Little DoDo is in the hospital with DKA

Well---

I have not been here in awhile. Things for little DoDo and me had been going pretty good. We had a rough time since his diabetes diagnosis earlier this year-- my grandmother had passed away soon after which was only about 6 months since my grandfather had passed. There has been a lot of family drama, new job stuff.

DoDo had been doing very good with his insulin and BGs. We were getting to 80-100 at his nadir with his AMPS and PMPS in the 200s-250s with Prozinc at just over 2.00 units a day.

This past week was tough on the whole cat family. I had installers in my home from Monday to Wednesday laying down new wood flooring in my downstairs. DoDo didn't seemed to be too stressed although all the cat family definitely was. Some would skip meals although DoDo did not appear to have a wane in appetite. He still gobbled down breakfast and dinner-- as well as his dried salmon treats for blood monitoring.

I went camping on Friday night for the weekend and my mom spoke to me on Saturday morning saying that around 2:00am DoDo strained to poop in the box. He yowled and then went pooping all over her room and dragging his rear. He acted to be in a bit of pain but she thought he was showing signs of constipation. He refused to eat even the kitty crack Hill's A/D (we use this when he goes too low). He began to hide and I told her to not dose him with insulin-- I guess I was just remembering what my vet had said when he was first diagnosed with diabetes that if he doesn't eat do not dose, if he eats 1/2 dose 1/2 etc. I wish I had told her differently. He didn't improve although he was still drinking water and urinating-- and then he did show some signs of interest in a tiny bit of Hill's A/D.

When I got home today, I tried to coax him out to greet me and I definitely decided that he was just way too lethargic and dehydrated looking to be just suffering from constipation (something that when constipated he will have loss of appetite but not look so weak).

I was not surprised when the vet came out and based on his blood tests, she diagnosed him with DKA
Here are the results because who knows if they will ever be helpful to another:

Dehydration: Stated to be 10%
Glucose: 418 mg (this was done at 4:16pm-- he was 286 mg/dl with my Relion meter at 1:00pm)
BUN: 43 mg HIGH
Na: 137 mmol LOW
K+: 4.1 mmol (high normal)
Cl: 118 mmol
TCO2: 8 mmol LOW
Anion gap: 16 mmol
Hct: 42% HIGH
Hb: 14.3 g HIGH
pH: 7.132 LOW
PCO2: 22.1 mm Hg LOW
HCO3: 7.4 mmol LOW
Base Excess: -22 mmol
PCV: 47%
TS: 10.5 lipemic g/dl

I left him with the sheet I had been sleeping with to place in his cage. He did look to be "more" alert and I got him to give me an elevator butt and purr before I left. We are planning (my mom and I) to visit him tonight.

The vet said she thought he was in the middle of severity that she has seen in DKA cases-- not the best, but not the worst.

I have to say-- I wish I had been home to test his ketones in his urine-- something. I think I will be buying the blood ketone tester and strips to have on hand for my mom when I am away. I was so shocked at how fast the DKA developed. He was his normal cheery self on Friday evening at dinner time.

So please keep him in your thoughts.

Sending prayers and purrs that little DoDo will be back to his cheery self shortly.

Mel

Sending prayers for little DoDo, I hope he makes a full recovery and is feeling better very soon.
jeanne

Prayers and healing thought being sent to DoDo.

Thanks everyone. My mom and I just visited our little fellow and he looks so pitiful. They are concentrating on getting him hydrated right now and will then put him on an insulin pump sometime tonight if he is doing better with hydration. So far his lungs and heart sound good. He is not being fed anything right now or offered anything but water.

The vet said that they are also going to check for pancreatitis and will begin to offer him food in the morning when he is not so dehydrated. If they can't get him to eat we may be looking at a feeding tube.

I dropped off another item for him to smell tonight (a pillowcase of mine). He seemed to perk up a little when my mom and I were talking to him. He also stretched out from his meatloaf position which is a plus as he usually never stretches out unless he feels safe and better.

Hopefully no calls tonight from the vet!

Sending healing vibes for Little DoDo....sure hope and pray he feels better soon. Lets hope you caught this early enough that all will be well...... Please keep us posted!

I soo know what you are going though. But I will offer a recomendation. Go with the urine strips there pretty accurate and much much cheeper then the blood meter. I also heard from a few people that the blood meter was not as correct as the pee ones.

I hope he is doing better soon.

woden's mom, thought i'd get a clarification.
are you saying test glucose via urine strips rather than blood in meter?
or are you saying check for ketones via urine instead of blood?

if so, don't think either statement is accurate. best to test via blood, unless the pet owner for some reason is unable to learn to home test blood glucose. if you're talking ketone testing, yes, most of us would have to use urine strips at home and have the ketones tested in the blood at the vet unless we wanted to buy the expensive meter. but the belief is that testing for ketones via blood would be more accurate. some owners whose cats are prone to ketones get the glucometer that can also test blood for ketones, as an extra precaution.

sweetie, i hope DoDo is feeling better soon. (((Hugs)))
if your cat is DKA, he is getting insulin at the hospital, right? normally they'd use a fast-acting insulin as part of DKA treatment.

Blood testing for ketones is both more accurate and more up to date than pee testing. But this is mostly useful when you're already in a dka episode or expecting one. For e most part urine testing is fine.

If the cat is already sick and throwing ketones, blood testing is probably best.

Hi there

So.... DoDo is now getting insulin in the hospital. They have not tried to feed him as of yet as they are doing an ultrasound this morning of the abdomen (they want to confirm pancreatitis and see what else is going on) and they are also doing an EKG on his heart-- he has a small heart murmur.

Other than that they did start the insulin drip this morning-- and they said his glucose levels are coming down nicely. They said he has been drinking water and that he has also did well during the night.

I just woke up myself, I went camping and caught a bug.. ugh..

Visiting hours are from 11-1p and later tonight from 7-9 so my mom and I are going to go when she gets back home and then later tonight too.

Hopefully my little fellow will be more perky today.

FYI-- I intend to buy the Precision Xtra monitor and also more urine strips. It is just very difficult to get him to do the urine strips and I fail pretty miserably with it.

I was told and through research that ketones show in the blood before dumping into the urine. So at that point you may have ketones showing in blood but not quite yet in the urine-- if they are showing more than a trace in urine then you know you have quantity in the blood as well.

The only way we could get a urine sample from Oliver was if we changed the litter out to aquarium gravel and put him alone in a room with it. He would not pee if we were in the same room....

Prayers for little DoDo.

Re: Update on DoDo's DKA

I have another update.

As I write, DoDo is in surgery to place a catheter into his jugular for easier medicating and blood draws. He is also having a feeding tube put into his esophogus. The vet recommended the tube just so when DoDo comes home if he goes back into I refuse to eat mom, then we have a method to get the proper calories and water into him. Hopefully he will be waking up soon and I should get a call to let me know how he did. When I called at 4:30 he was just about to begin the procedure.

Luckily today, his kidney and liver values are normal. His blood pH is above 7.2 and is normal. He still has some ketones in his body so they are still flushing those out. His blood glucose is also coming down. When I visisted him this morning he looked better-- in terms of being hydrated, but he definitely looks depressed and just out of sorts. He perked up slightly when we came and saw him (my mom and I) but not enough to really make me think WOW What a change!!!!

He is vomiting a little and I don’t think they will start to feed him until tonigth when the tube is completely in-- they had to lay off trying to feed him because of the abdominal ultrasound. So far the vet said that his pancreas is not hugely enlarged but it is darker in color and the fat surrounding it is brighter which she says points to showing some of a pancreatis bout.

My mom will be visting him tonight as I will not be able to since I have to work this evening. So I won't be able to see him until tomorrow night-- since I have to go into work tomorrow and visiting hours are 11-1pm and 7-9pm.

They think he may need another 2 or 3 days in the hospital. I also talked with this vet about potentially changing to Lantus-- which is her preference. It just seems like even on Prozinc we battle at times and it doesn't seem like we have gotten really consistent although thankfully it is pretty rare for us to be in the 300s or 400s.. Or *cringe* the 500s. I also just think that there seems to be more experience and support for Lantus on the boards and elsewhere. Anyhoo the vet said we could really look at that once DoDo is stable and recuperating.

*sighs* I am totally getting nervous that it is almost a full hour after I have called and they said he was going into the procedure-- and no call. *lol* they said the surgery would take like less than 10 min.. So now I am thinking.. Omg did they have to do CPR?? Is he okay???

Worried mom here…

Thanks for the update. Purr'n and praying for Little DoDo's recovery.

thanks for the update, and i'm glad you know about ketones in the blood versus urine. was worried that might confuse you.
my cat is on lantus and i find the lantus forum members here very helpful. you might want to read the stickies at the top of the forum when you get a chance to get a better idea of how the insulin works.
so nice to read how you are going all out for your kitty. sending prayers for a quick full recovery soon. (((Hugs)))

Yes meter for blood, and pee strips for ketones(very buisy week around here). I had a ketone meter and it was horribly horribly expensive to operate and I found I got better results with the strips for testing ketones. I am not the only person to note that issue with the home blood ketone tester.
Lucky for me I have a cat that will pee for me on comand >.< And we check his ketones everyday due to his cronic ketone tossing. But go with what you can use.

In anycase now that he has had one episode of DKA you need to be very watchfull for future bouts. It's not uncommen for DKA treatment to take 5 to 8 days or longer in a 24 hour vet.

What type of feeding tube are they putting in? are they planning on sending him home with it?

Did the surgery go ok?

Re: DoDo is doing so much better

So a lot has happened. I had to work a late shift at work since we were implementing a system change at work.

When I saw DoDo on Monday morning, he was pretty much unchanged although obviously more hydrated.

He did go through surgery very well. He had no complications except for his temperature got down to I believe 98 degrees right after but he went back to normal during recovery. The catheter could not be placed in his neck as the vet felt his veins are just too small in that area (he is a small cat and once when he had a urinary blockage they had to use the smallest catheter that they even make to place in his urethra). They opted to put the catheter into a larger leg vein. The feeding tube went in without incident. He came out of recovery pretty slowly but without any issues. He had a little more vomiting, but they did notice that when he urinated he would not just sit there, he actually would now move away from it. One of the nurses even caught him sitting up sometime in the evening. If he stopped vomiting they were going to try to feed him at 1am.
DoDo was able to be fed a little-- he pretty much just licked at some of the food at 1am but he kept it down. His sugars were still in the mid 200s range but his other blood values were very improved.

This morning my mom went to visit him and so in between 830am when I got his evening update call and noon when she saw him-- he had really rebounded. He was allowed to be removed from his IVs and could go into a visiting room with her. She said that he could not be bothered to visit with her and spent most of his time sniffing and exploring everything. He seemed to not be bothered at all by all of his tubes and catheters. She said only later in the visit did he even care to hang out with her! Also, the nurses had said he had eaten all by himself that morning before the visit. She laid him on the little couch with her so he could get some sun and then he just purred and head butted. He tried to meow a few times but was not really successful in doing his usual meow, I think it must have something to do with the post surgery.

I cant wait to go see him tonight! Hopefully he will be able to come home soon. The vet is supposed to call me this early evening to discuss the plan for the next 24 hours.

wonderful update. continued healing vines and hope he dodo comes home soon.looks promising

Great update, Glad tohear that he seems to be getting better and should be coming home fairly soon. Its so scary when they have to be away from us.
Continued healing vibes for little DoDo

Mel

Sure sounds positive..... Please keep us updated!

Positive thought for Dodo

woo hoo! that sounds great!
you can bring a used t-shirt for him (something you don't mind getting lost). your familiar smell could be a comfort to him while he's there.

So---

I visited tonight and he was in the middle of eating some dinner.

I didn't get a chance to talk to the vet today, but the nurse told me the plan for the night was to begin to transition DoDo back to Prozinc versus the short acting insulin.

I found it sad-- there were two other kitties who were in the ICU with DKA. I told the one couple visiting their fur baby about felinediabetes.com.

The other two kitties were hospitalized the day after DoDo so some of them still look pretty sad.

One DVM told me that DoDo definitely perked up when I saw him. We did a lot of head butts and I snapped a few pictures. He tried to meow once but he is pretty hoarse.

he may have meowed a lot there and just lost his voice a little.
seems like he's doing much better. really glad he was eating!
thanks for the update.
i know -- so sad about the DKAs. some don't make it, so it can be so heartbreaking. but many people here's cats had DKA and are thriving now.
hoping dodo does even better and can be back home with you asap once he's more stabilized. right now he's exactly where he needs to be.

Re: All of the well wishes...

Must have worked.

DoDo had the option of coming home tonight, but I figured might as well have DoDo stay one extra night just for extra safety. The vet and nursing team is going to treat him the same way as if he were home. So the charge for the stay will not be so sad.

The vet told me today that DoDo was very fussy with everyone. He mouths a lot! When my mom went to go see him he tried to jump out of the cage-- he really is anxious to get home too.

So tomorrow, I am working from home and will go pick him up when they call-- I can't wait to get him back here and spoil him rotten with hugs and kisses.

The vet and I talked-- I asked if the emergency hospital had regular staff and an internist that I could continue his diabetes treatments with-- his vet (the day vet) said that she does take patients and she will continue to be DoDo's doctor in his diabetes treatments and pancreaticitis flares. I am also excited that she is confident we can begin working on transitioning DoDo to Lantus in the next few weeks.

I am supposed to be working from out of town at the end of this month (in tandem with going to a wedding out of town) but I think I am going to reschedule the work trip until the follow month-- just so I can make sure that he is okay and get him stable.

I can't wait to go visit him tonight again!

Great news :RAHCAT :RAHCAT :RAHCAT So glad he is doing better!

Re: Another update

So... DoDo was doing great tonight-- his BG levels off of the insulin pump not so much.

They are striving to keep him in the 200s... and his PMPS was 546!!!

Of course-- I guess I know why-- they are feeding him Hill's M/D dry. Egads. They had been feeding him wet (it looked like fancy feast flakes) and some Hill's dry and he seems to have preferred the dry so I guess in an effort to encourage him with an appetite they have continued to feed it-- I can understand anything to get him to positively eat on his own. I did read the notes that if he doesn't eat his prescribed calories then he is to get a wet M/D slurry in his feeding tube.

They went off of my prozinc numbers (I do 2.5u BID but he is on a raw diet although i think i am planning on just putting him on a premium canned food so it is easier to communicate with the vets about his nutrional levels) and they had to up it to 3.5 while on the dry. I will see how it goes tonight while he is in their care and then tomorrow I will talk to the vet. I don't mind so much feeding something like Purina DM wet versus Hills M/D, but I wont be feeding any dry food.

He was very fussy tonight--he found the perch in his cage and they told me he loves to spend time up on the perch. I was pleased that the other DKA kitty that was beside him and who I met the parents of-- is doing really well too. I told the family again about the WalMart meter and this site. I hope they come join.

I have to admit-- I am very stressed about his Prozinc numbers-- I am a control freak and it just stresses me out.

here is a pic from tonight-- IVs are out, catheter is not and of course feeding tube is still in him.

Wonderful update...I'm so glad that little DoDo is doing so much better as well as the other DKA kitty next to him. Once you get him home and back on a proper diet his numbers will probably drop rapidly, afterall not only is he getting dry fud right now there is also all the vet stress going on, and missing his beans.

Keeping him in my thoughts and prayers for a complete recovery.

Mel

Re: DoDo is coming home at 11!

So.... I am getting ready (I am working from home today and got a late start with feeding the other kitties, medicating one of my others and then since I was late my nervous kitty threw up his dinner-- so then I had to go back and refeed him.. so I have yet to take a shower) to pick him up at 11.

Hopefully I can go ahead and set up a new appointment to discuss the Lantus transition and get him back on his low carb wet diet.

I can't wait to get that little fellow home!!

Re: DoDo is home!

Well, DoDo is home- and I am home from all of the shopping I had to get done this evening.

I picked up the Precision Xtra meter (I can't find the ketone strips anywhere locally so I will have to wait until they get in), Ketostix, more Relion testing strips, etc.

When I got back from the pharmacy this evening, I thought I would *try* to get DoDo to urinate. I took him to test and then I nuzzled and loved on him and stood him in the litter box-- he decided to urinate!

So I took out the strip and voila! Done.

He had no ketones. Yay!

He has had dinner, I gave him his clavamox through his feeding tube (that thing rocks for that), and rinsed with 10mls of water. He also ate a 1/2 can of Sophisticat. I have to keep an eye on him-- at the vet they wanted to give him 3.00 units and prescribed 3.00 units of Prozinc, but he was also eating more carb heavy foods. So-- I will keep my eyes on him and test again in another hour or so.

Last I looked, he was sacked out on my mom's bed. He seems so exhausted, just utterly spent. Of course I imagine it is a complete difference for him to be back at home-- without being poked at every hour.

Great news.

Yes, he is probably very tired.

Give extra scritches from me and my kitties.

So happy to see your little man is home with his beans. Yeah I bet the poor guy is just worn completely out, but sleep right now is probably the best thing to let his body heal.

Give him a bunch of extra scritches and cuddles from the gang here.

Mel

Re: More updates

Whew---

So last night was tough--we started going down the hypo path which concerned me and when food was not helping to bring him up all that much (plus since he has been home DoDo has decided he likes to save his food and eat throughout the next few hours he decided he was not all that hungry). I rubbed a little Karo in his mouth and then I felt comfortable with where he would end up.

At any rate, I also changed his bandage today and started the process to order 2 kitty kollars in order to help out with his e-tube. The e-tube is a miracle for feeding him his antibiotics and like with his blood checks and insulin shots, he is so patient.

On another note, I have a civvie kitty who is on 30 days supply of antibiotics for a mystery infection. He was a grade 4 heart murmur that he has had for years. Giving him his antibiotics is always stressful even though they are liquid clavamox. He gets 2 ml since he is a big boy. At any rate, he begins to salivate when he seems me coming and then he acts as if he is about to have a heart attack once the medicating is over. It takes him awhile to recover. I was getting so paranoid since he was breathing heavy the past couple of days-- and his breathing rate was around 40-45 breaths per minute. He would eat but not with gusto and I was planning on taking him to the vet if things progressed worse.

However this morning, he had glimmer in his eyes and he was all about eating and being his bossy self. He even came upstairs to sit with me and come and get me when it was time for dinner. So finally it looks like the antibiotics have kicked in after 5 days.

At any rate, I will be going to bed now. I need to call my mom (where DoDo is sleeping with her downstairs) to do another blood check in a couple hours just to make sure we are not going too low.

How exciting that Little DoDo is home. Give him lots of love - I'm sure you have already. Just an FYI, I have the Precision Xtra meter and could not find the ketone strips here in Mpls either. I got mine on ebay - 10 strips for $9. They came sooner than if I had ordered them through my pharmacy.

Pattie

Pattie

I also found some on ebay and in fact the postman dropped off 4 packages today.

I wasn't bidding against you - was I. I am glad you got them already. I do love ebay at times.

Pattie

Nah! I bought them with buy it now.