Cat has CRF

"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. Phone281) 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

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

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

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

"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.

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

"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.

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