Need advice: cat lost appetite, fever, no diagnosis

sierramist

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Hi everyone,

Our 4-year-old girl, who is normally very active, spunky, and hungry has taken a turn and so far no one can figure out really what's happening.

This happened in a matter of a day or so. Wednesday - fine, eating her meals enthusiastically as normal, then Thursday her appetite started to taper. Didn't finish breakfast, only ate a little by the end of the day. Then Friday morning all we could get her to eat was a little Churu and a bite or two of kibble, no wet food. This is a cat that usually inhales kibble, so we knew there was something wrong and took her to the vet.

Vet couldn't find anything obviously wrong at all. Did labs and the only thing off was low potassium/phosphorus and her temperature was a little high. So they decided to admit her for IV fluids with potassium and also gave Onsior for the fever. We were worried about her staying at the vet because she isn't really skittish but HATES the sounds of other animals and the vet gives her a lot of stress.

They kept her for over a day, about 28 hours, and while there she did eat a little for them but not entirely normal. Hoping it was just stress, they released her back to us this afternoon with a couple of days more of the Onsior, and we have an appetite supplement too.

I've been very insistent with the vet that something else must be going on, but was willing to go with the wait-and-see approach regarding this "fever of unknown origin." The idea was to get her eating normally then recheck her labs/potassium in a week or so. I know how potassium CAN effect a lot of things due to our other cat with heart disease and was hoping this was just a fluke.

She was VERY stressed on the car ride home, to the point of panting, but after we arrived she seemed very normal. Didn't hide, wanted attention and cuddles, even played like normal for a while, vocal like normal. Later on she came up to sleep with my husband and was doing these little jerks and shudders while curled up with him, which was concerning. They would go away after she fell asleep, so we thought maybe just anxiety after everything?

But she had zero interest in dinner, or crunchy treats. Later tonight we tried kibble again and no reaction at all. She is usually a cat who sprints as soon as she hears me scoop it up, and she was still just laying down on the couch. I DID get her to eat a little Churu, her favorite, but nothing else so far. It seems tonight she just wants to sleep and be left alone.

I'd love some advice on what might be happening here. Could her actions tonight be just the stress of her experience at the vet? She does seem jumpy and more fearful than usual, but that could also be interpreted as pain. I just have this gut feeling they have missed something. Or maybe it's a combination of both. We haven't given her the appetite supplement just yet, because I feel like it might cover up how she's actually doing. If she's not eating tomorrow we'll try it, but for now I'm just really worried. What would cause these sudden symptoms that wouldn't appear on labwork?
 

Antonio65

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Did the vet run a protein electrophoresis test?
When sudden symptoms like the ones you mentioned appear, my first thought goes to FIP.
 
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sierramist

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I don't believe so — I'm not familiar with that test. What does it help indicate?

How would she have caught FIP? We do have two other cats in the household, and neither of them are exhibiting any similar symptoms. All are indoor cats with very limited exposure to outside influences.

Wondering too, if she's having some pain and the Onsior has worn off toward the end of the day, contributing to her behavior. We'll give the next dose in the morning so perhaps that will be telling.

She'll lick a little bit if we present her food like she's interested (or nauseated?), but won't actively eat anything but a little Churu at the moment. Gets up for a short while then comes and lies back down. Doesn't seem weak though — cleaning herself, stretches, will jump, etc.

Did the vet run a protein electrophoresis test?
When sudden symptoms like the ones you mentioned appear, my first thought goes to FIP.
 

Antonio65

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One of my rainbow bridge cats took Onsior in the past due to joints ache, so I believe it is good pain killer and anti-inflammatory med.

FIP is a disease that may be dormant in a cat. According to some studies, over 90% of cats are carrier of the virus (FCoV) that can stay dormant for the whole cat's life, or it can mutate and trigger the disease.
I have a few cats going from lively and healthy to sick in a very few days.
According to recent studies, FIP isn't contagious, it shouldn't pass from one cat to another. And I think I can agree with that.

The protein electrophoresis is a test to evaluate the levels of the immunoglobulins and assess if there's an active infection. It appears as a curve on a two-axis graph with a few waves. The first wave is the higher and it's normal, the other waves must be lower and rather flat.
Sometimes a routine CBC test could say nothing, but the electrophoresis reveals the infection (IgG high).
FIP is a nasty disease and it can be not easy to diagnose.
 

silent meowlook

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How high was the fever? Did they give you a copy of the lab work? If so, can you post it? Did they take any X-rays?
 

misty8723

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Did the vet run a protein electrophoresis test?
When sudden symptoms like the ones you mentioned appear, my first thought goes to FIP.
My first thought also, having lost a cat to FIP. I hope it is not. There is a cure now but I understand it's expensive. I would have moved heaven and earth to get a cure for my Darcy.
 
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sierramist

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How high was the fever? Did they give you a copy of the lab work? If so, can you post it? Did they take any X-rays?
It was 103.4 at it's highest before we left her at the vet Friday, and was back down in normal range when we picked her up yesterday. They did do labs but I didn't receive a copy. Kicking myself for not asking yesterday! No x-rays or fecal. They attributed her lack of eating to the low potassium but when I pushed back on that I didn't get much response.

Some developments today. Last night we let her sleep with us and she threw up overnight a good amount of food, which seemed odd to me as she didn't have much yesterday evening so this would have been what she had at the vet almost 12 hours earlier. Shouldn't that have passed out of her stomach by then? I took a look at the vomit and it seemed to be very... furry. There was a small hairball but all the food bits were connected by fur. In addition to that she had little drops of diarrhea in AND out of the box with a drop of bright blood in it, which has never happened with her before. I took a sample of this just in case.

She wouldn't eat breakfast or anything at all this morning, not a single treat, and just wanted to curl up somewhere. We were able to get the Onsior down her and a bit of Mirataz on her ear, and about 2 hours later she was acting almost completely normal, scavenging for food. She ate about a 1/3 can of wet food, eagerly ate two small helpings of kibble, and a little Churu, and was excited for treats. Even played a bit. We attributed it to the Onsior helping with what seems to be this ongoing fever and thought we might be able to get through the day before going back to the vet tomorrow.

BUT, now, just a few hours later, she seems to be in a bad way again. Curled up, not interested in lunch or treats at all again. Very confused as to what is happening here. I think we're going to go ahead and go to our emergency vet clinic, which I hate to do for both her stress level and $$$, but I just feel like our regular vet has missed something very important. Could this be something intestinal? A blockage or infection?
 

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Feed her anything she will eat ! Can of Tuna or salmon or something like that! And get another vet to check her! good luck!
 

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Yeah, it's pricey. But the peace of mind that you did everything you could is worth it. I recommend X-ray and ultrasound to rule out blockage or something else that wouldn't show in bloodwork.

The reaction you saw was probably the Mirataz more than the other one. Though I have no experience with Onsior, I do with mirtazapine (Mirataz) which can and does work up many cats into excited states. The pills more than the gel can really get them going. It's probably because most guardians don't give the full dose of the gel to guard against the mirtz zoomies and screamies. With the cats I've given it to, I've found the best thing is to know they are going to be excited or excitable (or distressed) and to sit with them through it. The rush is usually only an hour or two anyway. When I give it to Betty, I time it so her rush will coincide with an hour or two that I can have her sit in my lap and chirp it all out while I stroke her. Then she'll go tear into a plate of food and sleep it off. Krista was largely the same way.

Betty had a fever of unknown origin as a reaction to an endoscopy with biopsy. She went to the emergency vet the next day when she was lethargic and not eating. She went to her specialist who performed the endo the day after. I didn't realize the specialist could fit me in so quickly or I would have gone to him first. In any case, she got fluids and a whole lot of imaging. And all they could do was 🤷‍♂️ . The specialist wanted to start her on pred with the thought that would restart her appetite. I balked saying that that was an immuno-suppressing drug, and her fever indicates she's clearly fighting something. So his second offering was a short course (five days) of a broad-spectrum antibiotic (Veraflox.) As much as I don't like liberal use of antibiotics, I didn't have any other ideas or options. I took the prescription and gave her a dose. Wouldn't you know it? The very next day she started to turn around.

Get the imaging done because I'd hate for you to miss something. But if the imaging doesn't turn up anything, ask about a short course of antibiotics.
 
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silent meowlook

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So, yes, everything you describe sounds like an intestinal obstruction or blockage. Especially the drips of diarrhea, the fact that when she does eat she feels worse at the time the food should be moving through her intestines. FYI, don’t give Onsior to a cat that isn’t eating or is vomiting. Make sure to tell the ER vet what meds were given and when.
 
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sierramist

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I called the emergency vet earlier, but the first appointment they could get us in is a couple hours from now. This afternoon she HAS perked up at times and ran to her favorite stimuli, like the basement door opening or the food container opening, which seems positive. But still, no, she's not acting normal.

I did give her a little Churu earlier hoping to keep her hydration up and she ate about 3/4 of it, but yeah I get that might not be the best IF there is something intestinal going on. I did have some gabapentin on hand so we went ahead and gave her a half capsule of that just now hoping to lessen the stress of the vet experience.

Would an x-ray show if it's an obstruction? We have limited resources even at the emergency vet and I'm not sure if they can do an ultrasound on the fly.

The reaction you saw was probably the Mirataz more than the other one. Though I have no experience with Onsior, I do with mirtazapine (Mirataz) which can and does work up many cats into excited states. The pills more than the gel can really get them going. It's probably because most guardians don't give the full dose of the gel to guard against the mirtz zoomies and screamies.
We give the transdermal gel Mirataz to our other cat who has heart disease daily, so I'm pretty familiar with it. We only give him a half dose or so and that's what I gave her this morning. I do find that with our other cat it tends to take longer to kick in, even as long as a day or so.

Thanks for everyone's help so far. I swear, our regular vet does seem to keep missing things. This is the second time this year I had to advocate for one of my cats and ended up at emergency because they didn't do a thorough enough job. Will keep you updated when we know more!
 

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An X-ray would show a foreign body. It would also show a build up of food and/or feces. So yes, I believe an X-ray is probably a good first option if you can only afford one at this time. An ultrasound might pick up a growth/tumor. But an obstruction would require more immediate treatment. So if you have to prioritize one, I would probably prefer the X-ray. But you should have this discussion with the ER doc as I have no medical training.
 
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sierramist

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Just got back from the ER. They did x-rays and said that her stomach is dilated and colon has lots of gas. There were some odd bits in her stomach but no obvious obstruction. Moreso looked backed up, I suppose. They asked if she eats litter, which we've never observed before. She does love to chew on things but I've never seen her actually eat anything. Her fever was back, too, even on the Onsior today - 103.5.

Luckily one of the docs who works at our normal vet was moonlighting tonight and already knew a little about her case and could review her labs from Friday. She gave some sub-q fluids, Cerenia shot for nausea, and Metoclopramide that would "jump start" her stomach a bit. They gave her an injection of antibiotic (Veraflox) with more for us to continue with beginning tomorrow evening.

The plan is to take her back to the regular vet tomorrow morning so they can keep and observe her further, run more tests if needed, etc. We still don't have a definite diagnosis but at least more information and that it doesn't seem to be immediately life threatening. FIP isn't 100% off the table but the vet isn't looking there quite yet, especially since we seem to have this digestive issue.

Even though she was loopy by the time she got home, she was immediately hungry and ate a little wet food which I'm hoping is a good sign. So either the fever is lower and/or the Cerenia and/or Mirataz are working. Hoping we find out more tomorrow. So stressful!
 

stephanietx

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My cat has had gastroenteritis previously and he was running a fever, very lethargic, wouldn't eat, and all the things. His x-ray also showed a build up of gas and possibly a touch of constipation, though he had good poops. Most likely, it was caused by an intolerance to something in his food. It took about a week for him to recover. The vet told me that sometimes it's caused by an infection, but sometimes it's not. He also had an antibiotic, fluids, and we actually gave him Science Diet a/d to get him to eat, knowing it would cause him diarrhea, but at least he was eating. You can give Simethicone (baby gas drops) unflavored and without artificial sweeteners or flavorings to help decrease gas.
 
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sierramist

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More updates! So last night after eating that small bit of food, she went south again. Very lethargic, couldn't get comfortable, obviously unhappy. She slept with us in our bedroom again but was very wobbly still and unlike herself. Did not want to eat anything this morning so I knew her fever was back.

We took her back into our regular vet as planned first thing, and they did repeat x-rays and repeat labs. The good news is that her stomach is completely empty now, it's moved into her colon, so confirmed no blockage.

However, her temp was 106.8! So it seems that the Onsior, when she's on it is doing good at knocking that down but isn't strong enough or lasting long enough. So she's hospitalized again, for fluids, more potassium (which was still low), injectable Onsior, and antibiotics. The labs did show that her white cell value is now starting to increase. But we still don't have an obvious cause.

They tested for FeLV/FIV just in case and it was negative. No FIP unless it's the dry type. We're looking at getting test for this just in case, but the results don't come back for days. Best next test was sending out a CBC with pathology review to look at her cells and see if it's something else like cancer or autoimmune or what we'd want to treat with steroids.

It's all very overwhelming to not have a cause for this. As soon as the fever lowers she's basically her normal self! But it looks like she'll need more supportive care overnight at the vet until we can figure something out or one of these treatments kicks in. Very scared. The vet says she's seen cases like this and it isn't immediately life threatening, but it's definitely a mystery right now.
 
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sierramist

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Some quick good news! They just called and her temp is back down to 100.6 and she's eating a bit. She'll be there overnight and we'll check her tomorrow and see what the CBC results tell us.
 

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That's good news about her fever, but certainly an odd case. Hoping they figure it out quickly :vibes::vibes::vibes:
 
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