Elderly CKD Cat Jakey Has Progressed to Needing Fluids (IV outpatient followed by regular SubQ at home)

[epona]

I really just need a bit of reassurance and vibes.
And some tips about what list of questions I need to compile to ask the vet before Monday.

We're in the UK btw.

He is a neutered male OSH nearly 18 years old and was diagnosed with CKD early in 2022 at age 15, he's been on renal diet and daily Fortekor pill since then so about 2.5 years before having a recent decline in kidney function, I think 2.5 years managing it by daily pill and diet is pretty good?

He gets a quarterly vet check, we don't do bloods and urinalysis every time if he seems to be stable, but this year he had 2x urinalysis in May and July because he developed a bacterial UTI, and at his quarterly check on Monday he'd lost weight, we knew he'd been off his food a bit (not anorexic, but still eating just not as enthusiastic, for a usually greedy cat) so knew what was coming and had full geriatric blood panel and urinalysis (sample collected by cystocentesis) done.

There is a lot more protein in his urine now than there was in July, and his blood tests show a decline in kidney function, plus one of his kidneys is enlarged and irregular which the vet detected on physical examination.

The vet wants to have him in the local surgery as an outpatient all day Monday and Tuesday with him coming home Monday night, for IV fluids (this rather than an overnight stay at the main vet hospital because of £££). Then I'll be trained to give subcutaneous fluids at home.

Now before pointing me to a website or info sheet, please know that I have already read absolutely every bit of information I can absorb about this!!!

I would like to hear more about your own experiences of giving subcutaneous fluids at home, rather than clinical info.

Also what should I ask the vet, other than what it's going to cost to make sure I have enough money in the account I want to pay from and don't faint on the waiting room floor
I am going to ask for a copy of all the test results to be emailed to me tomorrow, they usually do this automatically but I may need to give them a nudge.
As he will be coming home on Monday night with an IV catheter, will he need to wear a cone? He is terrified of cones but I can go out Saturday and get him a soft collar.
I need to ask whether I can buy supplies for doing subQ online instead of from the vet (markup central!!!).
Also is he alright to have his usual medication before going in for IV rehydration.
Oh also I should ask them to check his heart, he sometimes has a fast pulse when he is examined and has had a low grade (but deemed benign) heart murmur (like a lot of cats do) for most of his life. There's no evidence that he has any major heart issue but I'd rather check again before pumping him full of fluids.

If you can think of anything else I need to ask the vet clinic before Monday, please let me know.

Also, have a picture of him laying up me with his paws on my shoulders, just because:

 

[fionasmom]

I gave subQ fluids to my last dog for a long period of time. The most important thing for me was to be shown initially every detail of the administration. If you are in any way uncertain or nervous about doing it, have a vet tech walk you through every part of it. My cats have been less receptive to it, and Jamie was taken into the vet for 10 days in a row once so that they could do it. That is quite common out here and vets charge a minimal amount... like $5 USD for it. If a cat is easily transported for a short distance and does not panic at the vet's office, it is something to keep in mind if need be.

I ordered all the supplies from Chewy and they were much less expensive than the vet. I understand that you are in the UK and possibly have a source that you can use?

If he pulls at the catheter, he might need a cone.
Ask your vet about the timing of the medication with the IV rehydration.
A heart condition would possibly contraindicate fluids. I assume that there has never been one, but it is something to ask the vet as a precaution at his age.

I think 2.5 years managing it by daily pill and diet is pretty good?

This is a very good track record and his age attests to it.

Do you think or know if he will be receptive to the subQ fluid use at home?

 

[epona]

I gave subQ fluids to my last dog for a long period of time. The most important thing for me was to be shown initially every detail of the administration. If you are in any way uncertain or nervous about doing it, have a vet tech walk you through every part of it. My cats have been less receptive to it, and Jamie was taken into the vet for 10 days in a row once so that they could do it. That is quite common out here and vets charge a minimal amount... like $5 USD for it. If a cat is easily transported for a short distance and does not panic at the vet's office, it is something to keep in mind if need be.

I ordered all the supplies from Chewy and they were much less expensive than the vet. I understand that you are in the UK and possibly have a source that you can use?

If he pulls at the catheter, he might need a cone.
Ask your vet about the timing of the medication with the IV rehydration.
A heart condition would possibly contraindicate fluids. I assume that there has never been one, but it is something to ask the vet as a precaution at his age.


This is a very good track record and his age attests to it.

Do you think or know if he will be receptive to the subQ fluid use at home?

He's a very unintelligent and clumsy cat (that sounds horrible but it's the truth, bless his sweet little soul) and might well try to pull an IV catheter out even if it hurts, so I think I'll just get a soft collar over the weekend so he can't reach any relevant bits of his body, I need to add to my list of questions where the catheter will be located in his body, I imagine one of the veins in his front or rear legs.

I think he will be fine with subQ at home - the flip side to him being daft and clumsy is that he is the sweetest gentlest creature that ever graced the earth.

I lost my Sonic (my soulcat) early 2022 because he developed CKD rapidly and was diagnosed when he went into crisis which would have required hospitalisation and although he was cuddleable and sweet to me (glued to me in fact, complete velcro cat, we were souls tied together in some way), he wouldn't even let me clip his claws and if anything even vaguely medical needed doing it took 3 people and a big towel, it would have been so so stressful for him to be in a hospital situation or even giving him fluids at home, and I had to let him go despite it utterly and completely breaking my heart. It wasn't even like he bit or scratched, because he didn't, but his stress levels were through the roof even for small things and it wouldn't have been fair to him to put him through a lot of stress just to extend his life a bit. That was a horrible decision, but in my heart I know it was the right one.

Jakey is not like that, he's very easy to handle, he doesn't like being put in the carrier to go to the vet but we've worked out a method for that, and he is very easy to handle, I can basically tip him on his side when he is laying down to trim his claws, I'd be very surprised if he was difficult when it came to giving fluids.

 

[FeebysOwner]

Hi. I just recently lost my 19+ yo who had CKD, among other medical issues. The sub-Q fluids were started nearly 1 1/2 years ago, and probably about 1 1/2 years after her initial diagnosis, which she was really already Stage 2 CKD. I was nervous at first, but it really turned out to be pretty uncomplicated and much easier/comfortable as time passed. I gave her 100ml daily.

This should be the same information you will receive when the vet shows you how to give sub-Q, but you asked for personal experience. You pull up on the loose skin at the base of the neck, insert the needle and then open the line. Having a second person, especially at the beginning, is helpful but not absolutely necessary if you have to go solo. Holding the needle in place, opening the line, watching the amount being given, closing the line, and removing the needle is what it takes. You will change the location of the needle placement each time you need to give fluids so that the same place isn't punctured twice in a row. I rotated left, middle, right and then repeated that pattern. Never use the same needle twice, and if by chance you make a mistake (and fluid comes out from the other side of where you placed the needle, you stop, get a new needle and start over again. If I screwed up more than one time in that given day (that only happened two times), I quit for that day and resumed the next. Feeby was like Jakey, and she accepted the fluids pretty much without issue.

I also ordered my lines and sub-Q fluids through Chewy (and another place for the needles I liked best), at a fraction of the cost that my vet wanted to charge. I don't think you have Chewy yet, but I thought I heard it was going to be available to you some in the (near?) future. So, I will have to defer that part to the UK members on this site. There is a specific needle that I got, but I think it is pretty much universally used compared to the ones most vets want to supply. That needle enabled me to administer 100 ml in no more than 3-4 minutes. I can look up the actual needle I got if you want.

Has your cat's cobalamin (B-12) level been tested? If low, he can be given B-12 shots at home through his sub-Q line (there is a y-port on the lines that enable this to be done efficiently and quickly). Low B-12 seems to be relatively prevalent in CKD cats. It helps a cat to better absorb their nutrients, and can aid in weight gain for some.

Is Jakey on any anti-nausea meds and/or an appetite stimulant? Also, pretty common with CKD cats.

If his phosphorus level is high, even though he is on renal food, adding a phosphorus binder becomes another control method to help keep toxins from building up in his system. There are other metabolic/enzyme numbers in a blood Chemistry panel that might require attention as well, but better to address those when you know what they are.

High blood pressure is also common in CKD cats, so I think you are going to have that checked, which is good. It usually takes a couple of rounds of testing to make sure an accurate reading is obtained. About 3 times at intervals during one visit, and then again in a week or so. However, if it is very high, the vet may want to start BP meds after the first set of readings. You always start low on these and then increase the dose after additional testing. Feeby's pressure was very high, but a very small dose brought her down to a good reading. Feeby had a heart murmur, but it never escalated to requiring treatment.

I think I covered most of what I know and learned throughout Feeby's journey with CKD, about appropriate testing and meds/supplements. It's a start anyway.

 

[epona]

Hi. I just recently lost my 19+ yo who had CKD, among other medical issues. The sub-Q fluids were started nearly 1 1/2 years ago, and probably about 1 1/2 years after her initial diagnosis, which she was really already Stage 2 CKD. I was nervous at first, but it really turned out to be pretty uncomplicated and much easier/comfortable as time passed. I gave her 100ml daily.

This should be the same information you will receive when the vet shows you how to give sub-Q, but you asked for personal experience. You pull up on the loose skin at the base of the neck, insert the needle and then open the line. Having a second person, especially at the beginning, is helpful but not absolutely necessary if you have to go solo. Holding the needle in place, opening the line, watching the amount being given, closing the line, and removing the needle is what it takes. You will change the location of the needle placement each time you need to give fluids so that the same place isn't punctured twice in a row. I rotated left, middle, right and then repeated that pattern. Never use the same needle twice, and if by chance you make a mistake (and fluid comes out from the other side of where you placed the needle, you stop, get a new needle and start over again. If I screwed up more than one time in that given day (that only happened two times), I quit for that day and resumed the next. Feeby was like Jakey, and she accepted the fluids pretty much without issue.

I also ordered my lines and sub-Q fluids through Chewy (and another place for the needles I liked best), at a fraction of the cost that my vet wanted to charge. I don't think you have Chewy yet, but I thought I heard it was going to be available to you some in the (near?) future. So, I will have to defer that part to the UK members on this site. There is a specific needle that I got, but I think it is pretty much universally used compared to the ones most vets want to supply. That needle enabled me to administer 100 ml in no more than 3-4 minutes. I can look up the actual needle I got if you want.

Has your cat's cobalamin (B-12) level been tested? If low, he can be given B-12 shots at home through his sub-Q line (there is a y-port on the lines that enable this to be done efficiently and quickly). Low B-12 seems to be relatively prevalent in CKD cats. It helps a cat to better absorb their nutrients, and can aid in weight gain for some.

Is Jakey on any anti-nausea meds and/or an appetite stimulant? Also, pretty common with CKD cats.

If his phosphorus level is high, even though he is on renal food, adding a phosphorus binder becomes another control method to help keep toxins from building up in his system. There are other metabolic/enzyme numbers in a blood Chemistry panel that might require attention as well, but better to address those when you know what they are.

High blood pressure is also common in CKD cats, so I think you are going to have that checked, which is good. It usually takes a couple of rounds of testing to make sure an accurate reading is obtained. About 3 times at intervals during one visit, and then again in a week or so. However, if it is very high, the vet may want to start BP meds after the first set of readings. You always start low on these and then increase the dose after additional testing. Feeby's pressure was very high, but a very small dose brought her down to a good reading. Feeby had a heart murmur, but it never escalated to requiring treatment.

I think I covered most of what I know and learned throughout Feeby's journey with CKD, about appropriate testing and meds/supplements. It's a start anyway.

Thank you, that is fantastic info!

He is on BP meds - Fortekor is an ACE inhibitor and has been our main attack against his renal condition so far, and it's worked really well for him in terms of how long it staved off the progression of the disease.

I will ask the vet to check before putting him on IV fluids, in a way I'd rather he deteriorate a bit at home and spend time with us rather than have heart failure in a cage at the vets iykwim. (I mean I'd prefer it entirely if he would live as long as I do, but even with all the medical intervention in the world that's unlikely)
I'll also ask about the B12 and any other supplements that might help.

 

[FeebysOwner]

Oh, btw, re: UTIs. Also common in CKD cats. Feeby was having repeated infections due to bacteria, long before her CKD diagnosis. I put her on pure-D mannose and over the course of 2+ years she only had one. It binds with many of the bacteria that can cause UTIs and helps flush them out of the bladder so that they don't accumulate. Others on this site believe it also is good for overall bladder health. This is the one I gave her, just 1/4 tsp a day mixed in her food.
UTI Pets Pure D-Mannose Powder | WellnessPartners.com™

EDIT: Feeby 'crashed' right before she went on fluids. The vet wanted her hospitalized for IV fluids, I didn't want to do that, so I brought her home and gave her sub-Q fluids myself. Within a week her kidney numbers went back down to where they were before. I am not saying for you to do that, I am just telling you what I did.

 

[epona]

Oh, btw, re: UTIs. Also common in CKD cats. Feeby was having repeated infections due to bacteria, long before her CKD diagnosis. I put her on pure-D mannose and over the course of 2+ years she only had one. It binds with many of the bacteria that can cause UTIs and helps flush them out of the bladder so that they don't accumulate. Others on this site believe it also is good for overall bladder health. This is the one I gave her, just 1/4 tsp a day mixed in her food.
UTI Pets Pure D-Mannose Powder | WellnessPartners.com™

EDIT: Feeby 'crashed' right before she went on fluids. The vet wanted her hospitalized for IV fluids, I didn't want to do that, so I brought her home and gave her sub-Q fluids myself. Within a week her kidney numbers went back down to where they were before. I am not saying for you to do that, I am just telling you what I did.

Thank you!
I'm not confident about doing subQ at all so I am ok with him having IV fluids at the vet clinic as a start point, I can see he's a bit dehydrated.
Hopefully having to do this will cure me of my lifelong needle phobia

My husband used to be a nurse (for humans) so he will be fine to help but he works odd shift patterns and also Jakey doesn't really love him that much or sit on him, you know what some cats can be like in terms of loving some people, liking others and just going nah to some! Most cats like my husband but the cat that was his soulcat (Radar) died several years ago and the 2 OSH Sonic and Jakey bonded to me almost exclusively and Jakey is not going to sit on my husband's lap for subQ treatment.

 

[FeebysOwner]

We had Feeby on the couch or on the bed, wherever she was at the time (her two favorite places). No lap sitting - too hard to manipulate her and what was going on with the fluids. My husband held her and the needle in place after I inserted it, and then I watched the fluid amount and talked to her (and him). I closed off the line and removed the needle and then I brought her reward treats which he fed her. She was better for him about eating treats, but seemed to take her cues from me about the more 'medical' stuff. It's all about figuring out a routine that works for everyone involved. You'll get there!!

 

[epona]

We had Feeby on the couch or on the bed, wherever she was at the time (her two favorite places). No lap sitting - too hard to manipulate her and what was going on with the fluids. My husband held her and the needle in place after I inserted it, and then I watched the fluid amount and talked to her (and him). I closed off the line and removed the needle and then I brought her reward treats which he fed her. She was better for him about eating treats, but seemed to take her cues from me about the more 'medical' stuff. It's all about figuring out a routine that works for everyone involved. You'll get there!!

I think Jakey will probably be better off on my lap, as he is always on me and if he is near me he tries to get on my lap.
It's almost impossible to keep him off my lap tbh
My husband will help with doing the fluids though, he can sit next to us with Jakey on my lap and he can handle the business end of the proceedings.

 

[Meowmee]

I really just need a bit of reassurance and vibes.
And some tips about what list of questions I need to compile to ask the vet before Monday.

We're in the UK btw.

He is a neutered male OSH nearly 18 years old and was diagnosed with CKD early in 2022 at age 15, he's been on renal diet and daily Fortekor pill since then so about 2.5 years before having a recent decline in kidney function, I think 2.5 years managing it by daily pill and diet is pretty good?

He gets a quarterly vet check, we don't do bloods and urinalysis every time if he seems to be stable, but this year he had 2x urinalysis in May and July because he developed a bacterial UTI, and at his quarterly check on Monday he'd lost weight, we knew he'd been off his food a bit (not anorexic, but still eating just not as enthusiastic, for a usually greedy cat) so knew what was coming and had full geriatric blood panel and urinalysis (sample collected by cystocentesis) done.

There is a lot more protein in his urine now than there was in July, and his blood tests show a decline in kidney function, plus one of his kidneys is enlarged and irregular which the vet detected on physical examination.

The vet wants to have him in the local surgery as an outpatient all day Monday and Tuesday with him coming home Monday night, for IV fluids (this rather than an overnight stay at the main vet hospital because of £££). Then I'll be trained to give subcutaneous fluids at home.

Now before pointing me to a website or info sheet, please know that I have already read absolutely every bit of information I can absorb about this!!!

I would like to hear more about your own experiences of giving subcutaneous fluids at home, rather than clinical info.

Also what should I ask the vet, other than what it's going to cost to make sure I have enough money in the account I want to pay from and don't faint on the waiting room floor
I am going to ask for a copy of all the test results to be emailed to me tomorrow, they usually do this automatically but I may need to give them a nudge.
As he will be coming home on Monday night with an IV catheter, will he need to wear a cone? He is terrified of cones but I can go out Saturday and get him a soft collar.
I need to ask whether I can buy supplies for doing subQ online instead of from the vet (markup central!!!).
Also is he alright to have his usual medication before going in for IV rehydration.
Oh also I should ask them to check his heart, he sometimes has a fast pulse when he is examined and has had a low grade (but deemed benign) heart murmur (like a lot of cats do) for most of his life. There's no evidence that he has any major heart issue but I'd rather check again before pumping him full of fluids.

If you can think of anything else I need to ask the vet clinic before Monday, please let me know.

Also, have a picture of him laying up me with his paws on my shoulders, just because:

View attachment 485442

He’s a beauty for sure and 18 is amazing

I have been through this with several of my cats over the years who had CRF. And gave SQ at home first with Tess, who had heart disease and her kidneys were damaged from Lasix. She lived about six months after the kidney disease because she had anemia and other organ failure, she was able to tolerate the fluids even though she had HCM and congestive heart failure.

Then Byron had some sub at home but he had high blood pressure and never seemed to really progress to CRF.. he was on high blood pressure med for a long time. He died due to negligence at the Dvm long story.

Then Wizard had CRF and lymphoma. He got some sub Q fluid at home and he also went in sometimes to the hospital for IV fluids during the day. He left us at 21 or more.

Sybil went into heart failure from too much sub q fluid for CRF. So I would caution to be careful about how much fluid they give him because it can cause congestive heart failure even if your cat does not have hcm.

She had advanced HCM which we didn’t know about at the time. We had to stop the fluids because she couldn’t tolerate any fluid and they just treated her heart disease, but she only lived about four or five months then. She left due to saddle thrombus at 17.5. At that time they didn’t give them real anticoagulants.

As for the cost, I was able to order the fluid in bulk from a regular pharmacy for Tess and Wizard. The lines and the needles I got from my DVM. Ordering the fluid in bulk cut down on the cost. I think I might’ve got the lines and the needles from the pharmacy for Wizard too, but I can’t remember now. I am in the US so it may be different there.

Giving the fluid was not so bad- I hung the bag up high and made sure to clear out the line each time. I usually did it with them on the couch or a bed. Your Dvm tech will show you how to do it. It’s not hard. I always did it in that area between their shoulder blades because there’s a little hollow area there. You can mark a line with permanent marker on the bag to make sure you give them the right amount of fluid.

I don’t remember if Wizard ever had a catheter kept in him maybe because there was a time when he would go a few days a week for IV fluid instead of subcutaneous at home. I think they put a bandage around it and he never tried to do anything to it. Your dvm will let you know about the meds.

I never put a collar on my cats for anything because when I did, they just ripped it off. You could try one of those donut things instead if he doesn’t like the collar and he needs it.

You could do an echo on him to make sure he doesn’t have HCM as a precaution if you can afford it in addition to everything else. Ask your dvm about amounts of fluid and how many days per week, he may not need it every day even. After what happened with Sybil I will be a lot more cautious about it if my other cats need it, hopefully not. I think I remember that they tried splitting the dose for her, but she couldn’t tolerate the fluid at all after the heart failure, the cardiologist said no more fluid at all.

Hugs

 

[silent meowlook]

Hi.
The IV catheter will be on one of the front legs. They can place a catheter guard over it to prevent him from getting it out.

A catheter guard, if they don’t have one, can easily be made, using the inside hard cardboard tube from vet wrap. A slice is made on the roll and then it is wrapped with vet wrap.

SQ fluids can be purchased with a prescription, as well as the lines and needles. I use a 20 gage needle as opposed to an 18 gage.

I always warm the fluids up in a bowl of warm water prior yo giving. You turn the bag upside down so as not to get the area the line goes into wet.

I hang the bag at the highest point I can, I use the hinges on the door and do the fluids on the floor.

My cat has a heart murmur, so I give 50cc twice a day instead of 100 all at once. This way I can make sure all the previous fluids are absorbed before I give anymore. This is done to prevent or reduce the risk of fluid volume overload, which can lead yo congestive heart failure.

 

[epona]

In other news - when he was in for his quarterly checkup last Monday, I agreed to him getting a Solensia antibody treatment injection as like many elderly cats he is a bit stiff in his joints with arthritis.
Very very expensive.
I wasn't expecting it to work quickly, but he's already been more lively and active doing circuits of our flat instead of staying on or near the sofa, he's getting up and walking to the nearest litter tray instead of just weeing wherever he happens to be, and he's started to eat a lot better instead of leaving chunks of food, which makes me think he might have had some arthritis affecting his jaw and causing his reduced/picky eating.
Now keeping my fingers crossed that he doesn't get the itching side effect that seems to be relatively common.

 

[epona]

He's at the vet today for day 1 of IV fluid therapy.
Fingers crossed it all goes well and he's not too stressed.
They really like him at the vets because he's so sweet and gentle and easy to handle (I once saw a stand-in vet from another branch and she said "oh I've been told what a lovely gentle cat you are" which is always nice to hear), I expect he'll be getting plenty of cuddles.

 

[fionasmom]

I have always suspected that vets and vet techs really appreciate loving cats as they are few and far between when they have to make that trip.

 

[epona]

He ended up having 3 days of IV fluids during the day and coming home at night, he's so much more alert and his coat is lovely, really soft and silky.

We have to take him back in tomorrow to have our SubQ tutorial with the nurse, who has fallen completely in love with our sweet and gentle boy - he's had a lot of cuddles while he's been at the vet, he's very chilled out when he's there so it's more like dropping him off at kitty daycare when he has to go in, he doesn't seem in the slightest bit stressed by being there and begs for cuddles from the staff

So I'm hoping that he'll be OK with subQ at home, it could give him a new lease of life, at least for a bit

 

[fionasmom]

That is too sweet that he is such a lovely boy!

 

[epona]

Did his first lot of SubQ at home today.
Vet wants him to have 120ml a week for now and see how he gets on with that, 3x 40ml spread across the week works best for us and our schedules, so we're going with that for now. We're giving syringe and butterfly needle method a go.

I think I'd struggle a bit doing it solo - simply because I have arthritis in my hands and keeping the cat still (even though we're feeding him during, he does tend to move around naturally when eating), the needle in place, and operating the syringe requires a bit more manual dexterity than I possess, but my husband used to be a nurse and it's really good to have him in control of the needle end of the proceedings.

We got most of it in where it was supposed to go before Jakey finished his meal and went hold on what's going on here then and managed to disengage from the needle - I'll know to feed him a bit more and keep a bit more of a firm arm around him next time. Most of it went in and that is better than nothing so we're happy enough with that as a first attempt.

 

[fionasmom]

You are making a good start.

 

[epona]

You are making a good start.

I just find it scary right now, I know I will get used to it, I just hate needles - I was prepping the syringes and butterflies and making sure there was no air in them and my hands were shaking due to my needle phobia - it's important for me to do that part though so I get more used to dealing with the needles.

I tube fed my dear departed (for something when he was younger, not related to his death) Radar through an oesophagostomy tube 5 times a day for over a month, if I managed that I can manage this, and I'd do anything for my boys (past and present).

 

[silent meowlook]

I would look into doing it with the line because it is so much easier and you can do it solo.