Bella – Frightening kidney values

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Does this help?
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Alicia2022 said:
Thank you, Suzanne! And I have a similar tablecloth :)
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yes, it’s one of those cotton woven tablecloths … homespun they’re called, I think? My friend gave me that chart a few years back when I needed it, and she loaned me some aluminum hydroxide powder. She sometimes acts as a moderator on the felinecrf group.
 
Suzanne & Darcy said:
yes, it’s one of those cotton woven tablecloths … homespun they’re called, I think?
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Oh, I learned a new word!
Suzanne & Darcy said:
My friend gave me that chart a few years back when I needed it, and she loaned me some aluminum hydroxide powder. She sometimes acts as a moderator on the felinecrf group.
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Many thanks to you and your friend.
We're going to see a new vet on Saturday, I just posted on the ckd group with questions and a bit of freaking out.
 
I think, if there's a chance of her staying at the new vet, you should bring the ProZinc because they may not have it on hand. I always took Darcy's insulin with me when he had to stay. First it was ProZinc (which the ER vet did not have on hand) and then it was Lantus and then Levemir (neither of which did they have at the ER vet or at my regular vet.)
 
I'm not sure if I would repeat bloodwork either (as someone on the kidney group said.) I would bring the bloodwork that you had done with me. I would also bring her whole record from the other vets. They may insist on seeing new bloodwork, but it's probably too soon to see changes in it. Definitely get them to check the Blood Pressure to make sure (hopefully to rule out hypertension.) The part that bothers me is that you said she doesn't really even want to get up to eat? She's eating lying down? Is she eating a normal amount? No more mouth pawing? Any more teeth chattering? Did you start the phosphorus binders? And you are still giving Cerenia and Ondansetron? (can't remember actually if you started Ondansetron, but definitely you did give Cerenia and it seemed to help.) Is she still having problems walking? With a phosphorus of 17 (which it was before you said) that can cause hind leg weakness. I'm sure you are very nervous about tomorrow.
 
Thank you, Suzanne. We’ll take Prozinc and her favorite food with us tomorrow.

Yes, Bella is mostly eating lying down. I mean, if we try to make her stand to eat, she does stand for a bit. She eats ½ to 2/3 of her usual food intake. She’s paving and grinding her teeth after a few bites when eating pate without water added. As soon as she starts doing it, we switch to “pate soup” instead.

She walks to her litter box and then back to her den and this is it. On a sunny day (two days ago) she was more active and demanded to go outside and eat grass. A few days ago she made it to the second floor bedroom but then didn't seem to have strength to jump on the bed.

Today she was lying in her litter box. Twice. Produced a tiny poop once. Yes, we started the phos binder so I guess she’s now constipated. I’ve ordered Miralax, should arrive tomorrow.

Cerenia seemed to help for a few days but now I’m not sure if it’s working.
 
Hospitalized Bella today. Bloodwork looks rather hopeless.
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SDMA 69.
Blood pressure: 105/86 (92)
95/42 (73)
88/59 (69)

We brought her upstairs for the night and that was a mistake because her litter box was too far away and she ended up peeing on the bed in the morning. Then we noticed that her back legs are barely holding her.
I choose this vet because she’s a dental specialist and two days ago things still looked like we might consider doing a dental. So the vet was surprised with Bella’s bad shape and it seemed at first she doesn’t know what to do. This vet does not think it make sense to give Bella antibiotics at this point.
Only IV (with vitamin B complex added).
Because of Bella’s heart murmur they can’t be too aggressive in treatment.
They promised oral bupe. Didn’t want to give her an injection because she never had it before. Does it make sense?
 

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Were you able to bring a phos binder to the vet? I think it could help kitty feel a bit more comfortable
 
Got a call from the hospital. Told them about rechecking the bloodwork and urinalysis. They say Bella is eating and alert. I'm going there soon to visit.
BUT
They put a Libre on her and she maintains numbers between 150 and 190 and they say she does not need insulin with these numbers because they're afraid she drops too low. What should I do? This hospital is the only emergency options around here. Her recent doses of Prozinc were 0.25 u under 200 and 0.5 units over 200 (because of her limited food intake).
 
Alicia2022 said:
They put a Libre on her and she maintains numbers between 150 and 190 and they say she does not need insulin with these numbers
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A Libre sensor can be off quite a bit from ear pricks. I would check @home with ear prick and compare with the Libre. THe Libre reading can be higher orm lower than ear prick. I had one sensor that switched which one was higher about halfway through the sensor's 14 day life. Do you have a means of reading the Libre? Which Libre? The old 14 day, the newer Libre 2 or the newest Libre 3?

I myself would say 150-190 may need insulin depending upon how BG is over the day. If it drops lower then I would give a little insulin,n in your case a very little insulin.
 
So you are saying that they are not giving her insulin while she is there? Because they say she doesn’t need it? Well I do not agree that she doesn’t need it, but your priority for now is to get her stabilized so she can go home. If she’s really not getting out of blue numbers then maybe it will be okay for a few days. I have found that they really don’t check the cats BG as much as I would like while they’re in ER care. So maybe it’s just as well.
 
Visited Bella. We checked her BG with ReliOn and it's 164 , 30 hours after her injection yesterday morning. She's eating, but I suspect she's only doing it for us. I don't like that her third eyelids are visible (I kinda noticed it yesterday, before she was admitted, but today they're more visible.
 
Darcy’s third eyelid was visible when he had an infection and was hospitalized.

Are they just thinking she’s had a crash with the kidney disease? I’m so happy y’all got to see her. It must have been an encouragement to her. Although it’s so hard to leave them again.
 
Monday Feb.20 update:

So, now she has pancreatitis. Amylase 2685. Was 1156 in June and 1739 in October.

New test results:

https://drive.google.com/file/d/11cBptZx7adSqFXZWhfNpjJH2SsN4hLM5/view?usp=sharing

https://drive.google.com/file/d/1sRbg0mfAivMTboabRBC9_Fsz00og7X-G/view?usp=sharing

https://drive.google.com/file/d/1eXkhvcN_YU0EdVXdV8BP6niRQiyunbIH/view?usp=sharing

https://drive.google.com/file/d/1BQvHdrE4SM7mqX5mZt9JYR9qXWVUNzLV/view?usp=sharing

https://drive.google.com/file/d/1LztcAulJ6TnALNUZ2bqolzO4wbx3S7iq/view?usp=sharing

https://drive.google.com/file/d/1IEN9dKSyyYX3YD51_g7bN3HYS6esevI6/view?usp=sharing


No insulin shots since AM 2/18/2023. I was shown Freestyle Libre data: Bella’s BG maintains numbers between 150 and 200.

Bella gets Baytril, buprenorphine, Pepcid, vit B complex, phos binder. We gave her 1/8 tbsp of Miralax.

They had to decrease IV fluids to 5 ml/hr this morning because she had tachycardia (and 4/6 heart murmur). Because of this decrease, the emergency vet is not sure it makes lots of sense to keep Bella hospitalized even though her kindey values are a bit better. They will decide tomorrow morning (it will be 48 hours in the ICU). I think if you guys feel it would make sense to keep Bella there for another 24 hours I may push for that but honestly I am not sure.

The vet says that any dental work on our cat would “push her over the edge”, so best case scenario they send Bella home with some buprenorphine and we should feed her whatever she likes to.

She is alert but weak, wants to go around and explore the room, has difficulties walking but wants to do it anyway, jumped on the couch in the visitation room. Eats bit by bit but is interested in food (but not in the low-fat food they tried giving her).

This is my first experience ever with a critically ill cat. In terms of Bella’s life expectancy, are we looking at a few more weeks? We want her back home and will do anything to keep her comfortable but I’m not sure if another ICU visit will make sense.
 
Alicia2022 said:
Monday Feb.20 update:

They had to decrease IV fluids to 5 ml/hr this morning because she had tachycardia (and 4/6 heart murmur). ]
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I've heard that subqs are easier on the heart, and according to the advice I got here (for my cat) 100cc a day or every other day. I'd wait for a mod to be more clear on that though. You can do it at home too!

I'm really praying for the best for you guys. I'm sorry I don't have alot to add, I'm still semi new here. But, as a person that has had dozens of ICU and hospice pets, you are doing and have done a great job. You are an amazing pet parent do not ever doubt that.
 
I have made a few replies on the kidney group. I’m so sad for you having these results for Bella. Honestly, nobody knows how long she will be able to be happy with you at home. On the ckd group, there are many cats that have lived a long time with “bad kidney values”. Helen even mentions this on the felinecrf website. That is why we say to treat the cat and not the numbers. When you get her home, you can give her the treatment she needs to be comfortable. She may do well for a long time. Nobody can predict the future for her.
 
Thinking of you and Bella this morning. I’m praying for her and you. She will need some fluid support, just give her smaller amounts so she has time to absorb it. Why were they giving her low fat food? Because of pancreatitis? I think it’s encouraging that she is up and about and wants to explore, etc. That is a good sign.
 
Alicia2022 said:
Yes, but she dissmissed it right away. My question that I also asked at the ckd group is whether we indeed should feed her whatever she pleases (if we add phos binder)?
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I think it’s paramount that she eats. It’s so hard on them losing weight. Honestly, there are people on the group with cats who would only eat “Party Mix” treats and that was it! So that’s what they got. I’m not recommending that, but it makes a point that eating is most important.
 
Oh, I thought that was “old school” thinking about feeding low fat food to cats with pancreatitis? Maybe somewhat reduced fat, but not ultra low fat? Is that what you have read?
 
Suzanne & Darcy said:
I thought that was “old school” thinking about feeding low fat food to cats with pancreatitis?
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Yep, she also talked about low proteins for ckd cats...although she mentioned that this is debatable. In any case, Bella won't eat either of them, so I have to figure out her food. She hates Weruva, unfortunately.
 
Hi everyone, we brought Bella back home. Her creatinine and phosphorus improved a little bit, BUN is higher today than yesterday. Check-out process took a while, and Bella was unusually active, trying to escape from the carrier all the time.
Once she got home, she decided stay in the carrier. She ate a bit, drank a tiny bit, but did not urinate since we got home (5 hours ago), I sure hope she will do it soon.
I have a few questions regarding medications dosage, please let me know if something does not look right to you guys:
1) Vit 12 injection: 0.25 ml subQ once a week
2) Buprenorphine (0.3 mg/ml): 0.25 ml by mouth every 8-12 hours [I thought that maybe too much for her 8 lbs, and I’m just cautious about this stuff so we gave her 0.1 ml for now, will wait for your guidance and her reactions]
3) Pepcid 10 mg: ¼ tab once daily [I realized I don’t have it; I have Omeprazole delayed release capsules 20 mg – but it may be difficult to deal with them for such small doses?]
4) Aluminum hydroxide: recommended increase to ½ tsp per day
5) Insulin: not recommended unless glucose is consistently above 250. Bella’s BG was 169 this evening, so we did not give her insulin, we have to work on a new strategy regarding insulin. Unfortunately, we had to ask the hospital to remove her Libre sensor because none of our cell phones is compatible with it.
 
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Bupe dose is .01 to .04 mg. per kg for a cat. So anywhere between .03 and .14 would be okay. It's really a matter of how she's feeling and if the pancreatitis is causing her pain. But there's a wide range of safety with Buprenorphine so you often see prescribed. My cat Marcus who weighs 11.6 pounds and recently had surgery was prescribed a dose of .15 and it really did make him stop being in pain. So his dose was less than .25. Just try to get the liquid on her inner cheek/gums in that buccal pocket in the corner of her mouth. How did she do on the .10? Did her pupils get large?
 
Everything else seems okay. Is she getting Cerenia? Ondansetron? How many fluids will you give? Has Rekha or anybody given you any suggestions on that -- with her heart murmur? There are charts and such on the ckd site.

Are you going to try Niacinamide to help with the phosphorus. I did with Darcy and it seemed to help, of course I was also using binder.
 
Thank you, Suzanne. Bella did good on 0.1 bupe, I don't know about the pupils, will check next time. Rekha agreed that 75 ml of fluids should be okay in our case. Bella is getting Cerenia (1 divided pill per day). The hospital did not have ondansetron and I'm not totally sure I understand why she needs it. At check-out they said I can order everything from Chewy and they will approve it.
So, niacinamide should be in addition to the aluminum stuff? I thought it was just another option.
My main question for this board is insulin dosage. To give or not to give, that's here the question! We're debating this today, her BG was 202, so we decided to give 0.25 u and ended up with a fur shot! Crazy. I'm going to create a new topic, probably in Prozinc forum.
 
Alicia2022 said:
Thank you, Suzanne. Bella did good on 0.1 bupe, I don't know about the pupils, will check next time. Rekha agreed that 75 ml of fluids should be okay in our case. Bella is getting Cerenia (1 divided pill per day). The hospital did not have ondansetron and I'm not totally sure I understand why she needs it. At check-out they said I can order everything from Chewy and they will approve it.
So, niacinamide should be in addition to the aluminum stuff? I thought it was just another option.
My main question for this board is insulin dosage. To give or not to give, that's here the question! We're debating this today, her BG was 202, so we decided to give 0.25 u and ended up with a fur shot! Crazy. I'm going to create a new topic, probably in Prozinc forum.
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Okay. See you over on the ProZinc forum. That’s where I spend a lot of time. Let me look at her ss.
 
Niacinamide can be used alone or in conjunction with phos binders. Just wait and see if her phosphorus comes down with the binders to about 4. If it remains high, you could add in some Niacinamide.
 
I did use phosphorus binders (AlOH) in Darcy and it actually drove his phosphorus down too low! Vet had me discontinue the binder due to it worsening his constipation (although Ondansetron did that too) and I used Niacinamide, starting at about 50 mg per day. I put it into a gelatin capsule since it tastes terrible and I could not risk him not eating and not getting the dose into him.
 
Did you give her any insulin today? I see that last night she didn't, and that looks fine. I don't see a preshot test for today so I was just wondering.
 
Suzanne & Darcy said:
Did you give her any insulin today? I see that last night she didn't, and that looks fine. I don't see a preshot test for today so I was just wondering.
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I've just updated Bella's spreadsheet, her AM preshot was 194 so we gave her 0.25 u, and right now she's 164 so we skip. I hope to have more time on the weekend to test her several times a day, but in general I think I would skip insulin if she's under 180 and give 0.25 if she's over. I wanted to consult about this on the Prozinc forum but now I'm just so dragging behind on many things.
 
Alicia2022 said:
Thank you, Katrina. Planning to catch up on work stuff during the weekend actually. No bathtub here :) But the weather today was very nice and warm, so I spent some time in the backyard together with Bella!
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Aw I use to do that with my 1st diabetic cat! We would have bg curve picnics all day! Then I found out I'm highly allergic to trees lol! I was desperate for him to lose weight I hoped critters would make him run, it was being far from me that made him sprint back to me! I'm happy you guys had some nice weather for that and I hope it continues for yall :cat:
 
It looks like last night’s skip resulted in the yellow preshot this morning. Maybe you can try a drop dose when she’s borderline like that. Or a .10 dose is an option rather than a skip. There were no midcycle tests yesterday but it looks like she did fine since she had the blue PMPS. That is not a criticism as I know you are overwhelmed caring for her now. With my cat Ginger who is on a lot of meds, I have an Excel spreadsheet that I print out and I check off each medication as I give them- just so I don’t forget anything.
 
Suzanne & Darcy said:
Or a .10 dose is an option rather than a skip
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I barely see where is that 0.25 on the syringe, so the lowest dose we're giving so far was "0.25-"
We'll observe her ## for a couple of cycle, then I guess we'll figure out the new strategy. So many variables here.
Tomorrow she was active, eating a lot, wanting to jump on furniture, etc.
Today she's asleep and doesn't want to leave her den, so I had to feed her some "soup" right there and I will try mirataz.

Suzanne & Darcy said:
I have an Excel spreadsheet that I print out and I check off each medication as I give them
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I want to do the same and I've actually posted questions on Tanya's group about the right meds schedule. I haven't receive any replies so far so if you could respond here that would be so helpful :cat: :
1) is it true that no medications should be given two hours before and two hours after the phos binder? And no food or drink 30 min before and after buprenorphine? And should famotidine be given first and then antibiotics or vice versa?

She's on baytril, famotidine, buprenorphine, phos binder, subQ, cerenia, insulin, miralax, B12 injections.
2) If she's eating, does she need mirataz?
3) She used to get Adequan for arthritis every month or so, is it safe to give it now and does it make sense to give it?
 
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