CKD kitty/SubQ and other questions

[skylerlark]

My cat has been diagnosed with CKD and a course of subQ provided for administration at home. 200 mil of Lactated Ringer's every other day. However, my cat is overly affectionate (not usual) and eats everything in sight after administration. The next day he won't eat and is very sluggish, albeit after quick morning walk. I've talked with my vet about this and he said not to give him any more after I must've overdosed him for an extra day, the bags I have are incredibly difficult to read, they have no markings except for raised numbers down the back of a 1000 mil bag. He hadn't eaten for that entire third day so am reluctant to do that again. I'd definitely given him less yesterday.

I trust my vet but I am, after all, with my cat all the time, not just at the clinic. I've seen a post somewhere where a cat owner was advised by her/his vet to give just 100 mil every day to spread it out more evenly. That vet had said 'the cat pees most of it out anyway'. I've heard that giving too much can cause problems with the heart, however my cat's heart appears to be fine, I've been told. I'm planning on giving him some more subQ tomorrow but at a lesser volume. Any and all advice welcome. Thank you.

 

[Furballsmom]

Hi, this may provide a little bit of information;

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Subcutaneous Fluids

 

[skylerlark]

Yes this makes sense. There are two vets at the clinic and when shown how to administer them by the junior vet, I of course asked 'how often?' I was told '1 to 2 times per week. This was obviously an error as my cat reverted to his poorly self after the following day. I asked the senior vet about this and asked whether every other day might be better. He just agreed, so no science there then. This vet has been in practice for many years. But from observation it does appear 200 mil every other day causes over hydration. The junior vet had also told me to give my cat subQ's 'when he stopped eating'. Great. So I must have him hungry before administration. Anyway, I liked that the link also agreed less and more often much more sensible so will give him 100 tomorrow as he hasn't eaten anything (as yet) today. Possibly because he ate so much yesterday :/ He also stumbles a little sometimes. Vets are a nightmare, rather alike doctors. The last one had him on IV for an entire week and then a plethora of supplements only, which made him worse. This should have been picked up by one of the many vets and their blood tests a long time ago as cat's always drunk water constantly. Thanks again for this. Looks like I'm on my own but will consult again with clueless vets next week.

 

[silent meowlook]

Hi. Over hydration from fluids can cause congestive heart failure. A good way to avoid this is to give less, like 50 cc to 100cc and make sure all the fluids from the previous dose are completely absorbed before giving more.
When checking your cats hydration status you check the skin turger, which is how quickly the skin on the back of the shoulders, scruff area, Bounces back to normal when gently pulled up and released. When doing this you have to take into consideration the age of the cat. If a senior, just like with people it goes back down more slowly and if the cat has had recent weight loss which would also slow the skin down and even cause excess skin,
As well as doing that, you look at the eyes. Do they appear sunken? Feel the gums, are they moist, wet, dry and or tacky?
It is a good idea to get a stethoscope. A cheap one is fine. You can get one for as little as $10.00. Get comfortable listening to his heart and lungs. To do this, with the cat standing in front of you, place the stethoscope bell against the left side of the chest down low behind his left elbow. Don’t push to hard. Just relax and get familiar with what it sounds like. It is hard to get a rate on a cat but it can be done. With larger animals the heart sounds like “luv-dub, luv-dub” on a cat you will just hear the first sound of the beat. For starters coins for 6 seconds and add a zero to get your rate. Then you can move the bell more to the top of the cats chest to hear the lung sounds. There shouldn’t be any wet sounds.
When your cat is resting, watch his breathing. Get familiar with what it looks like when he is normally breathing. You can count the respiration rate as well.
Getting familiar with your cat’s normals will help you know when to take action if he is acting abnormal. Respirations that are fast or seem labored are cause for concern and yoj need to call your vet.
Make sure your cat is eating. If he isn’t there are appetite supplements that can be given that work well.
Cats with kidney disease often get nauseous. There are anti nausea meds that can be given as well.
When you do give fluids, you might want to get a smaller gage needle like a 20 gage to give them so you don’t give to much to fast. Also warm the fluids first.
Learn what 50 or 10” cc of fluids feel like on your cat. For me 100c. Is a littlesmaller than my fist. That can help you in having how much he has had.
You can take a piece of white tape and a black marker and mark on the bag over the tape what your next line you are giving is.
The bags are marked usually at 100ml increments. Then there is a shorter line in between the numbers and that is 50cc.
Sometimes it helps to let 100 cc of fluids run from the bag into a cup to help you visualize the amount.
Most of all, keep your cat as stress free as you can. Don’t feel you have to get his vitals constantly or all at the same time. It’s best to just be casual and not stressed yourself.
I know it’s allot to process. If your vets aren’t helpful get different vets. I like cat only vets since all they do is cats.

Hope this helps.

 

[Twylasmom]

How much does your cat weigh? 200 ml at once seems like a lot. A good rule of thumb is 10 ml per pound. 100 ml every day, or every other seems like a better place to start and would prevent over hydration. Are you doing subqs on your own or do you have a helper? Even if they are just monitoring the bag that can help a lot.

 

[skylerlark]

How much does your cat weigh? 200 ml at once seems like a lot. A good rule of thumb is 10 ml per pound. 100 ml every day, or every other seems like a better place to start and would prevent over hydration. Are you doing subqs on your own or do you have a helper? Even if they are just monitoring the bag that can help a lot.

He weighs around 5.5 kg. I gave him 100 mil early this morning. As yet he's still turning his nose up at food. But if memory serves, he usually doesn't eat until late afternoon anyway, unless he's had 200 mil and will eat everything in sight. If he doesn't eat again today I'm stuck. But that's glass half empty talk. I had been giving him CBD oil but current vet advised caution, with which I tend to agree as He'd started stumbling a bit after administration. Bit of a bother as CBD does stimulate appetite. Another odd thing is that he will now only drink rain water, bit difficult as El Nino effect raging (no rain) so have to give him pond water. They do tend to prefer drinking any old muddy water anyway. I'd tried mineral water but nooooo. As far as checking his heart, that I would prefer to leave to the vet. I'm seeing him next week for a blood test update. Thanks both for your responses. Much appreciated.

 

[skylerlark]

How much does your cat weigh? 200 ml at once seems like a lot. A good rule of thumb is 10 ml per pound. 100 ml every day, or every other seems like a better place to start and would prevent over hydration. Are you doing subqs on your own or do you have a helper? Even if they are just monitoring the bag that can help a lot.

He's around 5.5 kilos so 12 pounds = circa 112 mil. But I erred on the side of caution and gave him the recommended 100 this am. He slept all day (well, cat) but much more than usual. He's eaten very small amounts so hoping the smaller amounts of fluid have a cumulative effect over time? I can handle it myself very easily, he's a calm cat, thank goodness. Thanks for your response.

 

[jayna]

My cat has been diagnosed with CKD and a course of subQ provided for administration at home. 200 mil of Lactated Ringer's every other day. However, my cat is overly affectionate (not usual) and eats everything in sight after administration. The next day he won't eat and is very sluggish, albeit after quick morning walk. I've talked with my vet about this and he said not to give him any more after I must've overdosed him for an extra day, the bags I have are incredibly difficult to read, they have no markings except for raised numbers down the back of a 1000 mil bag. He hadn't eaten for that entire third day so am reluctant to do that again. I'd definitely given him less yesterday.

I trust my vet but I am, after all, with my cat all the time, not just at the clinic. I've seen a post somewhere where a cat owner was advised by her/his vet to give just 100 mil every day to spread it out more evenly. That vet had said 'the cat pees most of it out anyway'. I've heard that giving too much can cause problems with the heart, however my cat's heart appears to be fine, I've been told. I'm planning on giving him some more subQ tomorrow but at a lesser volume. Any and all advice welcome. Thank you.

Regarding fluid administration:
Someone suggested drawing a dark black line with a sharpie or marker all the way across the bag before you start the administration of fluid. Draw the line at the level you want to stop at so you can see easily when the fluid level approaches this line. I give my cat fluids solo and it was very hard to tell how much I had given until I found that little trick.

 

[skylerlark]

I've marked the quantities and cat much better but still eating less. He doesn't look emaciated, in fact he looks about the size he should be. He'd been overweight before when he'd been on kibble for his constipation, he's now on wet food. I've just noticed his urine is now foamy, is this a side effect of CKD? Or the subQ fluids? I can't get to the vet until middle of next week. Any advice, again, much appreciated.

 

[skylerlark]

Pretty sure my cat's had CKD for longer than thought, but not picked up early enough by a plethora of vets. However, last night he was acting very odd, like extreme restlessness. This is so confusing, latest vet has at least 50 years experience, very kind old man with younger assistant vets. Spoke to one this morning and asked for latest blood test results. She told me his levels had only dropped 1.1% despite being on home subQ for a month and wants me to take him in tomorrow for an hour's IV and general check. This hospital is very popular with the local people and don't doubt the vet. But he did say he preferred a natural diet and had a 20 year old cat he's always fed on tuna in spring water with reduced sodium. Cat will not eat renal diet and vet agrees it has very little nutrition. Is it just 'his time'? Even vet says he looks remarkable for his test results. He's around 9 years old (stray). Very quiet today although still eating, drinking, not so much.

 

[skylerlark]

Part II
Couldn't find an 'edit' button. I'm beginning to think the reason for his decline is the tuna, although low sodium and packed in water, it's high protein and phosphorous. I've looked at commercial alternatives and they are either unavailable or have tried before and made cat worse. There's virtually no nutritional value in them and they're loaded with carbs/grain and poor animal bi products. Do you agree? And thinking about making my own (if he'll eat it - very picky). There are a lot of home made's on the web but any additional/proven to work ones most welcome.

 

[Kflowers]

I understand that some cats are willing to eat the KD diet, the renel diet, but I have to say I've never met a cat, and only one dog, who was willing to touch the stuff. That your cat doesn't like doesn't mean you've done anything wrong, or that your cat is strange or stubborn. But there are many on this site who will come with information to help you.

 

[skylerlark]

I've done a LOT of research on these 'renal' diets and have come to the conclusion they are a complete and utter scam. My vet before this one almost killed my cat by forcing it and bullying me to get cat to eat it. He looks great on the tuna but his kidneys aren't holding up. Taking into account the new subQ regimen and the measly 1.1% drop I can only conclude the very high phosphorus content in tuna may be the cause. Current vet probably fed his 20 year old cat tuna since a kitten. My cat's had all sorts. I found an astonishingly pricey food 'Weruva' so look forward to some more affordable low phos recipes please. Thankyou.

 

[FeebysOwner]

Do you add a supplement to the tuna to make it nutritionally complete? If not, that could also affect him as he could be deficient in vitamins and minerals that are found in foods made for cats. Look into EZComplete and/or Alnutrin for supplements. If you have questions about how to use EZComplete, the company staff is more than willing to work with you. I don't know if Alnutrin does the same or not. I use EZComplete, because at least half of my cat's diet is baby food meats, which of course are not nutritionally complete for a cat.

Re the tuna and phosphorus, depending on what his creatinine is, he may benefit from a phosphorus binder. My cat won't eat the renal foods, nor most of the lower phosphorus cat foods, so I add Phos-Bind to the food she will eat. I only started this after she reached a creatinine level that indicated she could benefit from removing some of the phosphorus in her system. Some cats will experience harder stools, or even constipation, when given a phos binder, so a lot of folks will give them Miralax to offset that. Knock on wood, I have not yet had to do that, but will if the issue presents itself.

The web site that was mentioned in your other thread is a wonderful resource for 'everything CKD' and I highly recommend it. It is very thorough and detailed, which tends to intimidate folks; but I guarantee you it is worth pushing past that feeling and reading - perhaps a section at a time. You can always start with the sections that interest you most. This site also includes information on the various stages of CKD, and how the stages are quantified. There is also a section that includes a listing of lower phosphorus foods that are not prescription or renal diets.
Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Everything You Need to Know to Help Your Cat (felinecrf.org)

 

[skylerlark]

My last vet had him on IV for a week as he wasn't eating, this after being on Canin Fiber for his long time constipation, so that couldn't have helped. He then force fed him the awful renal 'not a food', I took him home, that vet then recommended a plethora of supplements. The Ipatakin binder made him worse. In fact the only good recommend was Krill oil containing Astaxanthin (must be that one) comes in gelatine like capsules. There was a Petonic containing Multi B iron which made him constipated and a few others I'd subsequently binned. Even that vet said 'perhaps he should lay off the supplements for a while', BUT my main contention was his insistence on the renal not a food whereby he looked at death's door, skin and bones. He was actually bullying me into feeding it to him and it became obvious he was being 'funded' to push it. He was also 'going to med school one day a week' with only one day off a year.

I then went full circle to the oldest most established and popular vet here. Unfortunately I believe dementia setting in as he recommended tuna in spring water for a CKD cat. He'd said he had a 20 year old cat on it for life, but I'm guessing the cat never had CKD and also has a personal physician.

I stopped the tuna yesterday and overnight he became his old affectionate self. I'd fed him a 'smoothie' containing Albumin which he likes, but of course he must have more than that. It occurred to me that perhaps mixing in some shredded chicken or something might help with the protein issue. I'm still giving him the Krill oil daily.

Taking him for a session on IV this morning and a chat re diet with his younger assistant. Also ordered a catbackpack in case he needs to be dropped off at local clinic for more IV sessions and road outside my house still not finished so no vehicle (sorry, too much information).

BTW, look up those yearly FIP inoculations, very dangerous for cats (and dogs) as there are live viruses in them which may cause harm further down the road and are unnecessary. Thanks for your reply and advice.

 

[skylerlark]

Welp, took cat to hospital for just one hour's IV admin suggested by vet as his numbers had only declined a fraction after a month on daily subQ.. I told vet I believed the numbers weren't improving as he was recommended to eat tuna in spring water only. I showed vet little can of Kidney Support - Albumin. Vet said it was very good (contains egg white and chicken, albeit pureed). When we arrived back home, cat looking very wobbly, peed a lot and hasn't touched his food. Question: Should I continue with his daily subQ in the morning or give him a day off? He's definitely better on subQ, I'd thought maybe they were just 'flushing him out' but it's just made everything worse. Bluddy vets. Grrrr

 

[FeebysOwner]

I wish you had asked the vet that, but I would guess sub-Q fluids should continue as usual - although probably not same day as the IV. You might call them and let them know about him being wobbly, especially if that wasn't happening before the IV admin. Is that the only thing they did while you were at the vets?

Is this Kidney Support - Albumin a cat food? If it is, and what you listed for ingredients is all that is in it, it is not nutritionally complete. If he is not getting proper vitamins and minerals, he isn't going to feel good. If you are discontinuing the tuna, what are you going to replace it with? I cannot stress enough that his food NEEDS to be nutritionally complete.

What are his kidney values? Creatinine, BUN are the two primary numbers. What about his phosphorus level?

Here is what I can tell you - depending on his kidney values, most CKD cats receive sub-Q fluids, B-12 injections, anti-nausea meds, and possibly an appetite stimulant, along with a phosphorus binder if your cat is not eating a renal food (which I personally don't like them either). The latter can cause constipation in some cats, and if so, giving them a small dose of Miralax (polyethylene glycol 3350) will be helpful. Krill oil (or something similar) is a good idea too and could actually help if a phosphorus binder would cause constipation. Ipatikin is only one of several different types of phosphorus binders, so it isn't your only option.

I really cannot stress enough about reading up on CKD through that web site link I gave you. The more you know, the more you know what to discuss with the vet and what to ask questions about.

 

[skylerlark]

I wish you had asked the vet that, but I would guess sub-Q fluids should continue as usual - although probably not same day as the IV. You might call them and let them know about him being wobbly, especially if that wasn't happening before the IV admin. Is that the only thing they did while you were at the vets?

Is this Kidney Support - Albumin a cat food? If it is, and what you listed for ingredients is all that is in it, it is not nutritionally complete. If he is not getting proper vitamins and minerals, he isn't going to feel good. If you are discontinuing the tuna, what are you going to replace it with? I cannot stress enough that his food NEEDS to be nutritionally complete.

What are his kidney values? Creatinine, BUN are the two primary numbers. What about his phosphorus level?

Here is what I can tell you - depending on his kidney values, most CKD cats receive sub-Q fluids, B-12 injections, anti-nausea meds, and possibly an appetite stimulant, along with a phosphorus binder if your cat is not eating a renal food (which I personally don't like them either). The latter can cause constipation in some cats, and if so, giving them a small dose of Miralax (polyethylene glycol 3350) will be helpful. Krill oil (or something similar) is a good idea too and could actually help if a phosphorus binder would cause constipation. Ipatikin is only one of several different types of phosphorus binders, so it isn't your only option.

I really cannot stress enough about reading up on CKD through that web site link I gave you. The more you know, the more you know what to discuss with the vet and what to ask questions about.

I live in SE Asia so asking anyone anything you'll get ten different answers and in any case why did the boss recommend high phosphorous tuna when he knew cat had CKD? After much consideration I've just given him his regular dose of subQ in the hope it will get him to start eating again. He didn't eat anything yesterday. The vet always gives an injectable multi vitamin, so there's that. His behaviour had definitely changed (more affectionate) after the day of eating Choo Choo (that's the name of the very popular kidney support smoothie, (unable to post a link) don't know if it's in the West but you can look it up on Lazada Thailand and Google Translate) and is supposed to be a complete food and does have all the vitamins and minerals, but now he won't eat that either, I'll just have to see if he eats later today. He normally won't eat in the mornings anyway.

I do agree it doesn't look substantial enough as a complete food but what else to mix it with? When I'd mentioned this to vet she said 'you can give ONE teaspoon of tuna with it but NOT the water as that's where all the minerals congregate' or words to that effect, so much for all those 'just pour a little tuna water on it (whatever unpalatable food) then. I've just done that and he ignored it and is now trying to eat the bamboo leaves in the garden. He loves grass but there is none as the weather's been so hot.

I've read felinecrf.org many times and even posted it to erstwhile vet, calling it 'the cat bible'.

 

[skylerlark]

• ChuChu Cat Nourishing Smoothie with egg white formula contains antioxidants as high as 91.28 µmol per 80 g serving.
• It is a soft texture cat food with high protein.

• Egg white extract albumin (Albumin) formula with high protein. help build muscle Repair the wear and tear of the body

• Suitable for cats who need special kidney care.

• Protein is extracted from egg whites, fish, chicken and vitamins in the right amount.

• Complete nutrition, high protein, helps maintain health. when healthy Good immune system, not easily sick, get sick quickly

• No preservatives. least processed

• For cats over 3 months old.

• The can is opened. Store no more than 3 days (in the refrigerator).

 

[silent meowlook]

Hi. Forgive me, I didn’t read replies. Didn’t have time to do more than skim over your posts. But, this is important.( I am not a veterinarian. I did work decades in vet hospitals, emergency, specialty, feline only. I hold no license in veterinary medicine)

Do not feed fish everyday. Just like people should not eat fish every day, cats should not either. Sadly our oceans (all) contain chemicals and mercury etc. in micro doses it’s not a problem but fed daily it becomes a problem.

If you think about what a cat would normally eat and how they eat it will help in your diet decisions. A cat living wild will hunt, unsuccessful most times but then maybe catch a mouse or even a rat. They eat the mouse, clean themselves and take a nap. They wake up hours later and repeat this many times throughout their 24 hour day. There are few cats that fish. So cats need meat, not fish.

Cats are designed to eat small meat meals. They do not process carbohydrates, and all dry food has carbohydrates. Cats obtain most of their water through their food.

For a cat with kidney disease, hydration is vital to their survival. Hydration can be achieved with a canned diet and multiple water sources for them to drink out of. Most cats will need supportive fluids to help maintain their hydration. This is done with SQ fluids, which you should learn to do at home. The best way is more frequent small doses 50 to 100mls as opposed to larger doses less frequently. You have to be careful with fluids, making sure that all have been absorbed before giving more. It is possible to send a cat into congestive heart failure by giving too much.

A cat with CRF can still lead a good quality of life. There are medications to help. You can give famotadine to help with the acid reflex they can get from the acidosis. There are anti nausea drugs you can give. Nausea is usually why they stop eating. Vit B12 is a water soluble vitamin, so it never hurts to supplement that. There are other medications you can give should they become anemic, and most CKD cats will. You also have to make sure they are kept as close to stress free as possible. It is very common for CKD cats to have high blood pressure, so that dose need to be checked and treated if they are hypertensive.

Some issues I have in the treatment so far. Tuna is a big no as far as I am concerned. I agree with you that most of the prescription diets are of poor quality, but they are nutrition complete. If you must feed a renal diet the Royal Canin bits in gravy is the most palatable, but it still is a prescription diet. Most important is a good protein diet with quality protein because these cats will lose so much muscle. It is good to check the phosphorus levels on the blood work and see if you need to add a phosphate binder like aluminum hydroxide. Probiotic are a very good idea. Azodyl in my experience works well but it is expensive, so if you are limited don’t waste your money on it and use aluminum hydroxide.

I also am confused by your vet and the couple of hours of IV fluids. That isn’t going to do anything but stress the cat out and risk over hydrating him if they are giving a higher rate than normal.

Check the potassium on the blood work and see if it is low. Potassium can be supplemented but you don’t want to give too much or give if not needed.

Some tips : warm up fluids before giving and use a 20 gage needle, not an 18 gage. Make sure there are soft warm places for your cat to go where you never disturb him. Better to give medication an hour late than to let your cat think he is never safe.

Use allot of litter. Cats on fluids urinate allot and without enough litter it clumps on their feet.

Make sure to check his toenails as they can become thickened and grow in circles because he doesn’t use them as much.

Understand that when you are giving fluids you are only diluting down what is in him. You are not curing anything or fixing the kidneys, you are supporting them. Don’t expect improvements with lab values.

Do you have a copy of his blood work?