TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

 
 

FLUID THERAPY: SECTION OVERVIEW

 

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Site Overview


What You Need to Know First


Alphabetical Index


Glossary


Research Participation Opportunities


 

WHAT IS CKD?


What Happens in CKD?


Causes of CKD


Early Detection


How Bad is It?


Is There Any Hope?


Acute Renal Failure


 

KEY ISSUES


Nausea, Vomiting, Appetite Loss and Excess Stomach Acid


Maintaining Hydration


The Importance of Phosphorus Control


All About Hypertension


All About Anaemia


All About Constipation


Potassium Imbalances


Metabolic Acidosis


Kidney Stones


 

SUPPORT


Coping with CKD


Tanya's Support Group


Success Stories


 

SYMPTOMS


Alphabetical List of Symptoms and Treatments


Fluid and Urinary  Imbalances (Dehydration, Overhydration and Urinary Issues)


Waste Product Regulation Imbalances (Vomiting, Appetite Loss, Excess Stomach Acid, Gastro-intestinal Problems, Mouth Ulcers Etc.)


Phosphorus and Calcium Imbalances


Miscellaneous Symptoms (Pain, Hiding Etc.)


 

DIAGNOSIS: WHAT DO ALL THE TEST RESULTS MEAN?


Blood Chemistry: Kidney Function, Potassium, Other Tests (ALT, Amylase, (Cholesterol, Etc.)


Complete Blood Count (CBC): Red and White Blood Cells: Anaemia and Infection


Urinalysis (Urine Tests)


Other Tests: Ultrasound, Biopsy, X-rays etc.


Renomegaly (Enlarged Kidneys)


Which Tests to Have and Frequency of Testing


Factors that Affect Test Results


Normal Ranges


International and US Measuring Systems


 

TREATMENTS


Which Treatments are Essential


Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and PTH (Calcitriol)


Miscellaneous Treatments: Stem Cell Transplants, ACE Inhibitors - Fortekor, Steroids, Kidney Transplants)


Antibiotics and Painkillers


Holistic Treatments (Including Slippery Elm Bark)


ESAs (Aranesp, Epogen etc.) for Severe Anaemia


General Health Issues in a CKD Cat: Fleas, Arthritis, Dementia, Vaccinations


Tips on Medicating Your Cat


Obtaining Supplies Cheaply in the UK, USA and Canada


Working with Your Vet


 

DIET & NUTRITION


Nutritional Requirements of CKD Cats


The B Vitamins (Including Methylcobalamin)


What to Feed (and What to Avoid)


Persuading Your Cat to Eat


Food Data Tables


USA Canned Food Data


USA Dry Food Data


USA Cat Food Manufacturers


UK Canned Food Data


UK Dry Food Data


UK Cat Food Manufacturers


2007 Food Recall USA


 

FLUID THERAPY


Intravenous Fluids


Subcutaneous Fluids


Tips on Giving Subcutaneous Fluids


How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


Dialysis


 

RELATED DISEASES


Heart Problems


Hyperthyroidism


Diabetes


Polycystic Kidney Disease (PKD)


Pancreatitis


Dental Problems


Anaesthesia


 

OBTAINING SUPPLIES CHEAPLY


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SAYING GOODBYE


Saying Goodbye


The Final Hours


Coping with Your Loss


Other People's Losses


 

MISCELLANEOUS


Prevention


Research


Canine Renal Failure


Other Illnesses (Cancer, Liver) and Behavioural Problems


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Home > Fluid Therapy

 


Overview


  • Because CKD cats have damaged kidneys which can no longer concentrate urine, they are at risk of dehydration.

  • In early stage CKD, the cat can usually drink enough to maintain hydration but eventually most CKD cats will need some form of fluid therapy.

  • This page explains more about the goals of fluid therapy.

  • Other pages in this section of the site discuss the main types of fluid therapy used for CKD cats.


Types of Fluid Imbalance


 

Fluid therapy is usually required because of an imbalance in the cat's body fluids. According to 2013 AAHA/AAFP fluid therapy guidelines for dogs and cats (2013) Davis H, Jensen T, Johnson A, Knowles P, Meyer R, Rucinsky R & Shafford H Journal of the American Animal Hospital Association 49(3) pp149-159, there are three main types of fluid disturbances:

 

Volume Changes


The amount of fluid in the body is out of balance, such as when a cat is dehydrated or when s/he has suffered blood loss for some reason.

 

2013 AAHA/AAFP fluid therapy guidelines for dogs and cats (2013) Davis H, Jensen T, Johnson A, Knowles P, Meyer R, Rucinsky R & Shafford H Journal of the American Animal Hospital Association 49(3) pp149-159 state "Hypovolemia refers to a decreased volume of fluid in the vascular system with or without whole body fluid depletion. Dehydration is the depletion of whole body fluid. Hypovolemia and dehydration are not mutually exclusive nor are they always linked...Common causes of hypovolemia include severe dehydration, rapid fluid loss (gastrointestinal losses, blood, polyuria), and vasodilation."

 

Content Changes


The body's fluid composition is out of balance, such as when blood potassium levels are too high (hyperkalemia) or too low (hypokalaemia). Hyperkalaemia may be seen in particular when a cat has a blockage, such as kidney stones, or acute kidney injury.

 

2013 AAHA/AAFP fluid therapy guidelines for dogs and cats (2013) Davis H, Jensen T, Johnson A, Knowles P, Meyer R, Rucinsky R & Shafford H Journal of the American Animal Hospital Association 49(3) pp149-159 state "If life-threatening hyperkalemia is either suspected or present (K 6 mmol/L), begin fluid therapy immediately along with medical therapy for hyperkalemia." This will normally be in the form of intravenous fluids.

 

See Potassium for more information on hyperkalaemia.

 

Distribution Changes


Fluids are in parts of the body where they should not be, such as ascites (fluid in the abdominal cavity). This may happen for various reasons, such as if the cat has heart disease or cancer, or if the cat is given too many fluids.

 

Fluid Imbalances in CKD Cats


For most CKD cats, the main problem is volume changes in the form of dehydration. Occasionally a CKD cat will also have problems with content changes or with distribution changes (the latter is often associated with concomitant heart disease).

 


Fluid Therapy Phases


 

According to Colorado State University College of Veterinary Medicine, there can be three phases for fluid therapy:

 

Emergency Phase


The goal is usually to stabilise a critically ill animal who has lost a life-threatening amount of body fluids, e.g. because of a road accident. This will normally be in the form of intravenous fluids in a hospital setting. Fluid therapy in the emergency feline patient (2010) Hetzel N Feline Update Spring 2010 discusses the use of fluids in emergency situations.

 

As a person with a CKD cat, you will usually not be concerned with this phase, though occasionally cats who suffer severe blood loss will be in the emergency phase:

 

Replacement Phase


The goal is usually to correct dehydration, which may be very severe in some cases, such as in a CKD cat who has crashed. This will normally be in the form of intravenous fluids in a hospital setting.

 

Maintenance Phase


The goal in this phase is to keep the cat's hydration status properly balanced. If the cat has just received replacement fluids, initially the maintenance phase will also be performed in hospital via intravenous fluids until the vet is sure the cat is now stable. Maintenance fluids in a hospital setting are usually also necessary for cats who are not eating or drinking. 2013 AAHA/AAFP fluid therapy guidelines for dogs and cats (2013) Davis H, Jensen T, Johnson A, Knowles P, Meyer R, Rucinsky R & Shafford H Journal of the American Animal Hospital Association 49(3) pp149-159 say "Urine production constitutes the majority of fluid loss in healthy patients. Maintenance fluid therapy is indicated for patients that are not eating or drinking, but do not have volume depletion, hypotension, or ongoing losses."

 

Once the cat is stable, subcutaneous fluids (sub-Qs or sub-cuts are commonly used for maintenance purposes.  Introduction to fluid therapy (2008) Dr S DiBartola states "The subcutaneous route is convenient for maintenance fluid therapy in small dogs and cats." Most cats who require sub-Qs are given these at home by their caregiver.

 


Types of Fluid Therapy


 

There are a number of different types of fluid therapy. Introduction to fluid therapy (2008) Dr S DiBartola states "The route of fluid therapy depends on the nature of the clinical disorder, its severity, and its duration." Your vet will decide which is the best method for your cat.


Oral Fluids


Oral fluids, including drinking and the water contained in food, are the best way for CKD cats to manage their hydration needs. They are cheap, easy and safe. 2013 AAHA/AAFP fluid therapy guidelines for dogs and cats (2013) Davis H, Jensen T, Johnson A, Knowles P, Meyer R, Rucinsky R & Shafford H Journal of the American Animal Hospital Association 49(3) pp149-159 state that oral fluids are appropriate when the "Gastrointestinal tract is functional and no contraindications exist (e.g., vomiting)."

 

Unfortunately CKD cats may eventually not be able to take in sufficient fluids orally to manage their hydration needs. Even if they can do so, they may need support on a temporary basis if they have problems with vomiting or diarrhoea, which increase body fluid losses, or if they have pancreatitis. In such cases some of the other methods described below will probably also be necessary.

 

Go to Oral Fluids

 


Subcutaneous Fluids (Sub-Qs or Sub-cuts)


Subcutaneous fluids are fluids which are injected under the skin with a small needle. Sub-Qs are much easier to give than intravenous fluids (see below) and most people are able to learn how to give them at home.

 

Sub-Qs are normally used when the cat can no longer drink enough to remain hydrated, which in practice tends to be once creatinine levels are consistently over 3.5-4.0 mg/dl (USA) or 300 -350 Ámol/l (international). This equates to high Stage 3 of the IRIS staging system. They may also be needed on a temporary basis for cats who develop problems with vomiting or diarrhoea, which increase body fluid losses, or for cats with pancreatitis.

 

Introduction to fluid therapy (2008) Dr S DiBartola states that "The subcutaneous route is convenient for maintenance fluid therapy in small dogs and cats."

 

2013 AAHA/AAFP fluid therapy guidelines for dogs and cats (2013) Davis H, Jensen T, Johnson A, Knowles P, Meyer R, Rucinsky R & Shafford H Journal of the American Animal Hospital Association 49(3) pp149-159 state that sub-Qs are used for "Anticipated dehydration or mild fluid volume disturbances in an outpatient setting ...Subcutaneous fluids are best used to prevent losses and are not adequate for replacement therapy in anything other than very mild dehydration."

 

This page explains more about when to start sub-Qs, how much to give and how often, and how to cope with giving them.

 

Go to Subcutaneous Fluids

 


Subcutaneous Fluids Tips


This page discusses the pros and cons of the different fluid types (Lactated Ringers, Normosol etc.) and which other supplies to choose, such as needles. It also gives helpful tips on how to make things go as easily and smoothly as possible for you and your cat.

 

Go to Subcutaneous Fluids Tips

 


How to Give Subcutaneous Fluids with an IV Administration Set


This page is a photographic guide to giving fluids with an IV administration set (also known as a venoset or a  giving set). This method is commonly used in the USA.

 

Go to Subcutaneous Fluids with a Giving Set

 


How to Give Subcutaneous Fluids with a Syringe


This page is a photographic guide to giving fluids with a syringe. If you are allowed to do sub-Qs in the UK, you will probably be offered this method.

 

Go to Subcutaneous Fluids with a Syringe

 


Winning Your Vet's Support


Many people outside the USA and Canada will find that their vet is reluctant to allow them to give sub-Qs at home. This page gives suggestions on how to ask your vet to permit you to try sub-Qs if they are appropriate for your cat.

 

Go to Subcutaneous Fluids: Winning Your Vet's Support

 


Intravenous Fluids (IV Fluids)


Intravenous fluids are fluids given into a vein ("on a drip"). This treatment is normally only used for cats who are hospitalised, so it tends to be reserved for cats who are in crisis (which is sometimes referred to as "crashing"), or who have acute kidney injury or kidney stones; it may also be appropriate for cats with severe vomiting or diarrhoea. Introduction to fluid therapy (2008) Dr S DiBartola states "The intravenous route is preferred when the patient is very ill, when  fluid loss is severe, or when fluid loss is acute."

 

Intravenous fluids are also used to support cats undergoing surgery under anaesthesia, such as dental surgery.

 

Go to Intravenous Fluids


Dialysis


Dialysis is only available at a limited number of veterinary centres in the USA and is incredibly expensive (it costs literally thousands of dollars). Unlike human CKD patients, who tend to have dialysis regularly on an ongoing basis, cats normally only have dialysis as a short term treatment (e.g. to tide a cat over who is awaiting a kidney transplant).

 

Go to Dialysis

 

 

This page last updated: 04 August 2016

 

Links on this page last checked: 04 August 2016