OK, take deep breaths and try not to panic. If they are putting her on IV fluids rather than simply doing sub-qs, then it sounds like she is crashing, but they CAN come back from that. I'll be honest, at this point it's 50/50. Here is an exerpt from Tanya's website about kidney cats in crisis:
Cat in Crisis: Very High Numbers and/or Receiving Intravenous Fluids (IV)
Since it is so hard to diagnose CKD early (see What Happens in CKD? to understand why), your cat may be in crisis at diagnosis. Please do not be too despondent if this is the case, particularly if your cat has crashed and is on a drip, as happened to Thomas. Many cats have horrendous bloodwork at diagnosis, or may experience a sudden crisis after having CKD for a while, which is often a reflection of severe dehydration. The true bloodwork values will not be apparent until your cat is rehydrated and stabilised, either via sub-Qs for less critical cases or via IV for more severe ones.
For cats who are in crisis, there is usually a trigger of some kind, such as:
Some cats with very high numbers will actually be suffering from acute kidney injury (AKI) rather than CKD, or possibly acute on chronic kidney disease. Whilst AKI is difficult to treat, if treatment is successful the cat may actually make a complete recovery.
Cats with severe anaemia (PCV or HCT below 20%) often appear extremely ill, but usually feel and look dramatically better once the anaemia is under control.
There are a variety of possible outcomes for a cat who has crashed and is on IV with extremely high bloodwork values:
For a severely ill cat, one or two days on IV are simply not going to be long enough. Thomas was on IV for four solid days and nights, and only began to eat a little on day 3. Also, Thomas's numbers did not improve at all on IV fluids. He had urea of 89 mmol/l (BUN: 241 mg/dl) at diagnosis, and it was the same after four days and nights of IV. Some cats will actually have numbers which worsen while on IV fluids. Try not to panic! Your cat did not get this sick overnight, and s/he won't necessarily get better in only 2-3 days. In Thomas's case, my vet suspected he would fall into category 4 of my possible scenarios above, but in fact he was in the second category. He was acting a little better by the end of the four days on IV fluids, and with home treatments over a few weeks we eventually reduced his numbers to urea 27 mmol/l (BUN: 76 mg/dl) and creatinine 316 µmol/l (US: 3.57 mg/dl), where they stabilised for some months.
So even if you are dealing with category 4, I would recommend that you make sure that your cat is given a reasonable stint on IV, and is given a reasonable chance of success at home, especially if anaemia is present. Being at the vet's is very stressful for most cats, and they often need a few days at home convalescing before they begin to act better.
In Prolonging the life of the renal failure patient (2000), Waltham Focus 10(3) pp10-14, Dr Jonathan Elliott states that "in a retrospective study, the correlation between plasma creatinine and survival in cats who presented with signs of stable CKD was very poor, with only 5% of the variation in survival time being predicted by the initial plasma creatinine concentration."
In The laboratory diagnosis of feline kidney disease (2008) Heiene R Veterinary Focus 18(2) pp16-22, Dr Heiene states "cats can sometimes, especially in cases of acute kidney injury secondary to obstructive FLUTD, develop creatinine values of 1600-1800 μmol/L (20.98-23.6 mg/dL) and yet recover."
Vet Info mentions a cat they treated who lived for eight years with CKD despite initially presenting in crisis (click on Kidney Failure - Daily Fluid Treatment).
Here is the actual webpage if you want to be able to click on any of the links: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Is There Any Hope?
Keep us posted don her progress. Yes, there are "bags" you can put cats in to contain them where basically only their heads are out. Not sure how that works for sub-qs since you need their scruff available to insert the needle, but get the info from your Vet and have them show you how to do it, even do it there in their office with her in whatever contraption will work. You should be able to do it alone if she's contained, once you feel comfortable. Remember, you aren't hurting her, you are helping her! Just keep that in mind and be strong. There are all kinds of helpful hints on Tanya's website about giving fluids too, along with places to buy what you need for really cheap.
Cat in Crisis: Very High Numbers and/or Receiving Intravenous Fluids (IV)
Since it is so hard to diagnose CKD early (see What Happens in CKD? to understand why), your cat may be in crisis at diagnosis. Please do not be too despondent if this is the case, particularly if your cat has crashed and is on a drip, as happened to Thomas. Many cats have horrendous bloodwork at diagnosis, or may experience a sudden crisis after having CKD for a while, which is often a reflection of severe dehydration. The true bloodwork values will not be apparent until your cat is rehydrated and stabilised, either via sub-Qs for less critical cases or via IV for more severe ones.
For cats who are in crisis, there is usually a trigger of some kind, such as:
- infections, such as urinary tract or kidney infection or occasionally dental problems
- kidney stones
hypertension
Some cats with very high numbers will actually be suffering from acute kidney injury (AKI) rather than CKD, or possibly acute on chronic kidney disease. Whilst AKI is difficult to treat, if treatment is successful the cat may actually make a complete recovery.
Cats with severe anaemia (PCV or HCT below 20%) often appear extremely ill, but usually feel and look dramatically better once the anaemia is under control.
There are a variety of possible outcomes for a cat who has crashed and is on IV with extremely high bloodwork values:
- The cat's numbers improve on IV and the cat looks and acts better, and continues to do well at home.
- The cat's numbers do not improve on IV, but the cat nevertheless acts better, and the numbers gradually reduce at home (usually with sub-Q therapy).
- The cat's numbers do not improve on IV or with sub-Qs, but the cat acts better and continues to do well at home despite the high numbers.
- The cat's numbers do not improve on IV, and the cat continues to act ill once s/he is home, and is put to sleep.
- The cat's numbers do or do not improve on IV, but the cat crashes again once at home.
For a severely ill cat, one or two days on IV are simply not going to be long enough. Thomas was on IV for four solid days and nights, and only began to eat a little on day 3. Also, Thomas's numbers did not improve at all on IV fluids. He had urea of 89 mmol/l (BUN: 241 mg/dl) at diagnosis, and it was the same after four days and nights of IV. Some cats will actually have numbers which worsen while on IV fluids. Try not to panic! Your cat did not get this sick overnight, and s/he won't necessarily get better in only 2-3 days. In Thomas's case, my vet suspected he would fall into category 4 of my possible scenarios above, but in fact he was in the second category. He was acting a little better by the end of the four days on IV fluids, and with home treatments over a few weeks we eventually reduced his numbers to urea 27 mmol/l (BUN: 76 mg/dl) and creatinine 316 µmol/l (US: 3.57 mg/dl), where they stabilised for some months.
So even if you are dealing with category 4, I would recommend that you make sure that your cat is given a reasonable stint on IV, and is given a reasonable chance of success at home, especially if anaemia is present. Being at the vet's is very stressful for most cats, and they often need a few days at home convalescing before they begin to act better.
In Prolonging the life of the renal failure patient (2000), Waltham Focus 10(3) pp10-14, Dr Jonathan Elliott states that "in a retrospective study, the correlation between plasma creatinine and survival in cats who presented with signs of stable CKD was very poor, with only 5% of the variation in survival time being predicted by the initial plasma creatinine concentration."
In The laboratory diagnosis of feline kidney disease (2008) Heiene R Veterinary Focus 18(2) pp16-22, Dr Heiene states "cats can sometimes, especially in cases of acute kidney injury secondary to obstructive FLUTD, develop creatinine values of 1600-1800 μmol/L (20.98-23.6 mg/dL) and yet recover."
Vet Info mentions a cat they treated who lived for eight years with CKD despite initially presenting in crisis (click on Kidney Failure - Daily Fluid Treatment).
Here is the actual webpage if you want to be able to click on any of the links: Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Is There Any Hope?
Keep us posted don her progress. Yes, there are "bags" you can put cats in to contain them where basically only their heads are out. Not sure how that works for sub-qs since you need their scruff available to insert the needle, but get the info from your Vet and have them show you how to do it, even do it there in their office with her in whatever contraption will work. You should be able to do it alone if she's contained, once you feel comfortable. Remember, you aren't hurting her, you are helping her! Just keep that in mind and be strong. There are all kinds of helpful hints on Tanya's website about giving fluids too, along with places to buy what you need for really cheap.
). I found that it was the "trying to keep him still" that upset my cat, not the actual giving of fluids. So it's a matter of finding a way that keeps her comfy. My cat liked to lay on a specific pillow, and get chin scratches, but if it did not do this, he would try to get away. Also if the fluids were too cold he would squirm. I know I don't know your cat and I'll admit that my cat, in general, was pretty easy to deal with, but it can be done. You may just have to try a few times to find what works for you and your kitty.
. But I let them go before it got to the point where they might suffer unduly, so it's possible that might have happened if I'd let them die at home, I just don't know. 
. I know it's difficult, especially after the loss of your son, but I also know you don't want her to suffer 
. Is she having more bad days than good? That's really the defining line 
, since, unfortunately, this isn't something that will go away 
.
. Too, too often. 
. 
You are a great Mom in every way.
