https://www.felinediabetes.com/FDMB...175-4-149-6-131-pmps-154.234943/#post-2630179 Good morning! I gave Naomi her insulin 3,75 hours ago. I also gave her half pouch of kd. I saw her eating so I went back to sleep. Woke up now and saw she had eaten her food. I gave her the other half pouch and she ate all of it at once. I didn't give her Zofran this morning. My question is do I have to continue a few more days with zofran to make sure she has a chance her eating will go back to normal or stop? Is it a safe drug for kidneys to be given for many days?
Tanya's kidney site does not say anything about Zofran being unsafe. https://felinecrf.org/appetite_loss_nausea_vomiting.htm
She’s inching back up. At some point when you can be home to monitor she is going to need more juice I think.
I was thinking to give her more insulin at PM, and less or none at AM. She did well the days I skipped the morning dose. What are your thoughts? The other alternative would be to give her insulin as soon as I come back home around 13:30 or 14:00. And then at 1:00 at midnight and wake up 2- 3 times to check on her
You can’t live like that setting alarms. I’d be more inclined to take 1/8 unit increase both cycles. I had to do that with Max. You aren’t where you need that yet and maybe pain control will make it so it’s not necessary.
OK. What's 1/8 increase of the current dose? 1/4 is . 25 I mean how I would figure out in the syringe? Sometimes it's difficult even with . 25
What I wrote does not follow TR but with Max .25 didn’t work. I had to use digital calipers to make it work. You could fill a syringe with colored water and practice counting drops. Then you would give half of that.
It's a little bit confusing for me. I've watched a video before showing how to use calipers. I'll have to order one and do some practice
Hi Yanna, Just catching up with yourself and Naomi. Am I correct in thinking that increasing the frequency of administration of ondansetron (Zofran) has been helping her to eat better? It sounds like it from your opening post today, and I'm really pleased for both of you that it seems to be working for you. IIRC at the moment you are dosing at 2mg TID. If the ondansetron is the 'magic bullet' helping Naomi to eat better then reducing the dose of ondansetron or suspending treatment will likely see her eating difficulties return. Should that prove true then you may need to consider adding ondansetron to her daily maintenance treatment regimen. With a bit of trial and error, you may be able to identify the minimum dose required (size and frequency) to provide the anti-nausea benefit Naomi needs. The recommendation from Tanya's site for dosing of this medication is as follows: For chronic nausea in CKD cats, however, many people find a dose of 1mg is fine, but needed at least twice daily, and if that doesn't work, then three times daily. Very occasionally, cats need ondansetron four times a day. I would start with a dose of 1 mg twice a day, and if you find this is not enough, speak to your vet about increasing the frequency initially, and if necessary, the dose. Based on my experience managing nausea and appetite issues in my own cats, I find that it is much, much easier to keep a cat with some bit of appetite eating than to get it to resume normal eating from a standing start. Now that Naomi is at last now eating on her own again (yay!!!) I would be very reluctant to mess with the status quo too much or too fast. For the reason stated above and having been in very similar situations with my own cats, rather than stopping ondansetron completely I would suggest you try reducing the dose size and/or adjusting the frequency of administration to the minimum needed to maintain the anti-nausea benefit to Naomi (essentially the reverse of the process from Tanya's Site above). Possible downward titration steps to try: * 2mg TID (current dose, total 6mg/day) * 1mg TID (total 3mg/day) * 2mg BID (total 4mg/day) * 1mg BID (total 2mg/day) Just as it can take a few days for a cat to derive the full benefit from a given dose of ondansetron, so too it may take a couple of days before one can judge how well/poorly any dose adjustment will work. If at any stage after a dose/frequency change Naomi's eating problems return, even partially, then I'd suggest returning to the previous effective dose straight away so that you don't lose any of your hard-won ground. Once she's stabilised again, try a different dose size/frequency. For example, a reduction to 1mg TID might be less effective than changing to 2mg BID, or vice versa. I don't see any way round the trial and error, short of a magic wand that would enable our little ones to be able to speak so that they could tell us what works best. I can dream... Ondansetron is extensively metabolised in the liver. There are caveats about dosing for human patients with hepatic impairment on several drug sites but I've not come across any specific warnings about patients with kidney insufficiency. According to this article: Clearance [of ondansetron] occurs by hepatic metabolism (95%) rather than renal excretion. According to drugs.com: Elimination Metabolism and Excretion: Ondansetron is extensively metabolized in humans, with approximately 5% of a radiolabeled dose recovered as the parent compound from the urine. The metabolites are observed in the urine. The primary metabolic pathway is hydroxylation on the indole ring followed by subsequent glucuronide or sulfate conjugation. Specific Populations Renal Impairment: Renal impairment is not expected to significantly influence the total clearance of ondansetron as renal clearance represents only 5% of the overall clearance. However, the mean plasma clearance of ondansetron was reduced by about 50% in patients with severe renal impairment (creatinine clearance less than 30 mL/min). The reduction in clearance was variable and not consistent with an increase in half‑life.. Hepatic Impairment: In patients with mild-to-moderate hepatic impairment, clearance is reduced 2‑fold and mean half‑life is increased to 11.6 hours compared with 5.7 hours in healthy subjects. In patients with severe hepatic impairment (Child‑Pugh score of 10 or greater), clearance is reduced 2- fold to 3- fold and apparent volume of distribution is increased with a resultant increase in half‑life to 20 hours. [Emphasis mine] At some stage one has to weigh up risks and benefits of particular treatment options. From the above it seems that ondansetron does not impact the kidneys greatly but I suggest you confirm that with your vet. I couldn't see any caveats or warnings on Tanya's Site. One thing to consider is that if a cat can't eat enough then that, too, can cause problems for diabetic cats, with or without other comorbidities, because it can interfere with the cat's ability to safely receive enough insulin. Not getting adequate insulin would also carry risks, in particular: * BG levels not at optimum - higher BG levels can put an additional strain on the kidneys, increase risk of developing UTIs (especially if BG levels creep above the renal threshold) , slow healing from infections in general, and increase risk of organ damage (all of which are of great concern for CKD cats) * greater risk of problems with ketones - doubly so if cat is neither getting enough insulin nor enough food. I hope some of the above helps you a little bit. Mogs .
Your post helps me a lot! Thank you! Yesterday 9/9 I tried feeding her without Zofran and she ate 2 1/2 pouches on her own. BG increased a lot. This morning 9/10 she was not too willing to eat, yet I gave her 1 unit because bg was 262. Shouldn't have stopped Zofran on 9/9 I need to update ss and start a new thread when I go back home Thanks
It’s not good to stop ondansetron until she’s eating normally for several days. Then decrease slowly, from three times to times a day fir example for several days. Max was in it fir a few months the first time. Subsequent ones was t needed as long because I found his dose.
Yes I realized this morning. Shouldn't have stopped it. When I return home i'll give Zofran again whether she's eaten her food or not. Thanks Elise!
That's exactly what I was referring to above. If you reduce/stop or stop the ondansetron dose, it can take a little while before the reluctance to eat re-emerges. If, after reinstating the ondansetron, Naomi starts eating better again then that is good evidence to give your vet that nausea is very much a factor in her reluctance to eat without supportive meds. When Naomi was eating well on the ondansetron, how long was it since she had been given the diazepam by the vet? How long is it since Naomi received any other appy stimulant(s)? Mogs .
Vet's prescription was 2mg once a day. It didn't work. I took initiative and increased the frequency to 2 mg twice a day. Again it don't work. Vet told me to stop it and gave her one diazepam inj. It worked only for that day. Didn't take her back to vet. Increased the frequency to 2 mg three times a day for 2 days. It worked. Third day I stopped. I shouldn't have.
