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Kidney Disease - Page 2

post #31 of 66

Please see the site I sent you in my post above.  My cat hated to be handled and she tolerated daily subq fluids.  If you warm the fluid a little it is better, just have the tube immersed in warm water, not the bag, as the fluid travels to the needle.  The cats do not mind much if the needle is of good quality, sharp, and large enough for fluids to pass quickly, but not so large as to cause pain when inserting.  The site felinecrf.org has a ton of info.  Giving subq fluids is quite common. 

 

I cannot stress enough how much I am against giving a large quantity of fluids non-stop to a cat.  My cat died after a 2 day infusion and I have encountered at least two other cat owners who recently experienced the same thing.  Cats often cannot handle a large volume of fluid all at once.  It enters their lungs and causes them to suffocate. 

 

My cat was fine when I picked her up from the vet Monday evening.  Tuesday evening she had labored breathing.  She was gone Wednesday morning.  She was strong physically, but her body could not process the fluids.  Knowing how much to give is hard to gauge when you give so much at once as it takes a long time to see the symptoms.  By then it is too late.  Giving her Lasix/Salix/Fluorosemide did not help.
 

post #32 of 66
Quote:
Originally Posted by WhollyCat View Post


Aw...alright.gif don't feel sad, hon. You've come to a great site to give you a helping hand! For what it's worth, a Creatinine of 2.4/2.5 is not terribly high if the lab reference range is .6 - 2.4. It would be at the high end of normal if that is the reference range used by the lab. I'm just guessing as to the lab reference range. At other labs the 2.4/2.5 would be considered high, but not in the end stage of renal failure, more like the second stage of CRF. That is why it is vital to have these for the specific lab used.

 

So...that brings me to my next questions:

 

Besides his Creatinine, what was his BUN (blood urea nitrogen), Specific Gravity (urine), Ca (calcium), P (phosphorus), K (potassium), Na (sodium), and any other values you can get out of your vet. He should furnish these records--just request them and don't quit requesting them until the vet gives them to you.

 

Oh man, that is just absurd thinking on your vet's part about the fluids. You won't be doing a long drawn out process (around 5 minutes to administer the fluids!), you will do sub-Q fluids where the needle is inserted under the skin, not IV drip where it needs to be in a vein. It would be more stressful to have Darwin hooked up to a needle, etc. in a small cage for days on end when all he needs is a small amount of fluid (50-75mL) given once a day or every other day. Plus, how the heck would the needle stay in for that extended amount of time--my kitties would be bouncing off the walls of any cage! Honestly, I think you need to find a different vet. Your vet sounds utterly clueless when it comes to giving CRF kitties sub-Q fluids.

 

You need "ringer lactated" (Lactated Ringers Solution [LRS]), not sodium chloride because sodium chloride burns. Here's a link to different common sub-Q fluids. You want LRS because for one thing, that is closer in pH to what a kitty's body pH is. The sodium one, besides burning, has a very low pH--which you don't want.

 

Here's a video on how to administer sub-Q fluids demonstrated by a vet (one thing I should mention that he didn't is that you should always use a NEW sterile needle each time--never re-use a needle):

 

 

That being said, if you can add extra water to Darwin's food (and daily keep track of how much--you would have a log of how much for every day and how much each time by the end of that day) and/or use a dropper or needle-less syringe and syringe water by mouth (again, keep track of how much), you may not need to do the sub-Q fluids. You could aim for 5-10mL (cc's) per pound of Darwin's weight per day. Just add to his food and/or dropper/syringe by mouth that amount per day. Say he weighs 10 pounds, if you did 5mL per pound that would be 50mL per day. If doing 10mL it would be 100mL per day. You just spread it out the daily amount by adding to his food and by mouth with the syringe. Hope that made sense. If not, let me know and I'll try to explain it better.

 

I've got to say that my Tuffy hated getting sub-Q fluids, so on those days when he wasn't cooperating, I mixed extra water into his canned food, and if that wasn't enough I syringed water at the back side (between his back teeth on one side) of his mouth in small amounts--if I was going to give him 20mL/cc's I would do about 5mL at a time to make sure he didn't choke. I ended up doing it this way 90% of the time because it just wasn't worth the battle and stress that took place for my little guy giving sub-Q's.

 

Hang in there, sweetie, we're here to help! rub.gif

creatinine was 2.4 with a reference of .5-1.5

bun 19.2 with a reference of 7-18

 

my vet feels it best to totally and completely flush and detoxify darwin's kidneys. she wants to keep the IV inserted for 4 complete days using 2 bags each of sodium chloride and lactated ringer .my vet is an animal person. she's a total vegan, yells at owners who don't care properly care for their pets or follow her directions. people who want to put down their pets and she feels it

isn't necessary she goes crazy. people who won't spend money for the proper treatment--she goes ballistic. what i'm getting at she might not have the best bedside manner for owners, but,

for the animal she will do everything and anything in its best interests. she was top in her class and if she has any limitations it's only due to what costa rica lacks in medicines and technology.

i have total confidence in her. it's just my heart goes out to my son who has to go through this treatment. i know it's for his health, so in the long run, it's the best course of action.

i wish darwin would understand what is going on. he's so sweet i don't want him "thinking he's being punished". i'm ******* crazy, aren't i???

  thanks so much for taking the time to share all this info. i appreciate your empathy and compassion more than you can realize.

post #33 of 66
Quote:
Originally Posted by tjcarst View Post

Please see the site I sent you in my post above.  My cat hated to be handled and she tolerated daily subq fluids.  If you warm the fluid a little it is better, just have the tube immersed in warm water, not the bag, as the fluid travels to the needle.  The cats do not mind much if the needle is of good quality, sharp, and large enough for fluids to pass quickly, but not so large as to cause pain when inserting.  The site felinecrf.org has a ton of info.  Giving subq fluids is quite common. 

 

I cannot stress enough how much I am against giving a large quantity of fluids non-stop to a cat.  My cat died after a 2 day infusion and I have encountered at least two other cat owners who recently experienced the same thing.  Cats often cannot handle a large volume of fluid all at once.  It enters their lungs and causes them to suffocate. 

 

My cat was fine when I picked her up from the vet Monday evening.  Tuesday evening she had labored breathing.  She was gone Wednesday morning.  She was strong physically, but her body could not process the fluids.  Knowing how much to give is hard to gauge when you give so much at once as it takes a long time to see the symptoms.  By then it is too late.  Giving her Lasix/Salix/Fluorosemide did not help.
 


tjcarst--- please read my response to the post with the video. i would say the same to you, especially the part where i say i am grateful to you for your empathy and compassion. special

people take the time to share as you have in this thread. gracias, gracias, gracias...

post #34 of 66

Let me also add my experience with sub-q fluids has been it's not been that stressful for my cats.  I clear a spot off my kitchen counter (near the sink),have a cup holder on the side of the cabinet there, I hang the bag of fluids from that hanger - height works out just about right.  I get kitty in the position I need on a nice comfy towel, gently pull up the skin a bit where I want to go (between shoulder blades) and insert the needle (bevel side up) and open the flow clamp.  I talk to my kitty throughout, and usually give some wet food or a treat for them to eat during treatment.


Be SURE, if you can, to use ultra-thinwall terumo needles (UTW terumo).  Monoject needles are NOT as comfy.  Unfortunately, the company I've used, I do not know if they ship outside the us.Just ask your vet if they get/can get Terumo brand.  It is a consistent comment you will see if you look over the various websites on crf (hope you've checked out the first posts on the sticky on CRF I believe I mentioned..many links in those first posts) to use thinwall or ultra thin wall needles, and Terumo's are often the recommended brand.

post #35 of 66

My vet also believed a flush was necessary for my cat.  She was doing what she thought best to save my cat, not harm her.

 

My cat did not like strangers, did not like handled, etc.  Caging her up and leaving her for a weekend of IV fluids still causes me deep regret and pain.  It was the wrong decision for her.  Some cats cannot process the fluids.  Mine was one of them.  My vet would not have knowingly caused harm to my cat.

 

If you go to holisticat and read this persn's opinions on what she believes is best for a daily amount, this is the same info I am sharing with you.  I am in no way saying your cat will not do well with 4 days of fluids.  I only wish I had read this information before making my decision.  I thought the three day fluids at the vet would give me several months without worry.  This is not the case.  Daily fluids will likely still be needed. 

 

You will need to trust your vet, I know.  I am not a vet or tech and am not trained medically, just sharing my experience and wishing someone had pointed me in the direction to do more research.  By the time the fluids were stopped, it was too late. 

 

I really hope the fluids given to your cat make a world of positive difference in health and give you much more time together.

post #36 of 66
Quote:
Originally Posted by daddyincr View Post

creatinine was 2.4 with a reference of .5-1.5

bun 19.2 with a reference of 7-18

 

my vet feels it best to totally and completely flush and detoxify darwin's kidneys. she wants to keep the IV inserted for 4 complete days using 2 bags each of sodium chloride and lactated ringer .my vet is an animal person. she's a total vegan, yells at owners who don't care properly care for their pets or follow her directions. people who want to put down their pets and she feels it

...

 

Her values aren't that terribly bad actually. That is good!

 

Boy do I have to strongly disagree with giving two bags each of sodium chloride and LR. That is a total of 4000mL over the course of a few days (even half that would not be good!). That is 1000mL per day of fluids--or if you meant two bags total, that is still 500mL per day. I understand your vet's reasoning, but this is WAY too much fluid for a kitty's body to handle. Please read the following on the problems with giving too much fluid to a kitty. And an excerpt from Helen's website from that link:

 

Quote:
Fluid retention may be a sign of worsening kidney values  or of heart problems, but in many cases it is actually  a sign of overhydration from either intravenous fluids (IV fluids) or subcutaneous fluids (sub-Qs). Some vets believe it is impossible to overhydrate a cat through sub-Q fluids but unfortunately this is simply not true. Over the years, I've heard from quite a few people whose cats developed precisely this problem. In Renal disease (2006), Dr D Polzin states "Chronic subcutaneous fluid therapy can result in fluid overload in some patients, particularly when fluid volumes in excess of those recommended here are used. We have seen several cats given large quantities of fluid (200 to 400 ml/day) present with severe dyspnea due to pleural effusion. This condition can usually be avoided by reducing the volume of fluids administered."

 

So, let me tell you a short version of my Tuffy's story when my vet gave him "fluids to flush his kidneys" [just] overnight:

 

My sweet boy went in for IV hydration to "help" his kidneys. When I picked him up and brought him home, instead of being more alert and feeling better, he was in distress. His front legs were double the size they should be. He had liquid seeping from his eyes and nose. He was coughing. He was having trouble breathing and had a raspy sound when he breathed. In a panic I called the vet. I asked how much fluid was given to him. Got a non-answer in response because they knew I was po'd. Tuffy only weighed 8 pounds at the time, so logically I thought he would get around 80-150mL (tops!) of fluids over the course of this time. I didn't state that that was all that I wanted given to him--huge mistake on my part because that was clearly not the case. I came unglued and told them to never, ever give him so much fluid that he was literally drowning in it. I started Tuffy on a herb known for its diuretic properties, and thankfully, Tuffy didn't die unlike tjcarst's poor kitty. (I still have the same vet(s) to this day, but they are much more interested in treating my kitties as individuals instead of going by what was outdated thinking at the time with regards to IV fluids. We are actually friends now.)

 

Here's the link to Holisticat and the information tjcarst is talking about and a quote from that page with the accompanying link to WS University:

 

Quote:
Amount of fluids - As per Washington State Univ college of veterinary medicine, cats should get 5-10ml of subq daily per lb of body weight. I would be very careful going above this because we have had cats on my list develop fluids in the lungs. Many cats with undiagnosed heart disease can have complications from fluids. If you know your cat has heart disease, you can do what I did, and instead of subq, give fluids orally using a plastic syringe.

 

Please, for your kitty's sake, do NOT give the amount of fluids your vet is recommending. You are setting yourself (and your kitty) up for disaster. You are your kitty's advocate, so please don't be afraid to disagree with your vet. Any good vet is going to listen to you, as your kitty's guardian, and re-think their stance on the amount of fluids when given evidence to the contrary.

post #37 of 66

Thank you, Whollycat.  I found this site after losing my cat to too much fluid given to her one year 4 months ago.  It still causes me so much pain that I made such an un-wise decision that I cannot post on what a wonder my cat was for me, my soul mate kitty.  My husband's "one and only" best bud.

 

How could I not know to do more research.  Vets are supposed to know best.  Now I know I should have researched more.  My heart still aches. 

 

OP - please do as much research as possible before heading down this path.  At least try the sub q fluids.  Your cat should be able to tolerate 2-5 min of treatment daily or every other day.  Your kittlys kidney values are early in the stages of failure, so I really would not chance a "flush".  If the sub q fluids do not work, then I would consider resorting to the more drastic measures of IV fluids.  As a last resort.  Your kitty does not seem to be at this stage. 

post #38 of 66
Quote:
Originally Posted by tjcarst View Post

Thank you, Whollycat.  I found this site after losing my cat to too much fluid given to her one year 4 months ago.  It still causes me so much pain that I made such an un-wise decision that I cannot post on what a wonder my cat was for me, my soul mate kitty.  My husband's "one and only" best bud.

 

How could I not know to do more research.  Vets are supposed to know best.  Now I know I should have researched more.  My heart still aches. 

 

OP - please do as much research as possible before heading down this path.  At least try the sub q fluids.  Your cat should be able to tolerate 2-5 min of treatment daily or every other day.  Your kittlys kidney values are early in the stages of failure, so I really would not chance a "flush".  If the sub q fluids do not work, then I would consider resorting to the more drastic measures of IV fluids.  As a last resort.  Your kitty does not seem to be at this stage. 


I totally agree with doing sub-Q instead of IV for four days and everything else regarding OP's post.

tjcarst, you did the best you could for your baby with the knowledge you had then. Please don't feel bad. alright.gif We all at some point have the mentality that vets know best, but discover later that this is simply not the case. Thinking evolves and vets just can't keep up with current information, so it is up to us to be proactive and research, research, research. I'm so, so very sorry for the loss of your sweet baby under these awful circumstances...grouphug2.gif

post #39 of 66

perhaps i haven't explained everything clearly. i don't want darwin to be an inpatient. so i set up my bedroom as a mini clinic. my vet

came yesterday and put in the IV she set it for 250ml of ringers a day. basically the program is to flushout and detoxify his kidneys.

after that we'll see about the maintenance. my son in the states has had cats forever. i had him speak to his cat's vet, he said

this procedure is normal, but, usually done with the cat staying over, as mentioned previously i believe my home is cleaner

and he never has to be alone--i am taking time off from work until IV comes out. the first day he had @ 7 urine outputs first day. he's eating

great. strangely he cries when he sees me, and is quiet when i leave the room. i am his nurse. i check the flow of fluid, and clean out

his litter box as often as he urinates or eliminates. it's hard seeing him in this way, but i know it's for his health.
 

post #40 of 66

Awww, he probably is scared you will do something to him. My first cat Emily ran away from Mom when she was going to the vet every day for antibiotics.

 

I am glad Darwin can stay home with you during the flush and wish other CRF cats could do the same thing.

post #41 of 66

i do the water by syringe trick to my younger female as i hardly ever notice when she drinks. i'll do the same to darwin when he gets out of "jail"

post #42 of 66

Don't forget about B12 injections, it's very important in a CRF kitty. sub q fluids as mentioned, B12, an all wet diet (not necessarily prescription). http://www.felinecrf.org/

post #43 of 66
Quote:
Originally Posted by daddyincr View Post

perhaps i haven't explained everything clearly. i don't want darwin to be an inpatient. so i set up my bedroom as a mini clinic. my vet

came yesterday and put in the IV she set it for 250ml of ringers a day. basically the program is to flushout and detoxify his kidneys.

after that we'll see about the maintenance. my son in the states has had cats forever. i had him speak to his cat's vet, he said

this procedure is normal, but, usually done with the cat staying over, as mentioned previously i believe my home is cleaner

and he never has to be alone--i am taking time off from work until IV comes out. the first day he had @ 7 urine outputs first day. he's eating

great. strangely he cries when he sees me, and is quiet when i leave the room. i am his nurse. i check the flow of fluid, and clean out

his litter box as often as he urinates or eliminates. it's hard seeing him in this way, but i know it's for his health.
 


I just find it confounding that the vet recommended doing this when the kidney values are not that high. Usually getting a "flush" of fluids via IV is used when they are close to a crash (kidney numbers are high), or have crashed--not at this stage of the game. Fluids are not without their problems--they increase the work the kidneys must do, for one. All Darwin would need at this stage is extra water (amount as stated previously) added to his food and syringed via mouth during the day to keep up with his hydration.

 

You'll probably not read this because I'm pretty sure you're not going to question your vet, but I'm going to post it anyway smile.gif...When to Use Sub-Q Fluids and info on IV fluids. Knowledge is power, so others can decide what they would do from reading this thread.

 

Excerpt below:

 

Quote:

Although sub-Qs can be of great benefit to cats who need them, not all CKD cats need them immediately. As mentioned above, the purpose of sub-Qs is to keep the cat hydrated enough to avoid dehydration occurring. However, cats with early stage CKD can usually drink enough to offset their increased urination, and thus do not become dehydrated even without sub-Qs.               [MY NOTE: you can syringe and/or add extra water to their food!]

 

Processing sub-Qs in itself places an additional workload on the kidneys, plus it can flush out certain nutrients, reduce potassium levels and raise sodium levels. In Staged management of chronic kidney disease in dogs and cats (2009), a Presentation to the 34th World Small Animal Veterinary Association World Congress, Dr David Polzin states "Because recent evidence suggests excessive sodium intake may harm the kidneys, recommendations for long-term sodium administration in any form should be carefully considered."

 

Giving too many fluids or too soon may also increase the risk of overhydration. This is a particular risk for cats with heart problems. Therefore it is best not to begin fluids until the advantages are likely to outweigh the disadvantages i.e. when a cat would become dehydrated without them.

 

Dr Katherine James of the Veterinary Information Network believes that this tends to happen and that most CKD cats will benefit from subcutaneous therapy once creatinine levels are consistently over 3.5-4.0 US (300-350 international). This equates to high Stage 3 of the IRIS staging system. If your vet thinks your cat's CKD is less advanced than this, and your cat does not appear dehydrated, then it is probably safer to hold off on sub-Qs for the moment.

 

However, there are exceptions, and a small number of cats with creatinine below 3.5 US (300 international) may need sub-Qs. This tends to apply to cats whose creatinine is below 3.5 US (300 international) but who previously had a higher level, usually at diagnosis. So if, for example, your cat has creatinine of 6.0 US (550 international) at diagnosis, but this gradually falls to 3.5 US (300 international), s/he will still probably benefit from regular sub-Qs. Cats with pancreatitis are prone to dehydration and may need sub-Qs even if their creatinine level is lower than 3.5 US (300 international).

 

Also, any time more water is going out than is coming in, sub-Qs may be needed short-term. Thus, a CKD cat who is a bit below par because of vomiting or diarrhoea causing dehydration, or who stops eating or drinking, may benefit from sub-Qs as a one-off - my vet gave sub-Qs to my non-CKD cat when she had severe vomiting and diarrhoea for this reason.

 

 

post #44 of 66

Any update on Darwin?

post #45 of 66

after 2 days his face and eyes looked more brilliant. we had to stop the iv after 2 days. each day the needle became displaced. instead

of the fluid going directly into vein, it went to muscles. body absorbed the fluid, but, not what doc wanted. in trying to reinsert the iv

day 3 we discovered from days one and two and various blood tests before we started, the veins were a little weak, so we took a 24hour break.

late yesterday afternoon we started again. all good on the outside, except of course darwin is not a happy boy being in a cage. i put the cage on

a table right next to my bed. i can pet him through the bars as i lie down. tomorrow @ 5pm we take out iv.

post #46 of 66

Good news! 

post #47 of 66

whollycat-- 250ml day for 4 days based on darwin's weight

post #48 of 66
Quote:
Originally Posted by daddyincr View Post

whollycat-- 250ml day for 4 days based on darwin's weight

That is twice the amount that has been recommended if reading the above shared info in the studies.

 

I am hoping that since your cat is fairly young and barely in kidney failure, that his body and kidneys will be able to handle this much fluid.

post #49 of 66

Yeah that's A LOT!!! I'd honestly call the vet and make sure because that's a crazy amount. Usually 50 mls per day or even every other day.

post #50 of 66
Quote:
Originally Posted by finnlacey View Post

Yeah that's A LOT!!! I'd honestly call the vet and make sure because that's a crazy amount. Usually 50 mls per day or even every other day.

Darwin is getting fluids via IV at home, rather than sub-q. 

post #51 of 66

What percent dehydrated did the vet say he was? Need this to calculate an approximate mL range of fluid that could be given via the IV.

 

Are you monitoring Darwin's weight? Monitoring his urine output to adjust the IV fluids accordingly? How about his heart rate? How about his lungs? Did the vet run any additional testing to see where his kidney values were at after the first or second day of IV fluids?

 

Was the vet going to slowly wean him off the IV fluids? I would talk to the vet about this if this hasn't been mentioned as discontinuing the IV fluids suddenly can cause major problems with kitty's system processes because more harm than good can come by making rapid changes in the kitty's sodium and fluid load by giving IV fluids. Renal failure kitties have lost homeostasis (the ability to maintain internal stability), and can not make rapid adjustments in salt and water balance.

 

Still shaking my head and sigh.gif at this whole thing because any vet that knows kitties with CRF/CKD knows that at the low kidney values (not in crisis mode) Darwin has, with most likely minimal dehydration (unless a lot of vomiting and/or diarrhea has been going on), is not the course of action to be taken--minimal sub-Q fluids would be.

post #52 of 66

Is there an update on Darwin?  I've been thinking about him.

post #53 of 66

got the blood tests back. creatinine 2.0.. at the top or just out of normal range. for now i have been instructed to

make sure he gets a lot of water and keep up the science diet k/d diet. we don't have any other option here in

costa rica as far as prescription diet goes.

  his third eyelid has gone back hiding (haha, thank goodness)

as always his outward behavior is normal. one thing i notice is he appears to have some sensitivity

in his eyes. like at times when he isn't sleeping the eyes are 1/2 shut. concerns me.

 

as an aside his baby sister (no relation biologically) has decided she will  eat no other food except

what darwin eats. she's a healthy young lady, but, just wants to eat the science diet k/d like

her big brother. if it didn't concern me it would be funny.

 

thanks for all the support i have been shown here at the cat forum.

post #54 of 66
Quote:
Originally Posted by finnlacey View Post

Yeah that's A LOT!!! I'd honestly call the vet and make sure because that's a crazy amount. Usually 50 mls per day or even every other day.


not sure if i explained myself clearly---that was over a 24 hour time. darwin will be 3 in october and his weight is 12 pounds.

post #55 of 66

That's still way too much fluids, that can damage the heart and lungs. I would still make sure about this. As for the little one eating what her brother does, I'd feed them separately. Not sure it's healthy for her to be eating special kidney food continuously without a reason. She needs more protein than that. 

post #56 of 66

Glad to hear Darwin is feeling better!

 

There's also some disagreement on whether a low protein diet is actually beneficial to CRF / kidney failure kitties.  Lots of info here on the forums recently discussing this topic.
 

post #57 of 66

Yeah, I'm actually not for giving a kitty a low protein diet myself. To me that just sets up a whole host of other issues. 

post #58 of 66

funny that all wet canned foods here have @ 8-10% protein. the dry food whether innova or k/d each has @ 28% protein.

so, i mix the dry with wet.

post #59 of 66
Quote:
Originally Posted by daddyincr View Post

funny that all wet canned foods here have @ 8-10% protein. the dry food whether innova or k/d each has @ 28% protein.
so, i mix the dry with wet.

Dry and wet percentages aren't compared like that. You have to convert them both to "dry matter basis" before you make the comparison.

To do this you find the moisture content of a food. Most canned foods are around 78% moisture. So say you have a canned food with 78% moisture, listing 10 % protein. You take the 10 % and divide it by the dry percentage, which is 22 % (100-78=22), which makes the canned food 45 % protein, which is a decent amount.

Dry foods are usually about 10% moisture (or less) If you are feeding a dry food with only 28% protein (which is way too low for a cat) and the dry percentage is 90% (100-10=90) the dry matter percentage for the dry food is 31 %.

So now you can compare them on a dry matter basis

canned 45% protein
dry 31% protein

The quality of the protein matters too. Canned food is more likely to have meat protein, which the cat can actually use, as opposed to protein from grains, which just get pooped out.
post #60 of 66
I am glad Darwin is good. btw, I really like the name Darwin :)
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