CRF in Alex

"Phil P." wrote in message
news:3vmMh.8563$EA.2265@trnddc07...

"cindys" wrote in message
...
-----------
BUN 54.2
Creatinine 2.1
Urine specific gravity 1017 (Normal 10/23)
Potassium is in the middle of the normal range.

FTR, the BUN was around 24 or 25 in December, so it doubled in just a few
months.

BUN is not as important as creatinine. What was his previous creatinine?

I don't remember the exact number, but I do remember that there was not a
significant change.


I questioned the vet quite a bit about the subcu fluids. She said that
while
it is true that the diseased nephrons can never recover, the subcu will
"open up tubules" and prevent more nephrons from being lost.


As her for a reference on that on....


She stated that
she has almost never failed to see improvement in lab values once the
subcu
fluids are started.


Its true that fluid therapy will impove renal parameters *acutely*, but it
should not be used chronically as a form of dialysis.


She said the low protein diet was less critical, and
that it would be no big deal to keep Alex on his current diet. She said
that
her plan, anyway, is to repeat his bloodwork in three to six months, and
then we can go from there.

I know you think I should still get a second opinion regarding the subcu
fluids. Do you know if it is possible for me to speak to someone at
Cornell?

You might want to give Dr. David J Polzin at U of Minn. a call @
612-625-4254. You can also send him an email @
He's one of the leading experts on CRF in cats. I don't think he'll
charge
you for his opinion.

Thank you, thank you!


I think the question at this stage is a simple yes/no, i.e., I would ask
the
second opinion vet whether he/she generally believes it's a good idea or
a
bad idea to start subcu fluids in a cat with early CRF. I don't think the
cat would need to be reexamined.

You're right.



I am going to start Alex on the Omega-3 (from fish) as you have advised.
I
intend to give that to Bullwinkle as well (for prevention). My vet
advised
against starting the potassium until Alex's values slip out of normal
range.
Right now, they are in the mid-range of normal.

I really think you should find another vet. The reason for supplementing
potassium is so Alex's potassium *doesn't* "slip out of normal range" and
to
protect tissue from potassium depletion. Blood or serum potassium levels
are not accurrate markers of the body's potassium stores because ~97% of
the
body's potassium is stored in *tissue* not in the blood or serum. By the
time potassium "slips out of normal range" potassium depletion has already
begun in the tissues. IOW, cats with normal serum potassium levels can
still
have deficient potassium levels in the tissue.

And being in the medical field myself, I should have known/remembered that.

"Interestingly, muscle potassium content has been shown to be decreased in
normokalemic cats with spontaneous CRF, indicating that a total body
deficit
of potassium may develop well before the onset of hypokalemia." (David J
Polzin, DVM, Dipl. ACVIM)



Does all of this seem like a reasonable plan to you?

Dump your vet *now* before its too late.

We've been going to this office for years. We were previously seeing a
different vet in the same office who left for a different practice (a much
further drive and very limited hours). It's also going to be hard because
the vet has become somewhat of a personal friend, the office is near our
house, it's staffed 24/7, it has overnight boarding, and a hospital, etc.
Most of the other vet hospitals around here don't offer all of this. In
spite of all of that, I am willing to change to another vet, but how will I
know that the new vet will be better than the old one? One way, was I was
thinking of phoning a particular Cats Only practice and asking them how they
would treat my cat's CRF and see what they say. Or I could say "I was
thinking of doing this (naming what my vet had suggested), do you think
that's a good idea?"

Again, Phil, thank you so much.
Best regards,
---Cindy S.


Btw, Pepcid was a good idea. Uremia can cause uremic gastritis.


Thanks in advance.
Best regards,
---Cindy S.

Best of luck,

Phil

"cindys" wrote:


Dump your vet *now* before its too late.

We've been going to this office for years. We were previously seeing a
different vet in the same office who left for a different practice (a much
further drive and very limited hours). It's also going to be hard because
the vet has become somewhat of a personal friend, the office is near our
house, it's staffed 24/7, it has overnight boarding, and a hospital, etc.
Most of the other vet hospitals around here don't offer all of this. In
spite of all of that, I am willing to change to another vet, but how will I
know that the new vet will be better than the old one? One way, was I was
thinking of phoning a particular Cats Only practice and asking them how they
would treat my cat's CRF and see what they say. Or I could say "I was
thinking of doing this (naming what my vet had suggested), do you think
that's a good idea?"

Is your vet open to exchange of ideas and other opinions? Perhaps
Phil's advice may sound logical to your vet and he will modify his
recommendation.

wrote in message
...
"cindys" wrote:


Dump your vet *now* before its too late.

We've been going to this office for years. We were previously seeing a
different vet in the same office who left for a different practice (a much
further drive and very limited hours). It's also going to be hard because
the vet has become somewhat of a personal friend, the office is near our
house, it's staffed 24/7, it has overnight boarding, and a hospital, etc.
Most of the other vet hospitals around here don't offer all of this. In
spite of all of that, I am willing to change to another vet, but how will
I
know that the new vet will be better than the old one? One way, was I was
thinking of phoning a particular Cats Only practice and asking them how
they
would treat my cat's CRF and see what they say. Or I could say "I was
thinking of doing this (naming what my vet had suggested), do you think
that's a good idea?"

Is your vet open to exchange of ideas and other opinions? Perhaps
Phil's advice may sound logical to your vet and he will modify his
recommendation.
-------
Well, she'll go along with what I think is best for Alex, i.e., she's not
going to give me an argument about what I want to do, but that's not the
same as modifying her recommendation. When I told her that I didn't think I
wanted to change the food to NF, she said fine. When I asked about the
omega-3 and potassium, she said fine to omega-3 but advised against the
potassium for the reasons, stated etc. And if I speak to Dr. Prozin (I have
e-mailed and also left him a phone message), and he agrees with Phil, and I
tell her I don't want to initiate subcu fluids, she will say okay to that
too. But I don't think that's the issue.

I think the real issue here is that I have five cats, all of whom are her
patients. After this, will I still have confidence in her abilities, as a
whole? What happens when my next cat gets sick with something else? Am I
always going to be second guessing this doctor? That's really the issue at
hand. I have already made an appointment to get a second opinion at another
veterinary practice. Once I hear the other doctor's opinion and Dr. Prozin's
opinion, I will decide what I want to do. I lost another cat (Molly) to CRF
last October. The vet whom we were seeing during most of that time (the one
who moved to a more distant practice) never once suggested putting Molly on
subcu fluids until she was in acute renal failure at the end (as Phil said).
OTOH, she also never suggested omega-3, potassium supplementation at any
point. She did suggest the K/D food at some point in the middle but Molly
wouldn't eat it, so that was a moot point. My husband feels that overall she
was a better vet than this one. But was she really? Who knows? The reality
is that at some point down the road, Alex will die from CRF. No matter when
that happens, I will never know for sure if the interventions (any of them)
actually prolonged his life or shortened it. How can I know for sure if he
would have lived for six months more or six months less if only I had done
this or hadn't done that?
Best regards,
---Cindy S.

"cindys" wrote in message
...

snip
And if I speak to Dr. Prozin (I have e-mailed and also left him a phone
message),

----
Dr. Polzin, not Prozin. I did get it right on the phone message and e-mail
however.
Best regards,
---Cindy S.

"cindys" wrote in message
...

We've been going to this office for years. We were previously seeing a
different vet in the same office who left for a different practice (a much
further drive and very limited hours). It's also going to be hard because
the vet has become somewhat of a personal friend,


I realize switching vets or even getting a second opinion can make you feel
uncomfortable- especially if you have a close relationship with your vet.
However, I think your first loyalty should be to your cat, not to your vet.
You have to ask yourself "is this vet doing the best thing for my cat?".
From what you said she said, I'd have to say no. Just because she says she
has treated cats with CRF before doesn't mean she's good at it. Sounds like
she's mediocre at best.



the office is near our
house, it's staffed 24/7, it has overnight boarding, and a hospital, etc.
Most of the other vet hospitals around here don't offer all of this. In
spite of all of that, I am willing to change to another vet, but how will
I
know that the new vet will be better than the old one?

I know what you mean. You could go from bad to worse. If you have a vet
college near you, you might want to give them a call for a referral or you
could do a search for a ACVIM diplomate or ABVP feline specialist in your
area. They have much more training and experience. Very few general
practioners are really knowledgable about treating CRF. Renal diets and
fluid therapy are about the extent of their experience.



One way, was I was
thinking of phoning a particular Cats Only practice and asking them how
they
would treat my cat's CRF and see what they say. Or I could say "I was
thinking of doing this (naming what my vet had suggested), do you think
that's a good idea?"


I don't think a vet will give you a specific recommendations for a treatment
plan without seeing your cat.

If your email is working I can send you a very good file about CRF and the
importance of potassium.


Best of luck,

Phil

"Phil P." wrote in message
news:1cMMh.12704$e47.1204@trnddc05...

"cindys" wrote in message
...

We've been going to this office for years. We were previously seeing a
different vet in the same office who left for a different practice (a
much
further drive and very limited hours). It's also going to be hard because
the vet has become somewhat of a personal friend,


I realize switching vets or even getting a second opinion can make you
feel
uncomfortable- especially if you have a close relationship with your vet.

Hi, Phil! I'm bringing Alex to a different veterinary practice for a second
opinion on Monday.

However, I think your first loyalty should be to your cat, not to your
vet.
You have to ask yourself "is this vet doing the best thing for my cat?".
From what you said she said, I'd have to say no. Just because she says
she
has treated cats with CRF before doesn't mean she's good at it. Sounds
like
she's mediocre at best.

Thank you so much for the phone number and e-mail for Dr. Polzin. I have
been in touch with him. Basically, what he said was that it would be
unethical for him to provide a treatment plan for my cat. I wasn't really
asking him to do that, but since I did provide him with the lab values and
Alex's medical history, I can see why he would have interpreted it that way.

He said that he thinks some of my vet's suggestions are "optional," but he
disagreed that I needed to switch to a different veterinarian. He said he
would be willing to act as a consultant and communicate with the current
veterinarian directly if she were open to that (and I initiated that). I
thought that was incredibly kind.


the office is near our
house, it's staffed 24/7, it has overnight boarding, and a hospital, etc.
Most of the other vet hospitals around here don't offer all of this. In
spite of all of that, I am willing to change to another vet, but how will
I
know that the new vet will be better than the old one?

I know what you mean. You could go from bad to worse. If you have a vet
college near you, you might want to give them a call for a referral or you
could do a search for a ACVIM diplomate or ABVP feline specialist in your
area. They have much more training and experience. Very few general
practioners are really knowledgable about treating CRF. Renal diets and
fluid therapy are about the extent of their experience.

We have a *veterinary specialist* group. It is by referral from the primary
vet only. There are five specialists, none of whom is specifically for
renal. Two are for ophthalmology, one is for orthopedics, one may be
cardiology, one is surgery. But one of them (I can't remember which one) did
complete a renal residency, so I would try to see him. I have made an
appointment to get a second opinion from a different (general) vet on
Monday. Depending on how things go, I could ask her for a referral to the
specialist. Actually, what I would prefer to do is to make a photocopy of
the article you e-mailed me and present it to my current vet. Can you
reference for me any articles specifically about the subcu fluids? (Unless
the subject is addressed in the article you already e-mailed me- I just
turned on my computer five minutes ago and haven't read the potassium
article yet).

One way, was I was
thinking of phoning a particular Cats Only practice and asking them how
they
would treat my cat's CRF and see what they say. Or I could say "I was
thinking of doing this (naming what my vet had suggested), do you think
that's a good idea?"


I don't think a vet will give you a specific recommendations for a
treatment
plan without seeing your cat.

I have an appointment on Monday.

If your email is working I can send you a very good file about CRF and the
importance of potassium.

I got it. Thank you! I will ensure that Alex starts on potassium. Do you
have an article about subcu fluid treatment in early CRF?
Thank you again for all of your help. Yesterday, I was wreck, but after
communicating with you and Dr. Polzin, I am starting to feel better. I think
my next step is to e-mail back to Dr. Polzin and asked him what he thinks
about subcu fluid treatment in early CRF *in general* and thereby he won't
feel that I am asking him to write a treatment plan for my cat (which I
really wasn't).

Again, thank you again for all of your help and for e-mailing me that
article. I will keep you updated as I go along.
Best regards,
---Cindy S.

"cindys" wrote in message
...


Hi, Phil! I'm bringing Alex to a different veterinary practice for a
second
opinion on Monday.


Hi Cindi, I'm glad to hear it. You made a wise decision.


Thank you so much for the phone number and e-mail for Dr. Polzin.

You're welcome.


I have
been in touch with him. Basically, what he said was that it would be
unethical for him to provide a treatment plan for my cat. I wasn't really
asking him to do that, but since I did provide him with the lab values and
Alex's medical history, I can see why he would have interpreted it that
way.

He said that he thinks some of my vet's suggestions are "optional," but he
disagreed that I needed to switch to a different veterinarian.


I think that was just a professional courtesy. He's a very nice person.

It was bad enough that your vet didn't recommend a K+ supplement to protect
Alex's body's K+ stores, she should have definitely recommended a K+
supplement when she recommended fluid therapy. Cats with CRF produce more
urine and urinate more frequently
because they lose their ability to concentrate urine. Producing urine
rapidly and frequently promotes potassium loss-- fluid therapy induces
diuresis which increases rapid urine formation and thus even greater K+
losses. That's why most vets and human doctors prescribe a K+
supplement whenever they prescribe a diuretic. I think she erred at a very
basic level- which is inexcusable as far as I'm concerned. I couldn't trust
a vet who made such a basic error with my cats' lives. I see it as an early
waning sign to find another vet with more experience in treating CRF. Alex
can't afford to have a vet that learns by trial and error on him.


He said he
would be willing to act as a consultant and communicate with the current
veterinarian directly if she were open to that (and I initiated that). I
thought that was incredibly kind.

That's why I suggested you contact him. He's a very kind person and he
really cares about the animals' well-being.



We have a *veterinary specialist* group. It is by referral from the
primary
vet only. There are five specialists, none of whom is specifically for
renal. Two are for ophthalmology, one is for orthopedics, one may be
cardiology, one is surgery. But one of them (I can't remember which one)
did
complete a renal residency, so I would try to see him. I have made an
appointment to get a second opinion from a different (general) vet on
Monday. Depending on how things go, I could ask her for a referral to the
specialist.

It would be great if you could find a general vet who has a special interest
in nephrology- or at least CRF- and is up to date on current treatments.


Actually, what I would prefer to do is to make a photocopy of
the article you e-mailed me and present it to my current vet.

Here's another quote about potassium by Gary Norsworthy (excerpted from
Feline Practice):

"Recently, two important discoveries have been made concerning potassium and
older cats. A mild form of hypokalemia (low blood potassium) has been
identified in the older cat; it is associated with lethargy and inactivity,
a poor appetite and haircoat, and the development of a mild anemia.
Formerly, we have considered these to be part of the aging process. Now we
know that this process can be reversed with supplementation of potassium.
Unfortunately, we do not have a test to conclusively identify these cats
because the blood test for potassium is a poor reflection of the body's
total store of potassium. Blood potassium may be normal in cats who are
actually depleted of potassium within their body's cells. For these cats, a
30 to 45 day trial of potassium is necessary. If response occurs and
potassium supplementation is continued, the cat will continue to feel, act,
and eat better and will live longer.



The second discovery about low blood potassium is related to the effect of
potassium on the kidneys. The kidneys are the organs that usually wear out
first in the older cat. As the kidneys become less efficient in removing
waste products from the blood, the cat drinks more and more water in an
attempt to flush toxins from the body (via the kidneys). An undesired
consequence of increased urination is the loss of potassium from the body in
the urine. As urine production increases, more and more potassium is lost,
eventually leading to hypokalemia. The potassium loss associated with
increased urine production has a negative effect on the kidneys. Research
has demonstrated that low potassium will depress kidney function. This
results in a vicious cycle: declining kidney function results in increased
loss of potassium, and the loss of potassium then speeds up the
deterioration of the kidneys."



Do you see why its very dangerous to wait until Alex's K+ values "slip out
of the normal range"?



Can you
reference for me any articles specifically about the subcu fluids? (Unless
the subject is addressed in the article you already e-mailed me- I just
turned on my computer five minutes ago and haven't read the potassium
article yet).

Sure. Here's a quote by Dr. Kathy James- the Urology/Nephrology Consultant
for VIN:

"There are certainly some theoretical reasons why prolonged diuresis could
promote progression. The elevated glomerular filtration rate could be
associated with hypertension in the kidney itself. Also diuresis will result
in more Na+ filtered that has to be reabsorbed and more energy consumed by
the kidney.
More energy consumed means more O2 burned and more O2 metabolites the kidney
has to process. Just some theoretical reasons why we need to
start SQ fluids when crf cats are at risk for dehydration but not before."

Here's a link to a chart on my site that shows you how to calculate the
amount of fluid to administer at different levels of dehydration:

http://maxshouse.com/Calculation_of_...y dration.htm


I got it. Thank you! I will ensure that Alex starts on potassium. Do you
have an article about subcu fluid treatment in early CRF?
Thank you again for all of your help. Yesterday, I was wreck, but after
communicating with you and Dr. Polzin, I am starting to feel better. I
think
my next step is to e-mail back to Dr. Polzin and asked him what he thinks
about subcu fluid treatment in early CRF *in general* and thereby he won't
feel that I am asking him to write a treatment plan for my cat (which I
really wasn't).
Again, thank you again for all of your help and for e-mailing me that
article.

I'll send you Drs. Polzin & Osborne chapter on CRF from the lastest edition
(6th) of Ettinger's TBVIM. You won't find a better paper on CRF anywhere.



I will keep you updated as I go along.

Please cc a copy of your updates to my email (topcatATmaxshouseDOTcom). With
kitten season beginning I have even less time to follow the group.


Best regards,
---Cindy S.

Best of luck,

Phil

Hi Cindy,

Just wondering how Alex is doing. Did he see the second vet today? I hope
all is well.

Bonnie


"cindys" wrote in message
...

"Phil P." wrote in message
news:1cMMh.12704$e47.1204@trnddc05...

"cindys" wrote in message
...

We've been going to this office for years. We were previously seeing a
different vet in the same office who left for a different practice (a
much
further drive and very limited hours). It's also going to be hard
because
the vet has become somewhat of a personal friend,


I realize switching vets or even getting a second opinion can make you
feel
uncomfortable- especially if you have a close relationship with your vet.

Hi, Phil! I'm bringing Alex to a different veterinary practice for a
second opinion on Monday.

However, I think your first loyalty should be to your cat, not to your
vet.
You have to ask yourself "is this vet doing the best thing for my cat?".
From what you said she said, I'd have to say no. Just because she says
she
has treated cats with CRF before doesn't mean she's good at it. Sounds
like
she's mediocre at best.

Thank you so much for the phone number and e-mail for Dr. Polzin. I have
been in touch with him. Basically, what he said was that it would be
unethical for him to provide a treatment plan for my cat. I wasn't really
asking him to do that, but since I did provide him with the lab values and
Alex's medical history, I can see why he would have interpreted it that
way.

He said that he thinks some of my vet's suggestions are "optional," but he
disagreed that I needed to switch to a different veterinarian. He said he
would be willing to act as a consultant and communicate with the current
veterinarian directly if she were open to that (and I initiated that). I
thought that was incredibly kind.


the office is near our
house, it's staffed 24/7, it has overnight boarding, and a hospital,
etc.
Most of the other vet hospitals around here don't offer all of this. In
spite of all of that, I am willing to change to another vet, but how
will
I
know that the new vet will be better than the old one?

I know what you mean. You could go from bad to worse. If you have a vet
college near you, you might want to give them a call for a referral or
you
could do a search for a ACVIM diplomate or ABVP feline specialist in your
area. They have much more training and experience. Very few general
practioners are really knowledgable about treating CRF. Renal diets and
fluid therapy are about the extent of their experience.

We have a *veterinary specialist* group. It is by referral from the
primary vet only. There are five specialists, none of whom is specifically
for renal. Two are for ophthalmology, one is for orthopedics, one may be
cardiology, one is surgery. But one of them (I can't remember which one)
did complete a renal residency, so I would try to see him. I have made an
appointment to get a second opinion from a different (general) vet on
Monday. Depending on how things go, I could ask her for a referral to the
specialist. Actually, what I would prefer to do is to make a photocopy of
the article you e-mailed me and present it to my current vet. Can you
reference for me any articles specifically about the subcu fluids? (Unless
the subject is addressed in the article you already e-mailed me- I just
turned on my computer five minutes ago and haven't read the potassium
article yet).

One way, was I was
thinking of phoning a particular Cats Only practice and asking them how
they
would treat my cat's CRF and see what they say. Or I could say "I was
thinking of doing this (naming what my vet had suggested), do you think
that's a good idea?"


I don't think a vet will give you a specific recommendations for a
treatment
plan without seeing your cat.

I have an appointment on Monday.

If your email is working I can send you a very good file about CRF and
the
importance of potassium.

I got it. Thank you! I will ensure that Alex starts on potassium. Do you
have an article about subcu fluid treatment in early CRF?
Thank you again for all of your help. Yesterday, I was wreck, but after
communicating with you and Dr. Polzin, I am starting to feel better. I
think my next step is to e-mail back to Dr. Polzin and asked him what he
thinks about subcu fluid treatment in early CRF *in general* and thereby
he won't feel that I am asking him to write a treatment plan for my cat
(which I really wasn't).

Again, thank you again for all of your help and for e-mailing me that
article. I will keep you updated as I go along.
Best regards,
---Cindy S.

Same here. I haven't been posting, but I have been following this one
Cindy.
I really hope that all goes well with the second vet too.

S;o)

On Sun, 25 Mar 2007 10:16:24 GMT, Phil P. wrote:

"cindys" wrote in message
...


Hi, Phil! I'm bringing Alex to a different veterinary practice for a
second
opinion on Monday.


Hi Cindi, I'm glad to hear it. You made a wise decision.


Thank you so much for the phone number and e-mail for Dr. Polzin.

You're welcome.


I have
been in touch with him. Basically, what he said was that it would be
unethical for him to provide a treatment plan for my cat. I wasn't really
asking him to do that, but since I did provide him with the lab values and
Alex's medical history, I can see why he would have interpreted it that
way.

He said that he thinks some of my vet's suggestions are "optional," but he
disagreed that I needed to switch to a different veterinarian.


I think that was just a professional courtesy. He's a very nice person.

It was bad enough that your vet didn't recommend a K+ supplement to protect
Alex's body's K+ stores, she should have definitely recommended a K+
supplement when she recommended fluid therapy. Cats with CRF produce more
urine and urinate more frequently
because they lose their ability to concentrate urine. Producing urine
rapidly and frequently promotes potassium loss-- fluid therapy induces
diuresis which increases rapid urine formation and thus even greater K+
losses. That's why most vets and human doctors prescribe a K+
supplement whenever they prescribe a diuretic. I think she erred at a very
basic level- which is inexcusable as far as I'm concerned. I couldn't trust
a vet who made such a basic error with my cats' lives. I see it as an early
waning sign to find another vet with more experience in treating CRF. Alex
can't afford to have a vet that learns by trial and error on him.


He said he
would be willing to act as a consultant and communicate with the current
veterinarian directly if she were open to that (and I initiated that). I
thought that was incredibly kind.

That's why I suggested you contact him. He's a very kind person and he
really cares about the animals' well-being.



We have a *veterinary specialist* group. It is by referral from the
primary
vet only. There are five specialists, none of whom is specifically for
renal. Two are for ophthalmology, one is for orthopedics, one may be
cardiology, one is surgery. But one of them (I can't remember which one)
did
complete a renal residency, so I would try to see him. I have made an
appointment to get a second opinion from a different (general) vet on
Monday. Depending on how things go, I could ask her for a referral to the
specialist.

It would be great if you could find a general vet who has a special interest
in nephrology- or at least CRF- and is up to date on current treatments.


Actually, what I would prefer to do is to make a photocopy of
the article you e-mailed me and present it to my current vet.

Here's another quote about potassium by Gary Norsworthy (excerpted from
Feline Practice):

"Recently, two important discoveries have been made concerning potassium and
older cats. A mild form of hypokalemia (low blood potassium) has been
identified in the older cat; it is associated with lethargy and inactivity,
a poor appetite and haircoat, and the development of a mild anemia.
Formerly, we have considered these to be part of the aging process. Now we
know that this process can be reversed with supplementation of potassium.
Unfortunately, we do not have a test to conclusively identify these cats
because the blood test for potassium is a poor reflection of the body's
total store of potassium. Blood potassium may be normal in cats who are
actually depleted of potassium within their body's cells. For these cats, a
30 to 45 day trial of potassium is necessary. If response occurs and
potassium supplementation is continued, the cat will continue to feel, act,
and eat better and will live longer.



The second discovery about low blood potassium is related to the effect of
potassium on the kidneys. The kidneys are the organs that usually wear out
first in the older cat. As the kidneys become less efficient in removing
waste products from the blood, the cat drinks more and more water in an
attempt to flush toxins from the body (via the kidneys). An undesired
consequence of increased urination is the loss of potassium from the body in
the urine. As urine production increases, more and more potassium is lost,
eventually leading to hypokalemia. The potassium loss associated with
increased urine production has a negative effect on the kidneys. Research
has demonstrated that low potassium will depress kidney function. This
results in a vicious cycle: declining kidney function results in increased
loss of potassium, and the loss of potassium then speeds up the
deterioration of the kidneys."



Do you see why its very dangerous to wait until Alex's K+ values "slip out
of the normal range"?



Can you
reference for me any articles specifically about the subcu fluids? (Unless
the subject is addressed in the article you already e-mailed me- I just
turned on my computer five minutes ago and haven't read the potassium
article yet).

Sure. Here's a quote by Dr. Kathy James- the Urology/Nephrology Consultant
for VIN:

"There are certainly some theoretical reasons why prolonged diuresis could
promote progression. The elevated glomerular filtration rate could be
associated with hypertension in the kidney itself. Also diuresis will result
in more Na+ filtered that has to be reabsorbed and more energy consumed by
the kidney.
More energy consumed means more O2 burned and more O2 metabolites the kidney
has to process. Just some theoretical reasons why we need to
start SQ fluids when crf cats are at risk for dehydration but not before."

Here's a link to a chart on my site that shows you how to calculate the
amount of fluid to administer at different levels of dehydration:

http://maxshouse.com/Calculation_of_...y dration.htm


I got it. Thank you! I will ensure that Alex starts on potassium. Do you
have an article about subcu fluid treatment in early CRF?
Thank you again for all of your help. Yesterday, I was wreck, but after
communicating with you and Dr. Polzin, I am starting to feel better. I
think
my next step is to e-mail back to Dr. Polzin and asked him what he thinks
about subcu fluid treatment in early CRF *in general* and thereby he won't
feel that I am asking him to write a treatment plan for my cat (which I
really wasn't).
Again, thank you again for all of your help and for e-mailing me that
article.

I'll send you Drs. Polzin & Osborne chapter on CRF from the lastest edition
(6th) of Ettinger's TBVIM. You won't find a better paper on CRF anywhere.



I will keep you updated as I go along.

Please cc a copy of your updates to my email (topcatATmaxshouseDOTcom). With
kitten season beginning I have even less time to follow the group.


Best regards,
---Cindy S.

Best of luck,

Phil

Hi Phil,

Is there a risk of a CRF cat getting too much potassium? I have a very
early stage CRF cat (16 years old) he does not appear to drink or pee
excessively, though. His first test results we

Bun 42 mg/dl (Lab normal 16 - 36)
Creat 2.9 mg/dl (Lab normal 0.8 - 2.4)

I will be taking him back in for follow up blood work. He appears to be
doing well on NF food, though.

Thanks for all your wonderful info, I will be discussing this with my vet.

Patty