8/31 Alice AMPS 282, vet visit, bad kidneys :( PMPS 90 +3.7 46 +4.3 52 +4.9 92

AliceMeowliss (GA)

Member Since 2019
https://www.felinediabetes.com/FDMB/threads/8-29-alice-amps-157-6-46-7-78.234318/

Kidney problems are new to me. Will be doing phosphorus binder and daily fluids now. I’m going to need help.

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She’s angry about her blood draw and she bit my hand. Poor baby.
 

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I'm sorry Alice is going through all this.
How is her appetite?

Naomi has CKD too among other issues. Feeding her is a struggle. She was begging for food three months ago until she stopped one day all of a sudden
 
:bighug::bighug::bighug:I’m sorry to hear this. So far all 5 of the cats I’ve had over the years ended up with kidney disease. This website will give you all the info you need. Tanya’scrf.org

The numbers show it’s not early CKD. The best binder is aluminum hydroxide powder. It’s tasteless. Did your vet check her blood pressure? That should be done on your next visit if not done. We’re you told to give 100ml daily? That’s pretty standard. It explains the low potassium. That needs to come up to 4.0 if possible. I take it you are already supplementing it? She’s not anemic so that’s good. Was a urinalysis done? When were the last labs? Can you compare them? The WBC is high. Any chance an infection has caused a raise in her values? Since she was dehydrated some values could get better but the HCT could possibly go down. Are her gums nice and pink? When does your vet want you back?

the fluids will make her feel a lot better and so will lowering the phosphorus.
 
:bighug::bighug::bighug:I’m sorry to hear this. So far all 5 of the cats I’ve had over the years ended up with kidney disease. This website will give you all the info you need. Tanya’scrf.org

The numbers show it’s not early CKD. The best binder is aluminum hydroxide powder. It’s tasteless. Did your vet check her blood pressure? That should be done on your next visit if not done. We’re you told to give 100ml daily? That’s pretty standard. It explains the low potassium. That needs to come up to 4.0 if possible. I take it you are already supplementing it? She’s not anemic so that’s good. Was a urinalysis done? When were the last labs? Can you compare them? The WBC is high. Any chance an infection has caused a raise in her values? Since she was dehydrated some values could get better but the HCT could possibly go down. Are her gums nice and pink? When does your vet want you back?

the fluids will make her feel a lot better and so will lowering the phosphorus.

we started supplementing potassium with this K+ potassium gel when she had neck ventroflexion after a loss of appetite a couple weeks ago. Took about 105 hours for ventroflexion to go away which was too long and I suspected some kidney issues might have been at play.

I thought I was told 100mL twice daily. @Chris & China (GA) suggested I check with others as that may be high. I didn’t know to ask about BP but I’ll call tomorrow. We got in about 50 @ vet, should I give another 50 tonight instead of 100?

She had an elevated WBC about 6 months ago at last labs, we treated her with Veraflox. Since the antibiotics her IBD/bowel movements have been a little worse (drier, harder, larger diameter). I have Imuquin for probiotic.

my head was spinning after getting her labs and I had one other cat there with me too so... today I’m just trying to think of what I need to do with this evening, and how to space out all of her medicines.

what questions should I be asking? I can call back tomorrow.
 
Is the ziwipeak lamb not as good as far as phosphorous content goes? A friend back ordered some Koha ‘roo but we are waiting for it...
 
My head is spinning. I feel really lost this evening.
Drove home in some torrential rains. Dropped off other cat. Got home. Somewhere between almost crying and staring at nothing, so far.
 
What do you need help with? :bighug:
Schedule for all the meds. Making sure I don’t mess up giving her fluids. (I gave subq fluids to a car when I was in Minnesota in the winter and someone panicked at me and I panicked and pulled the needle out without clamping the line and it was.... :facepalm:)
I can’t think straight.
 
The ziwipeak lamb is listed at 254 mg P per 100kcals. Ideally you'd like under 200. Given the limits you have with Alice's diet, it's not a bad choice. Nature's Variety Instinct lamb limited ingredient is 243 so not much difference. Not sure about the Koha Roo - if it's the pate one in Dr. Lisa's list, it's over 400 P. Some people with CKD cats can't get then to eat anything but Fancy Feast which is way higher so have to give even more binder. It's most important that Alice eats.

How to Give Subcutaneous Fluids (Video)
I didn't refrigerate the fluids, just hung it from a coat hanger. You do want to warm it when giving it anyway.
Schedule for all the meds.
Can you list them all? Phosphorus has to be given with each serving of food.
 
Okay I have the meds and supplements together. Minus the insulin, and the bag of fluids, everything pictured here
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Lantus
Cerenia
Mirataz
Imuquin
Veraflox
Potassium gel
Maalox *
Subq fluids *

*the last two are all new to me. I’ve given subq fluids to a dying cat about 3 times a few months ago and can’t say I did my best. The Imuquin is because last time on ABs she seemed to have worse bowel movements from her IBD, and fortiflora isn’t the best to supplement probiotics.

Also, her shot time is off by an hour and twenty minutes right now. :\ with lower BGLs at shot time sometimes, I’ve been giving 0.5f instead of 0.75... I’d like to get her shot time straightened out but that’s at least.

also! The vet wasn’t sure the lump I’ve noticed is the same as her cancer. She said we should keep an eye on it, for now.
 

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@Wendy&Neko
Phosphorous with each meal? So I need to make a feeding schedule then instead of just “now she is hungry and I am home and awake” ...? Maalox instructions just say twice a day.

how do I warm the bag? I thought I needed to refrigerate to keep it... sanitary... less likely for microbes to grow, I don’t know. Should I take it out of the refrigerator now then?

This is just A LOT today. More than I expected.
 
Watch the video on tips on how to warm the bag. I just put it in a bread pan with warm water. Take it out of the fridge now.

Yes, binder binds with phosphorus in food, so must be given at same time as food. I took out how much I needed per day, and divvied into the 6 or so meals Neko got per day, larger amounts for the larger meals vs. snacks.

Might want to first check with the vet if any of those meds cannot be given together. With meds that could be given together, I was a fan of cramming what I could into a gel cap so it was just one pilling session. And find out if any other that must be given with food. You do want to separate antibiotics and probiotics by at least two hours. I tended to give antinausea meds 1/2 hour before appy stim - though I very seldom did give that. You want to make sure the cat is not nauseous when the appy stim kicks in.

Hopefully good news on the lump?
 
@Wendy&Neko

okay I watched the video, I do not have a thermometer, can I test the fluid on my wrist like for a baby bottle or something or...?

I will take it as good news for the lump For now although the vet probably was thinking, let’s see how her kidneys do....

ahhh I’m going to have to scramble to find a pan for the LRS bag, may have to use a saucepan because I hadn’t gotten any baking dishes since moving again this summer.

How much do I flush out of the line after each time I give her fluids?

it’s pretty easy to pill the Cerenia
Mirataz is transdermal, also doesn’t seem to work immediately, but more cumulatively - also wondered should I wash off her ear that she gets the Mirataz in, a few hours later? Noticed it was getting dirtier a little easier from the stickiness I suppose
Veraflox is liquid - I’ll have to find a good window to give that, so it is not around when she gets food
I thought the Imuquin on her meals could act as a treat and distraction from the fluids...

should I space apart her insulin and fluids? Can they interfere with each other, the depot, something?
Video recommends rotating where you give fluids but I already rotate her left and right sides for her insulin, I’m not sure where/how to change where her fluids will go
 
My comments may be half-finished because my brain is having trouble!

im about to give her a last call quick snack before two hour fast before shot. Anything she should have now? We gave Cerenia at vet....
 
How do others divide up meals? How many per day? How far apart? I’m looking at my ten tiny tupperware containers I was lucky enough to randomly buy, so I have them now. Yay. Her timed feeder has three cups (one open at all times). Two large meals and 3 snacks per day?

What is a good caloric goal for Alice in her situation? 6.2 lbs and we want her to be more like 7-8lbs on a regular basis.

If I feed her and don’t give the phosphorous binder... what are the risks?

I will do my kitty kidney research further later on in the week but this is only Monday, I have to take care of the house, 4 other cats here and one at my brother’s, the bunny, and schedule what days I’m working this week away from home. For now I just want to get through one night of meds and meals.
 
Subq fluids:

Alright I don’t think I got any in her. The line was clamped in two spots so wasn’t flowing at first. Then she repositioned and by the time it was flowing properly I think it just spilt all over her. :( :banghead:

Now I can’t get the used needle off to even try to put on a new one!!! :arghh:

Also she ate less than I would have liked.

preshot was only 90. I shot 0.5 because I’m moving her shot time up slowly for the next few days if I can, too.


How do I take this darn needle off?! It’s stuck. Ugh.

Edit: got the needle off! Whew.
 
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gentle grip with a pair of pliers. put cap back on needle first.
Thanks! Managed to get it by hand before I saw this but just in case I need to know for the future. :facepalm:

I’m also confused what I’m supposed to cap it with if I don’t leave the old needle on after.... so I just put a new one on (capped of course). I don’t understand how this is even so confusing!

Should I take another pass at it tonight or wait until the morning?

Either way she will get more potassium and food all night and monitoring.

Also, I decided to wait until tomorrow to start the antibiotic. Better timing.
 
i left the old one on changing when it was time again for fluids. that way, i was positive i was using a new needle.
terumo thin wall needles are a class above other needles. and flow faster.
20g needles flow as fast or faster than non-terumo 18g.

check alice's legs, ankles and belly for a pouch of fluid. you don't know how much went in and how much went everywhere. i'd wait. too much fluid taxes the heart. add a bit of water to food instead.

sorry, i can't answer your other questions. tanya's site is the ckd bible.
 
should I space apart her insulin and fluids? Can they interfere with each other, the depot, something?
That's a bit ECID. You may want to separate time and space. Some people noticed numbers going lower with fluids. When I gave fluids (scruff), I shot flank. The one time she had fluids at the vet near where she already had her shot, her numbers went down. After than, I usually gave fluids around +10 if she was on her way up, so hours before her onset.

The line should have closures on it to close the fluids from flowing. The video shows it. Both near the bag and at the end of the line where you insert the needle.
If I feed her and don’t give the phosphorous binder... what are the risks?
That meal will be higher phosphorus. You want to lower her phosphorus so make all her meals lower phosphorus ideally. It'll help her feel better, and slow the progression of CKD if her phosphorus is down.

@Wendy&Neko Her vet told her to give 100mls of fluids twice a day. Isn't that a lot of fluid for a 7lb cat?
I'm not a vet, not my area of knowledge. I agree with Kel's approach, wait for tomorrow for more fluids.
 
@Wendy&Neko Her vet told her to give 100mls of fluids twice a day. Isn't that a lot of fluid for a 7lb cat?

Cassandra. Click on the link. A lot of information about subq.
From: https://felinecrf.org/subcutaneous_fluids.htm
... Based on what I have seen over the years, the average 8-10lb (3.6-4.5kg) cat would usually be given around 100ml a day. Larger cats might need 125ml, or even occasionally 150ml for cats who weigh 15lb (6.8kg) or over, whilst smaller cats need smaller amounts, 50-75ml a day. Be cautious with cats with heart issues, who may have problems processing sub-Qs, and who may need smaller amounts, perhaps given more frequently, for example 50ml twice a day rather than 100ml once a day.
Since cats vary in their individual needs, you should seek your vet's advice on how much to give your cat, and start off gradually, and aim for the lowest level that will comfortably maintain hydration. If you live in a hot humid area without air conditioning, your cat might need more fluid than a cat in a colder climate. If your cat has a bout of vomiting or diarrhoea or is not eating, more fluids might be required in the short term to offset the fluid lost as a result of the crisis. Cats who are diagnosed following a severe crash may possibly require more sub-Qs, but this is not always the case, particularly for cats whose crash is causes by acute kidney injury, who may need no sub-Qs at all once they have recovered.
When deciding on how much fluid to give, you need to monitor your cat for dehydration and check that the fluid is being properly absorbed. A pouch is normal, and it usually takes 6-8 hours for the fluids to be absorbed, though some cats take longer. Many people find the simplest way to monitor their cat's need for fluids is by means of a weighing scale: you can weigh your cat regularly and if his/her weight goes down, this may indicate dehydration; if the cat's weight increases, the cat may be retaining fluid and at risk of overhydration. Coco's Page has more information on how to do this.​
 
The 100 ml twice a day could be to much. Normally it's 100 ml a day and if there are heart issues it should be less. I used these with Ollie for accurate measure.

https://www.shopmedvet.com/product/i-v-burette-set/iv-administration

I was never told to refrigerate the fluids. I used 500 bags since Ollie didn't get much. Vet said I could use bag and line for 2 weeks as long as line was flushed with new needle before inserting.each time.
 
The 100 ml twice a day could be to much. Normally it's 100 ml a day and if there are heart issues it should be less. I used these with Ollie for accurate measure.

https://www.shopmedvet.com/product/i-v-burette-set/iv-administration

I was never told to refrigerate the fluids. I used 500 bags since Ollie didn't get much. Vet said I could use bag and line for 2 weeks as long as line was flushed with new needle before inserting.each time.
Thank you.
How much do I flush from the line?
 
So I finally got *almost* approx 20% of a can into her for PM. This ended up requiring me to give her food straight from my hand in tiny bites.

tested her. 46. :banghead:

So now I’m going to give some Syrup and hope that that will also get her eating a little more.
 
She’s up to 92. That was with syrup mostly, after the 52. I wonder if it will be safe to take a nap in another thirty minutes (or at all??). :( She won’t eat this food (ziwi lamb) hardly. Maybe the phosphorous binder doesn’t taste good?

maybe she needs a different food but I’m running out of kidney friendly ish/diabetic friendly/IBD friendly choices. :banghead: :banghead: :banghead:

If the most important thing (one of them) is just getting her to eat right now.... would it be okay to get some fresh lamb and see if she will eat diced chunks lightly cooked? I thought maybe the “goopiness” of her food currently was not pleasing or hard for her to take bites at. Maybe. Of course I know that isn’t complete nutrition but maybe I could use it as a treat. Or even make a stew for more fluids.

sigh. There are several personal stressors right now that are making this very long day very too complex and disheartening.


Please just EAT, Alice!!!
 
On the lines I put link to. The tubing holds 10 ml. That's what I flushed. Ollie got 70 ml, so I filled chamber to 80 then flushed down to 70.
 
What did the vet give you?
Read the ingredients to see if it is flavoured or has sugars in it. Alice may be reacting the the taste (which is why most people use this one: aluminum hydroxide which will last you a very long time)
Maalox? I don’t think it has ingredients on it. I’ll ask my vet about it.

in fact, I should make a list of questions and call and ask her to call me at the end of the day (6pm CST).....
 
Another thing I was wondering was

shouldn’t the amount she gets mixed with her food be proportionate to the phosphorous content in the food?
For example: If I wanted to feed her the Koha kangaroo, high in phosphorous, I would want to add more binder, right? Is there a guide on ratio of binder to phosphorous content???
 
More reading for you, especially the aluminum hydroxide section. CKD is a much steeper learning curve than FD.
https://felinecrf.org/phosphorus_binders.htm

Maalox is inexpensive but aluminum hydroxide is much cheaper in the longer run. You only need to purchase it once.


Aluminium Magnesium Hydroxide

This type of binder, as the name suggests, also contains magnesium. Brand names include Maalox, Mylanta, Milk of Magnesia or Aludrox.
Binders containing magnesium are not suitable for CKD cats because they can cause high magnesium levels in the blood, which in turn may cause urinary tract problems such as stones in some cats.
PetCoach states "Do not use magnesium containing products in animals with kidney failure."
 
We had a kidney kitty Marlin who was given renal pro supplement (see Pic) that includes:
Calcium carbonate 100 mg/g, Chitosan 80mg/g, Potassium citrate 78 mg/g

Was sold through the vet.
 

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