24 July 2000 - 24 July 2020

Twenty years online!

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Commonly Used Objections

Persuading Your Vet To Work With You

What to Discuss

Veterinary Links Advocating Subcutaneous Fluids

If All Else Fails

When Subcutaneous Fluids Are Not Appropriate

My Experiences

If Your Vet Agrees

One Last Thought...




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

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Subcutaneous Fluids - Winning Your Vet's Support




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Home > Fluid Therapy > Winning Your Vet's Support



  • Whilst sub-Qs are not always necessary or appropriate (see below), most CKD cats do eventually end up needing them. See Subcutaneous Fluids for the criteria for deciding when sub-Qs are likely to be necessary.

  • If you live in the USA or Canada, where sub-Q fluids are a mainstream treatment, you are unlikely to need this page because you will most probably be offered sub-Qs. If you live anywhere else, you may well need it.

  • Much of the information here is geared towards the UK because that's where most of the complaints I receive about this issue come from, but hopefully the suggestions will be helpful wherever you live.



In many ways, fluid therapy in the form of subcutaneous fluids (hereafter referred to as sub-Qs, but usually known as sub-cuts in the UK), is the raison d'ętre for this website. I am absolutely certain that Thomas would have died without sub-Qs — yet sadly, they are an uncommon treatment in most parts of the world apart from Canada and the USA, though things are slowly changing.


I have been told that in Denmark it is actually illegal for a layperson to give sub-Qs at home to a cat. I don't know if this is true, but I've heard this from several sources, so it might well be. This may also be the case in Sweden (I have had conflicting reports). It can be particularly hard to win your vet over in the Netherlands. Most of the other European countries are on a par with the UK. i.e. you won't be offered sub-Qs routinely, and your vet will resist allowing you to use them if you ask, although if you are lucky enough to live in Germany, you may find obtaining sub-Qs less difficult.  Apparently you can buy fluids and needles without a prescription in Australia, though I would never give sub-Qs without your vet's knowledge and approval.


Commonly Used Objections

11 guidelines for conservatively treating chronic kidney disease  (2007) Polzin D Veterinary Medicine Dec 2007 states "The clinical consequences of chronic dehydration include decreased appetite, lethargy, weakness, constipation, prerenal azotemia, and predisposition to acute kidney injury. Additional loss of kidney function due to acute kidney injury is a potentially important cause of progression of chronic kidney disease." In other words, untreated dehydration can at best make your cat feel lousy and at worst may make the CKD progress faster.


Cornell University College of Veterinary Medicine has a video on how to give sub-Qs which states "This might be THE most important thing that you can do at home to help your cat."


Powerful stuff. Yet in the UK, your vet may well resist the idea of you giving sub-Qs at home.


British vets certainly know about sub-Qs and use them themselves when appropriate; yet they do not routinely offer them to clients for home use. Having lived in both the UK and the USA, where sub-Qs are considered to be a routine treatment, I do think this is partly down to cultural differences. The UK approach is geared towards what are perceived to be the cat's needs rather than the client's. This can actually be a good thing for cats: UK vets would never declaw a cat, for example, because it is considered of no benefit to the cat and is therefore illegal. Unfortunately, this may then cross over into the UK vet's approach to fluids: they think sub-Qs are quite simply a step too far, and painful and unfair on the cat, so they refuse to allow them.


Let's take a look at the usual objections I've heard of over the years and the counter arguments you can use if appropriate.


"Water is better"

This is true. Oral fluids are definitely better. If your cat can drink enough to remain hydrated, that is great, and sub-Qs are not appropriate. Unfortunately it is unlikely that your cat will be able to drink sufficient water over the longer term.


"Subcuts are not necessary"

They may not be necessary if your cat can drink enough to maintain hydration. Unfortunately, cats whose creatinine levels are consistently over over 3.5-4.0 mg/dl (USA) or 300 -350 µmol/l (international), which equates to high Stage 3 of the IRIS staging system, can usually no longer drink enough. You may be able to add water to your cat's food, or syringe small amounts of water in to your cat's mouth, but eventually most CKD cats do need sub-Qs.


"If your cat gets dehydrated, we'll use intravenous fluids"

Certainly IV fluids are a great way to rehydrate a CKD cat. Sometimes they are essential because if a cat becomes severely dehydrated, sub-Qs may not be effective because the dehydration prevents them being absorbed properly. However, IV fluids are also expensive for you and stressful for your cat who has to be hospitalised to receive them. Many cats don't eat when in hospital, not ideal for CKD cats who tend to be thin and have a poor appetite anyway. Therefore it is better to reserve IV fluids for a crisis situation (crashing).


The primary purpose of sub-Qs is to maintain hydration, thus avoiding dehydration, which reduces the risk of your cat crashing and needing IV fluids in the first place. Dehydration feels like a bad hangover or the flu. Would you like to spend a couple of weeks feeling progressively more ill as you develop dehydration which steadily worsens, then be hospitalised for IV fluids; or would you prefer to receive an at home treatment that takes just five minutes a day and prevents the dehydration occurring in the first place?


"Subcuts are painful"

In terms of technique, sub-Qs probably are painful if you use thick "kitty harpoons" for needles. And they certainly won't be pleasant if you follow commonly issued advice in the UK from those rare vets who permit you to use sub-Qs but who unfortunately recommend injecting 10ml of fluid into your cat ten times, rather than giving 100ml in one place with only one needle stick. Multiple sticks are not necessary: International Cat Care (a British charity which your vet should definitely be familiar with if you are in the UK) states "Generally around 10-20 ml/kg of fluid can be given at a single SQ injection site (around 60-100 ml for an average sized cat)", so giving 100ml in one place should not be a problem for a 10lb cat.


There are many ways to make the whole experience far more comfortable for your cat, and if you use the tips and techniques on this site, you should be fine. What do you think of Florence on the left? Traumatised? In pain? I have heard of several cats who actually come and ask for their sub-Qs if their human is late giving them. I don't think most cats are masochists who freely seek out painful experiences, so I think it's reasonable to conclude that cats do not find sub-Qs painful when they are done correctly.


"They are not effective"

This really depends upon what is meant by "effective." They are not the best choice for cats with kidney stones who need an IV fluids flush. Sub-Qs are not appropriate for a cat in bad shape who has crashed, who would benefit from intravenous fluids instead. However, the whole purpose of sub-Qs is to keep your cat hydrated so a crash is less likely to happen. Most of the cats on the Success Stories page — some of whom lived for years with CKD — received regular sub-Q fluids.


"They are too expensive"

I suppose they might be if your vet charges you a lot for your supplies. There are two other possibilities: the vet gives you a break on the price, or gives you a prescription so you can buy your supplies online cheaply.


"They cause infection or scar tissue"

In all the years I have been running this website (which began in 2000) and hearing about literally thousands of cats receiving sub-Qs regularly, I can only recall a couple of cases of infection. These were mild, localised infections which responded well to a short course of antibiotics.


Scar tissue is a potential risk, but if you rotate the area where you give sub-Qs, and don't use the strange British approach of giving up to ten needle sticks a day simply to give 100ml, the risks are very low. I know of people who have given sub-Qs for seven years who have not had problems with scar tissue.


"The only way I will agree to this is by inserting a catheter under anaesthetic"

Some vets are so convinced that sub-Qs are painful that they will only consider them if the cat is given a fluid port. There is information about these devices here, but they have a lot of downsides apart from the need for anaesthesia: they cost a lot to insert and to maintain, they can irritate the cat, they are prone to infection and often fail. It's also not really possible to let a cat with a catheter go outside, and if your cat is like Thomas, this would be removing a major source of pleasure from your cat. I don't understand why UK vets seriously consider this extremely invasive approach to be a reasonable alternative to sub-Qs with a needle. Isn't five minutes treatment a day with a needle a better choice than a permanent foreign body poking out of your cat?


"Your cat does not need fluids"

If your cat has crashed and been on intravenous fluids for a particular reason, such as a kidney stone, or to treat an infection, once the crisis is over your cat may perhaps not need ongoing sub-Qs. Similarly, a cat who has acute kidney injury may sometimes make a complete recovery and not need sub-Qs. Most cats in IRIS Stage 3, i.e. cats whose creatinine levels are consistently over over 3.5-4.0 mg/dl (USA) or 300 -350 µmol/l (international) will need sub-Qs in order to remain adequately hydrated.


"They are not appropriate for your cat"

This might well be true. They are not the best choice for cats with kidney stones who need an IV flush, though sub-Qs may be needed afterwards. IV fluids would also be more appropriate for a cat who has crashed. Sub-Qs are not a benign treatment, and can be risky for cats with concurrent heart disease. Please see below for when sub-Qs might not be appropriate.


"Your cat could not cope" or "You'll ruin your relationship with your cat"

Your vet is correct that you need to take your cat's personality into account. Some cats might not cope with sub-Qs. Most do. It's hard to know until you try.


"You can't trust what you read on the internet"

Your vet is quite right. There are some dreadful websites out there. I try to keep this one as accurate as possible, but I'm not a vet, so your vet may remain sceptical. In these cases it may help to show your vet some veterinary links on the subject (see below).


Persuading Your Vet to Work With You


The good news is it's not completely hopeless. Every year I hear from people whose vets have reluctantly agreed to them trying sub-Qs, and who are now complete converts, having seen how effective they are.


So, if your vet is sceptical about the idea, how do you persuade them to let you try? Well, in certain circumstances as discussed below, sub-Qs are not an appropriate treatment, so first try to ascertain whether in fact your vet has legitimate concerns and objections.


Next, you're going to have to negotiate. It's a scary word, but it just takes a bit of determination, a bit of practice, and remember the main goal: everybody has to leave the table happy. In any negotiation though, one party is probably happier than the other, and in this case we need this to be you. But that's OK, because you have so much more to lose: your vet might feel slightly driven into a corner by your demands, but you are facing losing your beloved cat. No contest really, is it. There is not much you can offer your vet in return for allowing you to do sub-Qs, but if you can reassure him/her that you have your cat's best interests at heart, say you will not continue with the sub-Qs if your cat really hates them, and suggest a fixed trial period (say 4-6 weeks), your vet may be prepared to compromise.


Please do not be rude to your vet. Your vet has extensive training and experience, and these should not be lightly dismissed. You are not trying to teach your vet how to do his/her job. However, vets encounter many different species and many different illnesses every day, and cannot possibly be expected to keep up to date on the latest developments for every illness and every species. You are in a far better position to do research, because all your efforts are invested in one particular family member, your cat, with one particular illness. So ask, don't demand. Explain that you wish to be partners in your cat's care. Try to make things easy for your vet. Marshall your thoughts, take some research along to support your request (see below). Most vets who are confident in their abilities may still think you are misguided but will welcome the opportunity to discuss and negotiate. Less confident ones may feel challenged.


Things to Discuss with Your Vet

Assuming there is no valid reason for not giving your cat fluids, these are some of the arguments you could use:

  1. Make it clear to your vet that you are very committed to your cat's wellbeing and that you wish to play your part and be proactive in treating your cat. My vet mentioned that in her experience very few people are prepared to go to such lengths for their cat: so ensure your vet knows that you are such a person.

  1. One thing that I think helped persuade my vet to let me give sub-Qs was when I explained to her that I knew we might not be able to save Thomas, but that it would help me personally to know I had done all I could for him.

  1. If your vet believes that sub-Qs will not help your cat, but concedes that they also will not hurt your cat, would he/she be prepared for you to use them for 4-6 weeks, so you can both see if they do in fact help? It is your time and money being used so the vet does not really have any valid reasons for objection on these grounds.

  1. If your vet feels sub-Q treatment is too invasive, ask whether your vet objects to clients giving their cats insulin objections? If not, politely ask what really is the difference between twice daily insulin injections and regular sub-Q injections?

  1. If your vet says sub-Qs are painful, ask on what this opinion is based. My vet agreed to me giving fluids because she believed that the sensation of the fluid going under the skin might feel a little strange, but she did not think they were painful. Unfortunately many UK vets do genuinely believe that sub-Qs are painful and stressful if given regularly, not least because few UK vets have any experience of sub-Qs being used on a regular basis. Look at Cookie (left) - does he look like he is in pain? Does he look traumatised? My Thomas did not fight fluids at all, he did not cry, he just sat quietly, and it was all over in under five minutes a session, as the photos in How to Give Subcutaneous Fluids: Syringe Method show. Here are some great photos of Shelly's cats (click on We Love Kitty Stickems if necessary) receiving fluids with no problems at all.

  1. Some vets think that sub-Qs are painful because they entail multiple injections, but if you give fluids the way we did or use a giving set as most Americans do, it is only necessary to insert the needle into the cat once in each session. It is also extremely important to use sharp needles: these are incredibly sharp and slide in so smoothly, there is no comparison with other needles. See Tips on Giving Subcutaneous Fluids for more information on needles.

  1. if your vet says that receiving fluids regularly could distress your cat, point out that in return for a mere 10 minutes a day treatment, your cat will receive a much better quality of life for the other 23 hours and 50 minutes in the day. If I had really thought that receiving fluids distressed Thomas, I doubt I could have brought myself to administer them; but they simply did not. Look at the pictures of Thomas being given his fluids in How to Give Subcutaneous Fluids: Syringe Method and Purr Box being given her fluids in How to Give Subcutaneous Fluids: Giving Set Method — you can see they are not distressed in any way.

Veterinary Links Recommending Sub-Qs


Since I am a layperson, and since the internet is full of unreliable, inaccurate advice, your vet may be sceptical if you quote this website. I understand that. In these cases it may help if you provide your vet with some veterinary evidence of the US philosophy and experiences regarding sub-Qs. Unfortunately there are no studies into using sub-Qs per se. This is because it is such a routine treatment in the USA that it would be considered unethical to withhold fluids from a control group in a study.


Try printing out some of these web pages. The first two are actually by British veterinary specialists. Surely if they consider sub-Qs to be appropriate in some cases, why not your vet?


ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease (2016) Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I, Langston C, Lefebvre H, White J & Quimby J Journal of Feline Medicine & Surgery 18 pp219-239 state "repeated subcutaneous fluid therapy (75-150ml every 1-3 days) can be used on an outpatient basis or by owners at home to maintain hydration."


International Cat Care is a UK cat charity which states "this is a very useful way of providing additional fluids to cats and helping to manage and prevent dehydration."


Cornell University College of Veterinary Medicine has a video on how to give sub-Qs which states "This might be THE most important thing that you can do at home to help your cat."


Chronic renal failure in the cat (2006) Sparkes AH Presentation to the World Small Animal Veterinary Association World Congress mentions giving sub-Qs at home.


Long Beach Animal Hospital explains how they routinely teach their clients how to give sub-Qs at home (click on Home Administration if necessary).


Vetinfo for cats - Dr Mike Richards discusses how the majority of his CKD client cats survive 1-3 years after at home sub-Qs are begun, with the record being 8 years - click on Kidney Failure: Daily Fluid Treatment.


Management of chronic renal failure: beyond the can (2001) Wallace M Presentation to the Atlantic Coast Veterinary Conference states that if a patient "is having trouble maintaining hydration due to polyuria, then subcutaneous fluids on an ongoing schedule are very helpful, especially in cats."


Sub-Q Testimonials provides testimonials from a number of people on how successful a treatment sub-Qs have been for their cats; print this out and show it to your vet if necessary, in order to emphasise what a mainstream treatment this is in the USA and Canada.


If All Else Fails


If you are in the UK and cannot win your vet's support, you may need to think about changing vets. It is not ideal timing having to do this when your cat is sick, it is not easy finding a UK vet who permits sub-Qs (I keep a list but it is very short and not very up to date), and many vets are reluctant to take on clients of another vet. If you are lucky enough to find a vet who will work with you, do not make negative comments about your first vet but focus on moving forward and establishing a relationship with the new vet.


If you are looking for a new vet, the chances of such a vet being on my list in your area are sadly rather low. I therefore recommend that you join Tanya's CKD Support Group and ask if anyone can recommend a vet in your area. I do read all messages sent to the group and I or one of the group moderators will contact you privately if there is a vet on the list in your area.


If you live in a remote area with limited choice of vets, or if you are unable to travel easily, ask your vet about using oral fluids instead. These may not be sufficient for cats with moderate CKD but they could help.


When Subcutaneous Fluids Are Not Appropriate


Fluids are not always appropriate, and should only ever be administered with veterinary approval. Subcutaneous fluids should NOT be administered to your cat if any of the following criteria apply:

Sub-Qs are not always appropriate and in fact in certain circumstances can do more harm than good. Do NOT give sub-cutaneous fluids to your cat if:

  1. Your cat is so severely dehydrated that your vet considers intravenous fluid therapy (IV) more appropriate. In certain circumstances IV is the only correct treatment. If your cat has high bloodwork levels (creatinine over 7 mg/dl or 627 µmol/L), s/he might benefit more from IV fluids initially, with sub-Qs provided once s/he returns home as needed.

  1. Your cat has a heart condition. Fluid therapy may still be possible but your vet must decide if it is appropriate for your cat, and determine the amounts and frequencies to be administered.

  1. Your vet has refused to agree to the procedure on other medical grounds.

  1. Fluids from the previous session have not yet been absorbed.

  1. your cat is overhydrated. This may be obvious, or your cat may feel "squishy", the way water in a plastic bag feels. Squishiness sometimes happens if a little air gets in with the fluids, and is not normally a problem, but if it happens consistently, your cat may need less fluid. Other symptoms of overhydration may include sudden weight gain, coughing and nasal discharge. See Symptoms for more information. Overhydration may be associated with a heart condition, but contrary to what some vets claim it can still happen in a cat with a perfectly normal heart. It is a good idea to weigh your cat regularly, to check for sudden or continuous weight gain which may give early warning of a problem.

  1. Processing the extra fluids in itself places an additional workload on the kidneys which can make the CKD progress faster; plus it can flush out certain nutrients, and giving fluids when they are not needed may increase blood pressure; so it is best not to begin fluids until the advantages are likely to outweigh the disadvantages. Dr Katherine James of the Veterinary Information Network believes that most CKD cats will benefit from subcutaneous therapy once creatinine levels are consistently over 3.5-4.0 mg/dl (USA) or 300 -350 µmol/l (international). If your vet thinks your cat's CKD is less advanced than this, then it is probably safer to hold off on sub-Qs for the moment.

  1. My vet agreed to us doing fluids in part because she felt Thomas would not find them too distressing. You and your vet do need to take your cat's personality into account in deciding whether to go this route; but do not necessarily assume your cat cannot cope, many cats who ordinarily hate medication of any kind tolerate sub-Qs because they make them feel so much better. I would suggest trying them for a few weeks at least.

  1. Many cats appear happier (more active and alert, with a better appetite) after sub-Qs. However, some may become lethargic for an hour or so afterwards. This is probably nothing to worry about, but if it happens frequently it may be that your cat is not processing the fluid very well, so I would ask your vet to check your cat for possible heart problems or fluid retention.

My Experiences


When my Thomas first crashed in the December, he had a urea level of 46 µmol/L (BUN of 241 mg/dl). He spent four days on IV fluids and came home on Christmas Eve. My vet had reluctantly agreed to sub-Qs at home, and I was supposed to start on Boxing Day, but I got real, proper flu and was in bed for nearly a week, so I was unable to give them. As a result, Thomas crashed again in early January. I asked my vet to put him back on IV fluids and she looked me in the eye and said "how many times are you going to ask me to do that?" I said as many times as necessary, but obviously it could hardly be a weekly thing. I hoped sub-Qs would be the solution. Thomas was stabilised on IV fluids once again, then he began his daily sub-Qs. He never needed IV fluids again, and never crashed until his final days seven months later. You can read Thomas's full story here.


By the following March Thomas was doing great. My vet could clearly see how effective the fluids had been and she told me that, back in December when Thomas first crashed, the entire practice had thought "you were, er, m..." and I said "mad?" and she laughed and said "no, misguided". Apparently every single member of staff thought that us giving sub-Qs would be a waste of time and effort, and she only agreed to us trying because she felt it couldn't harm Thomas and it might make him more comfortable. And I think she felt sorry for me, and did it as much for my sake as for Thomas's — she knew I'd feel better if I knew I'd tried all I could.


Thank God I had an open-minded vet! It probably helped that my vet knew me. I had previously adopted a cat from her which she had rescued, and she knew I moved heaven and earth to help my cats. But even if you have to move to a new practice, take heart. You want to find a vet who will partner you in caring for your cat, not patronise you. They do exist, I promise. You just have to find one of them.


If Your Vet Agrees


Great news! I maintain a list of British vets who permit sub-Qs. (Bad news: it's a very short list). Your vet is now eligible to be on this select list, so please send me your vet's contact details so I can add them to the list. The list is private because some of the vets do not want their details on the internet, so I do not publish it on the site.


Sometimes your vet will permit you to try sub-Qs, but, being unfamiliar with the concept, may not offer you the most appropriate equipment or technique. If problems then arise, you might be told "I told you so" rather than be given help obtaining better equipment or improving your technique. So if your vet does agree to you trying Sub-Qs, check out all the pages in the Fluid Therapy section, especially the Tips on Giving Subcutaneous Fluids page, to learn more about doing this in the easiest way for both you and your cat.


One Last Thought...


My vet now makes sub-Qs available to other patients when appropriate. One interesting observation: nobody has yet taken her up on her offer! This made me realise that sometimes the issue is not only the vet's approach but also that of the typical British client, who is happy to give the odd pill but that is about it.


You are not the typical client. You are going to fight to use sub-Qs. This could help you save your cat's life, but whatever happens, it will certainly make however long your cat has left a lot more comfortable. You will also contribute to an eventual change of approach that will make a massive difference to many other cats' lives.


Good luck!

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This page last updated: 01 July 2020


Links on this page last checked: 01 July 2020






I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.


If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.



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