CKD kitty/SubQ and other questions

[FeebysOwner]

Some of the information you provided above cannot be translated, but other statements appear to indicate that the foods contain 'the right vitamins'. I have no way of knowing whether or not it would be 'complete' based on US standards, but it would seem it is for your area.

You indicated you are very familiar with the feline crf web site, so I would focus more on the additional supplements and care related items and trust the foods you have available are adequate otherwise. And, if you do have blood work results, you can compare the details of those to what is on that web site for things to look at/worry about. If I can help with that comparison, I would be happy to try.

The vet's comment about the tuna versus the water is merely assuming that the 'chemicals/minerals' that are normally considered suspect/worrisome are in the water as opposed to the actual tuna - I am not sure about that. The thing is that giving your cat some tuna, and even the water is OK, but just not as the primary food source.

I hope to hear he has begun to eat some of his food.

 

[skylerlark]

I managed to syringe some into him but he then went to his litterbox. Out of desperation I gave him some Fancy Feast. It appeared the first half of the pouch stayed inside for a couple of hours and then he went back for more and then straight back to the litterbox again.

 

[skylerlark]

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?

This is a third world country with third world thinking. No I don't have a copy of his bloodwork and frankly could do nothing about it if I had. I've been to several vets now, they're a very mixed bag (it appears anyone can call themselves a vet here) and frankly after months visiting each one, all with wildly differing opinions (and prices) I'm done with the lot of them. I had the same problem with my dogs which left me bankrupt and them dead. I can see no other way out than a transplant, impossible. Thanks for your reply.

 

[skylerlark]

Some of the information you provided above cannot be translated, but other statements appear to indicate that the foods contain 'the right vitamins'. I have no way of knowing whether or not it would be 'complete' based on US standards, but it would seem it is for your area.

You indicated you are very familiar with the feline crf web site, so I would focus more on the additional supplements and care related items and trust the foods you have available are adequate otherwise. And, if you do have blood work results, you can compare the details of those to what is on that web site for things to look at/worry about. If I can help with that comparison, I would be happy to try.

The vet's comment about the tuna versus the water is merely assuming that the 'chemicals/minerals' that are normally considered suspect/worrisome are in the water as opposed to the actual tuna - I am not sure about that. The thing is that giving your cat some tuna, and even the water is OK, but just not as the primary food source.

I hope to hear he has begun to eat some of his food.

The only supplement I give now is the Krill oil capsules. One of the vets filled him up with probiotics, phosphorous binders, iron tonic all to no avail and some of which made him worse. He won't even touch the tuna now so that's another problem out of the way.

 

[skylerlark]

Just been on to vet again and asked why he did not eat after IV infusion yesterday. She said 'I think he was scared, I saw his pupils dilate'. She also told me they'd only given 200 mil, is IV the same as subQ? I'd read it was but now not sure as last time I'd followed their advice on 200 mil every other day he was bouncing off of the walls but crashed the next day. I'd told her I'd syringed some puree into his mouth but he'd gone straight to his litter box thereafter. I then told her that out of desperation I'd given him a pouch of Fancy Feast. He'd kept the first half in for a couple or so hours then went back to finish it off and straight back to litterbox again. If he can't keep food in (he doesn't vomit nor is it diarrhea), food seems to pass soon after eating.

She asked me to being in a picture with cat whereupon they would administer more IV. I'm very uncertain about this, given his reaction yesterday, quiet and not eating. He did however sleep in my room all night.

Then she mentioned a phosphorous test. He's intolerant to binders and can see no different outcome given the food's the same - Fancy Feast today, which she suggested I try to mix with the kidney protection smoothie, plus the usual subQ's.

This is getting extremely frustrating. I don't think they know what they're doing either and this to-ing and fro-ing is getting expensive and very stressful for the cat.

My question is, can IV infusion cause so much stress (after all, he's been given subQ for a month so used to it), that he refuses to eat?

 

[silent meowlook]

Hi. If he got 200mls IV in a short amount of time it can cause heart failure. Heart failure would cause him not to eat. Stress could cause him not to eat. Progression of his kidney disease can cause him not to eat.
Just to give you an idea on fluids. A ten lb cat in a hospital would get 10 mls an hour. That rate might get bumped up to 20 mls an hour for a short time. So, that would be about 200 mls for the entire 24 hour day. You should never give a cat a bolts of 200 mls which is what that would be given over 2 hours.

There is a difference with IV and SQ. SQ will still hydrate. I wouldn’t give 200 every other day. I would do 100mls every day. Making sure that all previous fluids from the prior time have been absorbed before giving more.

I wouldn’t recommend a transplant. Only a few hospitals do them and they take a kidney from a healthy cat. You have to provide a home for the healthy-cat that donates his kidney. The cats don’t volunteer to do this.

 

[skylerlark]

Hi. If he got 200mls IV in a short amount of time it can cause heart failure. Heart failure would cause him not to eat. Stress could cause him not to eat. Progression of his kidney disease can cause him not to eat.
Just to give you an idea on fluids. A ten lb cat in a hospital would get 10 mls an hour. That rate might get bumped up to 20 mls an hour for a short time. So, that would be about 200 mls for the entire 24 hour day. You should never give a cat a bolts of 200 mls which is what that would be given over 2 hours.

There is a difference with IV and SQ. SQ will still hydrate. I wouldn’t give 200 every other day. I would do 100mls every day. Making sure that all previous fluids from the prior time have been absorbed before giving more.

I wouldn’t recommend a transplant. Only a few hospitals do them and they take a kidney from a healthy cat. You have to provide a home for the healthy-cat that donates his kidney. The cats don’t volunteer to do this.

I have made an appointment at my just around the corner small clinic for IV. The Animal Hospital had told me 200 mls and that's what I TOLD my local vet. I'm obviously not a vet so have no idea how much, they, being vets, should.

The Animal Hospital had recommended 200 mls subQ (yes I know they're not the same as IV) every other day. But when I saw him bouncing off of the walls and eating everything in sight, then crashing the following day, I decided on the 100 mils every day to spread them out. The boss at hospital also recommended the tuna as he liked 'natural food' and has a 20 year old cat on it, however his cat doesn't have CKD.

I believe the high phosphorous content to be the cause of his very slightly improved creatin, jus 1.1 down but apparently his BUN is high and I'm done with them.

He has been eating Fancy Feast today, having refused everything else, but then immediately eliminating it, whole, not diarrhea and no vomit.

My local vet gave him life when I picked him up from the street. She had asked '200 mils right?' which is what the hospital told me. I will now have to tell her SHE, as a vet, must work it out. I'm not expecting any improvement, but she knows my cat very well so if it's a hospital stay (which I suspect/hope), so be it. Pointless otherwise. Thanks for your reply.

 

[silent meowlook]

Good luck. I hope he improves.

 

[FeebysOwner]

Then she mentioned a phosphorous test. He's intolerant to binders and can see no different outcome given the food's the same

How is he intolerant of binders - what happens? There are numerous different kinds of phosphorus binders, so I am not sure that he could possibly be intolerant to all of them. I feed my CKD cat a lot of Fancy Feast because there are way too many other foods that she refuses to eat. Because of that she gets a phosphorus binder to help keep her phosphorus level down. Use the felinecrf web site to refresh your memory about what ones your cat has had, and then look at the others that he has not had. I use Phos-Bind, an aluminum hydroxide composition, and only give Feeby a heaping 1/8 tsp daily, mixed with her Fancy Feast. This has not caused constipation in her (knock on wood), but some cats do get constipated and as I previously said, that can be resolved with Miralax (polyethylene glycol 3350) - a mere 1/8 tsp of that every day or every other day would likely do the trick.

I believe the high phosphorous content to be the cause of his very slightly improved creatin, jus 1.1 down but apparently his BUN is high

High phosphorus is not going to improve the creatinine level, but rather make it worse. Unless, his phosphorus level was low before - which would be unusual for a cat with CKD. I will take another look at the other foods you shared above to see if I can determine more about them - maybe they have something in them that works like a phosphorus binder? BUN is impacted by many things, including stress, so it can be elevated for reasons other than CKD. It is a number to follow, but there can be ups and downs in it due to other factors.

He has been eating Fancy Feast today, having refused everything else, but then immediately eliminating it, whole, not diarrhea and no vomit.

If he has no diarrhea, and the stools look healthy, then the food he just ate immediately beforehand is not what he is eliminating. If it were to go through his system that fast, it would be diarrhea. Babies and cats tend to poop shortly after eating, and even if that wasn't the case with your cat before, it could be his new 'norm' - and maybe even correlate to the food, especially if he hasn't been eating Fancy Feast with any regularity. Once he would be eating it more routinely, he might change when he defecates. My cat used to be like that, eat and very shortly thereafter she would use the litter box, also not diarrhea. She is a little bit less regular than that nowadays, but then she also gets fed some food 'around the clock' probably making her a little less regular.

About the blood work results - if you can't get them, can you ask for certain numbers and then write those numbers down to share with us? At a minimum - Creatinine, BUN, Potassium, and Phosphorus (assuming that was part of the blood work done. It may not have been since you mentioned the vet suggesting a phosphorus test).

Lastly, I agree with 100ml sub-Q fluids every day vs. 200 every other day. Better balance in rehydration. My cat is getting 100ml daily.

The title of this thread you created (before it was merged with your previous thread) was asking if your cat is end stage. The blood work values help to rate the stage, so that is why I keep talking about them. Numbers, of course, are only part of the equation, as every cat is different, but they do offer a gauge.

 

[skylerlark]

Good luck. I hope he improves.

Thank you. So do I, for the sake of my sanity and ability to eat something :/ Oh, and he now has IBS ..

 

[skylerlark]

How is he intolerant of binders - what happens? There are numerous different kinds of phosphorus binders, so I am not sure that he could possibly be intolerant to all of them. I feed my CKD cat a lot of Fancy Feast because there are way too many other foods that she refuses to eat. Because of that she gets a phosphorus binder to help keep her phosphorus level down. Use the felinecrf web site to refresh your memory about what ones your cat has had, and then look at the others that he has not had. I use Phos-Bind, an aluminum hydroxide composition, and only give Feeby a heaping 1/8 tsp daily, mixed with her Fancy Feast. This has not caused constipation in her (knock on wood), but some cats do get constipated and as I previously said, that can be resolved with Miralax (polyethylene glycol 3350) - a mere 1/8 tsp of that every day or every other day would likely do the trick.


High phosphorus is not going to improve the creatinine level, but rather make it worse. Unless, his phosphorus level was low before - which would be unusual for a cat with CKD. I will take another look at the other foods you shared above to see if I can determine more about them - maybe they have something in them that works like a phosphorus binder? BUN is impacted by many things, including stress, so it can be elevated for reasons other than CKD. It is a number to follow, but there can be ups and downs in it due to other factors.


If he has no diarrhea, and the stools look healthy, then the food he just ate immediately beforehand is not what he is eliminating. If it were to go through his system that fast, it would be diarrhea. Babies and cats tend to poop shortly after eating, and even if that wasn't the case with your cat before, it could be his new 'norm' - and maybe even correlate to the food, especially if he hasn't been eating Fancy Feast with any regularity. Once he would be eating it more routinely, he might change when he defecates. My cat used to be like that, eat and very shortly thereafter she would use the litter box, also not diarrhea. She is a little bit less regular than that nowadays, but then she also gets fed some food 'around the clock' probably making her a little less regular.

About the blood work results - if you can't get them, can you ask for certain numbers and then write those numbers down to share with us? At a minimum - Creatinine, BUN, Potassium, and Phosphorus (assuming that was part of the blood work done. It may not have been since you mentioned the vet suggesting a phosphorus test).

Lastly, I agree with 100ml sub-Q fluids every day vs. 200 every other day. Better balance in rehydration. My cat is getting 100ml daily.

The title of this thread you created (before it was merged with your previous thread) was asking if your cat is end stage. The blood work values help to rate the stage, so that is why I keep talking about them. Numbers, of course, are only part of the equation, as every cat is different, but they do offer a gauge.

His stools haven't been normal for as long as I can remember. They were when he was treated for liver disease but since then just lumpy stools, not diarrhea. This could be due to a change in diet causing IBS, I'll ask the vet of course.

I will call the former vet taking the blood work and have the numbers ready for clinic tomorrow.

 

[skylerlark]

Btw, it's extremely difficult to get any meds for animals. Ipatkatin made him ill and is the only one they have here. There's a VERY expensive practice who has virtually the same as the cheaper ones, the only thing they seem to be charging for is nice decor (as if your pet cares) and new equipment.

 

[skylerlark]

Just another 'btw', why on earth does he need IV 'once or twice a week - agree one hour not long enough for 200 mils) when he's on subQ 100 mils every day?

My main concern now is that he's unable to retain any food. Could be change in diet, both the Fancy Feast and the Albumin Choo Choo, but he's had many changes in diet (picky cat) and never had this before.

 

[skylerlark]

So worried about cat's inability to retain food in that he defecates straight after eating anything I called local vet and she asked for pictures of his litter box contents. She replied 'it looks like pee', although why he does it straight after eating solid food also and he's losing weight too seems to fly over her head. Which is why I took him to numerous other vets beforehand.

I've read (again) that medication can stop this, somewhat alike people take Imodium to stop Diarrhea. Anyone know about this? Thank you.

 

[silent meowlook]

Hi. Is he having diarrhea? If he has IBS he may not be absorbing Vitamin B12 , and may need to be supplemented with a weekly Vitamin B 12 injection. I would ask your vet about this.
Chronic Kidney disease causes muscle loss and weight loss. IBS also does.

 

[skylerlark]

Hi. Is he having diarrhea? If he has IBS he may not be absorbing Vitamin B12 , and may need to be supplemented with a weekly Vitamin B 12 injection. I would ask your vet about this.
Chronic Kidney disease causes muscle loss and weight loss. IBS also does.
[/Q]
No, thats the odd thing. His stools are malformed (have been for a while) and covered in cat litter of course. I sent a requested photo to the clinic vet and she said it looked like 'pee'. So how does that account for his running to his box after eating wet as well food then? Please, suspend any idea of critical thinking here.

I've asked over and over again about B12, but they only give a multi B complex, and I don't know how much comprises B12. Not enough I imagine. At one stage I was giving him the same Methycobalamin I take daily. Of course he then became constipated albeit more active. I don't believe that's available for cats here either, so out with the Miralax.

He hungrily ate some freshly prepared shredded chicken breast this morning but is now refusing it (mixed with suggested egg white) this evening. I knew he would. He watched me go out in a thunderstorm to buy some fresh.

 

[skylerlark]

I've just found B12 easily available here (wish the vets knew) and very cheap from multiple pharmacies. It's also administered sublingually so easy as I poke him with Ringers every morning. Thanks.

Btw, some asked about his numbers Creatin went from 9.10 to just 8.84 and BUN - 109 to 121.4 due to the high phos diet my vet is now pleased I've jettisoned :/

 

[skylerlark]

Hi. Is he having diarrhea? If he has IBS he may not be absorbing Vitamin B12 , and may need to be supplemented with a weekly Vitamin B 12 injection. I would ask your vet about this.
Chronic Kidney disease causes muscle loss and weight loss. IBS also does.

Hi. I've found B12 can bought in vials in pharmacies here so will procure some today. Have read they are to be given subcutaneously, same Ringers then, and I've calculated 4.6 kgs of cat = 230 micrograms every day for six weeks. However, having difficulty (math not my strong suit) converting micrograms to mils. Could you please help me out on this one? Thank you very much.

 

[silent meowlook]

Sure. What is the strength of the Vit B12?

 

[skylerlark]

Sure. What is the strength of the Vit B12?

1 mil contains 1000 mil of B12. They come in 1000 mg ampules. Thank you.