of two moderators here on the board they helped me to knock out the ketones with adding some Novolin R insulin along with his Lantus (this is something you would need help with as R is very powerful and you need to know just how much and timing of it ) My vet said they could do the R at the hospital also but, if I had people that were experienced with it that Bubba would be much less stressed at home and I agreed 100%

Incidentally, Bubba threw ketones in the 200 range as well which is unusual but it happens. He had his teeth clean in Sept of 2015 ( stress) and then his right eye removed in October. I believe all the stress brought on the ketones when a perfect storm was created. Remember , the recipe for developing DKA: is not enough insulin + , in appetence + infection or a systemic stress.

I hope Sam will be able to come home with you today and that you can keep the ketones away. Adding water to his food to keep the ketones flushed is what I did.

 

Thanks for chiming in! I will keep that in mind.

Quick update from the vet: Sam had ketones of 50 as of midnight last night when I brought her in. They are going to test for ketones tomorrow morning and apparently haven't since midnight. Sam won't eat which she normally doesn't want to at the vet so they are giving her Vetsulin now according to her levels. Not sure why they are doing Vetsulin other than because its fast acting? Her levels are 260 which isn't too bad considering the circumstances and the fact that she is stressed. All of the vet techs keep talking about how aggressive she is when she is there.

I told them I would bring her food from home and try to feed her if she doesn't eat all day. Hoping she can come home tomorrow before the bills get astronomical.

 

That was my concern too if Bubba was hospitalized with ketones and not eating. It's a vicious cycle.

Vetsulin is fast acting and shorter action than the Prozinc so perhaps that is why they are opting for that particular insulin so if they have to administer it again before 12 hours .

I hope you get to bring your baby home soon. Keep us posted.

 

Will do!

 

My kitty was hospitalized for 8 and 1/2 days with DKA, way back when. I was too new to feline diabetes then to remember much or ask questions, but I know they could not get him to eat. I kept bringing food and treats and trying to get him to eat for me, but he only ate a couple of treats. I don't know how they got nourishment into him, unless it is all provided via the dextrous drip? Maybe they were assist feeding him. They kept saying he could come home as soon as he started he eating on his own. He would not eat at the vets. So, after 8 and 1/2 days they relented and let him come home with a temporary feeding tube. Which he quickly dispensed with, and ate fine once he was home.
I hope Sam is soon eating and home or home and eating. I'm glad you took him to the vet. Best Of Luck.

 

I'm glad you took Sam in. DKA is nothing to mess with. Cinco nearly died of it, and was so sick the vet wanted to PTA.

I think it's a good idea to try taking food she is familiar with. I hope you did and she ate some.

Sending healing and appy vines.

 

I went visit Sam yesterday afternoon and she is not happy. She kept growling at me and didn't want to come out of the kennel. I was able to get her out and syringe feed her about a 1.5 syringes of FF classic. They are going to check for ketones and run a full lab again this morning and call me. I'm hoping she can have those ketones out so she can come home this afternoon. Not sure how feasible that is if she won't eat on her own. I hope they try to syringe feed her but she doesn't take well to any of the vet techs.

 

Sending good vetty vines and hope she will be able to come home ASAP.

 

I went and syringe fed Sam some higher calorie/higher carb wet food around lunch and my wife did the same about 7 pm. She seemed more alert and was able to come into an exam room with us instead of us having to feed her in the ICU area. The vet thinks she will be clear of ketones today but I'm a little skeptical being she hasn't been eating unless we go syringe feed her. I hope it is the case though. She is clearly ready to come home.

What has me concerned other than the fact that she hasn't been eating for them is they are still giving her 1.5 units of Prozinc twice daily and they haven't been able to get BG levels more than maybe once a day. They are monitoring her for clinical signs of hypo but that worries me. I tested her when I went feed her and she was at 140 which is good but that would of been at +8 if they are sticking to the 5:30 am/pm schedule like I asked. Hoping and praying she can make it home today.

 

Bless her! I am praying for healing for her and hopefully she will get home today or tomorrow.

 

You'll be a bit busy with nursing care when you get her home but there are lots of FDMB folks who have experience with post ketone kitties. The keys are calories, hydration and insulin.

• Calories: you'll need to feed her whatever she'll eat even if it's not low carb. Syringe feeding of plain meat baby food (no seasonings, garlic, etc.) might be the way you'll have to go at the beginning.
• Hydration: syringe water into her and/or add extra to any wet food she'll eat on her own.
• Insulin: she needs a high enough dose to keep ketones at bay and to do that you might need to feed more carbs, certainly more calories. It's possible that spending too much time in flat blue numbers was, for her, too much time being high. Looks like your goal will be more dark green numbers.

 

Update: Vet said she has no ketones all day and can come home tonight. She isn't wanting to eat so they gave her an appetite stimulant. Hoping she can relax back into being home and get back to normal. She is a bit lethargic and out of it. I did check her numbers every time I went feed her at the vet and she was at 140 and 160.

I plan on feeding her extra food an possibly higher carb food for a while. I also plan on adding water to her food every meal and letting her get water from the tub in the morning when she cries for it. lol

I was worried she was hanging around the same numbers for too long and that is why I started upping her dose a little more aggressively. I will continue to monitor her numbers with more food and possible higher calorie content. I'm sure I will be asking for dosing advice the next few days. lol

 

And possibly "higher carb" content to offset the effects of any extra needed insulin given and still keep her in safe numbers. You'll need to test more, too.

 

It sounds like you have a great plan for your home care. Make sure to continue to test for ketones daily for a while. Also, you can ask your vet for an anti-nausea medication, they work a little different than an appetite stimulant.

 

Thanks everyone for the tips and help. I asked them about an anti-nausea medication since she doesn't want to eat. I was hoping she would be ready to eat here at home but she still isn't interested and has been drinking a lot. She seems very lethargic and almost drugged like when she was on pain meds last time. I'm hoping after a good night's rest at home she will start coming around.

Also, her paw where they had the IV seems to be swollen. I'm not sure if its just fluid from the IV? It wasn't like that last time she had an IV.

 

The IV fluids can accumulate in a spot. If her paw isn't too warm or tender, that might be the case. Heat and tenderness signify inflammation and possible infection so keep an eye on it.

Don't wait too long to start syringe feeding if she doesn't start eating on her own. You can either try meat and broth baby food (nothing added like seasonings, onions, etc) or puree some of her regular wet food in a blender with a bit of water. Ketones can return and hepatic lipidosis is another serious complication of not enough food.

 

Her paw looks normal today. Not sure if they just had it wrapped too tight.

Poor girl is just laying around and vomited this morning. I syringe fed her this morning and last night when I brought her home. She isn't interested in food at all. I am still giving the 1.5 units to try and keep the BG down. She does seem to be going up after eating even just about 2 tsp by syringe. It is a more calorie dense and higher carb food. (Hill's A/D).

Should I be aggressive in her dosing and make sure she is only dropping after a shot? Good thing is we will be home the next 3 days so we can monitor her much better than during the week. I just don't want the ketones coming back. She did urinate earlier but I didn't see her go so I couldn't check for ketones.

 

Yes, that happens some times especially that when the bandage wrapped on after the IV catheter is removed is too tight or left on too long. It is sometimes called "big foot". It can also be due to problems when the IV catheter was inserted into the vein and fluid leaked into the surrounding tissue instead of going into the vein.

When did you notice the swelling?
Was it present when you left the vet?
Has the swelling went up? Down? since you noticed it?

 

Her paw is back to normal this morning. Thanks for following up.

 

I'd try to keep the blood sugars in the 100-150 range (for some extra wiggle room) and be somewhat aggressive in the dosing in order to keep the ketones down. Use the food and additional carbs to steer her blood sugars into that range if the insulin is dropping her below that. You'll have to test fairly frequently so you remain safe from hypos.

For food, aim for -at least- a 6oz can per day of a higher calorie food (180-200+ cals per can). If you can get more than that in her, great. Treats are ok too. Dry food ok too if she'll eat that, but then make sure she's getting fluids as well. You can use the insulin to lower numbers if she starts going too high.

Did her potassium level tested when at the vet? This can go low with ketones and extra insulin can lower it as well. Low potassium can increase the fatigue when mildly low and be serious if very low.

Were you able to get an anti-nausea?

Most cats are pretty lethargic and have no appetite at first. You should see improvement in a few days as long as ketones remain low and she remains hydrated. By 2 weeks, most cats are back to their baseline if there isn't any backslides.

 

OK. That's helpful. I will see what I can do.

Food has been an issue. I can barely get her to eat about 2 tsp of Hill's A/D by syringe. I was trying to give her that 3 times a day and my wife said she just threw up the food she syringe fed her.

Her potassium was very low so they gave her a bunch of injections for it while she was there as well as an antibiotic.

They said they didn't see the need for an anti nausea but I figured with all the antibiotics, fluids, and potassium injections on an empty stomach she probably doesn't feel well.

She is VERY lethargic. Just laying down sleeping or with her head down all day. No purring or talking. The only time she moves is if I'm trying to syringe feed her. I am worried about her getting ketones again at this rate.

 

I would insist on anti-nausea if you can. Also, if her potassium was low at the vet, she is going to need home supplementation most likely, especially when being more aggressive with the insulin. Ask your vet - low potassium will hamper recovery. You also need to have the potassium retested probably in about 3 days to make sure levels aren't too high or too low.

For home care you can also use unflavored pedialyte rather than water. It doesn't have enough potassium to increase if low (you still might need supplementation), however it will help prevent them from getting diluted even further. Make sure the pedialyte doesn't have xylitol (artificial sweetener) in it, it's toxic to animals.

 

Thanks for all of the information and ideas. I wife called the vet and they said to bring her back in. I'm just not sure what their plan of action is if I bring her in. Truthfully, I don't think I can swing another $1500 if they want to keep her for two more days

 

Just a quick update: Sam would not eat or drink at home and looked terrible. Tried syringe feeding her food and water and she wanted none of it. Her BG levels stayed pretty low but she started vomitting and looking worse so I took her back to the vet expecting ketones again since she isn't eating.

Different vet looked at her today and agreed with me that she has something else going on and we both thought pancreatitis. I'm kicking myself because I was supposed to ask about that the first day we admitted her and just assumed they were testing for that along with the other full lab workups etc. Turns out she has pancreatitis and that is probably what kicked this whole thing off. I'm pretty frustrated we went 2 days in ICU and over $1,000 for treatment and she wasn't even tested for pancreatitis.

The new vet gave her anti-nausea medicine and paint medicine to hopefully get her eating on her own. She is also starting 2 antibiotics to knock out the pancreatitis and keeping Sam again. We discussed a feeding tube since she never eats at the vet and we agreed to try syringe feeding after he new meds take effect.

They called this morning and said she did not take well to the syringe feeding and was spitting the food out and stressing so the feeding tube is going in. Hoping this will get her on recovery the quickest way possible. Hoping once the pancreatitis is under control everything else will fall into place.

She hasn't been dropping much if any for mid cycle even with an increasing dose. Could the pancreatitis have an effect on that? Pushing her numbers up because of the infection?

 

Pain from pancreatitis can push her numbers up. I'm glad you took her back and she is getting the treatments she needs. Good luck with the feeding tube. They save lives. Blessings and Prayers for Sam to recover quickly and feel better and eat better on her own soon.

 

Don't let the feeding tube scare you. It's less daunting than you might think and can be the key to getting your kitty feeling better and eating on her own. I had a kitty many years ago who had a feeding tube and she coped with it very well.

I agree that a quick test for pancreatitis should top of the list when a diabetic kitty is admitted. There are many people here with a lot of experience who can advise.

 

Very sad news everyone. The way Sam was looking before we brought her in and the look in her eye told me she wasn't going to make it but after an update from the vet saying Sam's feeding tube went well and she was up and given food, I was very optimistic and preparing for her to come home and doing my research on caring for her with a feeding tube.

We got a call Saturday night that Sam went into cardiac arrest and they were able to bring her back but she once again went into cardiac arrest and has passed on. This was very shocking and upsetting since they didn't let us visit her after the feeding tube procedure. It has been a tough weekend and we buried her yesterday afternoon by the house. We are going to miss that furball! She had me wrapped around her paw.

 

I am so sorry for your loss. Fly free Sam and watch over erveryone who loves you.

 

I am so so sorry! It's tough losing our furball. Take care!

 

I am so sorry for your loss. .

 

Oh no! I'm so very sorry you've lost Sam! This is shocking news. We all know how very difficult this is for you.

 

Oh my! I'm so so sorry to hear that this happened. We know how hard it is, but know that you did everything right. Fly free, sweet Sam!

 

I'm so sorry for your loss.

 

So so sorry for your loss.

 

Such sad sad news. You and Sam fought a valiant battle and you did everything possible to give Sam time and quality. Hold close the spedial memoreis to give you some peace and strength at this time.

 

Oh no! I'm so so sorry. You Truly did everything you could. Rip

 

I am so sorry (((((((Hugs))))))

 

Andrew, just reading everything that happened . Very sorry for your loss.
May fond memories of your beloved, Sam, warm your heart always

 

I am so sorry for your loss.

 

I am sorry you had to say good bye to your friend.

 

I am sorry for your loss. You were great kitteh parents and you did everything you could.

Sam was loved, and knew it. May she fly free and land softly at the bridge.