Help: Cause of death and Rigor Mortis

soyi

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Hello everyone,

It's my first time here so please excuse me if I posted in the wrong forum.

My cat (male, 7 years and 10 months old) passed away on March 15. We had had his company since he was 1 months old. And he had literally slept in the same bed with us for 7 years and 9 months and he was an unreplaceable part of our life. We are trying to accept the fact that he's gone but what has been bothering us is the treatment by the vet and the way how he passed away. He was seriously ill when my husband sent him to the vet, he vomited a few times the night before he's sent to the vet and he couldn't even stand up, usually he was around 4.5kg but he lost 1 kg of weight (sharp weight loss within days, turned out to be dehydration) by the time my husband noticed he was sick. Unfortunately those days I was away and my husband was busy working out of home all day long and the cat wasn't found being sick until it was really serious.

Then he was sent to the vet the next morning and they did some check for him: x-Ray, blood test, urine test etc. then they quickly diagnosed that he had diabetes based on his test results. He was treated with physiological saline solution intravenous and insulin. The vet suggested his situation was getting better after 1 day of treatment, which they called "intensive care": treatment mentioned above and blood sugar check every hour or so... During our visit, the cat looked really weak and wouldn't eat, although he managed to stand up upon seeing me, but promptly dragged back down by the pipe inserted in his foreleg. :'(

Despite everything, the vet made us believe that everything was under their control, so we left him there and went home, (we were not allowed to stay with our cat after 7pm.) which turned out to be the biggest regret in our life.. The next morning, the vet called us at 830am telling us our cat passed away. "Peacefully" that's what they said. And they said the nurse found he was in critical condition between 7-8 am and "tried to resuscitate him" by "giving him oxygen"...

when We arrived there at 10 am, my cat was laying on his side on an operation table, he still felt a little warm but in half hour, he had become completed stiff! Despite all the doubts, we took him home without asking any question. because my husband said he felt really weak that he couldn't even stand on his legs, and he said whatever we did now would not bring him back, so he only wanted to bury him as soon as possible.

After I slightly recovered from the sadness, I started to wonder if he really passed away like they said. I doubted that he was left there alone without anyone around, and died alone at night in a complete strange place (he was a very sensitive cat and always afraid to stay away from home)... And they didn't know it until the next morning someone went to work. Each time when we think about that, it hurts like hell... I suspect the vet tried to let my cat stay there as long as possible so they could make more money out of him, ignoring the fact that he was really dying and there was really not much they could or knew to do to save his life. Had they told us the truth and gave us the chance to make a choice, we would have chosen to bring him home, and watch him until the last minute, let him die in a place where he's familiar with, accompanied by the people who really cared about him.

So my questions are:
1, have the vet treated him in the right way? (Diagnosis and treatment)
2, When was the possible time he passed away? (Based on the time of rigor mortis.) He was about 4 kg when he passed away, (they managed to hydrate him a bit by saline IV.) The whole place was conditioned (at day time at least).

Attached are his reports, and bill.

Thank you everyone for your attention.
















 

red top rescue

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Your description of your cat's illness plus the telling factors on the lab results make it clear that your cat passed away from complications of severe ketoacidosis secondary to diabetes.  He also had a bacterial infection (as indicated by the high white blood cell count) and that's another common finding along with ketoacidosis.  I include a link to an article about ketoacidosis so you can understand it in more depth and perhaps understand all the chemical changes that were going on in your cat's body due to the diabetes, and you will also see what they prescribe for treatment is just what your vet did.   http://zimmer-foundation.org/sch/cbc.html

 I believe the diagnosis and the treatment were completely appropriate, having reviewed all the reports you included.  I do not think the vet knew your cat was going to die, since they had gotten him through the initial crisis, but he was still in serious danger, and he could not go home or he certainly would have died.  I do not believe they kept him in the hospital to make more money but because they were trying their best to save him. 

The hospital was not unattended at night because the reports show they were drawing blood every 2 hours to check his blood sugar and they were giving insulin to try to get it regulated.  The last time they drew blood was 6:30 AM and it was 306 and they gave him insulin again at that time.  You can see that they checked and graphed the results as his sugar went down in response to insulin and then came back up again.  Diabetics can go into coma when the sugar is too high and they can go into a coma when the sugar is too low.  He was not yet stabilized and he slipped into a coma sometime after 6:30 when he got the last dose of insulin and before 7:30 and 8:00 when the nurse found him.  They tried to revive him with oxygen but could not.  Yes, if he slipped into a coma, he passed away peacefully, just like going to sleep.

As for the rigor mortis, it is not unusual for rigor mortis in a cat to set in within a couple of hours. A friend of mine had a very ill old cat with kidney failure who was pretty much in a coma, but peacefully breathing.  She went to the grocery store to pick up some things and was only gone about an hour. When she returned, the cat was no longer breathing and was still warm, but he was already beginning to get stiff from rigor mortis.  He was very skinny and weighed under 5 pounds so it was very noticeable.

As for the diagnosis, the lab results are obvious for the diagnosis of ketoacidosis.  First, the two handwritten urinalysis reports show the urine was positive for glucose and for ketones both times. The urine pH was 5.0 (acidic) on the first specimen and 6.0 (acidic) on the second one, when normal range is 5.5 to 7.0.  His blood pH as shown on the meter was 7.084 and normal is 7.240 to 7.400.  The blood glucose was 558 when he came in (normal range is 64 to 170) and fluctuated widely in response to insulin as shown on the hourly graph report.  His white cell count was 39.0 when normal range is 5.0 to 18.9, which would indicate  a secondary bacterial infection his body was trying to fight off in addition to being disrupted by the metabolic imbalance caused by the untreated diabetes.  You did the right thing by bringing him in as soon as you noticed he was sick, and the vet hospital did all the right things, properly diagnosing him and doing everything they could to save him and get his diabetes under control, but it was just too late.  It's very sad, and I am so sorry for your loss.
 
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