Update- Back home again- HELP 1/5/21 Moo Moo won't eat, getting a lot worse

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phakewishard

phakewishard

Member Since 2020
Moo Moo isn't doing very well. I had to take her to the emergency vet Sunday, they said she had went into ketoacidosis. They kept her overnight, and now she's back home.

She won't even eat her treats, she's become so lethargic and I am very scared. Just before Christmas and a little after she was eating very well. She was prescribed (by a vet I don't normally see) amoxicillin and potassium clauvanate on the 29th (the vet had said it could be a herpes flare up, an eye infection, or a root tip infection, but didn't specify which one), could that be whats making her not eat? She didn't get it when at the emergency vet for 24 hours, and from how they sounded she was eating and drinking and doing well. Now she's home, and she did really well for the first couple hours Monday, and then got progressively worse again (I had given her the antibiotics when she got home). She hasn't been eating except what I hand feed her a couple times a day (she refuses any more than that), and her blood sugar numbers have been so low that I can't give her her insulin because of it.

In a previous post, I talked about how I was frustrated with the vet that prescribed her the antibiotic, and now I'm scared it's done some real damage. Please help, I haven't given her today's dose of antibiotics because I don't want her to get worse. I'm seeing her regular vet tomorrow for a follow up from going to the emergency vet, will that be too late?
 
Co-amoxiclav antibiotics can make a cat feel really nauseated. I had similar problems re inappetence with my civvie, Lúnasa, last year. I had to give her ondansetron twice a day while she was on that antibiotic and it helped a lot but she needed a fair amount of encouragement at times to get enough food down her every day (2 x 4-week courses).

With Moo Moo being lethargic, not eating, not getting insulin and having some form of infection/inflammation ongoing that's ticking every single box for DKA risk.

With those clinical signs I strongly recommend getting Moo Moo back to a vet as a matter of urgency. (DKA, while treatable, is a life-threatening complication of diabetes and both moderate/severe ketosis and DKA are medical emergencies.) Would your normal vet be able to see her as an emergency case today? If not, then you'd need to find someone capable of treating ketosis/DKA to see her as soon as possible today.


Mogs
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Pookie said:
Isn't that Clavamox?
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Correct. It goes by different brand names (e.g. Kesium tablets in the UK). 'Co-amoxyclav' is a catch-all description for this type of antibiotic formulation. And yes, it's an absolute pig of an oral treatment.


Mogs
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@phakewishard -

When at the vets, I suggest asking then whether they can give an injectable antibiotic. IIRC, there is an injectable co-amoxyclav product available. Each injected dose lasts 3 days. It might mean a few extra trips to the vets for the injections till the course is completed but it would be less likely to cause GI upset. Saoirse did better on the jabs than on the pills.

Also, when Moo Moo's ready to come home again, I'd strongly recommend pushing the vet to prescribe anti-nausea tablets that you can give at home if needed in order to help Moo Moo get enough food and insulin, thus preventing another relapse.


Mogs
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I agree with Mogs, you may need help to get the ketones under control and likely get the electrolytes back into balance, and certainly the fact that Moo Moo isn't eating can add complications to the situation.

I'd also suggest picking up some Ketostix from the pharmacy if you can, especially with history of DKA, you want to be able to monitor for ketones regularly.
 
I have been checking her ketones and everytime it says none, but that's obviously not the case if the emergency vet said she went into ketoacidosis. She's drinking water now, but she still won't eat.
 
Also, while at the emergency vet they gave her Intefferon and hyaluronidase, as well as b12 and a saline solution iv to get her blood pressure up. When she came in, her blood pressure was so low they couldn't get any blood to get a blood sugar reading.
 
phakewishard said:
I have been checking her ketones and everytime it says none, but that's obviously not the case if the emergency vet said she went into ketoacidosis.
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From my reading I understand that beta-hydroxybutyrate is the ketone body which has greatest involvement in DKA, but apparently some urine ketone test strips don't detect it. From this article:

Most urine testing kits detect aceto-acetate, not the predominant ketone beta-hydroxybutyrate. It is possible for the test to be negative with high levels of beta-hydroxybutyrate and then, as ketoacidosis improves and ketone levels fall, the urine test becomes positive (to aceto-acetate).​

According to the above, it's possible to have high blood beta ketones but to get a 'false negative' urine ketone test. (Another tick in the 'Pros' column for investing in a blood ketone meter.)


Mogs
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phakewishard said:
@Critter Mom They have an opening at 11am (2.5 hours from now). Should I give her antibiotic this morning or skip it?
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I'm very glad that you've secured an appointment with them. For the sake of the couple of hours before you see them, I'd suggest skipping the antibiotic dose for now and ask them about it. With covid restrictions I'm assuming that you won't be able to go into the vet's office, so I'd suggest writing down brief notes and any questions you have (including a note that you've skipped the antibiotic dose this morning and requesting advice on what to do next). You could then hand the note to the staff member who comes to pick up Moo Moo. Less chance of things being miscommunicated, more chance of answers. (Keep a copy of the notes for yourself too!)


Mogs
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@Critter Mom I'm one step ahead of you, I have a whole binder dedicated to Moo Moo that I'm planning on bringing with all of her info in it. The last time, Dr. B didn't like that I was measuring her blood sugar but my normal vet Dr G gave me pamphlets that talked about home monitoring. I hope I get to see Dr. G, but I don't know if I will have a choice.
 
To complement Christie's helpful tip list, here's another one from Tanya's Site:

Persuading your cat to eat

With mild nausea, one of the simplest things to try is elevating food and water bowls by a couple of inches. (Stick a couple of paperbacks or similar under them.) With the antibiotics in the mix for Moo Moo, however, I think you're gonna need to break out the 'pharmaceutical big guns' for the time being.

While you're out and about, it might be an idea to pick up some cat-safe baby food (meat and broth; no onions, garlic, chives). There's a list of suggested products in the link above. Many cats will take a little of that even when they won't touch any of their regular foods.


Mogs
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Moo Moo's food and water bowls are already elevated because was nauseous before diagnosis, and I thought it would help. It did, but now I can't raise them any more to help again. I wrote down her BG readings for the past week (I don't have a printer to print out the spreadsheet) and put it in her binder. I'm about to make the note about the antibiotic, and then hunt in my kitchen for something that she will eat. I finally got her to eat one of her old treats, even though it's higher in carbs, she then ate some freeze dried chicken to go along with it. I didn't want to give her the high carb treat, but at least she did eat a couple calories worth of food.
 
If ketones are suspected, all calories are good calories. (((Moo Moo))) Feeding little and often can help too.

Be sure to let us know how you get on at the vets.

:bighug:


Mogs
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@Critter Mom @Christie & Maverick
It was Dr. B, but he had a completely different attitude this time. They're keeping her until 5pm, when the office closes. He showed me the blood work and the BUN was so high the machine wouldn't read it. He said that her results show her kidneys are shutting down. He said that she's in critical condition and that it could go either way very fast.
If she makes it through this afternoon, I will take her home tonight and then tomorrow morning bring her back.
 
My recollection is that with in-house tests they can't measure BUN past 130, so I'd park that concern for the time being. Did they mention what the creatinine value was? It can happen that when both BUN and creatinine are suddenly elevated, that may indicate a kidney infection or some other acute issue. I'd be curious too about the electrolytes, can you see what those values are? If Moo Moo is in ketoacidosis, that can also affect BUN and creatinine levels. I'd ask what those electrolyte levels look like (I.e. Potassium, sodium, chlorides) as well as phosphorus levels. Can you ask for a copy of the blood tests and urinalysis? I wouldn't necessarily say kidneys are shutting down, just based on high BUN alone. Sending lots of positive vines and thoughts.
 
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He showed me the blood work, but I didn't really look at the other values in the moment. I believe phosphorus was high and so was creatine. I didn't see sodium chloride, but I assume it was high because she was on a saline IV sunday night into monday morning. I will get a copy of the blood work when I pick her up this afternoon. I think they ran a urinanalysis as well, which I will get a copy of. Sorry for the late reply, I've just been processing all of this information.
 
(((Moo Moo and her human)))

(I'm sorry, I don't know your name. :oops:)

Did the vet say anything about Moo Moo's hydration status? Dehydration can impact labs too.

Sending prayers and positive vibes for your little one and some :bighug::bighug::bighug: for you.


Mogs
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My name is Sydney, no worries on that. She had been drinking water through the night and this morning, but they're still giving her an IV right now to help. So, I assume she was dehydrated even though she was drinking water.
 
I know you are overwhelmed right now, I remember that feeling all too well, staring blindly at the labs and thinking what in the world am I supposed to tackle first, and it was many years ago when I dealt with kidney issues. Hoping when you get Moo-Moo home, we can help process some of the data and offer suggestions to help.
 
The vet didn't mention it, and I didn't see it when he briefly showed me the papers. There were a lot of red bars, indicating a lot of things were high on the blood test. Her white blood cell counts were all basically normal he said except for one but he said that could jusy be stress. Her sugar was low 200's, she didn't get an insulin shot this morning and only ate a couple treats. So that's also probably from stress.
 
We just got home from the vet and she is eating some, below are her blood tests from this morning. The vet said to not give insulin or amoxicillin tonight, and to bring her back in tomorrow morning. He said that they had given her some shots to get her through the night, but didn't say which ones.

He said her swollen eye is in fact an abscess, and he was able to aspirate it some and draw some puss out of it. She looks so sad with a swollen eye and shaved legs for the IVs.

Her potassium is way lower than it was on 12/16. It was 5.5 12/16, and is 3.4 today.

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I didn't see a result for ketones either, I don't think he ran a urine analysis on her. Which, in my unqualified opinion, is weird.
 
phakewishard said:
I didn't see a result for ketones either, I don't think he ran a urine analysis on her. Which, in my unqualified opinion, is weird.
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With a possible kidney issue in the mix I'd be inclined to agree. Hopefully it was done but they just forget to give you a copy of the results. Maybe check with them in the morning?


Mogs
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I will, and if they didn't I'll ask for one to be done. I don't think Dr. B sees as many diabetic cats as Dr. G, and Dr. G will be in tomorrow while she's there.
 
*finger guns* It is what it is, I'm going to be stressed until she feels better. Right now, I think she's irritated with me and her carrier, since she's had to go in it a bunch and gets poked when she does.
I'm just glad she was able to come home, I probably won't be sleeping much tonight to be honest. I have to leave work tomorrow morning to drop her off at the vet, so hopefully everything with that will work out. I will also probably have to leave work early to pick her up, and hopefully my manager doesn't fuss about it.
 
There are a few things that jump out. That is a sharp drop in potassium.
From my past experience, it would be something that I think needs to be managed via supplements, you want her firmly above 4. http://felinecrf.org/potassium.htm

Her weakness is a classic symptom of low potassium. But, you need to monitor regularly via blood work with vet if you give supplements, since too high is even more problematic, with serious health complications.

The phosphorus value is way too high, you need to get that in check immediately with phosphorus binders in her food, it is likely contributing substantially to her feeling unwell. Please do consult with your vet, but this is a good reference on phosphorus binders, and when they are needed, I know it is a lot of reading, but this website in general holds a lot of important info relating to kidney disease...http://felinecrf.org/phosphorus_binders.htm

I recall something about risk of tissue calcification when calcium x phosphorus is above 70, which she is, likely because the phosphorus is so high. I'm sure Marje will help refine some of my points, and may have other comments.


ETA: poor girl, I quickly scanned the labs before, and just saw your comment about the abscess in her eye :(. Give her lots of extra love from me, I'm glad she is home with you.:bighug:
 
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phakewishard said:
He said that they had given her some shots to get her through the night, but didn't say which ones.
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So sorry to hear about Moo Moo. Just wanted to ask if you got an invoice for today? I know my vet puts meds on the invoice so maybe you can see there what shots she was given. Hope she feels better :bighug:
 
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