How much to feed my sick 17 year old cat? MAY have CRF?

My kitty Ptolemy (P is silent) is doing MUCH better now that I've had him on subcutaneous fluids for a week and a half (100 cc a night) but he's not eating well at all. I have tried over 20 different wet foods, and it's just a hit or miss thing, and Pepcid A/C didn't seem to help nor the Mirtazapine. Sometimes he'll chow almost like normal, a whole can of cat food in a day, but that's one day in 5.  I have done all the tricks, like heating up the food, putting it on a plate, elevating the plate, and so on.  He's best about licking up the gravy. I have tried every wet food on the market, in many flavors.  I think the Clavamox was upsetting his stomach and stopped that last night, because it was never clear if he had an infection or not, and the subQ fluids helped so much.  

His creatinine and BUN were high, as if he had moderate CRF, but his blood work 4 months ago was fine, and I'd thought his problems yodeling at night and not grooming were due to dementia. He was very dehydrated when his blood work was done.  Everything else tested fine.

So how many oz of wet food do you think he needs in a day?

He's about a 12 pounder, currently inactive, 17 to 18 year old tomcat (sleeps all day).

I don't know if he will need daily subQ forever, but for now, he needs that. He really seems to have turned a corner for the better. Acting much more normal.  Oh, and I got a feeding syringe, and I'm also not worrying about putting him on CRF diet yet, because he just needs to EAT at this point, eat something.  I don't want him to associate the diet he will need long term with his nausea or loss of appetite now.

Good thing I have 3 other cats to feed. They are making out like little piggies with all that food Ptolemy won't eat. Oink oink!

Thanks everyone! I'm a new member.

I've had more than one cat get upset stomachs from Clavamox. He may not be eating simply because of that and you may need to wait a day or 2 for that to work out of his system and his appetite return.

I'm sure their is a scientific answer to your question on how much to eat, but having a 17 year old myself, I say as much as they want, particularly if Ptolemy is in early stages of CRF. The CRF taps their systems and building up any reserve will help him in the long run.

It's been a long time since I've had a CRF cat, but I do recall that he didn't like any of the prescription diets, but in place of that, I recall changing his dietary intake of protein. I want to say I went with a higher protein food, but please check with your vet before you do anything as I could be totally wrong here. As you mentioned, its better for them to eat something than to pick at something they don't like when they are ill.

Sub-q fluids helped by CRF boy more so than anything. It's so sad to put them through it, but they do feel so much better afterwards.

Welcome to TCS!

What was Ptolemy's phosphorus level from his labs (with reference ranges)? Higher levels can cause CKD kitties to not feel like eating, and you would need to use a phosphorus binder added to his food to combat this.

It may be that although he feels better in some respects, the amount of sub-Q fluids may be a little high for him. You could try reducing that to around 75mL and see if it helps. A rule of thumb for sub-Q fluids is 5-10mL per pound of body weight.

You could add B-Complex, such as Jarrow B-Right (a low odor B-complex that usually doesn't turn kitties off), and/or even talk to the vet about the injectible B12 in the form of methylcobalamin. B vitamins are water-soluble and are often lacking in CKD kitties, who lose much of their B's through urination. A lack of B's may in some cases be related to lack of appetite. Vitamin B deficiencies are also known to cause non-regenerative anemia. Your vet may therefore suggest a supplement in order to avoid these problems.

As far as how much to feed, how much did he eat before he was sick? I would aim for what he ate before because CKD/CRF kitties can lose a lot of weight too easily with their often-occurring inappetance.

Have you tried Fancy Feast or other food like this to entice him to eat? Not the best food, but he has to eat. How about little bits of lightly cooked chicken? Any favorite treats he likes that you could mix in and top off his food with? I would definitely syringe feed him small amounts multiple times a day (because small, frequent meals may help with any nausea issues) if he's in a slump food-wise.

I would not use the veterinary (or other purported protein restricted diets) CKD/CRF diets. Here's why: Besides these "diets" having crummy ingredients, kitties are obligate (strict) carnivores, so by feeding a protein restricted diet it will cause more muscle and organ wasting of their already compromised body system processes--this practice basically causes severe protein malnutrition for our little carnivores. As CKD progresses, the quality of the protein is important and should be looked at because a high quality meat protein will be easily digested and will therefore have less nitrogen by-products that can be taxing on the kidneys.

Hope this helps a bit. Do post about his phosphorus level...

It does sound a lot like your cat is having some kidney issues and that could be why he doesn't want to eat.  Dehydration can make him feel dizzy and sick.  I had a cat with kidney disease and my cat eventually yowelled at me from the other room.  She got treatment, but even then, looking back I now realize that the yowelling may have been related to the kidney issue.  Does your kitty vomit as well?  

I agree with the other poster that it may be time to start subQ fluids.  Also, you might try talking to your vet about other supportive medications.  There are some temporary ones for anti-nausea (eg. Cerenia) to help get kitty eating again.  I also gave mine Azodil, Epakitin and Potassium Chloride daily and it worked quite well to support my cat.  The vet should also have some advice about foods that are easier for the kidneys to manage.  

I hope this helps.

I do not have a print out of his lab results, but I believe only his BUN and creatinine were abnormal. I will have to call the vet office tomorrow for more info.  There was no urine test done, because the vet didn't expect CRF, I think. Does that mean he may be having high numbers due to severe dehydration? At this point, it makes no difference in treatment, because he needs fluids and food, or he won't make it no matter what is wrong.  I will check on phosphorus, though, but the Clavamox could very well be the main problem.

He always ate dry food before, and I only gave wet food as treats, and I have multiple cats, so it's difficult to know. My brother's old female cat, about a 9 pounder, eats about 5 oz of wet cat food a day, he says. She's more active than my kitty is right now, so I was shooting for about 5 oz a day. Does that sound reasonable?  I have not often succeeded at 5 oz, though. Usually about 3, which is just one Fancy Feast size.

He won't eat Fancy Feast, chicken, tuna or anything else reliably. I've done best so far with those little yellow tubs of Meow Mix wet food, and he will often eat the gravy in the Whiskas or Sam's Club pouches. The Fancy Feast has less gravy.( I've recently switched my other cats to the Merrick Before Grains dry food, but Ptolemy won't eat dry food right now, if he ever will again) I read about the phosphorus issue and CRF briefly in the past week, but at this point, the kitty won't open up his mouth and feed it (I'm a Weird Al fan, too).  

I don't think I've overhydrated Ptolemy, because he's only been well hydrated for maybe 3 days. He seems dehydrated again by the time I am ready that evening to give him more fluids. I think in hindsight, the vet should have kept him for a day or two and gave him IV fluids and other supportive care, instead of just some subQ and send him home, and not give me any subQ to give him. I think I've been playing catch up with a very sick cat all this time.  I wouldn't have even known I could do the subQ except that except that my sister had a CRF kitty for a couple of years.  It's a 35 mile trip one way to the vet because I'm rural, and I've been there several times in the past week and a half. It is so stressful to poke my kitty with a needle, but it REALLY helps.  Funny how I saw the same thing with my spouse a couple weeks ago - 2 bags of IV fluids, and the next day, he was so much better! Amazing.  We joke that I'm gonna give him subQ too, but he's fine now.

So does 5 oz of wet food a day sound about right for an old tomcat? 

tx for the supportive help! This is scary.  

Hopscotch said:

I agree with the other poster that it may be time to start subQ fluids. 

I also gave mine Azodil, Epakitin and Potassium Chloride daily and it worked quite well to support my cat.

The vet should also have some advice about foods that are easier for the kidneys to manage.  

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The OP is already doing 100mL sub-Q per day. Think you missed this?

Potassium is only supplemented if kitty has a deficiency, to do so just because another poster said it worked for their kitty is a bit misleading. JMO. One should not use a potassium supplement unless kitty is deficient, and only at the direction and guidance of a vet.

Vets do not always provide the best information when it comes to foods. A lot of them are still "old school" and recommend veterinary kidney diets. Most up-to-date vets do not recommend restricting good quality meat protein and have not for years. Please see my post above as to why it is not a good idea to restrict meat protein for a carnivore. When my Tuffy was diagnosed at 2 years old (with very scary high numbers on his lab results), I did NOT restrict quality meat protein (canned diet at the time--no kibble), which was contrary to what my vet at that time wanted to do--that vet basically gave Tuffy a couple months to live at the most; boy was he wrong! After leaving that vet's office scared and upset for my little guy, I researched all things related to kitties and CRF/CKD and followed my new vets advice on not restricting meat protein (which I brought up) and using a phos binder to keep Tuffy's phosphorus level in check. Tuffy lived for another 5-1/2 years. I repeat: boy was that first vet wrong on Tuffy's life expectancy!! If it was now, I would be even better armed to help Tuffy because I stay current on CKD issues with kitties, and I feel that Tuffy would have lived even longer.

A quality meat protein food is easier on the kidneys because it is more digestible, and nitrogen by-products are therefore not as much of an issue.

Don't mean to come across as disagreeable.

I'm certainly having some issues with my vet office, mostly the vet techs, who pushed the science diet on me when kitty won't eat at all  and many other issues (very bossy and all that), but this is the best vet office anywhere nearby. The rest don't know how to treat cats, because most people around here get treatment only for their dogs and horses. Lucky if they take the dogs to the vet for an exam even if they are hit by a car and survive.    Otherwise, I have to take kitty 45 miles each way to get to a bigger city. 

Ptolemy's potassium was a bit low 4 months ago, and I think the vet mentioned it was normal this time. But honestly, I was rather distressed to get the CRF news, so I'm not sure that I'm right.

I totally buy the carnivore thing.  Frankly, I don't think grains have done well by humans either, but at least we're omnivores.  RIght now, if kitty wants Meow Mix, that's what he gets, though. He won't even eat chicken. At this point, I'd go out and poach a pheasant if I was pretty sure he would eat it. He may. Wild birds have more flavor than chickens.  Maybe cruise around for some fresh road kill, yeah!!

You wouldn't believe how much of a relief to get all these supportive and informative messages. 

Kitty isn't all hunched up in that meatloaf position anymore. He's sleeping curled up like normal now, normal for about 2 days. He yawns and has marked a few things with his cheek.

Ok, gotta go do subQ on him now. tx again!

Hi WhollyCat, I get the impression that you are upset and I'm sorry if something I said hit a button.  I did somehow miss that Iluvcats3 is doing subQ fluids already.  My comment about food was really intended to mean low fat versus high fat food, though I didn't specify.  I agree that grains are not a natural part of a cat's diet.  I was only sharing my experience with the proviso of talking to a vet since I am no expert, just another pet owner. In no way am I trying to tell someone else how to treat their pet.  I also lost a pet with chronic kidney disease and it is upsetting so I understand.  But not being a person with the benefit of a vet's medical knowledge I would use message board information as input and leave the decision on treatment with the vet and the owner.  

Iluvcats3, I see you posted a reply while I was typing my message.  I'm glad these replies are helpful and I hope [color= rgb(24, 24, 24)]Ptolemy feels even better soon.  [/color]

Iluvcats3 said:

Ptolemy's potassium was a bit low 4 months ago, and I think the vet mentioned it was normal this time. But honestly, I was rather distressed to get the CRF news, so I'm not sure that I'm right.

I totally buy the carnivore thing.  ... At this point, I'd go out and poach a pheasant if I was pretty sure he would eat it. He may. Wild birds have more flavor than chickens.  Maybe cruise around for some fresh road kill, yeah!!

You wouldn't believe how much of a relief to get all these supportive and informative messages. 

Kitty isn't all hunched up in that meatloaf position anymore. He's sleeping curled up like normal now, normal for about 2 days. He yawns and has marked a few things with his cheek.

Ok, gotta go do subQ on him now. tx again!

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Aw, that is great to hear about him feeling better. Yeah, CKD/CRF can be so scary, but it can be managed for a long, long time. Wish some vets weren't so "doom and gloom" when giving this diagnosis to a kitty parent. <sigh>

Yes, do keep an eye on his potassium level--very important to keep on top of.

Oh! Before I forget--are you using Terumo needles? Back when Tuffy had to have sub-Q's the vet gave me needles. They were Monoject and were like pitchforks. I invested in Terumo needles and they would go in like butter (although Tuffy still hated sub-Q's and subsequently it didn't happen as often as I would have liked; I began giving him water by mouth with a syringe and added to his food to supplement the sporadic sub-Q sessions). Terumo's are much, much easier on poor kitty's injection sites. Most States you don't need a prescription for these, but a few you do. I think CT, IL, MA, NJ, NY and RI are the ones that you do.

I would make sure to have a urinalysis done with your next set of labs. In particular is specific gravity (SP). Specific gravity is an important measure of how well the urine is being concentrated by the kitty's kidneys, and therefore, how well the kidneys are actually functioning as filters. CRF (currently called CKD) kitties cannot adequately concentrate urine, so a low specific gravity is indicative of renal failure.

I can just picture poaching a pheasant! As time goes on you should check out the phosphorus levels in foods and try to stay with foods that are lower in phos. Chicken and turkey are normally lower in phos. Pheasant, not so much. Here's a table of phos amounts in a lot of different canned foods that may come in handy in the future: U.S. Canned Food Data. Keep in mind too, that you would have to determine if the [meat] protein is of high quality in the food and in sufficient quantity (more on cat food labeling some other time--don't want to overwhelm you). No grains, no to minimal fruits/veggies, as these can skew the protein amount (and alkalize their naturally acidic urine--not good). Just cuz it says chicken on the label does not mean all the protein comes from the chicken meat--it is a total of all protein sources in the food. But importantly it all comes down to kitty eating the food. If they don't eat it, it doesn't matter how low the phos level in the food is.

Originally Posted by Hopscotch
My comment about food was really intended to mean low fat versus high fat food, though I didn't specify.

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As with protein, kitties need a relatively high fat content in their food, unlike humans and dogs. Fat does not contribute to a lot of waste products for the kidneys to filter, so it is important to include, and not restrict, fat for CKD kitties. A diet high in fat will actually help a CKD kitty keep weight on without contributing to strain on the kidneys. Or maybe I misunderstood what you meant? If so, I apologize.

I hope Ptolemy will be feeling good soon

I never posted an update and should have, but here goes. I ended up having to put my kitty down after force feeding him for 3 weeks (he would eat a bit sometimes, and I followed him around with this or that wet food offering 20 times a day). He would fool me and do a lot better for half a day here and there, but overall, he declined the entire time.  I loved this kitty for 18 years and I still miss him very much.  Next time I will be much quicker to do SubQ fluids because I now know how, but honestly, I did not recognize the signs of dehydration well, and I was also dealing with my husband getting a total knee replacement at the same time, so I was overwhelmed. Thank you VERY MUCH for the advice.

Iluvcats3 said:

I never posted an update and should have, but here goes. I ended up having to put my kitty down after force feeding him for 3 weeks (he would eat a bit sometimes, and I followed him around with this or that wet food offering 20 times a day). He would fool me and do a lot better for half a day here and there, but overall, he declined the entire time.  I loved this kitty for 18 years and I still miss him very much.  Next time I will be much quicker to do SubQ fluids because I now know how, but honestly, I did not recognize the signs of dehydration well, and I was also dealing with my husband getting a total knee replacement at the same time, so I was overwhelmed. Thank you VERY MUCH for the advice.

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Oh honey, I'm so sorry for this outcome. Huge hugs to you...and many prayers. Just know that he had a wonderful life with you! You showed him the final act of unselfish love by doing what was best for him.

I'm so sorry. When you feel up to it, please consider posting a tribute thread in our Crossing the Bridge forum.

I will now close this thread.