Sickly kitten, help!

Hello,

I recently fostered three, 5 week old kittens. They had diarrhea and were on ponazuril when I got them. The ponazuril wasn't working well enough, so they were prescribed metronidazole. On the second night of taking that med, they got very sick and one passed away at the emergency vet in the morning The one who passed away had been sick about a day longer than the other one. I'd taken her to the foster agency because I was worried she was sick, they just gave her subcutaneous fluids and sent her home.
When I say they got sick over night, they were puking repeatedly, dry heaving.
Not wanting this other sick kitten to have that same fate, I took him to my vet and we hospitalized him there for 4 days, so they could make sure he kept fluids in and could monitor him around the clock. I didn't realize things can be so serious so quick, with guys this small. Now I know.
After I got him from the hospital yesterday, he seems to be hanging in there. He still has lots of diarrhea, and we are taking him to the foster agency twice daily for subcutaneous fluids, since kittens dehydrate so fast.
Good news is, he hasn't puked since we got him back, and he's choking down on this chicken and rice mush we made for him. Since he had the diarrhea we feel like a bland diet might be best, I think he agrees. He's currently taking amoxicillin, and the foster agency prescribed more ponazuril. I'm waiting to confirm with my vet tomorrow about the ponazuril before giving it to him.
He's weak and skinny, but hanging in there, and still sits on me and purrs. I spend a lot of time with him because he seems to eat More when encouraged. He's not drinking any water, but it could be he's not thirsty from all the sub q fluids.
Is there anything I am missing that I should be doing?

Also, these were kittens born to a feral mama. They removed them from her at 5 weeks so they wouldn't become feral themselves.
Oh, and I forgot to add, one of the three is perfectly healthy and doing great, thank goodness. We are keeping him separated from the sick one until he's better.

Have parasites been ruled out?

I think that's what the ponazuril would be for, but I could be mistaken. Unfortunately, the foster agency didn't do any testing, and the only blood test my vet ran was white blood cell count, which was normal. I'm going ask that they do a fecal test when we take him back to the vet for a follow up this Wednesday.

Parasites are common in kittens, and they won't always show up in fecal tests which is why rescues often go ahead and treat without testing. Ponazuril is good for coccidia, a common parasite. For giardia metronidazole is the usual treatment, which is probably what they suspected next, but it is one of the harsher giardia medications so possibly it was too much for the 5 week old kitten. Or the dehydration and malnourishment from the illness just took too much of a toll. I'm sorry you had to go through that.

Panacur is a much milder medication for giardia and some other possible parasites so that might be something to ask about.

You can give kitten milk replacer or goat milk to give him more nutrients and keep him hydrated. At that age, he might not understand what to do with water yet anyway. Also you can get a kitten bottle to feed him from if he is more comfortable nursing than eating solid food.

Making sure he stays warm is also a good idea, especially because he doesn't have his siblings or mother to cuddle with (although separating him from his healthy brother until he gets better was a good move!). One tip for providing a source of heat for a kitten to sleep with is to microwave a sock full of uncooked rice for a couple of minutes.

Thanks Molly 92! I actually did buy some kitten milk replacer but I haven't given it to him since he got back
from the vet, I'll put some out tonight. And if the ponazuril doesn't work this go around, I will ask about panacur. I do think the metronidazole was just a bit too much for his tiny system. It's so hard to know what exactly to do, they can go from seemingly healthy to near death in so short of a span of time!

You can also ask the vet to run the PCR diarrhea panel, but that's going to cost some money and the rescue/shelter might not want to fork it out.  If it was my cat, I'd do that.

Thanks, Stephanie. Never heard of it, but we'll
ask about it. I'm assuming it gets to the root of what is causing the diarrhea? We've paid for everything, the rescue hasn't paid. It was emergent so I didn't want
to wait and go through the channels for them to pay, I made that mistake with the one who passed We plan on adopting this little guy as soon as they'll let us anyway, so he's basically our cat.
Thanks again!

Ponazuril is best for Coccidia. The panacur for 5-7 days is much milder than metronidazole and cures Giardia, which causes nasty diarrhea and vomiting in tiny kittens. You have received very good advice so far!

I hope your little guy makes it! Thanks for all your vigilance! [emoji]128522[/emoji]