Sub-Q fluids for Older Cats

oneandahalfcats

TCS Member
Top Cat
Hi Dr. Kris, and welcome! This is such a great topic!

As a pet carer to a now 10 year old Tabby male, Max (avatar pic), I am naturally concerned about his vital organ health going forward. Max is a big boy, who fortunately has always been a good drinker of water, but since switching to the majority of wet food, his water drinking has reduced 'some', naturally. I add a bit of water to everyone's wet food as added insurance. Max has always been a big pee-er as well, going just the once per day in the morning, which through diagnostic testing, we determined was normal, for him. The switch in diet was in response to weight gain and issues he had been having with constipation, but his blood values to this point have always been good so no connection to disease. Max is due for a wellness blood test, and I am eager to see what his values are at this time, particularly for kidneys, liver and thyroid function.

After reading your intro on this presentation and awesome video on giving sub-Q fluids, my question to you is this : Do you advocate for intravenous fluids in older cats, regardless of whether there is an existing condition of kidney disease, and at what age is sub-q fluid therapy appropriate?

Thank you!
 
Last edited:

dr kris

TCS Member
Guest Expert
“i am naturally concerned about his vital organ health going forward”.
I love what you said. I want people to come in to the clinic and talk about that more (my industry could do a better job getting that message across too).

Off the top of my head, my last 3 usages for SQ fluids in older cats without kidney issues were the following:

1) arthritis. At my clinic, we use laser therapy, heat therapy, massage, and and a variety of medications or supplements. For some cats, nothing works like an NSAID. Just nothing. SQ fluids for those guys are my “safety ace in the hole”. If you google NSAIDS and cats for longterm use, then it’s all internet for internets sakes. As if cats were dehydrated horses being given banamine (that’s a vet thing where they scare the bejebus out of you in vet school with NSAIDS). Combine rational, justified use of NSAIDS with SQ fluids - hot damn. Happy cats. And the latest published research is bearing that out as well. I expect there to be also an effect of dehydration on the perception of pain. This is not for every cat, but for the right candidate it all works out.

2) Pancreatitis. I see lots of that, and some of these cats are chronic. The fluids help them when given at home.

3) Constipation. Had one little guy in today with 15 poop balls. Less appetite = SQ fluids for sure.

I’ll use fluids at any age (2 months to 22 years) if I can see the benefit of them for that patient.

Here is one thing I think about a lot. Cats age faster than us physiologically. So lets say I take a blood sample one year. And the CKD markers are at the high range of normal. But still normal. Do I begin fluids then? Do I assume, regardless of what the numbers say (creatinine is important but insensitive - just like some people i know) that the kidney is actively affected and during the year when i dont know what their body is up too I want to push judicious amounts of bloodflow and oxygen to that organ? Hmm……I could argue for either side of it, and the personality of the cat and person would play a big part.
 
SQ fluid therapy for cat’s diagnosed with renal insuffienceny is considered GRADE IV. This means there is evidence from descriptive studies, case reports, reports in non-feline species, rational from knowing the pathophysiology of the disease process, and opinions of experts.

I can tell you from my own experience that therapies designated Grade IV evidence (both in pain perception and feline health) have saved lives.  

So giving fluids without any clinic signs or issues on the bloodwork: It’s less than grade IV. Harder to justify and define the benefits.

BUT:

If someone came into the clinic, with high but normal numbers but no defined CKD, and was motivated to do it, I wouldn't stop them. I wouldn't squash that spirit of doing the best that we could do, even though the Grade level says different. I would test. You give the fluids, then let me recheck this blood work. Let me check the blood pressure. Any changes? Any issues? How does your cat feel about it? And so forth…so much of medicine is like that.

Like I say in the video, people did ridiculous things with fluids in the past (i.e. IV alcohol). But eventually, certain principles were proven true over time. I err on the side of proactive.

Thanks for letting me ramble - great question.  

k
 
OP
oneandahalfcats

oneandahalfcats

TCS Member
Top Cat
 
I love what you said. I want people to come in to the clinic and talk about that more (my industry could do a better job getting that message across too).

Off the top of my head, my last 3 usages for SQ fluids in older cats without kidney issues were the following:

1) arthritis. At my clinic, we use laser therapy, heat therapy, massage, and and a variety of medications or supplements. For some cats, nothing works like an NSAID. Just nothing. SQ fluids for those guys are my “safety ace in the hole”. If you google NSAIDS and cats for longterm use, then it’s all internet for internets sakes. As if cats were dehydrated horses being given banamine (that’s a vet thing where they scare the bejebus out of you in vet school with NSAIDS). Combine rational, justified use of NSAIDS with SQ fluids - hot damn. Happy cats. And the latest published research is bearing that out as well. I expect there to be also an effect of dehydration on the perception of pain. This is not for every cat, but for the right candidate it all works out.

2) Pancreatitis. I see lots of that, and some of these cats are chronic. The fluids help them when given at home.

3) Constipation. Had one little guy in today with 15 poop balls. Less appetite = SQ fluids for sure.

I’ll use fluids at any age (2 months to 22 years) if I can see the benefit of them for that patient.

Here is one thing I think about a lot. Cats age faster than us physiologically. So lets say I take a blood sample one year. And the CKD markers are at the high range of normal. But still normal. Do I begin fluids then? Do I assume, regardless of what the numbers say (creatinine is important but insensitive - just like some people i know) that the kidney is actively affected and during the year when i dont know what their body is up too I want to push judicious amounts of bloodflow and oxygen to that organ? Hmm……I could argue for either side of it, and the personality of the cat and person would play a big part.
 
SQ fluid therapy for cat’s diagnosed with renal insuffienceny is considered GRADE IV. This means there is evidence from descriptive studies, case reports, reports in non-feline species, rational from knowing the pathophysiology of the disease process, and opinions of experts.

I can tell you from my own experience that therapies designated Grade IV evidence (both in pain perception and feline health) have saved lives.  

So giving fluids without any clinic signs or issues on the bloodwork: It’s less than grade IV. Harder to justify and define the benefits.

BUT:

If someone came into the clinic, with high but normal numbers but no defined CKD, and was motivated to do it, I wouldn't stop them. I wouldn't squash that spirit of doing the best that we could do, even though the Grade level says different. I would test. You give the fluids, then let me recheck this blood work. Let me check the blood pressure. Any changes? Any issues? How does your cat feel about it? And so forth…so much of medicine is like that.

Like I say in the video, people did ridiculous things with fluids in the past (i.e. IV alcohol). But eventually, certain principles were proven true over time. I err on the side of proactive.

Thanks for letting me ramble - great question.  

k
Thank you Dr. ... I really appreciate your attitude, and your approach which is proactive. As long as something does no harm but can be helpful, why not. My only concern with Sub Q fluids is the needle poke, as the application uses a pretty big needle. That said, if I felt my cats were in need of this, I wouldn't hesitate. Water is life, its that simple.

You mentioned NSAIDs, and I am curious to know more about your position regarding this. Many of us here do not allow our cats to be given Metacam, which is an NSAID med, due to incidents of this causing severe side effects and the potential for renal failure in cats. For cats with kidney disease, using this could be fatal. If its not too much of a pointed question, do you use metacam, and if not, is there a better one in your opinion? My cats were given this in the past before learning of the risks, but I currently have an alert on their charts to not use, in lieu of something like Buprenex, for pain management. To be clear, are NSAIDs in your opinion, safer when used in conjunction with Sub-Qs, as Sub-Qs work to protect the kidneys during use?

No rush for an answer as I realize there are other Qs in the queue 
 
 
Last edited:

lcat4

TCS Member
Adult Cat
I am curious about oneandahalfcats' question.  As part of my cat's bladder cancer treatment, he daily received Onsior, a newer NSAID approved for post-surgical pain, in hopes of reducing (or at least maintaining) the level of inflammation associated with the cancer in his bladder and to help with pain.  He took it for several months (not the approved 3 day treatment) but stopped when his kidney levels spiked.  At that point we started sub-q's, which lowered his creatinine reading out of stage IV. He now gets Buprenex for evident pain and nothing for the cancer.  I don't know if the Onsior controlled the inflammation, but I do know that after stopping the Onsior, he strains more while peeing. 

It doesn't change anything now, but I wonder if the combination of Onsior and sub-qs might have changed our present situation?  Something to mention to our oncologist? 
 

dr kris

TCS Member
Guest Expert
LCat4 and 1.5 cats; this is a good thread to start with tonight:

Here is my take on it.

In some ways cat's have been the forgotten step child of veterinary medicine and research for sometime. There is a paucity of research addressing some pertinent issues regarding their health, as compared to other species. There is ooodles more information for say, stress in aquatic species or muscle physiology.

Now, all this is changing. There is much more information available in the last 10 years. And you are going to start to see opinions change and different protocols being recommended.

Metacam use in cat’s is traditionally contentious. This is changing. My background is in animal welfare and pain perception. From that perspective, NSAIDS use can be quite important - a modality not to miss.The amelioration of pain at the site of inflammation for some cats is the key to comfort. I’ve tested this. I’ve treated over a thousand cats or so with it (largely with fluids involved), and the latest research confirms my observations with it.

Would you believe there is data that shows that kidney levels in the blood stream actually drops with metacam use in some cats (geriatric, stage II CKD cats in a compensated state)? Reduction of chronic pain in these patients was surmised to increase appetite, drinking, mobility, which are all associated with longevity. CKD is a catch all term describing several different underlying kidney issues. Are some of those issues NSAID responsive? We dont know but that is where research needs to go...

My last CKD kitty was on metacam for 3 years. Every day. Non-responsive to buprenorphine. Grumpy - no massage for her. No weaning it down without issues arrising. In the end, it wasn't the kidneys or the metacam which caused her to pass at 20 years.

Im definitely not suggesting everyone go use metacam or any other NSAID. I use buprenorphine and half a dozen other analgesics in it's place every day. But I know the perception and utility of these sort of medications will change with time.

PS - I have seen side effects with it - mostly always as an interaction with some other medication it never should have been mixed with….or given when dehydrated or when hypovolemia was happening….
 
OP
oneandahalfcats

oneandahalfcats

TCS Member
Top Cat
 
I am curious about oneandahalfcats' question.  As part of my cat's bladder cancer treatment, he daily received Onsior, a newer NSAID approved for post-surgical pain, in hopes of reducing (or at least maintaining) the level of inflammation associated with the cancer in his bladder and to help with pain.  He took it for several months (not the approved 3 day treatment) but stopped when his kidney levels spiked.  At that point we started sub-q's, which lowered his creatinine reading out of stage IV. He now gets Buprenex for evident pain and nothing for the cancer.  I don't know if the Onsior controlled the inflammation, but I do know that after stopping the Onsior, he strains more while peeing. 

It doesn't change anything now, but I wonder if the combination of Onsior and sub-qs might have changed our present situation?  Something to mention to our oncologist? 
Hi LCat4 .. I am sorry to read of your cat's condition. Regarding your comments in reference to the bladder inflammation, I wonder if you are familiar with corn silk tea as a means of addressing this? Corn Silk Tea has been used in cats who are experiencing bladder inflammation due to urinary tract infections. It works to soothe and reduce inflammation. I wonder if this could also help in your particular situation?

Here are a couple of references on Corn Silk Tea:

http://www.webmd.com/vitamins-supplements/ingredientmono-140-CORN SILK.aspx?activeIngredientId=140&activeIngredientName=CORN SILK

http://www.holisticat.com/en/acute-conditions/36-feline-lower-urinary-tract-disease.html (Look under the Herbs section)
 
Last edited:

wasabipea

TCS Member
Alpha Cat
Corn silk tea? I've never heard of this. My kitty is on anti-anxiety meds because the vet thinks that a lot of her cystitis could be stress related - but there are so many drug interactions with amiltryptiline, I started to wean her off of it - but decided at this stage of the game and her other issues... maybe that wasn't the best idea. I'll have to read up on this some more, and maybe mention it to my vet (who will likely dismiss it).

Thanks for the info!
 
OP
oneandahalfcats

oneandahalfcats

TCS Member
Top Cat
Yes, there are many valid supplementary therapies that can work alongside conventional meds, but unfortunately some vets are not aware of this, or believe in it. Even in the approach to treating cancer in humans, you will find complementary therapies being used to fight diseases and manage side effects of conventional treatments. Vitamin C is one such therapy that is being used in tandem with chemotherapy in treating some cancers. I learned of this through John Hopkins when my mother was battling pancreatic cancer.

Personally, I am not comfortable with the idea of giving anti-depressants to address anxiety in cats for the reason you mention and some others, but I respect other people's choice to use this. It's good that you know to do weaning gradually.
 

wasabipea

TCS Member
Alpha Cat
I was really against the anti-depressants too, but she was always a worrier and was constantly battling bladder inflammatory diseases - cystitis. The vet thought it stress related and said to try them. The cat was a zombie for a couple of weeks - I felt terrible -  but once she got used to them, her old personality came back - but she wasn't as anxious and worried all the time. Even when my niece and nephew came over (she's very afraid of kids) she would hang out, eventually she would go upstairs if she was annoyed - but the sound of them used to send her light a bolt of lightning into hiding.

I started the weaning, but then figured with eveything she is going through it might just be best to keep the Roni v2 for now. The problem is finding a pain med that is compatible with that anti-anxiety med, and I'm finally accepting this stomach cancer diagnosis - she may need some pain meds soon.

How do you administer the corn silk tea? I'll have to check the links but can't until later, and even then with the meds and trying to get food into the cat (biggest challenge) and trying to get a feel for her condition - takes up a big portion of the evening.

I suppose this could be a different thread, it is in the Dr. Kris section... I'll check out the links when I have time and PM you with any questions if you don't mind. And yes, Vitamin C is great for lots of things - I think in cats they recommend it to help prevent struvite also, if I recall. I was looking into holistic options when Roni was battling oxalate stones years ago. Couldn't find anything.
 
Last edited:
OP
oneandahalfcats

oneandahalfcats

TCS Member
Top Cat
Hi Wasabipea .. Under the circumstances, I think you made the right decision to continue the amytrip. I have a skittish little female who also doesn't like sudden noises and strange people. She will make a bee-line for the bedroom every time new people show up. We just try to be mindful of this and keep an eye and ear out for situations, give her lots of love and allow her to have her own space to escape to. She also now lives with two males, where there was one before, which makes for some interesting dynamics and potential for added stressors at times.

I have been following your other thread and just wanted to say that I am so sorry about your girl. I hope in your time together that you can experience some happy, carefree moments. Please feel free to PM me if I can be of some help.
 
Last edited:

AbbysMom

At Abby's beck and call
Staff Member
Moderator
Thank you

 I'm not sure I'm making any of the right choices at the moment.
When you get to this point in a cat's life, you will second guess every decision you make. You are doing the best you can by your girl with the knowledge you have and even overcoming your fears of Sub-Q's. Not everyone would do that and it is something to be proud of. :hugs: :hugs:
 
OP
oneandahalfcats

oneandahalfcats

TCS Member
Top Cat
When you get to this point in a cat's life, you will second guess every decision you make. You are doing the best you can by your girl with the knowledge you have and even overcoming your fears of Sub-Q's. Not everyone would do that and it is something to be proud of.
  Absolutely.

When we found out 'Gustav' our 14 year old tuxedo had squamous cell carcinoma, I had many doubts. About the decision to try and save him, what is the best course of treatment if anything, decisions around managing pain and food, to deciding when it was time. This last part is the hardest when you are so heavily invested emotionally. But, we got through it and I finally made the decision and that it should happen at home. Learning to give sub-Qs is amazing, and I wished I had the knowledge and benefit of this at the time as it might have helped. You are doing great and will get through this. One day at a time 
 
Top