Cats » Complex case - Diabetes (confirmed) Triaditus (unconfirmed)

Ajay

This question is related to: Chester the Cat

Age:10
Gender:Male
Breed:DSH
Neutered:Unknown
Weight:2.85
Fed On:Recently homed stray. Balanced raw / currently Hills sensitive gi (at vets)
Kept:Indoor Cat

Complex case - Diabetes (confirmed) Triaditus (unconfirmed)

Looking for some help with a feline who is not a candidate for a biopsy to confirm Triaditus. I can give further background history.

22/8/17

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Ajay

Further details : I recently homed a stray who had just been confirmed diabetic. No past history other than his previous owners were traced, and rejected him. He'd been a stray for about 2 years.
At the vet I picked him up from he had been on an IV drip for about a week before starting Insulin ( Vetzinc) I picked him up on a Tuesday and he was in the vet by Sunday with high temperature and dehydrated with Keytones 2.5.
In those days with me he had been eating balanced raw for cats and Slippery Elm to help with loose faeces. He had been quiet, which considering his condition I was not greatly surprised.

22/8/17

Ajay

I had also been monitoring his Bg using AlphaTrak2 and Keytones using ketostix. Bloods revealed low potassium, high cholesterol, increased liver, increased kidney, thickened intestinal wall. Kidneys a little enlarged. Negative for HyperThyroid.
After 4 days at the vets, he appeared stabilised enough to come home. Discharged with new insulin (Caninsulin) and broad spectrum antibiotics.
On Thursday (last week) he was discharged. By Sunday, he was back in - High Temperature and dehydrated again. He is back on IV drip with a short course of antibiotics which he has now finished. Electrolytes nearly normal. Further bloods confirm kidneys are within parameters. His Insulin has just been increased to 2u.
Vet has suggested there may be a possibility of him having Triaditus but is unwilling to treat as such without biopsy, which he is not a candidate for due to his poor condition. I initially suspected a possible IBD due to his incredibly sensitive stomach.
Having done a bit of research, including medical journals, he is showing many of the symptoms. I have tried to suggest to the vet that I would be happy to home nurse him (I work from home) in whatever form that would take inc Sub Cue fluids if necessary.
I am looking for a little further guidance, if that is possible at all. Thank you.

22/8/17

Martina Stuart

Complex indeed!
Triaditis is a combination of pancreatis IBD and cholangitis or any 2 in combination.
The confirmed presences of diabeties in this can does not necessarily indicate the presence or pancreatitis and i would therefore suggest that ultrasound examination would be less invasive and less of a risk initially.
Is there any chance at all of obtaining a pre- adoption history as i suspect that such will substantially reduce your costs.
Should this situation deteriorate to a status of euthanasia or biopsy then i confess i would be temptred to assess the response to steroids whilst continuing th other medications he seems to respond to.
There is are excellent articles on the subject

23/8/17

Ajay

Thank you :)

Unfortunately there really is no history on Chester. No one knows where he's been for the 2 years since he left home. I think the assumption was he was healthy before then.

He was U/S on initial intake, which showed the thickened intestinal wall.

My concern is the "lack" of support when he comes home. Given that there is undigested food in his faeces. I have asked about the potential for some kind of electrolyte / nausea / support supplements to enable me to support his fragile digestion whilst it receives adequate nutrition / care to heal / improve to a point he can function / maintain homeostasis of a form? :)

23/8/17

Martina Stuart

the presence of undigested food in his faeces is a real concern. it s odes tend to suggest that there is not only a recurrent pancreatic problem affecting both the endocrine (insulin) and exocrine (digestive) functions of the pancreas but also other digestive as well as absorption problems.
Have you discussed the possibility/practicality of a temporary nasogastric feeding tube and the use of something along the lines of critical care formula.
It dos sound as though an exploratory laparotomy may be in order to assess the necessity/adviseability/and ethical humanity of biopsies and continuing treatment

23/8/17

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