Too much sub-Q fluids for CKD cat?

[FeebysOwner]

Feeby (almost 13 pounds) has been getting daily 100ml LR fluids since the beginning of May when her creatinine and BUN shot up. It has brought her numbers back down to the levels she had in January, Cre 3.5/BUN 62. That essentially puts her in Stage 3.

Despite the fact that she rarely has a fluid pouch when given fluids, her skin is taut, and it has become increasingly hard to find enough tented skin to inject a needle. I use various places within the 'saddle' region. I read that taut skin can also mean dehydration, but her skin wasn't this tight when she began taking sub-Qs in May. She now drinks less, as far as I can tell, but pees the same. I also heard of massaging the area to loosen up the skin, but that doesn't really seem to do anything.

I could go on and on about all the things that are wrong with her and all the meds/supplements that she is currently taking, but none of these things have changed since when she started the sub-Q fluids. I guess I could mention that she has been taking in less calories over the course of the past month but is not losing any weight. The only 'new' thing is that she is being treated for a potential UTI and is finishing off a 10-14 day round of antibiotics. I feel as if this issue with the tightness of her skin began before she started antibiotic treatment, FWIW.

I guess I am just looking to see if anyone else had to reduce the volume of sub-Q fluids once they started giving them to a CKD cat and what was the cause for doing so. Thanks.

 

[Meowmee]

Feeby (almost 13 pounds) has been getting daily 100ml LR fluids since the beginning of May when her creatinine and BUN shot up. It has brought her numbers back down to the levels she had in January, Cre 3.5/BUN 62. That essentially puts her in Stage 3.

Despite the fact that she rarely has a fluid pouch when given fluids, her skin is taut, and it has become increasingly hard to find enough tented skin to inject a needle. I use various places within the 'saddle' region. I read that taut skin can also mean dehydration, but her skin wasn't this tight when she began taking sub-Qs in May. She now drinks less, as far as I can tell, but pees the same. I also heard of massaging the area to loosen up the skin, but that doesn't really seem to do anything.

I could go on and on about all the things that are wrong with her and all the meds/supplements that she is currently taking, but none of these things have changed since when she started the sub-Q fluids. I guess I could mention that she has been taking in less calories over the course of the past month but is not losing any weight. The only 'new' thing is that she is being treated for a potential UTI and is finishing off a 10-14 day round of antibiotics. I feel as if this issue with the tightness of her skin began before she started antibiotic treatment, FWIW.

I guess I am just looking to see if anyone else had to reduce the volume of sub-Q fluids once they started giving them to a CKD cat and what was the cause for doing so. Thanks.

Did you ask your Dvm what might be causing that? I don’t think that ever happened with any of my cats who had fluids. What did happen was that Sybil was given too much fluid and she went into congestive heart failure, so you do have to be careful about that.

 

[FeebysOwner]

Meowmee - My vet is unavailable until 8/3 when Feeby will be re-checked for her UTI - long story behind this, which I won't go into details about at this juncture... Feeby does have high BP which is being treated but has not been diagnosed with anything heart related other than a possible G1 murmur.

Furballsmom - I don't know with a CKD cat that once sub-Qs are needed, that they ever stop. One of the reasons for asking here what I am asking.

 

[Meowmee]

Meowmee - My vet is unavailable until 8/3 when Feeby will be re-checked for her UTI - long story behind this, which I won't go into details about at this juncture... Feeby does have high BP which is being treated but has not been diagnosed with anything heart related other than a possible G1 murmur.

Furballsmom - I don't know with a CKD cat that once sub-Qs are needed, that they ever stop. One of the reasons for asking here what I am asking.

Sybil was not diagnosed either until then, they said it was very severe, and end stage. The cardiologist said to stop all fluids then as I recall.

 

[Twylasmom]

It could be that Feeby is developing scar tissue which is causing the tightness of the skin. I know that Twyla has scar tissue. If you think she is doing well and is hydrated you could try giving fluids every other day. If she goes back to drinking a lot or seems to react badly to the change you can go back to everyday.

 

[silent meowlook]

Hi. You do have to be careful with the fluids and high blood pressure as I am sure you know. Heart disease in cats is tricky and often times a murmur isn't heard. The only way to know for sure is to do an echocardiogram. But you also have to figure in the stress involved doing the procedure. It is such a fine line with these very ill kitties. Knowing what information and what diagnostics are warranted and which to skip so as not to stress the cat too much.

The only thing I can think of with the tightness of the skin is that perhaps it is ascites (fluid buildup in the abdomen). The fluid in the abdomen would cause a pull on the skin from the area you inject. I am not saying this is happening, because I don't know, But it is the only thing I can think of at the moment.

There are other ways to check for dehydration, Are the eyes sunken? Are the mucus membranes of the mouth dry and tacky? This can be deceiving with a cat with kidney disease because they are often nauseous and that can cause salivation.

With checking if the fluids are absorbed, be sure to check around the legs, as sometimes the fluids will settle there. Another good way to be watching for any fluid overload is to get daily weights on your cat. But only do this if it isn't to stressful. With my cat I got a baby scale at a thrift store, and it works great. Anyway, if you notice the weight going up and the appetite has not improved, then you know all the fluids might not be getting absorbed. If you do the weight method, it is important to weigh at the same time every day before giving fluids.

Another thing you can do is break up the fluids into two doses. Of course, that will be a bit of a pain. but that way you can make sure everything is absorbed first.

Signs of fluid overload to be aware of are, increased heart rate and or increased respiratory rate, watery eyes, clear discharge from the nose, lethargy.

If there isn't fluid in the abdomen and everything else seems to be fine, and you think it might be a technical error. try getting a different box of needles. Sometimes you get a dull batch. Try moving up to the scruff or above the shoulder blades. I always point the needle away from the head in the direction of the tail and I always stay above the shoulder blades.

I hope some of this helps, and I hope everything works out well.

 

[FeebysOwner]

Sybil was not diagnosed either until then, they said it was very severe, and end stage. The cardiologist said to stop all fluids then as I recall.

What were Sybil's symptoms? Or are you saying it was caught in some other manner?

It could be that Feeby is developing scar tissue which is causing the tightness of the skin.

Scar tissue after having received just under 3 months of daily sub-Q? There is no issue with the needles going in, it is having difficulty getting a good pinch of skin to form a tent. How would so much scar tissue develop in such a short time over a widespread area?

 

[Twylasmom]

Scar tissue after having received just under 3 months of daily sub-Q? There is no issue with the needles going in, it is having difficulty getting a good pinch of skin to form a tent. How would so much scar tissue develop in such a short time over a widespread area?

Well, it was just an observation. Twyla has scar tissue after getting fluids twice a week for a year so that is about the same number of sticks. That makes some areas thicker and she complains when the needle goes in.

 

[FeebysOwner]

S silent meowlook - for the first time in May, before the sub-Q fluids were started, one of the vets thought there might be a G1 R parasternal murmur but wasn't positive enough to actually diagnose it as such. That aspect has not been followed up as of yet. I want her vet to recheck for a murmur during her 8/3 appt. But, as I understand it, no treatment would necessarily be given for a grade 1, at least not unless an underlying cause could be identified. She does need her BP rechecked. But there are only so many 'tests' her vet is willing to do at a time, and I am not willing to drag her to the vet weekly to spread out testing.

There doesn't appear to be any ascites. I check for that, but thought my husband might be a better judge since he brushes her daily and he said no. She rarely ever acquires a fluid pocket when being given sub-Qs. And the only place one has occurred is located immediately adjacent to the injection site, and rarely lasts more than a few minutes. The higher on the back/neck the more likely for a pocket to develop. It is also even more difficult to gather up an adequate amount of skin the higher up on her body I go.

I weight her weekly, and her weight is stable, however as I noted above her average daily caloric intake has decreased from 245 down to 230 in the past month. I am not sure I understand the benefit of daily weigh ins.

She occasionally looks to have faster, deeper breaths, but I have wondered if it could be due to pain. She is getting Bupe for possible pain, though. No nasal discharge, but I have seen one of her eyes water from time to time. Lethargy has been ongoing for over 6 months, so that is not an indicator I can use specifically related to fluid overload.

The needles I am using are what I consider to be one of the best: Terumo thin walled 20g x 1". They slide in smoothly without resistance. I haven't tried the reverse method for insertion. What is the advantage?

I am tempted to back off the fluids, perhaps every other day rather than a lesser amount twice a day. The latter is twice the pokes, which I would prefer not to do. But I need to read up on the ramifications of not giving fluids every day, if there are any. If not that, perhaps I could reduce the amount of fluids given each day but need to read up on that too. I keep hearing that 100ml daily shouldn't be too much for a cat of her size, but if there is a cardiac angle involved, less might be more suitable.

 

[FeebysOwner]

Twyla has scar tissue after getting fluids twice a week for a year

How was twice a week determined appropriate for Twyla? Was it based on giving her more and finding out she didn't need it, or?

 

[AbbysMom]

I'm not sure if this helps, but Abby is stage three and gets 100ml of fluids twice a week. We started that in January or February.

 

[silent meowlook]

Hi. I am not recommending more diagnostics or vet visits as I know any time you take a cat out of their environment it is stressful to them. That’s why I say it is hard to decide what is worth causing the stress or not.

Twice a day is only beneficial if you care concerned she is getting to much at one time. I agree with less pokes the better, but if there is a chance to much, more than her body can be absorbed at one time, then it spreads it out a bit.

My own cat who is about 7 lbs gets 50 to 75 mls of fluids once a day or every other day depending on her hydration.

The watery eyes in fluid volume overload are both eyes and a watery look to them as though they are crying. It isn’t the same look like if they have a URI. Same with the nasal discharge.

From what you have described, it doesn’t sound like she is getting to much, but that is for you and your vet to decide as I am not with her and don’t have the credentials and license to make a diagnosis.

The advantage to pointing away from the head, which is the only way I give fluis, is it is a more direct route and if there are some scaring that has occurred, it is a new path for someone that has been doing it the other way. I also like to point away from the head as some cats want to bolt (mine) and I would prefer to not have a needle pointed at their head if they do.

The needles you describe are good. I also use the 20 gage, but not the thin walled. I am limited to what the local vet carries.

The weighing daily is to see if there is a daily increase of weight that could be the result of fluid overload or the cat not being able to utilize all the fluids being given at one sitting.

If my cat weighs #7 and I always give fluids at 5 pm and always weigh at 4 pm. If at 4 pm she weighs 7.4lbs and I know her appetite and amount of food consumed has not changed, then that alerts me that perhaps there are still additional fluids accumulated that have not yet been absorbed.

The benefit of fluids once daily is to avoid dips in hydration that can impact the kidneys.

Talk to your vet and discuss everything with them. They are really the only ones who should be making changes in what her care is.

 

[FeebysOwner]

The weighing daily is to see if there is a daily increase of weight that could be the result of fluid overload or the cat not being able to utilize all the fluids being given at one sitting. If my cat weighs #7 and I always give fluids at 5 pm and always weigh at 4 pm. If at 4 pm she weighs 7.4lbs and I know her appetite and amount of food consumed has not changed, then that alerts me that perhaps there are still additional fluids accumulated that have not yet been absorbed.

I appreciate the intent here, but Feeby is not consistent with when she eats, drinks, pees, or poops. They all vary for her, for whatever reason. So, weighing one day at 'X o'clock' before fluids might include a bladder with urine, a colon with stool, and food & water that she just ate. The next day when being weighed at the same time, she may have just peed - and pooped, and/or might have had a slow day eating/drinking up until that point. Not being argumentative here, or maybe I am still missing the point, I am just saying that a daily weigh-in is only a good indicator of accumulated fluids if all else impacting weight is equal from one day to the next.

The needles you describe are good. I also use the 20 gage, but not the thin walled. I am limited to what the local vet carries.

I get my needles from shopmedvet.com. However, I know they do restrict their sales of needles to professionals-only in some states (CT, DE, IL, MA, MN, NH, NJ, NY, and RI).

Nonetheless, I cannot talk with the vet until 8/3, so I hope maintaining her daily 100ml sub-Qs until that time isn't going to make any additional negative difference, assuming it is an issue at all.

 

[Twylasmom]

How was twice a week determined appropriate for Twyla? Was it based on giving her more and finding out she didn't need it, or?

It was what the vet recommended at the time as she was borderline between stage 2 and 3. She seems to be doing well on that schedule as her values have remained fairly stable over time. It’s also a practical consideration as fluids is a 2 person job with Twyla and I am paying someone to come in and assist.

 

[Meowmee]

What were Sybil's symptoms? Or are you saying it was caught in some other manner?

Scar tissue after having received just under 3 months of daily sub-Q? There is no issue with the needles going in, it is having difficulty getting a good pinch of skin to form a tent. How would so much scar tissue develop in such a short time over a widespread area?

Sybil didn’t have any symptoms which is odd because she had very advanced heart disease. But she had had asthma her whole life and then all the sudden it went into remission and she didn’t need treatment. Anyway, what happened was she had early crd, she was on fluids, but they overdid it with the fluids and the fluids caused her to go into congestive heart failure. So it made the heart disease worse.