Tanya's Comprehensive Guide to Feline Chronic Kidney Disease

"Intravenous" means the fluids are given into a vein.
As with humans, this treatment is usually only used in a hospital setting.
Intravenous fluids are therefore normally reserved for acute situations. In the case of a CKD cat, this would often be when a cat is severely dehydrated (crashing"). They may also be used for cats with kidney stones or kidney infections.

What are Intravenous Fluids? Back to Page Index

Intravenous fluids (IV) are a form of fluid therapy whereby the fluid is administered via a drip feeding into a vein (intravenous). If you've ever been in hospital, you were probably on intravenous fluids, which are sometimes referred to as "a drip." The fluid used is not simply water, it also contains the correct balance of electrolytes, which are salts required by the body.

This is a skilled form of treatment, and great care needs to be taken to ensure the rate of fluid flow is correct for the cat - too fast a flow can be dangerous (it can overtax the heart), too slow a flow may not rehydrate the cat quickly enough.

Because of this, IV fluids are usually only given at the vet's office, where the cat can be carefully monitored. If you are giving fluids at home, you are probably giving sub-cutaneous fluids, not IV fluids.

When to Use IV Fluids Back to Page Index

As explained on the Fluid Therapy page, intravenous fluids are often used to treat acute problems e.g. to stabilise a critically ill animal who has lost a life-threatening amount of body fluids, perhaps following a road traffic accident. They are also used to treat cats who are critically ill for other reasons, such as our George on the left who was extremely ill at this time, but with liver disease, not CKD.

In terms of CKD cats, IV fluids are commonly used for severely dehydrated sick cats (cats who "crash"). In most cases cats in this situation will have high bloodwork (creatinine over 550-650, or in US terms over 6 to 7). The IV fluids are being employed as a kind of flushing through of the kidneys to correct an acute crisis situation of severe dehydration and any resulting electrolyte imbalances, and to remove toxins from the blood.

IV fluids are also used for cats who have suffered some kind of acute insult to the kidneys, such as a kidney infection or kidney stones, or for cats who have acute renal failure. In some cases, they may succeed in flushing out kidney stones.

On the other hand, I have heard recently of some vets putting cats with low or medium level numbers (creatinine around 260-300, or US 3-3.5) on IV fluids. In most cases this is unlikely to be necessary, because most cats would not be dehydrated at this level. However, it may be appropriate if a cat is very dehydrated despite the low bloodwork, perhaps from vomiting or diarrhoea, and/or has a kidney infection or kidney stones.

IV fluids are not a suitable treatment for ongoing hydration purposes: they are too taxing on the kidneys and, since they increase the GFR (see What is CKD?), they could accelerate the loss of kidney function if done for too long; plus of course they entail a stay in the vet's office, which many cats find very stressful and which is also very expensive.

Cornell University College of Veterinary Medicine has a video showing a cat on IV and what it entails.

In Management of chronic renal failure: beyond the can (2001), a presentation to the Atlantic Coast Veterinary Conference 2001, Dr Melissa Wallace explains when and how to use IV fluids.

Fluid therapy for critically ill dogs and cats (2005) Schaer M Presentation to the 30th World Small Animal Veterinary Association World Congress discusses the use of IV fluids. This is a rather technical presentation for the layperson.

Goals of IV Treatment Back to Page Index

The aims of IV fluids are usually twofold:

to help the cat feel better i.e. to correct vomiting, lethargy and poor appetite, which are commonly seen symptoms in a dehydrated cat.
to stabilise the kidney values. The goal is not to lower the bloodwork values as such, but this usually will happen, because the dehydration is making the bloodwork look artificially elevated.

Monitoring Back to Page Index

Cats on IV fluids need close monitoring to ensure they do not become overhydrated, which is a strain on the heart. The cat should be checked once an hour, and heart and lungs should be checked every 3-4 hours. The cat should be assessed by a vet at least once every twelve hours and weighed regularly. The following should be routinely monitored:

the weight of the cat
blood pressure
electrolytes, such as potassium and sodium levels
chest sounds
fluid output (urination)

Unfortunately many American vet offices do not have anybody present at their premises overnight, so some of these tests cannot be performed for several hours, which is potentially very risky. I personally would not feel at all comfortable leaving a cat on IV fluids unattended. If your vet recommends IV fluids for your cat, but s/he would be left alone overnight, a possible compromise is for your cat to be on IV fluids at the vet's office during the day, but to come home (with catheter still in paw) overnight. Ideally though, your cat should be on IV fluids continuously but under supervision.

If your cat is on IV fluids at the vet's, make sure that s/he is also being fed. Many practices place food in front of a cat on IV but do not make sure the cat eats. Your cat will do better if s/he keeps his/her strength up by eating. The vet may add treatment to the IV fluids against stomach acid, so ask if this is being done. It is well worth trying to visit your cat each day, and if necessary offer to feed your cat yourself during your visits. The Persuading Your Cat to Eat page has tips on getting food into your cat.

Length of IV Treatment Back to Page Index

Most CKD cats stay on IV fluids for 2-4 days. For a severely dehydrated cat, the first 2-4 hours are used to rehydrate the cat i.e. the severe dehydration is quickly corrected. Cats stay on IV for longer than this though, usually for several days: this is the "maintenance" phase which is designed to give the cat a chance to stabilise.

IV fluids should not be stopped suddenly, but should be reduced gradually so as to give the cat's kidneys time to adapt. Most vets will start this weaning process once there are no longer any improvements in the cat's bloodwork. This tends to be measured over 1-2 days, so if a cat's creatinine level is unchanged on Day 3 from Day 2, that is when the vet would start gradually reducing fluids with a view to discharge probably on Day 4 if the cat remains stable.

One day on IV is unlikely to be sufficient for most cats to restore hydration and some degree of balance; so I am growing increasingly concerned recently at the number of vets who offer just one day on IV, tell the person their cat's numbers have not improved after that short stint, and recommend euthanasia. In most cases this is inappropriate in my opinion. Yes, not every CKD cat can be saved; but euthanasia is an irrevocable decision so you need to be very sure, and for most people that means giving their cat every chance. For a severely ill cat, one or two days on IV are simply not going to be long enough, so I would recommend that you make sure that your cat is given a reasonable stint on IV of 3-4 days if you can afford it. If your cat's bloodwork is still improving, your cat may stay on IV even longer, occasionally cats are on IV for as long as a week. IV catheters can usually remain in place for 72 hours before there is any risk of infection; after this, a catheter can be placed in the other paw if necessary.

Don't be too despondent if your cat's bloodwork does not improve after a few days on IV. In fact, sometimes the bloodwork actually worsens after 1-3 days on IV. Some vets may recommend euthanasia if this occurs, but don't feel obliged to agree to this. Further improvement may occur gradually once you take your cat home and use sub-Q fluids. Thomas is a good example of a cat who did not respond dramatically to IV fluids, but they did help stabilise him, and he continued to improve once he came home. Initially Thomas was on IV for four solid days and nights, and only began to eat a little on day 3. He had urea of 89 (BUN: 241) at diagnosis, and it did not actually improve after four days and nights of IV either. But he was acting better in himself by the end of the four days, and with home treatments over a few weeks we eventually reduced his numbers to urea 27 (BUN: 76) and creatinine 316 (US: 3.57), where they stabilised for some months.

What to Expect After IV Back to Page Index

When your cat comes home from a session on IV in hospital, don't expect him/her to bounce back immediately. Most cats are exhausted - if you've ever been in hospital, you'll know how hard it can be to sleep well there - so fatigue and lethargy are normal. Your cat will probably not drink much either - s/he will be well hydrated from the IV fluid. Many cats hide, which indicates they are not feeling 100%. Give them time. Most cats need a few days at home convalescing before they begin to act better. Appetite may take some time to return, or your cat may need a little help in this department, perhaps treatment for stomach acid or an appetite stimulant.

Most CKD cats who have been on IV fluids will need sub-Q fluids at home if they are to avoid crashing again. You probably won't need to start sub-Qs as soon as you return home because your cat will be nicely hydrated from the IV fluids. You will probably need to start sub-Qs a couple of days after returning home. Bring a few basic supplies home from the vet, and then check Obtaining Supplies Cheaply to find sources for obtaining the supplies you need more cheaply.

If your vet believes IV is the best treatment for your cat, you should give it very serious consideration - it really can be lifesaving.

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This page last updated: 27 June 2011

Links on this page last checked: 16 December 2010