Zora: Adventures: Subcutaneous Hydration for Chronic Renal Failure (CRF)

Zora, my tortoise shell cat, sitting on a stack of books near a window.

Zora, named after the African-American writer and anthropologist, Zora Neale Hurston

She had been losing weight for about a month, and I thought it might be a thyroid condition, so off we went to her veterinarian, Dr. Linda Jacobson. Unfortunately, it wasn’t her thyroid but her kidneys. Her prescription? Subcutaneous hydration, an all wet diet.

Kidney disease can be either chronic or acute. Chronic Renal Failure (CRF) is a progressive and irreversible deterioration of kidney function. Because cats hide their illnesses and the very early signs of CRF are subtle, you might only recognize the disease when your cat is at the 70% deterioration level — when more severe symptoms are obvious. The seemingly sudden onset might appear to be acute but is most often a crisis point of  CRF. On the other hand, Acute Renal Failure (ARF) is characterized by an abrupt shutdown of kidney function, most often accompanied by reduced urine production.  Though the prognosis is usually poor, if damage has not been too severe and medical treatment is aggressive, it is possible to restore normal function.

Subcutaneous fluids (also known as sub-Q’s or Lactated Ringer’s solution) are fluids — by prescription only — administered through a needle  inserted under the cat’s skin. Each bag contains 1000 ml. (one liter) of solution While some cats in CRF may never need them, most eventually do. Sub-Q fluids are an essential and ongoing part of CRF management. As the disease progresses, the cat may stop drinking, not drink adequate amounts of water or vomit frequently and become dehydrated. Sub-Q fluids help with rehydration. Without adequate hydration, the blood flow through the kidneys is reduced and more rapid deterioration of the kidneys follows. Subcutaneous fluid therapy won’t repair the kidneys, but will help the remaining kidney tissue function as effectively as possible.

The fluids can be supplemented with potassium if your veterinarian feels it is appropriate for your cat’s particular situation. CRF cats can able to live for several additional years with sub-Q fluids and the proper diet. I had a cat whose life was extended by 18 quality months with this regimen. Cats really do seem to feel better after hydration so it is well worth doing.

No treatment is perfect for all patients. Cats with heart conditions can be put in extreme danger through the administration of sub-Q fluids. (Zora has a heart murmur, so she can receive only  50 ml  (instead of 100 ml) of daily hydration.) Also, excessive fluids can put pressure on the pleural cavity and temporarily collapse a lung.

Administering Sub-Q’s at Home (from the Feline CRF Center — http://www.felinecrf.com)

You can administer sub-Q’s  at home. Your veterinarian or technician can train you. Practice at the veterinarian’s office the first few times so you’ll feel more competent doing it at home. Don’t feel bad if you can’t bring yourself to do it. Most vet’s offices will give the fluids on a regular basis, but the cost will be quite a bit more than doing it yourself and the cat may be more stressed out by frequent trips to the veterinarian’s office.

Some Tips for Administering Sub-Q’s at Home:

  • Always check the fluid bag for holes and leaks before using. This is done by gently squeezing the bag. If there is a hole, the fluids have been contaminated. Dispose of it and start with a new bag.
  • You may find it is easier as a two-person job, one to distract, pet, talk to and hold the cat firmly and one to administer the fluids.
  • If possible, choose an area in your home that has a window for the cat to look through and be distracted. If you are a two-person team, have one person amuse the cat by dangling a toy in front of him. Try diverting the cat with the smell of tuna on your fingers.
  • Warming the fluids will make the experience more comfortable for the cat. You can warm the fluid bag to just body temperature with warm water in the sink. ALWAYS test the temperature of fluids, just as you would test the temperature of a baby bottle, on the inside of your wrist, before administering fluids. The fluids should feel tepid to the touch.
  • Note: DO NOT use a microwave to warm your cat’s sub-Q fluids. Microwave temperatures vary and can heat unevenly. NEVER forget that overheated fluids can do great harm to a cat.
  • Hang the bag from a planter hook or cupboard handle which will give height to increase the speed of the flow.
  • Place the cat on a slick surface like a counter or tabletop so it will be harder for him to grab on to anything. Or you may find it helpful to confine the cat in a box, carrier, bathtub or sink and then stuff towels around him so that he’ll be less likely to squirm around and jerk the needle out. You can also wrap a towel around the cat to confine him. The soft carriers with zippers at the top also can be used for confining the cat and administering the sub-Q fluids at the same time. Check with your veterinarian about using a restraint bag.
  • An #18 gauge needle will make the procedure go faster, but might be more painful for the cat. A #20 gauge needle is smaller and is less painful, but fluid injection goes slower. It depends on what your cat will tolerate.
  • Make note of each insertion site and alternate between sites each time you administer the fluids. Using the same insertion point over and over may cause scar tissue to build up and eventually cause difficulty when inserting the needle.
  • The hardest part is getting the needle in far enough so that it doesn’t easily pop out and not so far that it goes all the way through the ‘tent’ and out the other side. Also, you may hit muscle in which case the cat will feel it and react and the flow will stop. You have to move the needle around inside slightly sometimes to keep a good flow going.
  • Never use the needle more than once. If you drop the needle or the cat jerks it out, ALWAYS start over with a new needle rather than risking contamination. The needles are extremely sharp, so be careful not to jab yourself.
  • Don’t get discouraged. If you or your cat becomes stressed out during the sub-Q, stop and try again later. There are times your cat may tolerate the fluids quite well and just won’t at other times. Cats seem to pick up on our vibes, so stay calm and if it doesn’t go well one day and you don’t get the entire dose in, just do the balance later that day or the next. As time goes on, you’ll begin to feel like a pro and wonder why you were so worried about this.
  • After the sub-Qs are done, give your cat a treat or some favorite food. Cats may tolerate the sub-Qs better if they come to expect that something good will come immediately afterward.
  • Ask your veterinarian about returning used needles and equipment for safe medical waste disposal. You may also purchase a Sharps container for storage (inquire at your pharmacy) or make your own container. Label a ziplock bag or closed container, such as a coffee can or plastic soda bottle, “used”, and place the used needles in it to avoid using them again. Tape the lid when the container is full. Mark your homemade containers with a biohazard label. Store them in a safe place away from children and animals.
  • Although fluid bags are well sealed and the tubing is designed to prevent contamination, the safest way to store partially used bags is in the refrigerator. Warming the bag for the next session then becomes an absolute necessity.

Below is a Youtube demonstration:

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About Amirh

Ever-evolving spirit moving about via body. I'm a writer and a an ever-evolving spirit in service of animals through my blog and Buddhist and Reiki practices. My blogs: AllCreaturesLargeAndSmall.wordpress.com. and AmirhBahati.wordpress.com. For more about me: http://amirhbahati.wordpress.com/about/
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