Cat with kidney disease has low potassium level under 3.0 mEq/L

Has anyone had experience using phosphorus binders?  The vet prescribed a liquid phosphorus binder, Aluminum Hydroxide, for Sandra.  I haven't started her on it yet.  She still has a couple of days left with her antibiotic.  The vet said it shouldn't be a problem for Sandra to take the phosphorus binder while still on antibiotic.  But I was reading Tanya's website for ckd cats and noticed she said binders should be generally kept away from antibiotics. 

I also read the phosphorus and potassium citrate can cause aluminum toxicity.  The vet said I can stop giving Sandra the potassium supplement as her prescription k/d food already contains potassium.  I wonder if a phosphorus binder is necessary or if it will cause more harm?  The vet didn't even suggest to wait until Sandra's phosphorus level (15) is rechecked before adding the binder.  But she thinks Sandi's back leg weakness may also be caused by the high phosphorus level in addition to the arthritis.

I've never used phosphorus binders...mainly because Callie is such a picky eater, and our Vet said they definitely have a taste to them.  Plus, her phos levels haven't been too high yet, and she hasn't shown any symptoms.

I guess you say this particular page on Tanya's website:  http://www.felinecrf.org/phosphorus.htm  It definitely indicates leg weakness can be caused by high phos levels.

Sandra was mostly sleeping yesterday and seemed tired.  I woke up this morning to check on her and she had thrown up in three different places.  I hope this is a one time thing.  I wonder if it may have to do with the Miralax dose that she is on.  The vet told me to give her 1/4 teaspoon twice a day.   Maybe this is too much?  She did have two bowel movements yesterday which is not normal for her.  Or maybe the vomiting is from the phosphorus binder.  I started her on it yesterday.  I don't know why the vet would start her on a phosphorus binder without first checking her numbers. I did not give her any Miralax or phosphorus binder this morning.  We are monitoring her today.  She licked some canned food and ate a bit of dry k/d food.  Her follow up vet visit is Saturday.  I hope this is not related to the kidney disease.  I am so worried.  I don't want to lose her.  She has been with us since she was 3 months old. 

Depending on WHICH phos binder you are using, this could be the culprit.  It's definitely a balancing act using these while feeding a k/d diet.  Did your Vet explain all that?

Have you seen this page on Tanya's website?  http://www.felinecrf.org/phosphorus_binders.htm   VERY important, I would say.

My kidney girl sometimes just has bad days (more than I like )  It happens.  Sometimes I think....this is it...we need to let her go , and then she'll perk up and act like "normal" for several weeks, then go into a slump for a couple of days and then go back to her old self for awhile.  AND, sometimes when she's straining to have a BM, she will throw up.  If you found 3  "puke piles" and 2 BMs, it's possible she really strained to get out those BMs and it caused the vomiting.  Were they near the litter box.  My girl will immediately  jump out of the box and vomit when this occurs...sometimes leaving behind a BM, sometimes not.  BUT, I don't think it would be caused by the Miralax itself. (the vomiting)

mrsgreenjeens said:

 
Depending on WHICH phos binder you are using, this could be the culprit.  It's definitely a balancing act using these while feeding a k/d diet.  Did your Vet explain all that?

Have you seen this page on Tanya's website?  http://www.felinecrf.org/phosphorus_binders.htm   VERY important, I would say.

My kidney girl sometimes just has bad days (more than I like

)  It happens.  Sometimes I think....this is it...we need to let her go

, and then she'll perk up and act like "normal" for several weeks, then go into a slump for a couple of days and then go back to her old self for awhile.  AND, sometimes when she's straining to have a BM, she will throw up.  If you found 3  "puke piles" and 2 BMs, it's possible she really strained to get out those BMs and it caused the vomiting.  Were they near the litter box.  My girl will immediately  jump out of the box and vomit when this occurs...sometimes leaving behind a BM, sometimes not.  BUT, I don't think it would be caused by the Miralax itself. (the vomiting)

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My vet did not mention anything regarding using a phosphorus binder while Sandra was already on a prescription k/d diet.  She prescribed Sandi a liquid form of Aluminum Hydroxide.  I have looked at Tanya's website.  The vet even said to discontinue the potassium supplement.  This is odd considering that the phosphorus binder may cause her potassium to go down.  I hope that is not what's happening.  The vomit was not far from the litter box, about 2-3 feet and 2 BMs just like you said.  I hope to God it was a one time thing.  So far today she has not vomited and has eaten.  She seems less tired today too.

Thanks so much for your help.  It's reassuring. 

mrsgreenjeens said:

 
Depending on WHICH phos binder you are using, this could be the culprit.  It's definitely a balancing act using these while feeding a k/d diet.  Did your Vet explain all that?

Have you seen this page on Tanya's website?  http://www.felinecrf.org/phosphorus_binders.htm   VERY important, I would say.

My kidney girl sometimes just has bad days (more than I like

)  It happens.  Sometimes I think....this is it...we need to let her go

, and then she'll perk up and act like "normal" for several weeks, then go into a slump for a couple of days and then go back to her old self for awhile.  AND, sometimes when she's straining to have a BM, she will throw up.  If you found 3  "puke piles" and 2 BMs, it's possible she really strained to get out those BMs and it caused the vomiting.  Were they near the litter box.  My girl will immediately  jump out of the box and vomit when this occurs...sometimes leaving behind a BM, sometimes not.  BUT, I don't think it would be caused by the Miralax itself. (the vomiting)

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Sandra has been doing well these past couple of days.  I came home from work Wednesday night to check on her and found her up on the couch.  She hasn't used her pet stairs to go up on the couch in a month.  She is now going up and down on her own.  She is still wobbly.  She's eating, drinking and using the litter box.  Her follow up vet appointment is tomorrow morning.  I am wondering if I should reschedule her appointment.  I feel like if I take her she is going to get very stressed as she really hates going to the vet.  And I noticed they are not gentle when they take her out of her carrier even though they know she has advanced arthritis in her spine.  I'm afraid if I take her she will relapse.  She seems to be making good progress. 

Just wanted to ask for advice - do you think it would be a bad idea to reschedule her appointment until the following Saturday?

Thanks.

Probably too late now, but I would probably cancel till next Saturday unless there is a very good reason (blood test?) for today's visit.

Why can't YOU take her out of the carrier before they have a chance?  That way you can be very gentle with her. 

Sandra's follow up is in a couple of hours.  She is still eating and drinking good.  She uses the litter box and has been having good BMs from the Miralax.  But she is still wobbly.  Yesterday she seemed more wobbly than usual.  She fell in the litter box and also fell slightly walking out of it, almost like she trips and quickly gets up again.  It will be interesting to see if her phosphorus level is responding to the prescription diet.  She did not care for the liquid  phosphorus binder the vet prescribed her a couple of weeks ago so the vet told me to discontinue it for now and we will see how her numbers look with the prescription food.  I did read about Epaktin as a phosphorus binder and saw that a lot of pet owners had very positive results.  I'm going to ask about using this as a possible phosphorus binder if she ends up needing one.  I will also ask about sub-Q fluids at home.  I hope my little baby is ok.  I'm worried about her.

Good luck with the exam.  You probably won't get the blood results today....we never do .  Our 16 year old kidney cat is a little wobbly too, but mainly just when she "shakes it off" as cats do.  She always tends to stumble a little after she does that.  Not the same though, I realize.

Even is Sandra's phos are stiff off, just remember there are still other options to try.  Some phos binders are more harsh than others, as you are learning.  With kidney cats, since they don't always feel like eating, it's a balancing act trying to get something inside them.  But fluids really DO help, so glad you are going to ask about them.

Keep us posted.

Sandra is back from the vet. They ran a kidney panel. Her BUN went down to 70. Before it was 83. Creatinine has gone up from 4.4 to 6.2. The vet said she is surprised Sandi isn't very sick already. Phosphorus has gone down from 15.6 to 10.8. But her potassium has also gone down again to 3.2 so the vet said to start her on the potassium supplement again. Also, her calcium has increased. The normal range is 7.8-11.3 mg/dL and Sandra is at 12.9.

They gave me a powder form of phosphorus binder to try, aluminum hydroxide. I'm to give 1/8 teaspoon mixed with food once a day.

The vet techs showed me how sub-Q fluids are given. They told me to think about if this is something I would be willing to do at home and let them know on Monday. It seems scarey. The needle is bigger than the one I use for her Adequan injection. And Sandra was struggling half way through the process. Another vet tech had to hold her. They said I would have to give her fluids 3-4 times a week for about 1 min each time.

When we got home she was very wobbly and shakey. I'm sure from the stress of going to the vet. She ate some of her prescription canned food and is now sleeping. I went and laid down next to her and hugged her and she started purring. So hopefully she is not too upset with me.

The vet wants to look into the Epaktin first and then let me know if it's a good supplement as it contains some phosphorus and calcium.

Does anyone have any suggestions in bringing down the creatinine?

Well, it's disheartening that her creatinine has gone up so much...believe me, I know.. .  Same thing happened to Callie at her last appointment.  She jumped up almost 2 points as well, and had been pretty stable up to that point.    BUT, it's great news that her BUN and  PHOS and gone down.     So it seems like her food is slowly working at decreasing her phos level.  Maybe she will tolerate this new Aluminum hydroxide binder better.  It's not supposed to have any odor or flavor.  I read if you dissolve it in a little water before mixing it in the food, it helps with the grittiness.  

She may always need to be on a small amount of Potassium supplements, from what it sounds like, since that is decreasing again.  I guess that's something you will simply have to keep an eye on.

Not sure WHY Epaktin is even in the picture, since it contains both phos and calcium, both of which she is too high in.

Does she have ANY other issues other than the kidneys and arthritis?  No anemia...that sort of issue?  If not, when we asked what to do to help Callie's rising creatinine, the answer we got was "more fluids".  That's it.  Increase her sub-q fluids from twice a week to 3 times a week.  It helps flush out the toxins because the kidneys can't do it.  NOW, let's talk about why Sandra is having a hard time with the fluids.  Honestly, I've seldom heard of cats not tolerating fluids at the Vet .  Do you have any idea what size needle they were using?  Did the warm the fluids first?  It's just kind of surprising.  Usually cats don't give the Vet's any problems....they normally just sit there.   And the one minute per day thing is odd too.  What are you planning on doing there?   She really does need fluids.  I give my girl lots of extra filtered water in her food...LOTS.  But she also gets her sub-q fluids.  We buy special, extra sharp, thin walled needles are smaller so she appears not to even feel as they go in, but we can get a pretty good flow with, then I warm up the fluids (and her fluids contain some potassium), and away we go.  We try to give her 150 ml each time.  I would say the whole thing takes maybe 5 minutes.  I also bundle her in a nice warm blanket she she stays warm while we're doing it.  Plus we hang the bag from the diningn room chandelier, so it's really high up.  The higher it hangs, the faster the fluids flow.  If you're afraid to give them, see if there is a Vet Tech in your area who will come to your home and help you.  We found one who does it when we go on vacation, etc.

I picked up Sandra's fluid supplies from the vet today.  Her only problems at the moment are the kidney disease and arthritis.  I'm supposed to give her 100 ml three times a week.  They gave me smaller size needles, size 22.  Is there even smaller size than this?  I'm very nervous about doing this.  I just don't want her to be uncomfortable.  I called some animal clinics in the area to see if they know of vet techs willing to come out to the home.  I figure if I can find a vet to give her the sub-Q fluids 1-2 times, that way I can watch and see how Sandra handles it at home and get comfortable with the idea of doing it myself.  She was not cooperating at the vets office and they were not gentle with her.  When we got home her wobbling was more pronounced.  She has since calmed down, but I am not going to stress her by taking her to the vet 3 times a week.  One clinic told me a vet tech will cost $75 per visit.  I am going to call a few more places in the morning and see if I can find a better price.  I am hoping I can find someone to come out tomorrow evening.  

She is still eating well.  I started her on the phosphorus binder.  She would not take it with the food, even though it does not have a taste.  She still new something was off.  I've just been mixing it with water and giving it to her by syringe.  So far she's been taking it without a problem.

I hope all goes well.

Some tips that might help:  20g flows faster, so if just stating out it might be easier.http://www.thrivingpets.com/index.php/terumo-needles-box-of-100.html   If you go with the 21g or the 20g needles, go for the "Ultra-Thin Walled" ones if at all possible  The inside diameters aren't affected, but the outside diameters are smaller, so they make a smaller hole.  Just like an insulin syringe, insert the needle with the bevel up. Keeping the needles in the freezer stops the sting a little bit and warming the fluids just a little bit also helps; you can test the temperature with an infrared thermometer or test on your arm.

I hope you can find a Vet Tech to help you.  My clinic was really patient and showed me how; but it helps to have an extra pair of hands starting out.

We found a Vet Tech who happened to live right around the corner from us!  She only charges $15 per visit.  I found her by simply calling ALL the Vets in my area and asking if there were any Vet Techs who did home visits. 

We also use the 20G Untra Thin Wall Terumo needles.  NOW, here is a website that is a must have for you, this is my "go to" for anything kidney related.  I usually refer to it before any Vet visits or phone calls, just because I want to be in the know.  This particular page is all about giving sub-q fluids:  http://www.felinecrf.org/subcutaneous_fluids_tips.htm#clothes_peg_trick

I will say that on that page it refers to having an IV pole to hold the bag, but we just use a coat hanger which we cut so one end can hang over either the shower curtain rod or from our dining room light fixture, then the other end we bent so the bag can hang on it.  Works perfectly.  And we heat up the bag in a bowl of hot water.  I tried the heating pad method, but it doesn't really seem to work.  I also heat up a bath towel in the dryer to wrap Callie up in so she stays nice and warm, which seem to help her feel more comfy. 

Remember, you are not hurting Sandra...you are HELPING her .  Your first time probably won't be perfect, but you'll improve each and every time.  You'll both get used to it in time.  Be sure to read that webpage above, because it has tips for even the most aggressive cat. 

Let us know how it goes

I found a vet tech that is going to come out tonight.  She is going to charge $12 per visit.  Hopefully after a couple of sessions, I can pick it up on my own. 

I let her know of Sandra's advanced arthritis and that she needs someone to be very gentle with her.  She sounded very understanding on the phone.  I hope all goes well. 

I feel a bit better knowing she is not going to go to the vet's office for fluid.  They were not at all patient when showing me what to do.  I felt like they were rushing and annoyed with me.  They just picked Sandra up by her scruff and put her down on the table.  Her leg was awkwardly stretched out, with the underneath part facing up.  I had to correct it for her.  And when the session was done, the vet tech went to grab her to put in the carrier and I quickly wrapped my arms around her and put her in by myself.  I really felt like crying.  The vet herself was not reassuring either, saying that fluid makes very little difference.  I can't believe she would say that, when all other materials I've read said that fluid therapy is vital.  I was so mad.  Sandra is still eating and drinking and using the litter box on her own and they made seem like it was all a wasted effor.  I am honestly going to look for another vet. 

This is great that you've found someone to come over and help  you .  And what a fabulous price too . 

I cannot believe how your Vet's office treated Sandra .  That sounds awful.  I would definitely be looking for another Vet.  Maybe the one where this new Vet Tech works?  If you like her, see what she thinks of her practice.  Funny, our Vet Tech does NOT recommend her practice.  They are more "dog people"

Tamu708 said:

 
I found a vet tech that is going to come out tonight.  She is going to charge $12 per visit.  Hopefully after a couple of sessions, I can pick it up on my own.

I let her know of Sandra's advanced arthritis and that she needs someone to be very gentle with her.  She sounded very understanding on the phone.  I hope all goes well.

I feel a bit better knowing she is not going to go to the vet's office for fluid.  They were not at all patient when showing me what to do.  I felt like they were rushing and annoyed with me.  They just picked Sandra up by her scruff and put her down on the table.  Her leg was awkwardly stretched out, with the underneath part facing up.  I had to correct it for her.  And when the session was done, the vet tech went to grab her to put in the carrier and I quickly wrapped my arms around her and put her in by myself.  I really felt like crying.  The vet herself was not reassuring either, saying that fluid makes very little difference.  I can't believe she would say that, when all other materials I've read said that fluid therapy is vital.  I was so mad.  Sandra is still eating and drinking and using the litter box on her own and they made seem like it was all a wasted effor.  I am honestly going to look for another vet.

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That's not right!   I would look for another place. Ask the girl who will be coming by to be honest with you and tell you where a good place to take older cats. The picking up by the scruff is unacceptable!!!!!!!!!!!!!!!!

Tamu708 said:

 
I picked up Sandra's fluid supplies from the vet today.  Her only problems at the moment are the kidney disease and arthritis.  I'm supposed to give her 100 ml three times a week.  They gave me smaller size needles, size 22.  Is there even smaller size than this?  I'm very nervous about doing this.  I just don't want her to be uncomfortable.  I called some animal clinics in the area to see if they know of vet techs willing to come out to the home.  I figure if I can find a vet to give her the sub-Q fluids 1-2 times, that way I can watch and see how Sandra handles it at home and get comfortable with the idea of doing it myself.  She was not cooperating at the vets office and they were not gentle with her.  When we got home her wobbling was more pronounced.  She has since calmed down, but I am not going to stress her by taking her to the vet 3 times a week.  One clinic told me a vet tech will cost $75 per visit.  I am going to call a few more places in the morning and see if I can find a better price.  I am hoping I can find someone to come out tomorrow evening.  

She is still eating well.  I started her on the phosphorus binder.  She would not take it with the food, even though it does not have a taste.  She still new something was off.  I've just been mixing it with water and giving it to her by syringe.  So far she's been taking it without a problem.

I hope all goes well.

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My experience with sub-q needles:  the vet gave us 18 gauge Monoject needles, which are pretty darned big!  So of course after all my reading I wanted to try Terumo ultra thin will 20 gauge.  But even with those, the time to get the fluid in practically doubled.  And it turned out for us that minimizing the time for Amber sitting still was far more important than minimizing the stick, which she hardly felt.  Waiting for the 20 gauge to finish she started to get antsy and want to run away, which she hadn't done previously. So back to the 18 gauge monsters we went.  You can get 100ml in with those in about a minute or less.  Hang the bag high (like above your head, with cat on floor), and try to warm it to around body temp (you can test on your arm) by immersing in warm water (keep the tubing dry either by suspending it above the water or put the whole contraption inside a jumbo ziploc bag).

Once someone shows you I promise you'll be able to do the fluid yourself.  I always thought I couldn't do anything with needles but I was quite comfortable with it after a few tries.  Not every cat will tolerate it as easily, but Amber was normally pretty ornery with handling yet liked the sub-q fine.  We had her lie in a favorite basket turned into a bed, which we could carry over to the sub-q site (the same place each time).  The basket was otherwise left out in a different spot where she would sleep in it at other times of day.  Typically when it was time for the sub-q in the evening every couple days, she was already lying in the basket anyway, which we just carried over with her in it.  The point of this is really you make it into a routine and Sandra will hopefully understand the routine and maybe even associate it with feeling better afterward, thus making it not an ordeal which she is fighting.

It's unfortunate the vet practice was not patient with demonstrating.  Our vet showed us himself, even letting us try it while in the office.  The first time at home was not so easy but after a couple it was surprisingly uneventful.  And yes fluid treatment is typically vital, as it has a direct effect on the cat's general sense of feeling well. Best wishes to you in caring for Sandra.

Thank you everyone for all the helpful information provided.

The vet tech came by and gave Sandra her sub-Q fluid.  She received 100 ml.  The vet tech was very nice and patient.  She was very gentle to Sandi.  The whole time she was stroking her head and speaking softly to her.  Sandra did hiss when the needle first went in, but after that she stayed calm and still.  She definitely feels better.  She is more perky and it has noticeably increased her appetite.  I warmed the bag up before the vet tech arrived.  I was amazed at how quickly there was improvement.  When she received fluid at the vet's office last Saturday, there was no improvement at all.

The next session is Thursday.  The vet tech said she is going to have me do it next time.  I am going to use the smaller size needles.  She used the bigger ones.  I imagine that's why Sandra hissed at first.  I am so happy that I didn't have to take her to the vet.    

The office that the vet tech works in is a good 35 min. drive from us.  I wouldn't want to go that far.  It would be too stressful on Sandra.  I did find a couple of vet offices near us that got excellent reviews.  I am definitely planning on a vet change for Sandra.  

I hope this fluid therapy improves Sandi's kidney numbers.

SO glad you saw the immediate improvement in Sandra .  Callie always comes for food almost immediately after her fluids.  That's how I can tell she feels better.

Also glad it went well with the tech.  Hopefully the smaller needle will do the trick next time.  Try freezing it as well to see if that makes a difference.  Some people say it does.  I've never tried it because none of my cats have ever even seemed to feel the needles (maybe because we've always used Terumo )

Even if it doesn't improve her numbers,if it makes her feel better, it's all worth it.