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Kolbard
April 22nd 09, 03:03 AM
Hi,

I wouldn't even be posting about this, except Google Groups search is
broken.

My 16 year old cat was recently diagnosed with CRF (about 2-3 weeks
ago). She isn't dehydrated, but her phosphorus levels are through the
roof (19.7 at her last test). The vet didn't even mention anything
about phosphorus binders, but I was able to locate a website in 2
minutes. She's very skinny and fatigued. Anyway, I'd like to start
her on AlternaGel until we can get the powdered kind that mixes with
food, but since she isn't eating much, what can I do? Should I mix up
a syringe with diluted food and the gel? I read that the binders only
work when given with food. I'm kind of rattled about all this,
especially since I finally looked at a copy of my cat's numbers and
the vet doesn't seem to know what she's doing (we're going to look for
another one ASAP if we cannot discuss the phosphorus binders with
her).

For reference, my cat's numbers are:

ALB 4.4 *
ALP 18
ALT 82
AMY 2381 *
TBIL 0.2
BUN 171 *
CA 10.8
PHOS 19.7
CRE 7.9 *
GLU 134
NA+ 143
K+ 3.8
TP 8.8 *
GLOB 4.3

The BUN, PHOS, and CRE numbers are particularly alarming to me. The
vet actually mentioned that the numbers weren't out of sight, at first
test, but they were very high even then (I hope I'm typing these out
correctly):

ALB 4.4 *
ALP 18
ALT 40
AMY 2837 *
TBIL 0.2
BUN 138 *
CA 11.2
PHOS 14.0 *
CRE 5.9 *
GLU 135
NA+ 142
K+ 3.6 *
TP 9.1 *
GLOB 4.7

Thank you,

Kolbard

cybercat
April 22nd 09, 04:14 AM
"Kolbard" > wrote in message
...
> Hi,
>
> I wouldn't even be posting about this, except Google Groups search is
> broken.
>
> My 16 year old cat was recently diagnosed with CRF (about 2-3 weeks
> ago). She isn't dehydrated, but her phosphorus levels are through the
> roof (19.7 at her last test). The vet didn't even mention anything
> about phosphorus binders, but I was able to locate a website in 2
> minutes. She's very skinny and fatigued. Anyway, I'd like to start
> her on AlternaGel until we can get the powdered kind that mixes with
> food, but since she isn't eating much, what can I do? Should I mix up
> a syringe with diluted food and the gel? I read that the binders only
> work when given with food. I'm kind of rattled about all this,
> especially since I finally looked at a copy of my cat's numbers and
> the vet doesn't seem to know what she's doing (we're going to look for
> another one ASAP if we cannot discuss the phosphorus binders with
> her).
>
> For reference, my cat's numbers are:
>
> ALB 4.4 *
> ALP 18
> ALT 82
> AMY 2381 *
> TBIL 0.2
> BUN 171 *
> CA 10.8
> PHOS 19.7
> CRE 7.9 *
> GLU 134
> NA+ 143
> K+ 3.8
> TP 8.8 *
> GLOB 4.3
>
> The BUN, PHOS, and CRE numbers are particularly alarming to me. The
> vet actually mentioned that the numbers weren't out of sight, at first
> test, but they were very high even then (I hope I'm typing these out
> correctly):
>
> ALB 4.4 *
> ALP 18
> ALT 40
> AMY 2837 *
> TBIL 0.2
> BUN 138 *
> CA 11.2
> PHOS 14.0 *
> CRE 5.9 *
> GLU 135
> NA+ 142
> K+ 3.6 *
> TP 9.1 *
> GLOB 4.7
>
> Thank you,
>
> Kolbard

cindys
April 22nd 09, 06:55 AM
On Apr 21, 10:03*pm, Kolbard > wrote:
> Hi,
>
> I wouldn't even be posting about this, except Google Groups search is
> broken.
>
> My 16 year old cat was recently diagnosed with CRF (about 2-3 weeks
> ago). *She isn't dehydrated, but her phosphorus levels are through the
> roof (19.7 at her last test). *The vet didn't even mention anything
> about phosphorus binders, but I was able to locate a website in 2
> minutes. *She's very skinny and fatigued. *Anyway, I'd like to start
> her on AlternaGel until we can get the powdered kind that mixes with
> food, but since she isn't eating much, what can I do? *Should I mix up
> a syringe with diluted food and the gel? *I read that the binders only
> work when given with food. *I'm kind of rattled about all this,
> especially since I finally looked at a copy of my cat's numbers and
> the vet doesn't seem to know what she's doing (we're going to look for
> another one ASAP if we cannot discuss the phosphorus binders with
> her).
>

-------------
Ask your vet to phone in a prescription to BCP Pharmacy in Texas
1-800-481-1729. They have custom-formulated the phosphorus binder
(aluminum hydroxide) into capsules. I was told (by my vet) that the
aluminum hydroxide has a horrible taste to cats, and if you mix it in
the food, the cat will not eat that food again. The last thing you
want to do is discourage your CRF cat from eating. The reason you have
to give the aluminum hydroxide capsules at the same time as the food
is because you are trying to bind the phosphorus that it is in the
food. Another thing you can do (in addition to the capsules, not in
lieu of them) is provide your cat with a low phosphorus canned cat
food. Try to avoid dry cat food.

See: http://webpages.charter.net/katkarma/canned.htm

I would also try to avoid low protein foods. That is the traditional
advice, and that is probably what your vet would advise, but cats need
at least a moderate amount of protein for healthy muscles. I will
leave it to Phil to elaborate on that subject. All I can tell you is
that after my cat Alex was diagnosed with CRF, I kept him on a low
phosphorus, moderate protein, regular canned cat food diet. I NEVER
used one of the prescription diets which I am personally convinced is
nothing more than a way for the pet food companies to make more money.
Dry foods are never preferable to canned foods because they are made
of grains (cats are obligate carnivores), and the cat is always in a
state of mild dehydration (even if he drinks a lot of water). And the
last thing you want is for a CRF cat to be dehydrated. At any rate, I
must have done something right because Alex's numbers (BUN and
creatinine) stabilized and then even improved a little. He lived with
CRF for 2+ years and ultimately died from cancer. Had he not died from
cancer, he probably could have gone on a lot longer with the CRF. The
vet (correctly) predicted that he would not die from CRF.

BTW, another problem with a CRF kitty is weight loss (you mention that
your cat is thin). If your cat isn't eating, ask your vet about giving
him 2.5 to 5 mg of Pepcid every day. Cats with CRF tend to feel
nauseated (which is why they don't want to eat). The Pepcid gets rid
of the nausea.
Good luck.
Best regards,
---Cindy S.

Kolbard
April 22nd 09, 08:09 AM
On Tue, 21 Apr 2009 22:55:06 -0700 (PDT), cindys
> wrote:

>On Apr 21, 10:03*pm, Kolbard > wrote:
>> Hi,
>>
>> I wouldn't even be posting about this, except Google Groups search is
>> broken.
>>
>> My 16 year old cat was recently diagnosed with CRF (about 2-3 weeks
>> ago). *She isn't dehydrated, but her phosphorus levels are through the
>> roof (19.7 at her last test). *The vet didn't even mention anything
>> about phosphorus binders, but I was able to locate a website in 2
>> minutes. *She's very skinny and fatigued. *Anyway, I'd like to start
>> her on AlternaGel until we can get the powdered kind that mixes with
>> food, but since she isn't eating much, what can I do? *Should I mix up
>> a syringe with diluted food and the gel? *I read that the binders only
>> work when given with food. *I'm kind of rattled about all this,
>> especially since I finally looked at a copy of my cat's numbers and
>> the vet doesn't seem to know what she's doing (we're going to look for
>> another one ASAP if we cannot discuss the phosphorus binders with
>> her).
>>
>
>-------------
>Ask your vet to phone in a prescription to BCP Pharmacy in Texas
>1-800-481-1729. They have custom-formulated the phosphorus binder
>(aluminum hydroxide) into capsules. I was told (by my vet) that the
>aluminum hydroxide has a horrible taste to cats, and if you mix it in
>the food, the cat will not eat that food again. The last thing you
>want to do is discourage your CRF cat from eating. The reason you have
>to give the aluminum hydroxide capsules at the same time as the food
>is because you are trying to bind the phosphorus that it is in the
>food. Another thing you can do (in addition to the capsules, not in
>lieu of them) is provide your cat with a low phosphorus canned cat
>food. Try to avoid dry cat food.
>
>See: http://webpages.charter.net/katkarma/canned.htm

I read here that the Generic Aluminum Hydroxide Dry Gel Powder is
supposed to be odorless and tasteless:
http://members.verizon.net/%7Evze2r6qt/supplies/binders.htm

Is it not?

I've never had luck pilling cats; I'd probably become a raging
alcoholic if I tried on a daily basis. ;]

>
>I would also try to avoid low protein foods. That is the traditional
>advice, and that is probably what your vet would advise, but cats need
>at least a moderate amount of protein for healthy muscles. I will
>leave it to Phil to elaborate on that subject. All I can tell you is
>that after my cat Alex was diagnosed with CRF, I kept him on a low
>phosphorus, moderate protein, regular canned cat food diet. I NEVER
>used one of the prescription diets which I am personally convinced is
>nothing more than a way for the pet food companies to make more money.
>Dry foods are never preferable to canned foods because they are made
>of grains (cats are obligate carnivores), and the cat is always in a
>state of mild dehydration (even if he drinks a lot of water). And the
>last thing you want is for a CRF cat to be dehydrated. At any rate, I
>must have done something right because Alex's numbers (BUN and
>creatinine) stabilized and then even improved a little. He lived with
>CRF for 2+ years and ultimately died from cancer. Had he not died from
>cancer, he probably could have gone on a lot longer with the CRF. The
>vet (correctly) predicted that he would not die from CRF.
>
>BTW, another problem with a CRF kitty is weight loss (you mention that
>your cat is thin). If your cat isn't eating, ask your vet about giving
>him 2.5 to 5 mg of Pepcid every day. Cats with CRF tend to feel
>nauseated (which is why they don't want to eat). The Pepcid gets rid
>of the nausea.
>Good luck.
>Best regards,
>---Cindy S.

Thanks for the Pepcid advice. I'll prod around for further info and
check it out.

How are the "Senior" formula cat foods for a CRF cat? I know that
they're low in P and Ca, especially Science Diet and Royal Canin (I
thank Phil P. for that info).

Take care

Kolbard

cindys
April 22nd 09, 01:32 PM
On Apr 22, 3:09*am, Kolbard > wrote:
> On Tue, 21 Apr 2009 22:55:06 -0700 (PDT), cindys
snip
>
> I read here that the Generic Aluminum Hydroxide Dry Gel Powder is
> supposed to be odorless and tasteless:http://members.verizon.net/%7Evze2r6qt/supplies/binders.htm
>
> Is it not?

I couldn't say. I'm just repeating what my vet told me (and since she
wasn't selling the capsules, she didn't have anything to gain by
lying). Maybe my vet was unaware of this product or it's new. (Alex
has been deceased for over a year, and he was taking the capsules for
a couple of years before that). If it works for your cat, great,
because the pre-made capsules from the place in Texas cost about $55
for a one month's supply.
>
>
> >I would also try to avoid low protein foods. That is the traditional
> >advice, and that is probably what your vet would advise, but cats need
> >at least a moderate amount of protein for healthy muscles. I will
> >leave it to Phil to elaborate on that subject. All I can tell you is
> >that after my cat Alex was diagnosed with CRF, I kept him on a low
> >phosphorus, moderate protein, regular canned cat food diet. I NEVER
> >used one of the prescription diets which I am personally convinced is
> >nothing more than a way for the pet food companies to make more money.
> >Dry foods are never preferable to canned foods because they are made
> >of grains (cats are obligate carnivores), and the cat is always in a
> >state of mild dehydration (even if he drinks a lot of water). And the
> >last thing you want is for a CRF cat to be dehydrated. At any rate, I
> >must have done something right because Alex's numbers (BUN and
> >creatinine) stabilized and then even improved a little. He lived with
> >CRF for 2+ years and ultimately died from cancer. Had he not died from
> >cancer, he probably could have gone on a lot longer with the CRF. The
> >vet (correctly) predicted that he would not die from CRF.
>
> >BTW, another problem with a CRF kitty is weight loss (you mention that
> >your cat is thin). If your cat isn't eating, ask your vet about giving
> >him 2.5 to 5 mg of Pepcid every day. Cats with CRF tend to feel
> >nauseated (which is why they don't want to eat). The Pepcid gets rid
> >of the nausea.
> >Good luck.
> >Best regards,
> >---Cindy S.
>
> Thanks for the Pepcid advice. *I'll prod around for further info and
> check it out.
>
> How are the "Senior" formula cat foods for a CRF cat? *I know that
> they're low in P and Ca, especially Science Diet and Royal Canin (I
> thank Phil P. for that info).

I will always defer to Phil's advice. He is much more of an expert
than I am. But IIRC, most senior foods are low in phosphorus because
cats are generally very prone to developing CRF as they age. If I had
to choose between the above two foods, I would go with the Royal Canin
(which is what I buy for my cats for dry food, even though I continue
to try to convert them to canned food exclusively). I think Science
Diet is mostly junk. But if possible, your cat will be much better off
with a low phosphorus, moderate protein, canned food. If Phil tells
you something different from this, then go with his advice rather than
mine, but I think he will say the same as I'm saying (who do you think
taught me this stuff ? ;-)
Best regards,
---Cindy S.

April 22nd 09, 08:54 PM
----
> Ask your vet to phone in a prescription to BCP Pharmacy in Texas
> 1-800-481-1729. They have custom-formulated the phosphorus binder
> (aluminum hydroxide) into capsules. I was told (by my vet) that the
> aluminum hydroxide has a horrible taste to cats, and if you mix it in
> the food, the cat will not eat that food again. The last thing you
> want to do is discourage your CRF cat from eating. The reason you have
> to give the aluminum hydroxide capsules at the same time as the food
> is because you are trying to bind the phosphorus that it is in the
> food. Another thing you can do (in addition to the capsules, not in
> lieu of them) is provide your cat with a low phosphorus canned cat
> food. Try to avoid dry cat food.
>

I have a friend with two CRF cats. She feeds them some of the grain-
free Wellness canned and Innova Evo venison canned, along with a
phoshorous binder. She buys a big jar of powder without the need for a
prescription from www.thrivingpets.com. Contrary to what the other vet
said, the binder she uses has no taste (she has tasted a bit herself
just to see) and the cats accept it readily as a treat just before
their meal (she mixes the binder with a small amount of chicken baby
food). If, for some reason, the cat won't accept it that way, a simple
alternative is to mix the binder with a small amount of the chicken
baby food, and suck that up into a 3 ml oral syringe and "inject" it
into their mouth. I hope this is helpful to you.

Rene

cindys
April 22nd 09, 09:49 PM
On Apr 22, 3:54*pm, wrote:
> ----
>
> > Ask your vet to phone in a prescription to BCP Pharmacy in Texas
> > 1-800-481-1729. They have custom-formulated the phosphorus binder
> > (aluminum hydroxide) into capsules. I was told (by my vet) that the
> > aluminum hydroxide has a horrible taste to cats, and if you mix it in
> > the food, the cat will not eat that food again. The last thing you
> > want to do is discourage your CRF cat from eating. The reason you have
> > to give the aluminum hydroxide capsules at the same time as the food
> > is because you are trying to bind the phosphorus that it is in the
> > food. Another thing you can do (in addition to the capsules, not in
> > lieu of them) is provide your cat with a low phosphorus canned cat
> > food. Try to avoid dry cat food.
>
> I have a friend with two CRF cats. She feeds them some of the grain-
> free Wellness canned and Innova Evo venison canned, along with a
> phoshorous binder.

I used to feed my CRF kitty the grain-free Wellness, but IIRC, the
Innovo Evo was high in phosphorus. (??) The Wysong is also a great
choice (in terms of both quality and low phosphorus). I ordered a case
of it from Pet Food Direct. Unfortunately, my cat refused to eat it :-
(. I was able to donate the remaining cans to a shelter.

>She buys a big jar of powder without the need for a
> prescription fromwww.thrivingpets.com. Contrary to what the other vet
> said, the binder she uses has no taste (she has tasted a bit herself
> just to see)

None of my current cats requires a phosphorus binder, but I will still
share this information with my vet who is very open to learning about
new products. The reason she worked with the BCP pharmacy was because
at the time, the only options she was aware of had a bad taste. The
pharmacy put the product together in accordance with her instructions.
It would have been much easier for her to say "Go to thriving pets
website." FTR, I did buy the product directly from the pharmacy. It
wasn't something the vet was selling.

BTW: Aluminum hydroxide = Maalox.
Best regards,
---Cindy S.

Kolbard
April 22nd 09, 11:24 PM
I was unable to go today, but my mother took her to another vet today,
in the hopes of getting her on an IV again, to see if it helped. The
vet took one look at her numbers and said, "Short answer, no, I can't
do anything." I've read of cats with numbers higher than these who
survived; should I try every damned vet in town until I find one who's
competant?


On Tue, 21 Apr 2009 21:03:39 -0500, Kolbard
> wrote:

>Hi,
>
>I wouldn't even be posting about this, except Google Groups search is
>broken.
>
>My 16 year old cat was recently diagnosed with CRF (about 2-3 weeks
>ago). She isn't dehydrated, but her phosphorus levels are through the
>roof (19.7 at her last test). The vet didn't even mention anything
>about phosphorus binders, but I was able to locate a website in 2
>minutes. She's very skinny and fatigued. Anyway, I'd like to start
>her on AlternaGel until we can get the powdered kind that mixes with
>food, but since she isn't eating much, what can I do? Should I mix up
>a syringe with diluted food and the gel? I read that the binders only
>work when given with food. I'm kind of rattled about all this,
>especially since I finally looked at a copy of my cat's numbers and
>the vet doesn't seem to know what she's doing (we're going to look for
>another one ASAP if we cannot discuss the phosphorus binders with
>her).
>
>For reference, my cat's numbers are:
>
>ALB 4.4 *
>ALP 18
>ALT 82
>AMY 2381 *
>TBIL 0.2
>BUN 171 *
>CA 10.8
>PHOS 19.7
>CRE 7.9 *
>GLU 134
>NA+ 143
>K+ 3.8
>TP 8.8 *
>GLOB 4.3
>
>The BUN, PHOS, and CRE numbers are particularly alarming to me. The
>vet actually mentioned that the numbers weren't out of sight, at first
>test, but they were very high even then (I hope I'm typing these out
>correctly):
>
>ALB 4.4 *
>ALP 18
>ALT 40
>AMY 2837 *
>TBIL 0.2
>BUN 138 *
>CA 11.2
>PHOS 14.0 *
>CRE 5.9 *
>GLU 135
>NA+ 142
>K+ 3.6 *
>TP 9.1 *
>GLOB 4.7
>
>Thank you,
>
>Kolbard


Kolbard

cindys
April 22nd 09, 11:58 PM
On Apr 22, 6:24*pm, Kolbard > wrote:
> I was unable to go today, but my mother took her to another vet today,
> in the hopes of getting her on an IV again, to see if it helped. *The
> vet took one look at her numbers and said, "Short answer, no, I can't
> do anything." *I've read of cats with numbers higher than these who
> survived; should I try every damned vet in town until I find one who's
> competent?
-----------
Kolbard, I don't think these vets are incompetent, and I don't think
the issue is one of survival per se. I think the issue is how long is
your kitty going to maintain a good quality of life.

I was getting mixed up between your cat and the cat in the other
thread with CHF, ("When is it time to call it a day?") but the same
principle applies. There is no cure. It's not a question of whether or
not the cat is going to survive but rather for how long can the cat
maintain a good quality of life?

In the past, I have had two cats with CRF. In the first cat, the
disease was very advanced. I did everything I could to keep her
comfortable. It wasn't a question of her survival. It was a question
of using medications to keep her comfortable and knowing when to call
it a day. I think I waited too long. By the time I had her euthanized,
she was wobbly on her paws and drooling quite a bit (probably from
nausea). But since she was still eating and walking around and using
her litter box, I mistakenly believed she was okay.

Cats are very stoic and hide their suffering well. Even when I had her
euthanized, I felt guilty for having her euthanized too soon. Now, I
wish I had done it a week or two earlier. My vet (whom I trusted
completely) pointed out how bad the numbers were. I should have
believed her. Euthanasia isn't about the cat. It's about the person.
Please see what I wrote to Eddy in the "When is it time to call it a
day?" thread.

With my second cat, his CRF was much milder. His numbers were only
slightly elevated. He died from cancer. If he hadn't had the cancer,
he probably could have gone on for a very long time with the CRF and
had a good quality of life for a lot longer. But his numbers were
close to normal, not through the roof.

So, yes, try to maximize your cat's treatment but only for the sake of
his/her comfort. If the numbers are really high, and all the vets are
saying the same thing, that there is no hope, nothing that they can
do, consider that they may know what they're talking about. Please be
sure that your cat isn't just being stoic. You say your cat is "skinny
and fatigued." Cats get skinny from not eating, and the reason cats
don't eat is because they feel sick or have pain. This does not sound
good.

I will be interested to hear what Phil has to say about the numbers.
I'm so sorry you're going through this. I've been there (as have many
of the other posters to this forum), and it's miserable.
Best regards,
---Cindy S.

cindys
April 23rd 09, 12:51 AM
On Apr 22, 6:24*pm, Kolbard > wrote:
> I was unable to go today, but my mother took her to another vet today,
> in the hopes of getting her on an IV again, to see if it helped. *The
> vet took one look at her numbers and said, "Short answer, no, I can't
> do anything." *I've read of cats with numbers higher than these who
> survived; should I try every damned vet in town until I find one who's
> competant?
------------
BTW, I think your cat should have IV fluids ASAP since she is
dehydrated. The cat will feel MUCH better once she is rehydrated. You
can even be taught to do this yourself at home. I can't believe a vet
would refuse to do this, no matter how grave the cat's condition.
Best regards,
---Cindy S.

Kolbard
April 23rd 09, 03:21 AM
On Wed, 22 Apr 2009 16:51:36 -0700 (PDT), cindys
> wrote:

>On Apr 22, 6:24*pm, Kolbard > wrote:
>> I was unable to go today, but my mother took her to another vet today,
>> in the hopes of getting her on an IV again, to see if it helped. *The
>> vet took one look at her numbers and said, "Short answer, no, I can't
>> do anything." *I've read of cats with numbers higher than these who
>> survived; should I try every damned vet in town until I find one who's
>> competant?
>------------
>BTW, I think your cat should have IV fluids ASAP since she is
>dehydrated. The cat will feel MUCH better once she is rehydrated. You
>can even be taught to do this yourself at home. I can't believe a vet
>would refuse to do this, no matter how grave the cat's condition.
>Best regards,
>---Cindy S.

She had IV fluids last week, but it didn't seem to help her more than
a day.

My mother decided to take her back to the vet who didn't want to treat
her after seeing the numbers, and told him she wanted him to go ahead
and do it anyway. He was hard-line negative. So, she took her back
to the original vet and apparently she does know about phosphorus
binders, she just didn't mention them before (???). I was she'd get
her back on IV, but she gave her a SubQ and sent her home. She
mentioned Maalox and Tums (!!) as P inhibitors, but I'm not sure if I
want to try those. Someone somewhere, possibly here, mentioned Pepcid
as an anti-nausea measure, but I don't know how much to give.

Kolbard

Phil P.
April 23rd 09, 04:47 AM
"Kolbard" > wrote in message
...

> She had IV fluids last week, but it didn't seem to help her more than
> a day.

....because she probably didn't get enough fluids or for long enough. Once
your cat is adequately hydrated, you should concentrate on increasing the
excretion of the uremic toxins in her blood by increasing her urine output.
Fluids alone are usually enough to cause mild diuresis (fluid diuresis) and
flush out most of the uremic toxins- enough to shut down a uremic crisis.
But since your cat's BUN/Cr/and/P are so high, fluids alone probably aren't
enough. She probably needs a diuretic with the fluids (intense diuresis).
Intesnse diuresis removes uremic toxins *much* faster. With fluids alone
diruesis can take several hours to begin. As long as your cat doesn't have
heart disease or hypertension, ID will probably shut down her uremic crisis
fairly quickly.

Her K+ is already way too low as it is- even without fluid therapy she
urgently needs a K+ supplement. Fluid diuresis and especially intense
diuresis will increase K+ excretion and depletion even further, so she
*definitely* needs a K+ supplement *urgently*.


> My mother decided to take her back to the vet who didn't want to treat
> her after seeing the numbers, and told him she wanted him to go ahead
> and do it anyway. He was hard-line negative.

That's probably because he has little or experience treating CRF in cats. A
vet who knows anything about CRF in cats knows he should treat the ***cat***
not the numbers!


So, she took her back
> to the original vet and apparently she does know about phosphorus
> binders, she just didn't mention them before (???). I was she'd get
> her back on IV, but she gave her a SubQ and sent her home. She
> mentioned Maalox and Tums (!!) as P inhibitors, but I'm not sure if I
> want to try those. Someone somewhere, possibly here, mentioned

Pepcid
> as an anti-nausea measure, but I don't know how much to give.

The usual dose is 1/4 of a 10 mg tab of Pepcid *AC Original Strength* every
other day (don't use any other formulation). If that doesn't help, the dose
is usually increased to 1/4 tab every day. The maximum dose should not
exceed 1/4 tab twice a day (5 mg/day/cat) max. You might want to put the
1/4 tab(s) in a #4 gelcap before giving it to your cat to prevent her from
tasting it. Pepcid is very bitter- if your cat ever gets a taste of it -
pilling will be a nightmare. I'm not a vet- I'm just relaying what worked
for our CRF cats that were in a uremic crisis, so run this by a vet first.

Best of luck

Phil

Kolbard
April 23rd 09, 05:37 AM
Thanks for the advice, Phil. My biggest concern here is how can I get
the vet to do all these things? She was on the IV last Monday through
last Wednesday, but I was hoping they'd keep her longer. I wasn't
even aware her potassium was low. I was hoping she'd be back on the
IV tonight, but they just gave her a SubQ instead.

I tried syringing some food and AlternaGel, someone successfully.
Unfortunately, I tried to syringe some more food a short while later
and she threw it all up. She's so thin, I'm not sure she'll last much
longer without nourishment.

On Thu, 23 Apr 2009 03:47:18 GMT, "Phil P." >
wrote:

>
>"Kolbard" > wrote in message
...
>
>> She had IV fluids last week, but it didn't seem to help her more than
>> a day.
>
>...because she probably didn't get enough fluids or for long enough. Once
>your cat is adequately hydrated, you should concentrate on increasing the
>excretion of the uremic toxins in her blood by increasing her urine output.
>Fluids alone are usually enough to cause mild diuresis (fluid diuresis) and
>flush out most of the uremic toxins- enough to shut down a uremic crisis.
>But since your cat's BUN/Cr/and/P are so high, fluids alone probably aren't
>enough. She probably needs a diuretic with the fluids (intense diuresis).
>Intesnse diuresis removes uremic toxins *much* faster. With fluids alone
>diruesis can take several hours to begin. As long as your cat doesn't have
>heart disease or hypertension, ID will probably shut down her uremic crisis
>fairly quickly.
>
>Her K+ is already way too low as it is- even without fluid therapy she
>urgently needs a K+ supplement. Fluid diuresis and especially intense
>diuresis will increase K+ excretion and depletion even further, so she
>*definitely* needs a K+ supplement *urgently*.
>
>
>> My mother decided to take her back to the vet who didn't want to treat
>> her after seeing the numbers, and told him she wanted him to go ahead
>> and do it anyway. He was hard-line negative.
>
>That's probably because he has little or experience treating CRF in cats. A
>vet who knows anything about CRF in cats knows he should treat the ***cat***
>not the numbers!
>
>
>So, she took her back
>> to the original vet and apparently she does know about phosphorus
>> binders, she just didn't mention them before (???). I was she'd get
>> her back on IV, but she gave her a SubQ and sent her home. She
>> mentioned Maalox and Tums (!!) as P inhibitors, but I'm not sure if I
>> want to try those. Someone somewhere, possibly here, mentioned
>
>Pepcid
>> as an anti-nausea measure, but I don't know how much to give.
>
>The usual dose is 1/4 of a 10 mg tab of Pepcid *AC Original Strength* every
>other day (don't use any other formulation). If that doesn't help, the dose
>is usually increased to 1/4 tab every day. The maximum dose should not
>exceed 1/4 tab twice a day (5 mg/day/cat) max. You might want to put the
>1/4 tab(s) in a #4 gelcap before giving it to your cat to prevent her from
>tasting it. Pepcid is very bitter- if your cat ever gets a taste of it -
>pilling will be a nightmare. I'm not a vet- I'm just relaying what worked
>for our CRF cats that were in a uremic crisis, so run this by a vet first.
>
>Best of luck
>
>Phil
>
>
>


Kolbard

Kolbard
April 23rd 09, 06:18 AM
On Thu, 23 Apr 2009 03:47:18 GMT, "Phil P." >
wrote:
>Her K+ is already way too low as it is- even without fluid therapy she
>urgently needs a K+ supplement. Fluid diuresis and especially intense
>diuresis will increase K+ excretion and depletion even further, so she
>*definitely* needs a K+ supplement *urgently*.

I just checked the test results page, and the listed normal range for
K+ is 3.7-5.8. Hers was 3.8 at last test. Are these supplements
readily available from vet clinics?

Kolbard

cindys
April 23rd 09, 06:44 AM
On Apr 23, 1:18*am, Kolbard > wrote:
> On Thu, 23 Apr 2009 03:47:18 GMT, "Phil P." >
> wrote:
>
> >Her K+ is already way too low as it is- even without fluid therapy she
> >urgently needs a K+ supplement. *Fluid diuresis and especially intense
> >diuresis will increase K+ excretion and depletion even further, so she
> >*definitely* needs a K+ supplement *urgently*.
>
> I just checked the test results page, and the listed normal range for
> K+ is 3.7-5.8. *Hers was 3.8 at last test. *Are these supplements
> readily available from vet clinics?
>
> Kolbard
----------------
Yes. You can get the potassium supplement in the form of Tumil K
(which is a pill), a powder (Vet Solutions Renal K+ plus, which
supposedly has a beef flavor, but my cats hated it), or as a gel
(don't get any gel other than Vet Solutions Renal K+ - there is a
different gel which has a horrible smell and flavor). If your vet
doesn't carry any of these, they are easily accessible on the internet
from any number of sources.

http://www.amazon.com/Renal-K-Potassium-Gluconate-Gel/dp/B000FUMGXY/ref=pd_bxgy_k_text_b

Under the circumstances, I would have them shipped next-day air. If I
were you, I would go with the Vet Solutions Renal K+ gel. I used to
use this gel, and it worked out well. I currently use the Tumil K
pills for my cats only because the pills are cheaper, and I don't have
a problem pilling my cats. You can put the gel on your cat's paw, and
she will hopefully lick it off. If she doesn't, you can measure it
into a large oral syringe and squirt it in her mouth. The normal dose
is 2.5 mL (1/2 teaspoon) twice daily.

BTW, I am stunned that the price is only $7.99 + 6.16 shipping
(regular ground) from Medivet (sold through Amazon.com). My vet used
to charge me $21 for the same thing! At this price, I may return to
the gel.
Best regards,
---Cindy S.

Phil P.
April 23rd 09, 11:13 AM
"Kolbard" > wrote in message
...
> Thanks for the advice, Phil. My biggest concern here is how can I get
> the vet to do all these things?

At this point, I wouldn't waste time trying to find a general practitioner
that's experienced in treating CRF. I think you should consult a an ABVP or
ACVIM specialist ASAP-- if not sooner. I don't think you should wait another
second. If you live within range of a veterinary school, you should give
them a call. Most veterinary colleges have nephrologists and urologists on
staff and are fully equipped to handle uremic crises.

If not, do a search for an ABVP feline specialist in your area:
http://www.abvp.com/FindDiplomate.aspx

If you can't find an ABVP Diplomate in your area try:
ACVIM Board-certified Veterinary Specialist in Your Area
http://www.acvim.org/websites/acvim/index.php?p=3


She was on the IV last Monday through
> last Wednesday, but I was hoping they'd keep her longer. I wasn't
> even aware her potassium was low.

(From a recent post)
"Serum potassium levels are a poor indicator of total body stores of K+
since
>95% of the total body stores of K+ are contained in the cells
(intracellular fluid- ). If the K+ level is low in the blood
(extracellular fluid [ECF]- its *definitely* low in the cells. Your cat is
borderline hypokalemic. When serum K+ is low the body will draw K from the
cells to maintain adequate serum K+ levels. This is why potassium depletion
in the cells can occur long before the onset of hypokalemia. Serum K+ levels
should be kept in the upper half of the normal range because the ECF K+ pool
is so much smaller, tiny shifts between ICF and ECF can affect serum K+
levels tremendously."

If your email is a working address, I'd be happy to send you a paper on the
importance of K+ in cats with CRF. Its called "Renal Disease in Cats" The
Potassium Connection" by Steven Dow and Martin Fettman.


I was hoping she'd be back on the
> IV tonight, but they just gave her a SubQ instead.
>
> I tried syringing some food and AlternaGel, someone successfully.
> Unfortunately, I tried to syringe some more food a short while later
> and she threw it all up. She's so thin, I'm not sure she'll last much
> longer without nourishment.

Pepcid should help control nausea- although she'll probably need the
high-end dose, and/or metoclopramide (Reglan) which also controls nausea-
its a little stronger than Pepcid and works a little differently.

Along with the 1/4 tab of Pepcid, I include 1/4 tab of cyproheptadine in a
#4 gelcap (they fit). Cyproheptadine (Periactin), is an antihistamine which
acts like an appetite stimulant in cats.


Best of luck,

Phil

>
> On Thu, 23 Apr 2009 03:47:18 GMT, "Phil P." >
> wrote:
>
> >
> >"Kolbard" > wrote in message
> ...
> >[i]
> >> She had IV fluids last week, but it didn't seem to help her more than
> >> a day.
> >
> >...because she probably didn't get enough fluids or for long enough.
Once
> >your cat is adequately hydrated, you should concentrate on increasing the
> >excretion of the uremic toxins in her blood by increasing her urine
output.
> >Fluids alone are usually enough to cause mild diuresis (fluid diuresis)
and
> >flush out most of the uremic toxins- enough to shut down a uremic crisis.
> >But since your cat's BUN/Cr/and/P are so high, fluids alone probably
aren't
> >enough. She probably needs a diuretic with the fluids (intense diuresis).
> >Intesnse diuresis removes uremic toxins *much* faster. With fluids alone
> >diruesis can take several hours to begin. As long as your cat doesn't
have
> >heart disease or hypertension, ID will probably shut down her uremic
crisis
> >fairly quickly.
> >
> >Her K+ is already way too low as it is- even without fluid therapy she
> >urgently needs a K+ supplement. Fluid diuresis and especially intense
> >diuresis will increase K+ excretion and depletion even further, so she
> >*definitely* needs a K+ supplement *urgently*.
> >
> >
> >> My mother decided to take her back to the vet who didn't want to treat
> >> her after seeing the numbers, and told him she wanted him to go ahead
> >> and do it anyway. He was hard-line negative.
> >
> >That's probably because he has little or experience treating CRF in cats.
A
> >vet who knows anything about CRF in cats knows he should treat the
***cat***
> >not the numbers!
> >
> >
> >So, she took her back
> >> to the original vet and apparently she does know about phosphorus
> >> binders, she just didn't mention them before (???). I was she'd get
> >> her back on IV, but she gave her a SubQ and sent her home. She
> >> mentioned Maalox and Tums (!!) as P inhibitors, but I'm not sure if I
> >> want to try those. Someone somewhere, possibly here, mentioned
> >
> >Pepcid
> >> as an anti-nausea measure, but I don't know how much to give.
> >
> >The usual dose is 1/4 of a 10 mg tab of Pepcid *AC Original Strength*
every
> >other day (don't use any other formulation). If that doesn't help, the
dose
> >is usually increased to 1/4 tab every day. The maximum dose should not
> >exceed 1/4 tab twice a day (5 mg/day/cat) max. You might want to put the
> >1/4 tab(s) in a #4 gelcap before giving it to your cat to prevent her
from
> >tasting it. Pepcid is very bitter- if your cat ever gets a taste of it -
> >pilling will be a nightmare. I'm not a vet- I'm just relaying what worked
> >for our CRF cats that were in a uremic crisis, so run this by a vet
first.
> >
> >Best of luck
> >
> >Phil
> >
> >
> >
>
>
> Kolbard

Kolbard
April 23rd 09, 11:30 AM
On Thu, 23 Apr 2009 10:13:15 GMT, "Phil P." >
wrote:

>
>"Kolbard" > wrote in message
...
>> Thanks for the advice, Phil. My biggest concern here is how can I get
>> the vet to do all these things?
>
>At this point, I wouldn't waste time trying to find a general practitioner
>that's experienced in treating CRF. I think you should consult a an ABVP or
>ACVIM specialist ASAP-- if not sooner. I don't think you should wait another
>second. If you live within range of a veterinary school, you should give
>them a call. Most veterinary colleges have nephrologists and urologists on
>staff and are fully equipped to handle uremic crises.
>
>If not, do a search for an ABVP feline specialist in your area:
>http://www.abvp.com/FindDiplomate.aspx
>
>If you can't find an ABVP Diplomate in your area try:
>ACVIM Board-certified Veterinary Specialist in Your Area
>http://www.acvim.org/websites/acvim/index.php?p=3

I just checked and there aren't any close to me. The closest is maybe
5 hours away.

All I can hope for is that the vet agrees to put her back on IV. I
hate feeling so helpless, being at the mercy of the vets here.

Kolbard

cindys
April 23rd 09, 04:23 PM
On Apr 23, 6:30*am, Kolbard > wrote:
> On Thu, 23 Apr 2009 10:13:15 GMT, "Phil P." >
> wrote:
>
>
>
>
>
> >"Kolbard" > wrote in message
> ...
> >> Thanks for the advice, Phil. *My biggest concern here is how can I get
> >> the vet to do all these things?
>
> >At this point, I wouldn't waste time trying to find a general practitioner
> >that's experienced in treating CRF. *I think you should consult a an ABVP or
> >ACVIM specialist ASAP-- if not sooner. I don't think you should wait another
> >second. If you live within range of a veterinary school, you should give
> >them a call. *Most veterinary colleges have nephrologists and urologists on
> >staff and are fully equipped to handle uremic crises.
>
> >If not, do a search for an ABVP feline specialist in your area:
> >http://www.abvp.com/FindDiplomate.aspx
>
> >If you can't find an ABVP Diplomate in your area try:
> >ACVIM Board-certified Veterinary Specialist in Your Area
> >http://www.acvim.org/websites/acvim/index.php?p=3
>
> I just checked and there aren't any close to me. *The closest is maybe
> 5 hours away.
>
> All I can hope for is that the vet agrees to put her back on IV. *I
> hate feeling so helpless, being at the mercy of the vets here.
>
---------
I don't understand why they would refuse. If nothing else, it's money
in their pockets to treat your cat. Please continue to keep us
updated.
Best regards,
---Cindy S.

Phil P.
April 23rd 09, 07:07 PM
"Kolbard" > wrote in message
...
> On Thu, 23 Apr 2009 10:13:15 GMT, "Phil P." >
> wrote:
>
> >
> >"Kolbard" > wrote in message
> ...
> >> Thanks for the advice, Phil. My biggest concern here is how can I get
> >> the vet to do all these things?
> >
> >At this point, I wouldn't waste time trying to find a general
practitioner
> >that's experienced in treating CRF. I think you should consult a an ABVP
or
> >ACVIM specialist ASAP-- if not sooner. I don't think you should wait
another
> >second. If you live within range of a veterinary school, you should give
> >them a call. Most veterinary colleges have nephrologists and urologists
on
> >staff and are fully equipped to handle uremic crises.
> >
> >If not, do a search for an ABVP feline specialist in your area:
> >http://www.abvp.com/FindDiplomate.aspx
> >
> >If you can't find an ABVP Diplomate in your area try:
> >ACVIM Board-certified Veterinary Specialist in Your Area
> >http://www.acvim.org/websites/acvim/index.php?p=3
>
> I just checked and there aren't any close to me. The closest is maybe
> 5 hours away.


That's not that far under the circumstances- considering your cat urgently
needs correct and immediate treatment.


>
> All I can hope for is that the vet agrees to put her back on IV. I
> hate feeling so helpless, being at the mercy of the vets here.


Do you have a car? How far do you live from the nearest vet college?


Phil

Kolbard
April 23rd 09, 10:21 PM
On Thu, 23 Apr 2009 18:07:10 GMT, "Phil P." >
wrote:

>
>"Kolbard" > wrote in message
...
>> On Thu, 23 Apr 2009 10:13:15 GMT, "Phil P." >
>> wrote:
>>
>> >
>> >"Kolbard" > wrote in message
>> ...
>> >> Thanks for the advice, Phil. My biggest concern here is how can I get
>> >> the vet to do all these things?
>> >
>> >At this point, I wouldn't waste time trying to find a general
>practitioner
>> >that's experienced in treating CRF. I think you should consult a an ABVP
>or
>> >ACVIM specialist ASAP-- if not sooner. I don't think you should wait
>another
>> >second. If you live within range of a veterinary school, you should give
>> >them a call. Most veterinary colleges have nephrologists and urologists
>on
>> >staff and are fully equipped to handle uremic crises.
>> >
>> >If not, do a search for an ABVP feline specialist in your area:
>> >http://www.abvp.com/FindDiplomate.aspx
>> >
>> >If you can't find an ABVP Diplomate in your area try:
>> >ACVIM Board-certified Veterinary Specialist in Your Area
>> >http://www.acvim.org/websites/acvim/index.php?p=3
>>
>> I just checked and there aren't any close to me. The closest is maybe
>> 5 hours away.
>
>
>That's not that far under the circumstances- considering your cat urgently
>needs correct and immediate treatment.
>
>
>>
>> All I can hope for is that the vet agrees to put her back on IV. I
>> hate feeling so helpless, being at the mercy of the vets here.
>
>
>Do you have a car? How far do you live from the nearest vet college?
>
>
>Phil
>

We took her back to the vet to get her back on IV (and mention the
diuretic), but they couldn't IV her because she's still swollen from
the SubQ shot yesterday.

Kolbard

Kolbard
April 23rd 09, 10:43 PM
On Thu, 23 Apr 2009 18:07:10 GMT, "Phil P." >
wrote:

>
>"Kolbard" > wrote in message
...
>> On Thu, 23 Apr 2009 10:13:15 GMT, "Phil P." >
>> wrote:
>>
>> >
>> >"Kolbard" > wrote in message
>> ...
>> >> Thanks for the advice, Phil. My biggest concern here is how can I get
>> >> the vet to do all these things?
>> >
>> >At this point, I wouldn't waste time trying to find a general
>practitioner
>> >that's experienced in treating CRF. I think you should consult a an ABVP
>or
>> >ACVIM specialist ASAP-- if not sooner. I don't think you should wait
>another
>> >second. If you live within range of a veterinary school, you should give
>> >them a call. Most veterinary colleges have nephrologists and urologists
>on
>> >staff and are fully equipped to handle uremic crises.
>> >
>> >If not, do a search for an ABVP feline specialist in your area:
>> >http://www.abvp.com/FindDiplomate.aspx
>> >
>> >If you can't find an ABVP Diplomate in your area try:
>> >ACVIM Board-certified Veterinary Specialist in Your Area
>> >http://www.acvim.org/websites/acvim/index.php?p=3
>>
>> I just checked and there aren't any close to me. The closest is maybe
>> 5 hours away.
>
>
>That's not that far under the circumstances- considering your cat urgently
>needs correct and immediate treatment.
>

It seems like such a gamble. How do I even know I'll find the right
person to treat her? She still might not make it.

>
>>
>> All I can hope for is that the vet agrees to put her back on IV. I
>> hate feeling so helpless, being at the mercy of the vets here.
>
>
>Do you have a car? How far do you live from the nearest vet college?

The nearest vet college is about 8-9 hours away. I don't have a car
(I'm basically a bum) but my mother does. If we went, we'd have to
rent one, because the A/C is out. I'm afraid that my cat wouldn't
even make the trip, especially in a hot car.

Kolbard

Kolbard
April 24th 09, 02:53 AM
She's drinking water, urinating, and generally more active right now.
Earlier today, she was walking weirdly on her front legs, a sure sign
of low potassium levels. We gave her part of a K+ pill this evening
(NOW Foods), and either it's a coincidence, or it's working. I was
going to get a #4 gelcap, but all I saw were various #0's (#0, #00,
etc.). I will try syringing some food (and AlternaGel) later, but
not more than a few syringes worth.

On Thu, 23 Apr 2009 16:21:47 -0500, Kolbard
> wrote:
>
>
>We took her back to the vet to get her back on IV (and mention the
>diuretic), but they couldn't IV her because she's still swollen from
>the SubQ shot yesterday.
>
>Kolbard


Kolbard

cindys
April 24th 09, 03:33 AM
On Apr 23, 9:53*pm, Kolbard > wrote:
> She's drinking water, urinating, and generally more active right now.
> Earlier today, she was walking weirdly on her front legs, a sure sign
> of low potassium levels. *We gave her part of a K+ pill this evening
> (NOW Foods), and either it's a coincidence, or it's working. *

snip
------------
Hopefully, it's working. I'm not sure what Phil's response will be to
this, but when my sister's cat needed a potassium supplement, her vet
told her to just go to the supermarket and buy a sodium substitute
(one that contains potassium rather than sodium) and just sprinkle
some on the cat's food (which is similar to what you've done). When I
asked my vet about doing the same (when my cat needed a K+
supplement), the answer I got was that the supermarket sold potassium
chloride rather than potassium gluconate, and that was okay, but that
I would need to do the math to ensure that my cat was getting an
appropriate dose. So, to answer your question: I suspect that it would
probably be better if your cat got the official K+ supplement but you
needed to improvise and it's working fine.
Best regards,
---Cindy S.

Kolbard
April 24th 09, 03:57 AM
Hmm, I read a bit more and this "knuckling" seems to be from high
phosphorus levels rather than low potassium. I gave her a couple of
syringes of food/water mix just now, and a serving of AlternaGel. She
actually ate most of a cat treat, but it was one of the "bad" ones;
perhaps tomorrow I'll look for low-protein ones.

On Thu, 23 Apr 2009 20:53:17 -0500, Kolbard
> wrote:

>She's drinking water, urinating, and generally more active right now.
>Earlier today, she was walking weirdly on her front legs, a sure sign
>of low potassium levels. We gave her part of a K+ pill this evening
>(NOW Foods), and either it's a coincidence, or it's working. I was
>going to get a #4 gelcap, but all I saw were various #0's (#0, #00,
>etc.). I will try syringing some food (and AlternaGel) later, but
>not more than a few syringes worth.

Kolbard

Kolbard
April 24th 09, 03:58 AM
On Thu, 23 Apr 2009 19:33:16 -0700 (PDT), cindys
> wrote:

>On Apr 23, 9:53*pm, Kolbard > wrote:
>> She's drinking water, urinating, and generally more active right now.
>> Earlier today, she was walking weirdly on her front legs, a sure sign
>> of low potassium levels. *We gave her part of a K+ pill this evening
>> (NOW Foods), and either it's a coincidence, or it's working. *
>
>snip
>------------
>Hopefully, it's working. I'm not sure what Phil's response will be to
>this, but when my sister's cat needed a potassium supplement, her vet
>told her to just go to the supermarket and buy a sodium substitute
>(one that contains potassium rather than sodium) and just sprinkle
>some on the cat's food (which is similar to what you've done). When I
>asked my vet about doing the same (when my cat needed a K+
>supplement), the answer I got was that the supermarket sold potassium
>chloride rather than potassium gluconate, and that was okay, but that
>I would need to do the math to ensure that my cat was getting an
>appropriate dose. So, to answer your question: I suspect that it would
>probably be better if your cat got the official K+ supplement but you
>needed to improvise and it's working fine.
>Best regards,
>---Cindy S.

It's potassium gluconate that we're giving her. I found a website
with table of brands and conversions, and it said to give 4/5ths of a
NOW pill.

Kolbard

cindys
April 24th 09, 01:37 PM
On Apr 23, 10:57*pm, Kolbard > wrote:
> Hmm, I read a bit more and this "knuckling" seems to be from high
> phosphorus levels rather than low potassium. *I gave her a couple of
> syringes of food/water mix just now, and a serving of AlternaGel. *She
> actually ate most of a cat treat, but it was one of the "bad" ones;
> perhaps tomorrow I'll look for low-protein ones.
----------------
There has never been any evidence to demonstrate that CRF cats do
better with a low protein diet. And cats needs protein. When Alex had
CRF, I kept him on a moderate protein/low phosphorus canned food diet
and he did very well for two years (his BUN and creatinine numbers
actually decreased) until he died from cancer. According to what
you've written, your kitty is barely eating. If she is willing to eat
these cat treats, then I would encourage her to eat them and not worry
about their protein content, if I were you.

Based on your description, it sounds like your cat's situation is
nearly exactly the same as the situation I had with a different one of
my cats (Molly) three years ago. Her numbers were sky high. She was
wobbly on her feet, drooling from nausea, barely eating. She had been
like that for weeks, and she was getting worse. But the confounding
factor was that she was still walking around and using her litter box.
She was still purring and wanted to be with me. She was still able to
jump up on the couch (just barely) to take a nap. She was still
willing to eat a little bit of meat out of my hand. I went to the
grocery store and spent $10 on a steak and shredded it, and she ate a
little bit from my hand. For 17 years, I had eaten with her, played
with her, scratched her ears, cuddled up with her at night. I loved
her so much. She was my heart song. I just couldn't bring myself to
give up on her. It was so hard to let her go.... But she was really
suffering. Cats are very stoic. It must have taken every fiber of
Molly's being to put up what little of a good front she could. I know
you didn't ask, and I know what I'm telling you is unsolicited.

When you have a cat whom you love as much as I loved Molly and as much
as you obviously love your cat, it's very hard to be objective. The
grief at the prospect of saying goodbye is unbearable, and when
they're gone, the guilt is tremendous; even though you did everything
humanly possible to try to save them, you will always be convinced
there was something you overlooked, something more you could have
done.

Based on your description, your cat is extremely ill. Even though you
are doing anything and everything possible to save her, there is a
point where there is nothing more you can do or where you can provide
some treatment that will slightly improve the situation for a few days
only to have it deteriorate again. As you make decisions for her, I'm
sure you haven't forgotten that it's not just about keeping your cat
alive; it's about her quality of life and ensuring that she's not
suffering in the process.

I know what it's like to go through all of this. Many hugs and
purrs...
Best regards,
---Cindy S.

Phil P.
April 25th 09, 01:25 AM
"cindys" > wrote in message
...
On Apr 23, 9:53 pm, Kolbard > wrote:
>> She's drinking water, urinating, and generally more active right now.
>> Earlier today, she was walking weirdly on her front legs, a sure sign
>> of low potassium levels. We gave her part of a K+ pill this evening
>> (NOW Foods), and either it's a coincidence, or it's working.

snip
------------
> Hopefully, it's working. I'm not sure what Phil's response will be to
> this, but when my sister's cat needed a potassium supplement, her vet
> told her to just go to the supermarket and buy a sodium substitute
> (one that contains potassium rather than sodium) and just sprinkle
> some on the cat's food (which is similar to what you've done). When I
> asked my vet about doing the same (when my cat needed a K+
> supplement), the answer I got was that the supermarket sold potassium
> chloride rather than potassium gluconate, and that was okay,


Hi Cindy,

Actually, giving potassium chloride to a cat with CRF isn't a good idea
because of its acidifying nature and potentional to promote acidosis. With
the BUN/Cr levels as high as they are, and K+ low as it is, she's probably
acidotic already. If she is acidotic- which I think there's a good chance
she is, potassium citrate would be better than potassium gluconate because
citrate has an alkalinizing effect. With potassium citrate, you can treat
hypokalemia and acidosis with one drug. The only problem is the risk of
overalkalinization because in most cases the doses of potassium needed to
bring K+ levels into the upper half of the normal range are usually a lot
higher than the doses of citrate needed to resolve acidosis. I think he
should stick with potassium gluconate and if his cat is acodic, treat the
acidosis with bicarbonate separately.


When the vet saw the BUN/Cr/K+ levels, I'm surprised she didn't at least
check the cat's blood pH and serum bicarbonate.


Phil

Phil P.
April 25th 09, 01:25 AM
"Kolbard" > wrote in message
...
> Hmm, I read a bit more and this "knuckling" seems to be from high
> phosphorus levels rather than low potassium.

I don't think so.

Phil P.
April 25th 09, 01:32 AM
"Kolbard" > wrote in message
...
>
> It's potassium gluconate that we're giving her. I found a website
> with table of brands and conversions, and it said to give 4/5ths of a
> NOW pill.

Stick to Turmil-K powder or gel- its easier to measure accurately. What dose
of K+ did your vet prescribe? My guess is your cat needs more than 2
mEq/day.

Kolbard
April 25th 09, 01:52 AM
On Sat, 25 Apr 2009 00:25:51 GMT, "Phil P." >
wrote:

>
>"Kolbard" > wrote in message
...
>> Hmm, I read a bit more and this "knuckling" seems to be from high
>> phosphorus levels rather than low potassium.
>
>I don't think so.
>

No? Is it from low potassium?

We managed to get her back on IV at the vet's clinic. We won't be
able to speak with the doc until tomorrow, but I'll definitely lobby
for a diuretic; the vet assistant mentioned that they will use it
under certain circumstances.

Kolbard

Phil P.
April 25th 09, 04:59 AM
"Kolbard" > wrote in message
...
> On Sat, 25 Apr 2009 00:25:51 GMT, "Phil P." >
> wrote:
>
> >
> >"Kolbard" > wrote in message
> ...
> >> Hmm, I read a bit more and this "knuckling" seems to be from high
> >> phosphorus levels rather than low potassium.
> >
> >I don't think so.
> >
>
> No? Is it from low potassium?

That's my guess.

>
> We managed to get her back on IV at the vet's clinic. We won't be
> able to speak with the doc until tomorrow, but I'll definitely lobby
> for a diuretic; the vet assistant mentioned that they will use it
> under certain circumstances.


I think a BUN of 171, creatinine of 7.9 and Pi of 19.7 qualifies as a
"certain circumstance", don't you?

Kolbard
April 25th 09, 08:53 AM
On Sat, 25 Apr 2009 03:59:22 GMT, "Phil P." >
wrote:

>
>"Kolbard" > wrote in message
...
>> On Sat, 25 Apr 2009 00:25:51 GMT, "Phil P." >
>> wrote:
>>
>> >
>> >"Kolbard" > wrote in message
>> ...
>> >> Hmm, I read a bit more and this "knuckling" seems to be from high
>> >> phosphorus levels rather than low potassium.
>> >
>> >I don't think so.
>> >
>>
>> No? Is it from low potassium?
>
>That's my guess.
>
>>
>> We managed to get her back on IV at the vet's clinic. We won't be
>> able to speak with the doc until tomorrow, but I'll definitely lobby
>> for a diuretic; the vet assistant mentioned that they will use it
>> under certain circumstances.
>
>
>I think a BUN of 171, creatinine of 7.9 and Pi of 19.7 qualifies as a
>"certain circumstance", don't you?
>
>

I do, but I don't know if the vet does. In any case, we're pushing
for it.

Kolbard

Phil P.
April 25th 09, 09:51 AM
"Kolbard" > wrote in message
...
> On Sat, 25 Apr 2009 03:59:22 GMT, "Phil P." >
> wrote:
>
> >
> >"Kolbard" > wrote in message
> ...
> >> On Sat, 25 Apr 2009 00:25:51 GMT, "Phil P." >
> >> wrote:
> >>
> >> >
> >> >"Kolbard" > wrote in message
> >> ...
> >> >> Hmm, I read a bit more and this "knuckling" seems to be from high
> >> >> phosphorus levels rather than low potassium.
> >> >
> >> >I don't think so.
> >> >
> >>
> >> No? Is it from low potassium?
> >
> >That's my guess.
> >
> >>
> >> We managed to get her back on IV at the vet's clinic. We won't be
> >> able to speak with the doc until tomorrow, but I'll definitely lobby
> >> for a diuretic; the vet assistant mentioned that they will use it
> >> under certain circumstances.
> >
> >
> >I think a BUN of 171, creatinine of 7.9 and Pi of 19.7 qualifies as a
> >"certain circumstance", don't you?
> >
> >
>
> I do, but I don't know if the vet does. In any case, we're pushing
> for it.

If I were you, I'd also push (I'd actually insist) she add a K+ supplement
to the fluids. Your cat's K+ is already low- fluid diuresis will lower her
K+ stores even further. Cats can die of complete muscle paralysis from fluid
diuresis if the body stores of K+ are already severely depleted. Also, if
your cat is acidotic, she'll need a taurine supplement, too. K+ depletion
with acidosis can cause reductions in taurine levels that can be fatal.

I'll be trapping all weekend so I might not get a chance to get back here
for a few days. If I can't, I want to wish you the best of luck.

Phil

Kolbard
April 25th 09, 10:16 AM
On Sat, 25 Apr 2009 08:51:12 GMT, "Phil P." >
wrote:
>If I were you, I'd also push (I'd actually insist) she add a K+ supplement
>to the fluids. Your cat's K+ is already low- fluid diuresis will lower her
>K+ stores even further. Cats can die of complete muscle paralysis from fluid
>diuresis if the body stores of K+ are already severely depleted. Also, if
>your cat is acidotic, she'll need a taurine supplement, too. K+ depletion
>with acidosis can cause reductions in taurine levels that can be fatal.
>
>I'll be trapping all weekend so I might not get a chance to get back here
>for a few days. If I can't, I want to wish you the best of luck.
>
>Phil

Thanks, Phil. I really appreciate this.

Kolbard

Kolbard
April 28th 09, 07:31 AM
Just an update.

We weren't even able to speak with a vet until today. They had her on
IV from Fri-Mon, but no diuretic. Some of her levels have gone down,
but they're still very much in the bad range:

ALB 4.3
ALP 21
ALT 48
AMY 2375 *
TBIL 0.2
BUN 131 *
CA 11.2
PHOS 10.3 *
CRE 5.4 *
GLU 116
NA+ 148
K+ 5.5
TP 7.2
GLOB 2.9

QC OK
HEM 0 LIP 1+ ICT 0

She did seem much more alert when we first brought her back this
evening, but she's been sleeping in a chair since then; she hasn't
eaten any of the prescribed food, and as far as I can tell, she hasn't
drank any water, although she that may be because she was hydrated.
She tried to eat some regular dry food; I'm still wrestling with the
idea of letting her eat it.

I asked if it would be possible to put her back on IV with a diuretic,
but the vet said it would be better for her to rest a couple of days,
and then maybe we could give her a diuretic ourselves (?!), and
possibly an IV at home. I really want to find a place that will treat
this aggressively, but I just don't know if driving to the next big
city is feasible. This sucks. I really don't know what to do at this
point, besides playing pin the tail on the donkey with the other
clinics in town.

Kolbard

Kolbard
April 28th 09, 09:51 PM
She ate a few spoonfuls of food today, so far.

I forgot to mention that we asked the vet about Tumil-K, and she
prescribed half a tablet twice a day.

On Tue, 28 Apr 2009 01:31:27 -0500, Kolbard
> wrote:

>Just an update.
>
>We weren't even able to speak with a vet until today. They had her on
>IV from Fri-Mon, but no diuretic. Some of her levels have gone down,
>but they're still very much in the bad range:
>
>ALB 4.3
>ALP 21
>ALT 48
>AMY 2375 *
>TBIL 0.2
>BUN 131 *
>CA 11.2
>PHOS 10.3 *
>CRE 5.4 *
>GLU 116
>NA+ 148
>K+ 5.5
>TP 7.2
>GLOB 2.9
>
>QC OK
>HEM 0 LIP 1+ ICT 0
>
>She did seem much more alert when we first brought her back this
>evening, but she's been sleeping in a chair since then; she hasn't
>eaten any of the prescribed food, and as far as I can tell, she hasn't
>drank any water, although she that may be because she was hydrated.
>She tried to eat some regular dry food; I'm still wrestling with the
>idea of letting her eat it.
>
>I asked if it would be possible to put her back on IV with a diuretic,
>but the vet said it would be better for her to rest a couple of days,
>and then maybe we could give her a diuretic ourselves (?!), and
>possibly an IV at home. I really want to find a place that will treat
>this aggressively, but I just don't know if driving to the next big
>city is feasible. This sucks. I really don't know what to do at this
>point, besides playing pin the tail on the donkey with the other
>clinics in town.
>
>Kolbard


Kolbard

cybercat
April 28th 09, 10:05 PM
"Kolbard" > wrote in message
...
> She ate a few spoonfuls of food today, so far.
>
> I forgot to mention that we asked the vet about Tumil-K, and she
> prescribed half a tablet twice a day.
>

I have nothing constructive to add, just wanted to say that I am sorry that
you and your girlycat have to go through this. I don't know about CRF, but
do know how hard it is for the ones who love them when they are feeling so
poorly and barely eating. Praying she rallies.

Kolbard
April 29th 09, 07:53 PM
We took her to a third vet today.

The vet said her kidneys were tiny and barely there. She's nothing
but skin and bone. The vet agreed to put her on IV to try and flush
out the toxins, but said the process would end up repeated, and we'd
likely end up in the same spot again.

Phil, what kind of diuretic do you refer to? This vet mentioned lasix
(sp.) but said she wouldn't use it, because the other IV fluids would
have to be increased and it would just cancel everything out, making
her kidneys worse. I don't know if that's true or not, but I know
that there isn't a vet in this town that thinks she could be saved.

I don't have much hope, but I thought it was worth a try. There's no
way we could afford to take her to Dallas, at least at this point, so
this is probably the last effort to save her life. I don't know what
else to do.

Kolbard

Phil P.
April 29th 09, 10:24 PM
"Kolbard" > wrote in message
...
> We took her to a third vet today.
>
> The vet said her kidneys were tiny and barely there. She's nothing
> but skin and bone. The vet agreed to put her on IV to try and flush
> out the toxins, but said the process would end up repeated, and we'd
> likely end up in the same spot again.

Boggles the mind... Once the uremic crisis is over, SQ fluid therapy at
home should keep her hydrated and azotemia under control.

Is your cat urinating ok- or better- a lot? Very important.


>
> Phil, what kind of diuretic do you refer to?

For initial intense diuresis, we use hypertonic dextrose (10% or 20%) or
furosemide (Lasix). Hypertonic dextrose is good because you' can check to
see if diruesis is beginning by simply checking the sugar in the urine with
a simple urine dipstick. It also supplies some calories and energy without
increasing the BUN.


This vet mentioned lasix
> (sp.) but said she wouldn't use it, because the other IV fluids would
> have to be increased and it would just cancel everything out, making
> her kidneys worse.

Unbelievable.... The purpose of intense diuresis is to flush uremic toxins
out of the blood *quickly* to resolve a uremic *crisis*. ID is a *lot* less
taxing on the kidneys than a uremic crisis and death.


I don't know if that's true or not, but I know
> that there isn't a vet in this town that thinks she could be saved.

If you plan to live with cats, you might want to consider moving to a town
that has conscientious and competent vets. A lot of vets know what to do-
but many just don't *want* to go through all the trouble when they can make
the same or a little less for doing a lot less. Also, a lot of small
practices aren't equipped to do much more than spays and neutering and minor
procedures. OTOH, a lot of vets are just plain lazy and indifferent-- and
some just don't like cats- that's a fact.


> I don't have much hope, but I thought it was worth a try. There's no
> way we could afford to take her to Dallas, at least at this point, so
> this is probably the last effort to save her life. I don't know what
> else to do.


You live in Texas? Great!! I wish I knew that earlier (I should have
asked). Call Dr. Steve Taylor ASAP. He used to be at the Animal Medical
Center in NYC- now he's at the Lexington Boulevard Animal Hospital in Sugar
Land,.Texas. Phone:(281) 980-3737 (24 hour). He's an ACVIM Diplomate in
internal medicine and an expert in Feline CRF and in fluid and intense
diuresis. If your bozo vet's ego isn't too big, maybe he could ask Dr.
Taylor to advise him how to proceed.

I'll try to get back a little later and respond to your other posts.

Keep the faith,

Phil

Kolbard
April 29th 09, 11:14 PM
On Wed, 29 Apr 2009 21:24:50 GMT, "Phil P." >
wrote:

>
>"Kolbard" > wrote in message
...
>> We took her to a third vet today.
>>
>> The vet said her kidneys were tiny and barely there. She's nothing
>> but skin and bone. The vet agreed to put her on IV to try and flush
>> out the toxins, but said the process would end up repeated, and we'd
>> likely end up in the same spot again.
>
>Boggles the mind... Once the uremic crisis is over, SQ fluid therapy at
>home should keep her hydrated and azotemia under control.
>
>Is your cat urinating ok- or better- a lot? Very important.
>
>
>>
>> Phil, what kind of diuretic do you refer to?
>
>For initial intense diuresis, we use hypertonic dextrose (10% or 20%) or
>furosemide (Lasix). Hypertonic dextrose is good because you' can check to
>see if diruesis is beginning by simply checking the sugar in the urine with
>a simple urine dipstick. It also supplies some calories and energy without
>increasing the BUN.
>
>
>This vet mentioned lasix
>> (sp.) but said she wouldn't use it, because the other IV fluids would
>> have to be increased and it would just cancel everything out, making
>> her kidneys worse.
>
>Unbelievable.... The purpose of intense diuresis is to flush uremic toxins
>out of the blood *quickly* to resolve a uremic *crisis*. ID is a *lot* less
>taxing on the kidneys than a uremic crisis and death.
>
>
> I don't know if that's true or not, but I know
>> that there isn't a vet in this town that thinks she could be saved.
>
>If you plan to live with cats, you might want to consider moving to a town
>that has conscientious and competent vets. A lot of vets know what to do-
>but many just don't *want* to go through all the trouble when they can make
>the same or a little less for doing a lot less. Also, a lot of small
>practices aren't equipped to do much more than spays and neutering and minor
>procedures. OTOH, a lot of vets are just plain lazy and indifferent-- and
>some just don't like cats- that's a fact.
>
>
>> I don't have much hope, but I thought it was worth a try. There's no
>> way we could afford to take her to Dallas, at least at this point, so
>> this is probably the last effort to save her life. I don't know what
>> else to do.
>
>
>You live in Texas? Great!! I wish I knew that earlier (I should have
>asked). Call Dr. Steve Taylor ASAP. He used to be at the Animal Medical
>Center in NYC- now he's at the Lexington Boulevard Animal Hospital in Sugar
>Land,.Texas. Phone:(281) 980-3737 (24 hour). He's an ACVIM Diplomate in
>internal medicine and an expert in Feline CRF and in fluid and intense
>diuresis. If your bozo vet's ego isn't too big, maybe he could ask Dr.
>Taylor to advise him how to proceed.
>
>I'll try to get back a little later and respond to your other posts.
>
>Keep the faith,
>
>Phil
>
>
>

Thank you, Phil, we will call him as soon as we can. I never even
thought about having a vet consult with a specialist over the phone.
As long as she's breathing, I don't want to give up now.

BTW, the previous vet even recommended something called a fleet enema
to bring the phosphorus down!!! I've never even heard of such a
thing, and the current vet almost seemed offended when we told her
about it. Just doing a quick Google Groups search (amazing any posts
show up at all since their search is nearly broken), it sounds
extremely dangerous and wrong. I'm in disbelief.

Kolbard

Phil P.
April 30th 09, 12:46 AM
"Kolbard" > wrote in message
...
> On Wed, 29 Apr 2009 21:24:50 GMT, "Phil P." >
> wrote:
>
> >
> >"Kolbard" > wrote in message
> ...
> >> We took her to a third vet today.
> >>
> >> The vet said her kidneys were tiny and barely there. She's nothing
> >> but skin and bone. The vet agreed to put her on IV to try and flush
> >> out the toxins, but said the process would end up repeated, and we'd
> >> likely end up in the same spot again.
> >
> >Boggles the mind... Once the uremic crisis is over, SQ fluid therapy at
> >home should keep her hydrated and azotemia under control.
> >
> >Is your cat urinating ok- or better- a lot? Very important.
> >
> >
> >>
> >> Phil, what kind of diuretic do you refer to?
> >
> >For initial intense diuresis, we use hypertonic dextrose (10% or 20%) or
> >furosemide (Lasix). Hypertonic dextrose is good because you' can check to
> >see if diruesis is beginning by simply checking the sugar in the urine
with
> >a simple urine dipstick. It also supplies some calories and energy
without
> >increasing the BUN.
> >
> >
> >This vet mentioned lasix
> >> (sp.) but said she wouldn't use it, because the other IV fluids would
> >> have to be increased and it would just cancel everything out, making
> >> her kidneys worse.
> >
> >Unbelievable.... The purpose of intense diuresis is to flush uremic
toxins
> >out of the blood *quickly* to resolve a uremic *crisis*. ID is a *lot*
less
> >taxing on the kidneys than a uremic crisis and death.
> >
> >
> > I don't know if that's true or not, but I know
> >> that there isn't a vet in this town that thinks she could be saved.
> >
> >If you plan to live with cats, you might want to consider moving to a
town
> >that has conscientious and competent vets. A lot of vets know what to do-
> >but many just don't *want* to go through all the trouble when they can
make
> >the same or a little less for doing a lot less. Also, a lot of small
> >practices aren't equipped to do much more than spays and neutering and
minor
> >procedures. OTOH, a lot of vets are just plain lazy and indifferent-- and
> >some just don't like cats- that's a fact.
> >
> >
> >> I don't have much hope, but I thought it was worth a try. There's no
> >> way we could afford to take her to Dallas, at least at this point, so
> >> this is probably the last effort to save her life. I don't know what
> >> else to do.
> >
> >
> >You live in Texas? Great!! I wish I knew that earlier (I should have
> >asked). Call Dr. Steve Taylor ASAP. He used to be at the Animal Medical
> >Center in NYC- now he's at the Lexington Boulevard Animal Hospital in
Sugar
> >Land,.Texas. Phone:(281) 980-3737 (24 hour). He's an ACVIM Diplomate in
> >internal medicine and an expert in Feline CRF and in fluid and intense
> >diuresis. If your bozo vet's ego isn't too big, maybe he could ask Dr.
> >Taylor to advise him how to proceed.
> >
> >I'll try to get back a little later and respond to your other posts.
> >
> >Keep the faith,
> >
> >Phil
> >
> >
> >
>
> Thank you, Phil, we will call him as soon as we can.

You should have called him right away- before you replied to my post.


I never even
> thought about having a vet consult with a specialist over the phone.
> As long as she's breathing, I don't want to give up now.
>
> BTW, the previous vet even recommended something called a fleet enema
> to bring the phosphorus down!!!

DOWN??? Holy ****! Fleet ememas are contraindicated in cats because they
cause *severe* *HYPER* phosphatemia* and *severe* hypocalemia both of which
can be fatal. Fleet enemas are what's called "sodium phosphate retention
enemas". This vet should be prosecuted! Who is this vet?
Print out this journal piece and staple it to the incompetent, inept,
*******'s forehead:"Am J Vet Res. 1985 Apr;46(4):980-8.

Clinical, biochemical, acid-base, and electrolyte abnormalities in cats
after
hypertonic sodium phosphate enema administration.

Atkins CE, Tyler R, Greenlee P.

Ten clinically healthy cats were allotted into 2 groups. Group A was given
the
low (60 ml), and group B was given the high (120 ml) recommended dose of a
commercial hypertonic sodium phosphate enema. Enema retention was enforced.
All
cats developed clinical and/or laboratory abnormalities, with group B cats
being
more severely affected. Clinical signs that occurred rapidly included
depression,
ataxia, vomition, bloody diarrhea, mucous membrane pallor, and stupor;
tetany was
not seen. One cat in group B died. Laboratory abnormalities included
hypernatremia, hyperphosphatemia, hypocalcemia, hyperglycemia, calculated
hyperosmolality, and metabolic acidosis with high anion gap probably due to
hyperlacticacidemia. There were no significant gross or microscopic lesions
associated with enema administration. Therefore, the use of hypertonic
sodium
phosphate enema at recommended doses is potentially dangerous to cats.


PMID: 4014852 [PubMed - indexed for MEDLINE]

Related Links

Electrolyte abnormalities induced by hypertonic phosphate enemas in two
cats. [J
Am Vet Med Assoc. 1985] PMID:4086355

[Life threatening metabolic disorders after application of a sodium
phosphate
containing enema in the dog and cat.] [Schweiz Arch Tierheilkd. 2001]
PMID:11407250

Severe hyperphosphatemia and hypocalcemia following the rectal
administration of
a phosphate-containing Fleet pediatric enema. [Pediatr Emerg Care. 2004]
PMID:15232246"




I've never even heard of such a
> thing, and the current vet almost seemed offended when we told her
> about it. Just doing a quick Google Groups search (amazing any posts
> show up at all since their search is nearly broken), it sounds
> extremely dangerous and wrong. I'm in disbelief.
>
> Kolbard

Kolbard
April 30th 09, 01:51 AM
On Wed, 29 Apr 2009 23:46:23 GMT, "Phil P." >
wrote:
>> Thank you, Phil, we will call him as soon as we can.
>
>You should have called him right away- before you replied to my post.
>

I called just now and he isn't in --- they told me he'll be there at
7:30 in the morning. They asked if it was an emergency and I told
them yes, and gave them my name and number. I'm an f'ing moron for
not calling as soon as I got it from you.

>>
>> BTW, the previous vet even recommended something called a fleet enema
>> to bring the phosphorus down!!!
>
>DOWN??? Holy ****! Fleet ememas are contraindicated in cats because they
>cause *severe* *HYPER* phosphatemia* and *severe* hypocalemia both of which
>can be fatal. Fleet enemas are what's called "sodium phosphate retention
>enemas". This vet should be prosecuted!

I'm still in disbelief, myself. Thanks for the article. Unthinkable.

>
>Clinical, biochemical, acid-base, and electrolyte abnormalities in cats
>after
>hypertonic sodium phosphate enema administration.
>
>Atkins CE, Tyler R, Greenlee P.
>
>Ten clinically healthy cats were allotted into 2 groups. Group A was given
>the
>low (60 ml), and group B was given the high (120 ml) recommended dose of a
>commercial hypertonic sodium phosphate enema. Enema retention was enforced.
>All
>cats developed clinical and/or laboratory abnormalities, with group B cats
>being
>more severely affected. Clinical signs that occurred rapidly included
>depression,
>ataxia, vomition, bloody diarrhea, mucous membrane pallor, and stupor;
>tetany was
>not seen. One cat in group B died. Laboratory abnormalities included
>hypernatremia, hyperphosphatemia, hypocalcemia, hyperglycemia, calculated
>hyperosmolality, and metabolic acidosis with high anion gap probably due to
>hyperlacticacidemia. There were no significant gross or microscopic lesions
>associated with enema administration. Therefore, the use of hypertonic
>sodium
>phosphate enema at recommended doses is potentially dangerous to cats.
>
>
>PMID: 4014852 [PubMed - indexed for MEDLINE]
>
>Related Links
>
> Electrolyte abnormalities induced by hypertonic phosphate enemas in two
>cats. [J
>Am Vet Med Assoc. 1985] PMID:4086355
>
> [Life threatening metabolic disorders after application of a sodium
>phosphate
>containing enema in the dog and cat.] [Schweiz Arch Tierheilkd. 2001]
>PMID:11407250
>
> Severe hyperphosphatemia and hypocalcemia following the rectal
>administration of
>a phosphate-containing Fleet pediatric enema. [Pediatr Emerg Care. 2004]
>PMID:15232246"
>
>
>
>

Kolbard

Kolbard
May 4th 09, 11:03 PM
Just another update....

She's been at the third vet clinic since last Wednesday; I don't know
all the numbers yet, but apparently her phosphorus is 7 and her
creatinine is 4. Still high, but definitely an improvement. Still, I
worry it's not enough. The vet is giving her phosphorus binders, and
said she's eating well. She's taking her off the IV and we're
supposed to pick her up tomorrow, with a SubQ regimen to follow.

Kolbard

Kolbard
May 5th 09, 11:54 PM
Got her back today.

They couldn't get her BUN to go down, but everything else went down a
little. They said she's eating like a pig, but she'll only eat
regular canned food (not K/D).

Her numbers:

ALB-PS = 2.8 g/dl
TP-PS = 7.3 g/dl
CRE-PS H
= 4.6 mg/dl
IP-PS H
= 7.7 mg/dl
BUN-PS >140.0 mg/dl (damn)
Ca-PS H
= 12.2 mg/dl

The vet said her calcium is high, which could be a sign of cancer, but
didn't see a point in poking around for it (I kind of agree).

She's on a Lactated Ringers Solution, 100ml every other day. I'm
afraid she'll crash again tomorrow and we'll be back to square one
again (with no money to spend), but I'll just have to wait and see.

I gave the vet Dr. Steve Taylor's number, but I highly doubt she
bothered to consult with him; she said she used a woman from Texas
A&M. I didn't trying calling him again (he was gone the first time)
because I didn't see a point in getting his advice when none of the
vets (apparently) will follow it.

Kolbard

Phil P.
May 6th 09, 10:38 PM
"Kolbard" > wrote in message
...
> Got her back today.
>
> They couldn't get her BUN to go down, but everything else went down a
> little. They said she's eating like a pig, but she'll only eat
> regular canned food (not K/D).
>
> Her numbers:
>
> ALB-PS = 2.8 g/dl
> TP-PS = 7.3 g/dl
> CRE-PS H
> = 4.6 mg/dl
> IP-PS H
> = 7.7 mg/dl
> BUN-PS >140.0 mg/dl (damn)
> Ca-PS H
> = 12.2 mg/dl
>
> The vet said her calcium is high, which could be a sign of cancer, but
> didn't see a point in poking around for it (I kind of agree).
>
> She's on a Lactated Ringers Solution, 100ml every other day. I'm
> afraid she'll crash again tomorrow and we'll be back to square one
> again (with no money to spend), but I'll just have to wait and see.
>
> I gave the vet Dr. Steve Taylor's number, but I highly doubt she
> bothered to consult with him; she said she used a woman from Texas
> A&M. I didn't trying calling him again (he was gone the first time)
> because I didn't see a point in getting his advice when none of the
> vets (apparently) will follow it.
>
> Kolbard

The vet works for you- you don't work for her. Call Dr. Taylor, if he says
he'll consult *tell* your vet to call him. If she balks, tell her its not a
request.

All the things that you're not doing or think you can't do for your cat now,
will haunt you for the rest of your life.

Kolbard
May 7th 09, 10:31 PM
On Wed, 06 May 2009 21:38:37 GMT, "Phil P." >
wrote:

>
>"Kolbard" > wrote in message
...
>> Got her back today.
>>
>> They couldn't get her BUN to go down, but everything else went down a
>> little. They said she's eating like a pig, but she'll only eat
>> regular canned food (not K/D).
>>
>> Her numbers:
>>
>> ALB-PS = 2.8 g/dl
>> TP-PS = 7.3 g/dl
>> CRE-PS H
>> = 4.6 mg/dl
>> IP-PS H
>> = 7.7 mg/dl
>> BUN-PS >140.0 mg/dl (damn)
>> Ca-PS H
>> = 12.2 mg/dl
>>
>> The vet said her calcium is high, which could be a sign of cancer, but
>> didn't see a point in poking around for it (I kind of agree).
>>
>> She's on a Lactated Ringers Solution, 100ml every other day. I'm
>> afraid she'll crash again tomorrow and we'll be back to square one
>> again (with no money to spend), but I'll just have to wait and see.
>>
>> I gave the vet Dr. Steve Taylor's number, but I highly doubt she
>> bothered to consult with him; she said she used a woman from Texas
>> A&M. I didn't trying calling him again (he was gone the first time)
>> because I didn't see a point in getting his advice when none of the
>> vets (apparently) will follow it.
>>
>> Kolbard
>
>The vet works for you- you don't work for her. Call Dr. Taylor, if he says
>he'll consult *tell* your vet to call him. If she balks, tell her its not a
>request.
>
>All the things that you're not doing or think you can't do for your cat now,
>will haunt you for the rest of your life.
>
>
>

We called around today and found several vets that will use hypertonic
dextrose. Our vet that we've been using claims that it "causes the
skin to slough." What's the deal?

Kolbard

Phil P.
May 8th 09, 03:38 PM
"Kolbard" > wrote in message
...
> We called around today and found several vets that will use hypertonic
> dextrose. Our vet that we've been using claims that it "causes the
> skin to slough." What's the deal?


Hypertonic dextrose is used *IV* during the initial treatment of a uremic
crisis- not for SC fluid therapy.

Has your vet checked your cat's blood pressure yet? CRF cats are at very
high risk of hypertensive retinopathy and retinal detachment.

Kolbard
May 28th 09, 08:36 AM
Just an update, since I haven't posted in a while....

I'm not holding my breath or anything, but she's been doing better
since we've had her on a Lactated Ringer's drip every other day
(100ml). She isn't her old self fully, but she is eating (*crosses
fingers*) and somewhat more active. She runs to the door when she
wants to go outside, and she shows interest in catnip socks. She
won't eat any CRF-specific food, but we give her a squirt of phosphate
binder with every meal. I'm just happy she's eating right now. She's
still peeing on the furniture, and I don't want to be too optimistic,
but we're just glad that she's much more alert and not so deathly sick
as she was.

Kolbard