Cat won't eat - despite Cerenia and mirtazapine?

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trishia42

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Thank you so much for all the comments. Mao maybe ate about 120 calories today, which is way less than the absolute acceptable minimum of 200 and it's already 8:30 pm. We thought about trying different combinations or withholding/playing around, introducing additional things like Pepcid AC, but we also feel time is of the essence at this point and that we don't have much room in that aspect. He has been getting his required calorie intake for the last three days since he was being tube fed in the ER, but it doesn't look like we are cutting it here. My husband and I have started discussing the possibility of an e-tube; it's such a difficult decision to make though because I worry on how he will handle the procedure with the anaesthesia - so I have felt all along that it would be a "last card" situation, which we may have come to. I may try to syringe feed him just before bed if to make up for what we can't convince him to eat tonight. I feel there has been some improvement, given he wasn't eating at all at the clinic but he was also doped out of his mind there so who knows.

His breathing has also been fast; he was deemed asthmatic while in the clinic due to that x-ray and the vet warned me his breathing could be a little faster due to stress, asthma, and potential trauma from his stay at the ER clinic but I'm not sure it looks right. It was about 60 breaths/minute when we got home last night, decreasing to about 50 before bed. This morning more like 40-45 so I felt we were heading in the right direction - I did inquire with the clinic this morning and they told me it wasn't unusal to last a bit, and to monitor him for any key signs. He isn't on any inhaler medication right now, just the prednisolone (the idea was deal with the asthma issue once we had him more stabilized in respects to eating and food moving through). Tonight it's been oscillating between 40 or 50 but I am more concerned about the force his abdomen seems to be moving with the breaths - not sure if that is a cause for concern though? He's not exhibiting signs of breathing distress straight out (no panting, open-mouth, wheezing), but I still find it mildly disturbing - even more so if we are considering anaesthesia for the e-tube procedure. Video here:
I think tomorrow we will have to call and make a decision regarding this and it's just so hard to know what to do and whether I am doing the right thing. I just want to have my MaoMao by my side a bit longer and it feels like everything there's a sliver of hope, it just doesn't pan out.
 
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His breathing has also been fast; he was deemed asthmatic while in the clinic due to that x-ray and the vet warned me his breathing could be a little faster due to stress, asthma, and potential trauma from his stay at the ER clinic but I'm not sure it looks right. It was about 60 breaths/minute when we got home last night, decreasing to about 50 before bed. This morning more like 40-45 so I felt we were heading in the right direction - I did inquire with the clinic this morning and they told me it wasn't unusal to last a bit, and to monitor him for any key signs. He isn't on any inhaler medication right now, just the prednisolone (the idea was deal with the asthma issue once we had him more stabilized in respects to eating and food moving through). Tonight it's been oscillating between 40 or 50 but I am more concerned about the force his abdomen seems to be moving with the breaths - not sure if that is a cause for concern though? He's not exhibiting signs of breathing distress straight out (no panting, open-mouth, wheezing), but I still find it mildly disturbing - even more so if we are considering anaesthesia for the e-tube procedure. Video here:
Strangely the video would not show...but with downloading...I was able to view it.
I see what you mean.

Are you getting 17 breaths in that 20 second video?
Which would make it 51 breaths per minute.

I'm not really good when it comes to reading breaths or vitals with cats...but I kind of worry that Mao's breathing is not actually steady...either.
He seems to go fast...but then it's like it's unsteady.
Almost like the beats are not spaced evenly...arrythmia?

Do you think that any of the medications can cause this.?
Maybe the prednisolone, or cisapride, cerenia??
I don't know.
(edit to add: a painkiller definitely would...but I thought Mao is off of the painkillers now,...unless any of the meds..also have these effects...and how long a 'half-life' the meds have.)

I also found it so discouraging, that when looking for many wet cat foods, it was like you said...
Low calories..in a can.
Nothing I found was highly caloric, and also low phosphorus...for ckd cats.
How's a cat supposed to get all those calories...even in prescription foods.
(I think I'd go for kitten food, now, if it was okay for ckd cats.)

Mao is gorgeous, btw. That grey fur, looks so soft and dense.
Is Mao still drinking water?
 
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Yes, he is still drinking. We just managed to syringe feed him a bit - not a pleasant experience but not completely awful. I did feel like a bit of a monster though. Any of the meds could have effects of course - he's on such the cocktail who would know, especially with interactions. He certainly doesn't fit in the "respiratory distress" category at this time, but we are monitoring him. I certainly will be by his side all night long.

I will most likely call the clinic tomorrow to discuss things; I think we are at the point where an e-tube is the last hope we have. I just worry SO much about the anaesthesia risks, especially seeing him breathe this unusual way.
 

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Yes, he is still drinking. We just managed to syringe feed him a bit - not a pleasant experience but not completely awful. I did feel like a bit of a monster though. Any of the meds could have effects of course - he's on such the cocktail who would know, especially with interactions. He certainly doesn't fit in the "respiratory distress" category at this time, but we are monitoring him. I certainly will be by his side all night long.

I will most likely call the clinic tomorrow to discuss things;
I think we are at the point where an e-tube is the last hope we have. I just worry SO much about the anaesthesia risks, especially seeing him breathe this unusual way.
Yeah, I am a bit scared about that, too, now.
If Mao's breathing were more steady,...then I'd worry less.

Is the reason you have to decide tomorrow, friday, because they do not place e-tubes...on the weekends?
Or is it because the vets only gave you a few days of...eating with lower calories?

I'm just happy that your Mao is eating on his own,...and if you can manage to get those 'extra calories' into him...even if you have to set your alarm,...and 'wake up in a few hours...or more'....'middle of the night kind of thing'...then that may help to get to the 'calorie goal'.
I don't know if it's great for you to do this...because of your own sleep, and schedules, and such,...but if you can for tonight, or on the weekend...then it may buy you some more time?

Syringe feeding is actually pretty difficult, at first, and especially when the cat spits up more food, on you, and everywhere else, than goes inside of them.
If you can go as slow as you can...then it helps.

Another member, here, managed to 'syringe feed her cat with hepatic lipidosis'...but she had to do it around the clock, which was exhausting, and she even used those 'smaller syringes' 3ml...not the larger 10ml ones. She said it was easier to give smaller doses of food...but took way longer.

Good Luck to you, and Mao,...as always. :goodluck:
Hoping that your Mao's breathing and respiration rate gets better.
If you can, try to video tape him, while he is sleeping, too. Just to compare.
 

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Yes, he is still drinking. We just managed to syringe feed him a bit - not a pleasant experience but not completely awful. I did feel like a bit of a monster though. Any of the meds could have effects of course - he's on such the cocktail who would know, especially with interactions. He certainly doesn't fit in the "respiratory distress" category at this time, but we are monitoring him. I certainly will be by his side all night long.

I will most likely call the clinic tomorrow to discuss things; I think we are at the point where an e-tube is the last hope we have. I just worry SO much about the anaesthesia risks, especially seeing him breathe this unusual way.
I wasn't able to view the video (it didn't load in for me). How is his breathing now?

I am curious: did they stop giving fluids?

:grouphug2:
 
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The e-tube doesn't have to be tomorrow but time is a bit of the essence if we can't get enough calories in him. In the early hours this morning he started being very restless and looked bad with ears and whiskers down, hunching in the meatloaf position by the litter so we gave him 15 mg of gabapentin (which we had stopped to see if it would help with his eating), and that seems to have helped a bit. His breathing is still fast as of this moment and I find it terribly concerning; 20220513_094003.mp4 - plus he still has not poope which is yet another concern since this would be day two and they warned us his GI motility issues were also a big factor is deciding how to go ahead with his case. It looks like he's been trying since I've seen him go in and out of the litter a couple of times.

The clinic stopped the fluids when they noticed the breathing. We gave him subQ fluids yesterday morning, but only 50 mL to err on the side of caution. Since yesterday he has been drinking A LOT so on the one hand, that's good because he's getting hydrated but on the other hand it really worries me since I have to wonder if everything else might have caused his kidney condition to deteriorate rapidly... I don't want to lose hope but it's very hard not to at this point and I don't think I've ever felt so defeated and heartbroken.

He's been showing interest in food on/off but probably only had 40 calories so far this morning, so the situation is not getting any better. We skipped the Cerenia this morning and only have him the ondansetron, but I just don't know anymore. It seems that whatever we're trying, things aren't really improving and I'm a total loss as to what to do now. I will probably have to call the clinic when my husband gets home in a bit, but I'm so terrified that they'll just tell me it's better to let him go. I don't feel my heart can handle it - especially with all that we've tried.
 

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The clinic stopped the fluids when they noticed the breathing. ...
I think this was wise.

About him not pooping yet, it's an unfortunate catch-22 that many medications can cause constipation. Not a good thing, when these very same meds are often what is needed to help a kitty! Has he been able to urinate?

Overall, I'm really worried about him. Have you updated the vet yet today, about the various symptoms you are seeing? I can empathize with all the heartache you are going through right now - it's such a complicated situation.
 
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Yes, he still pees - about two-three times today so far (he is drinking more as mentioned). He will nibble a little more often when offered food but after so much he will stop, walk away, lick his lips and like open his mouth real wide like he's biting the air - I assume that's mild nausea still? I do feel subQ fluids could be useful but certainly don't want to use them now with the breathing rate. A lot of people are suggesting an echocardiogram but an ER one (if available within a reasonable amount of time) would most likely cost upwards of $5k. Wouldn't they have noticed the fluid overload on the x-ray? They specifically sent it for review to a radiologist for this reason and he came back with 'asthma' but I just don't know what to think anymore.

I am waiting still to talk to a vet at the ER clinic... I feel they're either going to say to bring him in (which will again skyrocket his stress, possibly making everything worse), or that there is nothing else they can do for us at this point.
 

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The e-tube doesn't have to be tomorrow but time is a bit of the essence if we can't get enough calories in him. In the early hours this morning he started being very restless and looked bad with ears and whiskers down, hunching in the meatloaf position by the litter so we gave him 15 mg of gabapentin (which we had stopped to see if it would help with his eating), and that seems to have helped a bit. His breathing is still fast as of this moment and I find it terribly concerning; 20220513_094003.mp4 - plus he still has not poope which is yet another concern since this would be day two and they warned us his GI motility issues were also a big factor is deciding how to go ahead with his case. It looks like he's been trying since I've seen him go in and out of the litter a couple of times.
I noticed that Mao's tail is still in a slightly up-position.

There was a long ago thread, I read, which mentioned how 'spinal pain causes constipation issues'...or it was that 'spinal pain' and all the nerves in that area...cause constipation?? (or it could have been the other way around, since I don't exactly remember)
Did the ER vets mention this at all?

About spine, nerves in that area, and it...leading to constipation?

I just wonder if some of what you are seeing with Mao, is still pain related,...or disc/nerve damage/inflammation...which leads to his colon motility issues...being that the nerves there might be affected.
He's been showing interest in food on/off but probably only had 40 calories so far this morning, so the situation is not getting any better. We skipped the Cerenia this morning and only have him the ondansetron, but I just don't know anymore. It seems that whatever we're trying, things aren't really improving and I'm a total loss as to what to do now. I will probably have to call the clinic when my husband gets home in a bit, but I'm so terrified that they'll just tell me it's better to let him go. I don't feel my heart can handle it - especially with all that we've tried.
A lot of people are suggesting an echocardiogram but an ER one (if available within a reasonable amount of time) would most likely cost upwards of $5k. Wouldn't they have noticed the fluid overload on the x-ray? They specifically sent it for review to a radiologist for this reason and he came back with 'asthma' but I just don't know what to think anymore.

I am waiting still to talk to a vet at the ER clinic... I feel they're either going to say to bring him in (which will again skyrocket his stress, possibly making everything worse), or that there is nothing else they can do for us at this point.
Is this the only ER available to you?
Because that sounds overboard with the prices of an echocardiogram.
(I had one done at a Specialty Referral Vet clinic, in oakville ontario, back in 2014, for about $740 CAD.
It was over 8 years ago, so I do imagine the prices have tripled, but upwards of $5k...sounds crazy high. But yeah, maybe they are like that at ER places, since they are emergency status...(and not regular...make an appointment and wait...type of thing).)

I would think they would have noticed 'fluid overload' on the x-ray, or ultrasound.
But prednisolone, also can cause some heart issues in certain cases..so not sure.
With asthma, pred is usually given,...yet perhaps other meds can be tried for Mao's breathing.

Also with his constipation, I would ask for a stool softener, or laxative, since the cisapride may be causing too many intestinal contractions. (it may be too strong for Mao).

Poor guy, I just feel for you and for your Mao cat. :frown:
I was so hoping that he would be better, and calmer, less stressed at home.
He's definitely less stressed at home, but like PushPurrCatPaws PushPurrCatPaws said,...the breathing is worrisome, since we don't know what the cause is.
 
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Tail is definitely getting better; didn't talk about the relation to constipation but I can bring it up tomorrow. There is also the possibility that his tail wasn't injured but was referred pain from the pancreatitis - hard to know.

Just talked to the vet and was able to send her some videos; she agreed that his breathing is very fast and that it looks like he required a decent amount of force - although she agreed the force aspect has gotten better today (
https://www.dropbox.com/s/lojdtltxxwhe9m/Mao_Breathing_FridayAfternoon_02.mp4?dl=0
). She reviewed the x-ray from Tuesday (back then his breathing rate was recorded as 40-44, so it's odd it got higher once home) and she says that yeah, there is no sign at all of fluid overload on it although it doesn't mean that wouldn't have changed. She said it would be odd if he had some fluid collecting that he would still be eating (also that he would still be laying normally on his belly).

So for now we are to monitor Mao over the evening and the night and try to measure his breathing rate when he is fully asleep (I think I got about 40 when he was like "half-asleep"), and sort of see if it improves now that we are stopping the mirtazapine - although it would be a rare side-effect, especially with the lower dose we gave him. If it gets worse at any point, or he displays any signs of distress, we are to bring him in immediately obviously. Otherwise, I am to call back tomorrow morning and we will go from there; it's likely we will bring him back for a follow-up x-ray at the clinic to see if they have been any changes and/or start an asthma inhaler medication (since I'm not too keen on long-term use of the oral steroid).

So I guess I still need positive vibes here! We're hoping it's just a temporary effect from some of the medications or asthma. If it's fluid collecting and a heart issue, I don't know what we will do at this point since it seems it will be a fight we cannot win.

This is the worse week I've had in a long time for sure. Again, thank you all for following and all the comments - I read them all and they mean a lot.
 

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So for now we are to monitor Mao over the evening and the night and try to measure his breathing rate when he is fully asleep (I think I got about 40 when he was like "half-asleep"), and sort of see if it improves now that we are stopping the mirtazapine - although it would be a rare side-effect, especially with the lower dose we gave him.
I can't believe I missed this.

I think the effects you are seeing with your Mao, with the restlessness, the cannot rest,...and even the fast breathing ALL have to do with the mirtazapine...and the side-effects from that medication.

I didn't realize that Mao was still on it, since I was only reading the 'cocktail list'...and forgot that you had it from before.
For some reason, I thought you were holding off on it, since Mao was eating.

(my 6 year old cat, started meowing like crazy, (she's chatty, but the mirtazapine caused her to be three times more chatty.
She could not rest, was pacing, moving, and kept coming up to me. I couldn't believe how strong that drug is. There are threads here, that call it 'meowzapine'...because of its effects.)

**I honestly think, that since you are stopping the mirtazapine...that your Mao will go back to his normal breathing rate, and be more comfortable, and calm. :bluepaw:

Because of his ckd status, I think that all the drugs have to be used cautiously, and that the vet should have known not to administer drugs at the same levels as other cats.
A lot of our cats and dogs are sensitive to medications, and all react differently, but somehow vets use a general formula.

T trishia42 ...I think you'll definitely see an improvement, and difference in how your Mao acts.
I just don't know the 'half-life of that mirtazapine. (have to look that up)

Is says:" Pharmacokinetic studies in cats have shown that the median half-life of oral mirtazapine is 9.2 hours for the 1.88-mg dose and 15.9 hours for the 3.75-mg dose in normal young animals; ..."
in this online article: Mirtazapine in Cats: Dosage, Side Effects, and Efficacy
So that means that you won't see it out of his system for another day, or two, depending on how much he was given.

"Specifically, when 6 cats with IRIS (International Renal Interest Society) stage 2 and 3 CKD were administered a single oral 1.88-mg dose of mirtazapine, it had a half-life of 15.2 hours; in comparison, its half-life was 12.1 hours when administered to geriatric cats and 9.2 hours when given to young normal cats.5,7 On the basis of accumulation factor calculations, the researchers concluded that CKD delays the clearance of oral mirtazapine and that a single low dose of mirtazapine resulted in a half-life compatible with a 48-hour dosing interval in cats with CKD;"

Hopefully, though, the smaller dosage means that it leaves his system faster. :crossfingers: 🙏 :bluepaw::greenpaw:
It also says that it clears slower in ckd cats...but hopefully, again, like you said, maybe it's just a rare side-effect, and not necessarily what's causing the fast breathing (tachypnea)

(my previous rainbow ckd/hcm cat took buprenorphine, and was so high, and it made his one pupil look blown, that I kind of freaked out. So afterwards, I mentioned it to an ER vet, who told me he never heard of this effect. How could he have not. Man was I disappointed and a bit angry, too.)
So I guess I still need positive vibes here! We're hoping it's just a temporary effect from some of the medications or asthma. If it's fluid collecting and a heart issue, I don't know what we will do at this point since it seems it will be a fight we cannot win.

This is the worse week I've had in a long time for sure. Again, thank you all for following and all the comments - I read them all and they mean a lot.
Sending you Loads of Health Vibes, Health Thoughts, and more prayers...that your Mao...gets better overnight, and can turn this thing around. :vibes::vibes::tabbycat:
Tell Mao, that you need him to sleep and purr with you, like he does, and that your arm is always free, as a pillow, too. :coolcat::lovecat:
 
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Because of his ckd status, I think that all the drugs have to be used cautiously, and that the vet should have known not to administer drugs at the same levels as other cats.
A lot of our cats and dogs are sensitive to medications, and all react differently, but somehow vets use a general formula.
...
"Specifically, when 6 cats with IRIS (International Renal Interest Society) stage 2 and 3 CKD were administered a single oral 1.88-mg dose of mirtazapine, it had a half-life of 15.2 hours; in comparison, its half-life was 12.1 hours when administered to geriatric cats and 9.2 hours when given to young normal cats.5,7 On the basis of accumulation factor calculations, the researchers concluded that CKD delays the clearance of oral mirtazapine and that a single low dose of mirtazapine resulted in a half-life compatible with a 48-hour dosing interval in cats with CKD;"
...

:agree: I forgot about this as well cat nap cat nap !

I haven't had a CKD cat, but I do remember reading some years ago about usage of buprenorphine in cats with CKD, Addison's Disease or underactive thyroids: it's all about the metabolism, and "normal" dosages of buprenorphine in cats with metabolic diseases can lead to an increase of buprenorphine deposits in the cat's system, pretty much leading to overdose situations. That probably applies to many or all drugs.
:oops:
 

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:agree: I forgot about this as well cat nap cat nap !

I haven't had a CKD cat, but I do remember reading some years ago about usage of buprenorphine in cats with CKD, Addison's Disease or underactive thyroids: it's all about the metabolism, and "normal" dosages of buprenorphine in cats with metabolic diseases can lead to an increase of buprenorphine deposits in the cat's system, pretty much leading to overdose situations. That probably applies to many or all drugs.
:oops:
Thanks for this added information, PushPurrCatPaws PushPurrCatPaws .:)
That totally makes sense to me, now. (at the time, I had no idea)

It's kind of like what you said before, though, in your post:
About him not pooping yet, it's an unfortunate catch-22 that many medications can cause constipation. Not a good thing, when these very same meds are often what is needed to help a kitty!
which I totally agree with.
We need the meds to help heal our cats.
But then we need the vets to Balance out, what they are giving, for the best therapeutic outcome, too.

(I'm not 'anti-meds'...at all, and I have the highest regard for good Vets...but I just don't know how they determine the 'right balance to use'...in certain situations. I guess that's where we laypeople, have to advocate and ask them, about the various meds and side-effects. But It's hard for us, to know what's best, or even what questions to ask...until our animals actually exhibit signs. :dunno:. Plus we're not professionals, who have seen way more cases, with the training that they do.)

(for instance, my 7 yr old cat, went into seizure, after being sedated for a routine x-ray, due to ketamine. Thankfully, the vet was able to reverse the seizure, but I was kind of in shock. I never had given it much thought, before, that you can bring a cat in, and potentially lose him, over what is supposed to be an ordinary procedure. My cat needed sedation, because he was growling at the vet-techs, they said. So I okayed it. Now, it's just noted in his chart, never to give ketamine to him.)

With T trishia42 's cat Mao, I'm just hoping that he's able to get better, and that the vets are suggesting appropriate dosages.

(I don't have first hand experience with pancreatitis, either, but just looking online brought me to the feline diabetes boards, which had a lot of personal information.
I didn't know that pancreatitis flares up, so often.)
Boots update - reaching the end of the road? plus nausea treatment questions - ondansetron dosing | Feline Diabetes Message Board - FDMB

Just will be Hoping that Mao, gets better from whatever his body is going through, and that his breathing improves, also. :crossfingers::grouphug:🙏:bluepaw: To me he looked better and more relaxed in the last video, but it did seem like he had an ever so slight tremble or slight shake, in his head, but it could be due to his breathing.
Just Hoping that he improves at home. :crossfingers::grouphug::tabbycat:
 

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Just will be Hoping that Mao, gets better from whatever his body is going through, and that his breathing improves, also. :crossfingers::grouphug:🙏:bluepaw: To me he looked better and more relaxed in the last video, but it did seem like he had an ever so slight tremble or slight shake, in his head, but it could be due to his breathing.
Just Hoping that he improves at home. :crossfingers::grouphug::tabbycat:
:agree: :grouphug2::hearthrob:
 
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Mao started having more a bit more difficulty breathing last when we were discussing if we should bring him in. Then he went upstairs and started breathing open-mouth. We rushed him to the ER vet and they put him in the oxygen cage. X-ray revealed pleural effusion (fluid outside the lungs) and blood test confirmed heart disease/failure.

He spent the night in the oxygen cage and was given furosemide doses all night (since his creatinine value was now actually just in the upper normal range). Although his breathing seemed to stabilize within the oxygen cage, if they took him out of it, it would go up again which would seem to indicate the furosemide is not working. Furosemide does not tend to work very well for fluid outside the lungs; it is usually better for fluid inside the lungs.

I am absolutely heartbroken and destroyed. I'm mad, I'm defeated - all of the last week was in vain. Yesterday he got so much better; he ate a full 250 calories on his on, he wanted to go outside, he moved around and cuddled with us - it seemed we were really turning a corned on the pancreatitis. The pain and anger I feel right now I can't even. We have an appointment this evening to help him cross over; I always wanted him to cross over here at home - in the place that had been his whole world since he was just a little kitten and that has now been taken from him since it'll happen in the cold setting of the clinic. He just doesn't deserve this; he didn't deserve any of this. He won't eat in the clinic; I left my vest with him last night and today we dropped off some of his favourite food and his favourite mat so that he can lay on something comforting and familiar in his final hours.

I can't help but feel that although I understand there was an underlying heart condition, that the administration of IV fluids while he was there for three nights earlier this week precipitated these events. When we visited on Monday, I saw the number at 23 mL/min, which would be 552 mL daily and according to things I see on the internet, it seems like too much to me. The vet that was monitoring then say they started at 2x the maintenance volume which they had decreased to 1.5x on Tuesday - it was that afternoon that they halted the fluids due to his breathing. Although the x-ray at that point did not reveal fluids, it's pretty clear it's what had started happening. We were also instructed to give him fluids on Thursday (we were told 100-200), but we only did 50 mL and I still feel terrible about it.

I'm not ready - I don't know how I will handle it tonight at all. My husband is also leaving the country for five days so it'll just be me in our empty house - angry, broken, defeated and just plain broken.

Thank you so much for all the support you have shown me during this past week - it has been the worse of my life and this will surely be the worse day (probably only close to the day we found our April passed away in our home one morning, not even three months ago).
 

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Yesterday he got so much better; he ate a full 250 calories on his on, he wanted to go outside, he moved around and cuddled with us
It may not help at the moment, but you had this with him and he had it with you. I'm so sorry. :hugs:
This might help:
Membership Checkout – APLB the Bronze membership is free
 
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PushPurrCatPaws

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Oh, T trishia42 , I am so very sorry to hear this, and so concerned about what you are going through. 😥
Poor Mao! This is crushing news, my heart goes out to you! Are you able to bring in more things with you from home tonight, beyond your vest and his favorite mat, to help him feel more comfortable and comforted?
 
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