Help! Cat keeps vomiting

[Tinjao]

My cat keeps vomiting, he was prescribed with ranitidine and co amoxiclav but vomits everytime he takes them. He also doesn't, even when we force feed him he'll just vomit.

History: He is 4 years old. about last month his creatine was elevated. He was confined in the vet clinic for about 9 days. He was hydrated and given oral clindamycin due to a slight problem in his gums probably gingivitis. Then his creatinine levels went back to normal and his gums were fine. When he got home he doesnt eat, but whenever we forced him with wet food he ingests it. We just thought he might've been depressed because he has never left the house and hated being confined elsewhere. However over the weeks he stopped eating and started vomiting.

Can anyone give me an advice on what to do? We're really worried, especially now since we can't bring him to any vets because all are closed due to the pandemic.

 

[Furballsmom]

Hi! I'm not a vet, but what about boiled unseasoned chicken, with possibly a little white rice in it?

 

[Tinjao]

We tried different kinds of food, sometimes he'd ignore it, or if he does eat it he'd vomit afterwards. But we haven't tried the unseasoned chicken. Thank you!

 

[Furballsmom]

I'm SO keeping my fingers crossed!!

 

[mentat]

Can you call your vet? Most are doing consults, follow ups, and initial intro via videophone live feed aka using telemedicine, using Face Time, Google Hangouts, gotomeeting.com, and healthcare patient-management apps that have a social/video feature which records, storing in "patient record." Ask them about Cerenia if you can get him/her on the phone, at least. They may be able to get it delivered to you via courier or an assistant. S/he can call it into a pharmacy, who may be able to ship it (private, independent pharmacies are excellent about this personalized option, rather than a large chain pharmacy. Great for nausea, deep abdominal pain, and halts vomiting, if that becomes an issue. Once all this factors of discomfort are addressed, his appetite may improve.

Creatinine is a kidney enzyme that is too high in the bloodstream ( as is Blood Urea Nitrogen, BUN) when the kidneys are unable to filter the blood, removing waste products (toxins), making urine. The higher these kidney enzymes, the more toxic the circulating blood, which makes them have acid reflux from their stomach churning bile acid, can lead to an ulcerated area in the stomach or upper small intestine, will alter the electrolyte balance of sodium and potassium in their tissues and bloodstream, and can make them feel very "crummy." Lethargy and pain is a secondary effect of kidney disease, chronic or acute disease, as the body tissues become dehydrated and tight/painful, without the healthy renal function that "cleans" and filters the blood of the toxic waste.

 

[stephanietx]

It's most likely the antibiotic. I have a cat who can't tolerate amiclav or clavamox. After about 3 doses, all she does is throw up. Call the vet and ask for a different antibiotic.

 

[mentat]

Ranitidine can help limit ulceration in the stomach, esophagus, and intestines; it does not affect vomiting or nausea. With persistent vomiting, fluid therapy may need to be restarted again. Cats get "behind" in hydration quickly when not eating, let alone he is also losing fluid via vomiting. Phone, telemedicine, video conferencing. Even another vet, starting a telemedicine visit with one who is not your regular DVM, if they aren't available over distance to guide you or see you. Your cat needs early intervention to stop nausea, vomiting, restart appetite, and rehydrate. Try to jumpstart the appetite WITHOUT antibiotic, with bland meat only baby food, of which cats love the Ham or Chicken flavor. With wet stinky cat food, mix with warm chicken broth. Tempt, offer, remove after 5 min. Try another option. Don' lay out more than one at once, as this can actually contribute to persistent nausea and food avoidance.

Get that doctor, ANY doctor, on the phone for a consult and/or video conference. You can search on facebook within your state or country, opening each listed page to see if they have a button at the top for calling; some advertise Telemedicine in large font at the top of their page right now, so many are utilizing it; any doctor, any where, can consult with you, as it does not have to be a nearby veterinarian to perform telemedicine and prescribe antiemetics, SQ fluid kit and home therapy, other diet options or Rx diet, syringe feeds to start eating, etc. Add antibiotic back in once you know he's had 2-3oz of wet food intake. Mask the antibiotic with broth from chickent or from a tuna/sardine/salmon can. Most antibiotics are very bitter, and cause hypersalivation (drooling) and nausea in cats. They are quite sensitive to bitterness, as well as solid medication adhering to or obstructing their esophagus. Chase any medication you pill or give manually with 2-3mL of water, broth, or baby food.

 

[Tinjao]

It turns out one of my cat's kidneys is enlarged none of our vets here know what to do since his cbc doesn't indicate any infection.

 

[Furballsmom]

I'm not sure where you're located, can your vets consult with a specialist? or a university medical veterinary department?

 

[Tinjao]

I am from the Philippines. All vets are closed. Probably resumes on Monday. Evem our vet was trying to contact a friend of hers who is a kidney specialist in the US. But we haven't heard back from her.

 

[Furballsmom]

our vet was trying to contact a friend of hers who is a kidney specialist in the US. But we haven't heard back from her.

Hopefully they are able to connect, let us know how things are going I'm keeping my fingers crossed for you!

 

[Tinjao]

Hopefully they are able to connect, let us know how things are going I'm keeping my fingers crossed for you!

Thank you so much! Maybe, just maybe you could ask an advice if you know any vet? We're really desperate to try anything. Our city is on enhanced quarantine, only I can go out since I work at a hospital.

 

[Furballsmom]

you could ask an advice if you know any vet?

Get that doctor, ANY doctor, on the phone for a consult and/or video conference. You can search on facebook within your state or country, opening each listed page to see if they have a button at the top for calling; some advertise Telemedicine in large font at the top of their page right now, so many are utilizing it; any doctor, any where, can consult with you, as it does not have to be a nearby veterinarian to perform telemedicine and prescribe antiemetics, SQ fluid kit and home therapy, other diet options or Rx diet, syringe feeds to start eating, etc.

...and mentat 's entire post above is quite helpful for you...

 

[mentat]

It turns out one of my cat's kidneys is enlarged none of our vets here know what to do since his cbc doesn't indicate any infection.

An enlarged or inflamed kidney can be more prone to infection, as inflammation, inflamed renal tissue, is a micro-culture breeding ground for bacteria, especially if blood is filtering through the inflamed tissue's vasculature into the urine. Blood grows bugs like nobody's business, with cell glucose and oxygen within blood feeding it.

But, eating and drinking are most important to a cat's health, as eating too little or not at all leads to hepatic lipidosis in cats very quickly; it's why we are so pro-esophageal feeding tube, quite inexpensive and easy to use at home was implanted, vs multiple vet visits with an inappetant cat needing fluids and syringe feeds an e-tube prevents. Drinking is so important as dehydration occurs in a cat after just 24 hrs of picking at or not eating food; most of their hydration (>80%) is from their diet. Dry diet cats will drink more water, especially if eating a higher sodium diet formulated exactly that way, with higher sodium to encourage thirst, such as Rx Royal Canin SO (struvite oxolate urinary diet) or Hill's Science Diet Longevity.

Pureed or pate meat, be it cat food or baby food, syringing with a larger open tip syringe, such as an oral feed syringe or a catheter tip syringe, to jumpstart appetite with "forced feeding" by placing syringe at roof of mouth or further back on tongue, expressing some food there, into mouch, and encouraging to swallow, holding jaw up, light stroking of neck underneath, sometimes is effective when no access to a vet to place e-tube or get the anti-emetics. When nauseated, it may abate when finally eating; it may get worse if the nausea is due to low gastrointestinal (GI) motility (movement) and stomach contents are immediately rejected.

Even in Phillippines, you can call for telehealth or telemedicine outside the country. Seek a vet in Japan or South Korea; they are accustomed to telemedecine consults, review his history, and can ask what meds you have on hand, send a prescription to a pharmacy for lactated ringer's solution liter and line for subcutaneous fluid admin, scripts for antiemetic (veterinary product Cerenia or human pharmacy med ondansetron, brand Zofran for ex), and prescription pate/pureed diet, such as Purina CN (critical nutrition), Hill's Rx a/d, or Royal Canin Recovery RS prescription diet.

How is his appetite? Energy level? Urination? Pain, how he sits/lies down, how he moves, posture, gait? I know it is so hard during times like these; We can try to be here for you but we are just not there, in your shoes, in your environment, with your access to supplies or professionals.
Describe what you do have to eat, any meat, broth, stock, syrup, OTC or Rx cat food, etc. Describe any GI meds you have. Ever given SQ fluids? Where is his progress now?

 

[mentat]

Pendragon Vet Pendragon Vet Telemedicine in Philippines.

 

[mentat]

Contact Us

• 436-3833(emergency hotline)
• [email protected]
• G/F Amaremca Bldg., 107-A Kalayaan Avenue Diliman, Quezon City

 

[Tinjao]

Thank you for your advice! Sorry it took so long for me to reply, been really busy at the hospital lately I haven't had the time to check my emails.

Last week we were able to bring him to another vet. The size of his kidney decreased however his creatinine was 2.8. They told me it is probably chronic

When he was discharged they gave me Metoclopramide syrup for vomiting, Doxycycline because of an infection he probably got from his IV line while at home, Renacure syrup which is a supplement for his kidneys.

So far the Metoclopramide doesnt last long because he vomits after about 2 or 3hours later if he eats again. So I give 10 mins interval in between metoclopramide, food, doxycycline and renacure.

We also give 150ml normal saline thru subcutaneous infusion once a day.

He sometimes drinks water, and when he eats in the middle of the day (when not on metoclopramide) he vomits again. Sometimes he eats his vomit quickly and then vomits again. It's so worrisome and frustrating.

I've also tried chopping his food to small pieces but not turning it to crumbs and he still vomits. That's why he was not prescribed with tablet forms because he would just vomit. Sometimes he asks for food and we dont give it to him because he will just vomit what he eats, unless if given metoclopramide prior.

So far he sleeps during the day but occasionally walks around the house or interact with other cats.

In addition also, before all this, he only eats royal canin S/O because it used to be his favorite until he got sick, sometimes RC indoor or fit. But right now we were adviced tononly give him RC renal and kidney care. But I dont know what's causing his vomit or is it really hopeless because of his kidney problem

 

[Furballsmom]

Maybe there's something here;

Tanya's Comprehensive Guide to Feline Chronic Kidney Disease - Diet and Nutrition Overview

This website also has a support group, so look for that as well.

 

[mentat]

Absolutely manageable though T Tinjao ! Honestly, CREA of 2.8 is completely better than pylonephritis (BUN and CREA would be 5-8x normal and he'd be a puddle cat, soooo lethargic). Chronic kidney disease, or chronic renal insufficiency/failure, as it is often also called. is NOT a death sentence by far, because cats compensate Very Well compared to dogs, humans, and exotics! I have managed 4 of my own for many years of life beyond diagnoses, and NONE of them died of kidney disease! Other, comorbid diseases, brought them low, such as congestive heart failure 5 years later in one, severe metastatic cancer in another, megacolon complications secondary to chronic GI disease gone acute one two many times of inflammation after a lifetime of management. Your baby can live many many many more years.

For now, the subcutaneous fluid therapy at home is daily, but that will lighten up. Honestly, daily is a lot for a creatinine of 2.8, so closely monitor his resorption of these fluids. If you are preparing to inject him today for example, and he still has the little "bags" of pockets palpable under the skin whereever gravity has caused them to center, such as near his elbows, behind his shoulder low to his abdomen, do not give him another dose. Call/email your vet and describe his hydration is improving, as he is taking longer than 24 hours to resorb the 150mL of lactated ringers solution; they should either suggest decreasing to 150mL every 48 hours OR 75mL very 24 hours, for example. We can definitely Over-hydrate in our mission to help our pets; vets need help knowing when to adjust their plan. If they insist you adhere to 150mL LRS in the face of his skin tissues obviously still saturated with parts of the bolus not yet absorbed, YOU decide to try 25-50% less for a single dose's administration, and see if that total volume is resorbed by the next day.

Depending on his size and dehydration, he may get down to as little as 75mL every 2-3 days to maintain his chronic kidney disease. Some do not even need it that often in early stages; the international renal group that devised a system of staging so All international veterinarians are on the same staging evaluation system is the International Renal Interest Society, aka IRIS. One of our animal diagnostic laboratories most of our American and Canadian veterinarians use is Idexx, and they have a good explanation of IRIS staging Chronic Kidney Disease. Idexx has a patented kidney value indicator they discovered 5 years ago that is now part of all their blood chemistry analyses in feline blood/urine profiles, SDMA. This page also reviews the advantage of knowing the SDMA value as an earlier indicator of chronic kidney disease, as well as acute on chronic episodes. Your cat's CREA will go down to a normal level while maintaining his home therapies controlling his disease process. SDMA may still be slightly high even in a euhydrated CKD cat, a good indicator for how well controlled he is if SDMA is slightly versus relatively vs Very elevated.

If you can have a vet submit a sample of his blood/serum/urine to Idexx Laboratories monthly until your cat's disease is well managed, then every 3-4 months while maintaining his CKD, their labwork really is the gold standard for kidney disease management here in the U.S.

Other CKD management tools for cat owners and their veterinarians are:
The Ins and Outs of Managing Feline Chronic Kidney Disease | Today's Veterinary Nurse colleagues of mine wrote this very well charted, explained, article. Vet nurses/techs and cat owners have this saved as a daily reference of markers, encouragement, treatments, and management tips.
Chronic Kidney Disease | International Cat Care International Cat Care is a world standard of care for feline medicine to which worldwide clinics can register, be members, contribute and learn from a world community of feline passionate veterinarians. Their link under the "Veterinary" tab has a Cat Friendly Clinic search tool to find cat-centric vets around the world. U.S. uses AAFP's Cat-Friendly clinic membership search tool, so many do not register with ICC in U.S., but we should!
Chronic Kidney Disease Cornell University's College of Vet Med is top of feline medicine education.
https://www.idexx.com/files/Diagnosispdf.pdf
https://www.idexx.com/files/Treatmentpdf.pdf
https://www.idexx.com/files/Stagingpdf.pdf
IRIS Kidney - Guidelines - IRIS Staging of CKD
http://www.iris-kidney.com/pdf/IRIS_CAT_Treatment_Recommendations_2019.pdf

You are doing very well by your sweet boy, managing him in top form to help him live with chronic kidney disease. Keep at it, and ask away here, and on feline renal/kidney disease facebook groups, other community boards online, and most of all, via close communication and updates with your boy's veterinarian. We are here for you as well.

 

[Tinjao]

Thank you for the support, really helps as this has caused our family a lot of stress especially in the midst of the pandemic.

He used to have a creatinine of 5 then became normal but went back up to (I dont know because my brother was the one who took him to the vet) but according to our new vet it dropped to 2.8.

I really am having a hard time because he vomits everything even his antiemetic medicine metoclopramide. Right now he hasn't eaten because Im hoping the doxycyline and renal supplement will be absorbed first before he vomits again. Do you have any advice on what should I do with the vomiting? I'm really having a hard time managing his medicines because I still work at the hospital