? Expired Lactated Ringers......okay to use?

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Sarah & Jackie

Sarah & Jackie

Member Since 2015
Jackie hasn't been doing so well last couple of days. Last time he really ate normally was friday morning. His Prednisilone dose was dropped almost a month ago and he is acting very much like he would act when he has an IBD flare up when we have tried to wean him off the Pred in past. We saw the vet friday evening and she told me to give him cerenia injection that night. I didn't, as he was not vomiting. Saturday AM, about 10 minutes after he received his oral doses of benazapril, lasix, and pred, he vomited them up and at that point, I did give the cerenia injection. We had a vet tech appt at 11:30AM saturday to observe my testing technique and I told her Jackie had stopped eating and was not feeling well. She called the doc in and we discussed labs from previous day as well as jack's not eating. we did give him his dosage of oral pred, and for some reason, I didn't ask her to give him an injection of pred to jumpstart his appetite. She did ask if I wanted her to give sub-Q fluids or if I had some at home and I told her I did, but they were expired, but were an unopened bag and she said it should be fine. However, I thought they were possibly expired as of 5/2014 and I now find they are actually expired 5/2012.....would you /have any of you used fluids this far out from expiration date? Even if they might not help, would they be harmful? Any experience, advice would be much appreciated. Oh, and Jackie hasn't had his lantus since friday AM, as he hasn't eaten. He did have another cerenia injection this morning. I will be giving an additional dose of pred tonite and we will most likely be back at vets ofc tomorrow, but would like to get him more comfortable ASAP. His BG about an hour and 1/2 ago was 448 using alphatrak2.
 
If his glucose is that high, it is safe to give a modest dose of the Lantus - 1/4 to 1/2 of what you normally give. This will do 2 things: it will get the glucose in the cells where it can be used and it may help trigger some appetite.

You can use an oral syringe to get some fluids in that way.

Are you testing for ketones?
 
Yesterday and day before-negative to trace- doc said (i think) testing from friday showed some glucose in urine? Does that sound right? What about the expiration date on the lactated ringers? No ketone check today as he hasn't urinated, to my knowledge.....I was gone for a couple of hours on errands though.
 
BJM said:
If his glucose is that high, it is safe to give a modest dose of the Lantus - 1/4 to 1/2 of what you normally give. This will do 2 things: it will get the glucose in the cells where it can be used and it may help trigger some appetite.

You can use an oral syringe to get some fluids in that way.]

He did actually come in for a pretty good drink this morning, but nothing since, as far as I know.
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The website for B. Braun, a company that distributes Ringers, says the shelf life is 18 months. It contains sugar, and that can degrade over time, according to another website. Another brought up the possibility of bacteria developing, but that was sited as unlikely. Sorry, not much help, I know.

If Jackie hasn't eaten since Friday, you really, really need to get some food into him. His is at risk of hepatic lipidosis if he goes too long without food, and for a cat, too long is a few days. Please try to get something into him - chicken baby food, boiled chicken, etc. Even if you have to spoon or finger feed. He may not be eating because he feels nauseous, but if you can get a little food into him and he realizes he didn't get sick, he might start eating. I know that's how my Minka has been during her chemo.

Sending lots of good appy vines.
 
He ate a few bites friday evening and a few bites yesterday, maybe a few pieces of grilled chicken last night, although that one may have been the other cat. Just gave him a can of FF gravylovers and he did drink the sauce out of it. He has been back at the water bowl and just urinated. Checked for ketones, between trace and small.
 
Ketones are dangerous and if they keep going up and lead to DKA, they can be fatal. If you're going to the vet today, maybe you could ask them to show you how to syringe feed him or they may choose to put in a temporary feeding tube.
To fight ketones, he needs food, fluids, and insulin. If he gets insulin, hopefully you'll be home to monitor and test. As long as he's showing some ketones, keep checking for them twice a day, if you can. Cats can go into DKA very quickly, and you don't want that. J.D. was a DKA survivor.
 
Definitely do whatever you need to get food into him. That's what happened w/ Tess in March and she spent 2 nights in the ER w/ DKA. The ER vet said the most important thing is getting them to eat, whatever you can get them to eat. Syringe feed if you have to, but choose a food that isn't on his regular rotation. I've been hearing about raw goat's milk, especially for IBD kitties. Answers+ or Bravo make it.

You should be able to get a new bag of Ringers from the vet now, or check Costco. Ours carries it. Being on fluids, really turned Tess around.
 
I would not risk using lactated ringers that old. I would worry about breakdown of not only the solution, but the bag that is holding it after that long.
 
Yes, when I checked him for ketones this AM, he was at the top of the chart and we immediately went to the vet. He is there now, being monitored and they will be giving fluids, insulin, and trying to get him eating.
 
I know how you feel. J.D. was hospitalized for 8 and 1/2 days during a snowy Christmas. I went to visit him every day (even though the drive was a long one). That's all I thought about, was him. I barely slept. I hope Jackie's ketones will be lowered before he reaches DKA.
 
Spoke to the Doc a little bit ago.....he is feeling a bit better now with some fluids and insulin in him. He has also had an appetite stimulant. Doc said he hand fed him a couple of spoonfuls of baby food earlier today and at about 3 this afternoon, he ate quite a bit of a can of FF on his own. He is going to stay overnight and hopefully will be able to come home tomorrow.
 
So glad you caught it early! Sending vines for a quick recovery.

A few things I observed after Tess had her episode:
  1. Her Levemir cycles really changed. Nadir is much earlier now. I'm not saying that will be the case for Jack, but watch for changes.
  2. I'm not a big fan of Rx diets, but they were feeding her a mix of M/D and W/D at the hospital and said she was scarfing it down!
    icon_eek.gif
    I hadn't been able to get her to eat much of anything. It turns out that it was the W/D that she loved. Too high in carbs, but just a little mixed in other food kept her eating. So if they get her eating, find out what it was and stick w/ it for awhile.
  3. Ask about using R insulin as a bolus. L&L don't do well on knocking down high numbers, R does then the basal insulin can have a chance to keep things even. You need to keep those numbers down because w/ such high numbers they feel crappy, don't want to eat, so you can't give insulin and things spiral out of control. HOWEVER, use much less R than the vet will probably suggest. Our ER vet said 1u, we only use .1u! You don't need a Rx for R insulin, get it at Walmart. They have a special deal w/ the maker and it's only $25, anywhere else $125!
  4. Keep up w/ the fluids! I think that has generally made her feel better by flushing out toxins and as a result she is eating much better. She is even gaining weight back!:joyful::joyful::joyful:
Finally, :bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:
 
Ann & Tess said:
So glad you caught it early! Sending vines for a quick recovery.

A few things I observed after Tess had her episode:
  1. Her Levemir cycles really changed. Nadir is much earlier now. I'm not saying that will be the case for Jack, but watch for changes.
  2. I'm not a big fan of Rx diets, but they were feeding her a mix of M/D and W/D at the hospital and said she was scarfing it down!
    icon_eek.gif
    I hadn't been able to get her to eat much of anything. It turns out that it was the W/D that she loved. Too high in carbs, but just a little mixed in other food kept her eating. So if they get her eating, find out what it was and stick w/ it for awhile.
  3. Ask about using R insulin as a bolus. L&L don't do well on knocking down high numbers, R does then the basal insulin can have a chance to keep things even. You need to keep those numbers down because w/ such high numbers they feel crappy, don't want to eat, so you can't give insulin and things spiral out of control. HOWEVER, use much less R than the vet will probably suggest. Our ER vet said 1u, we only use .1u! You don't need a Rx for R insulin, get it at Walmart. They have a special deal w/ the maker and it's only $25, anywhere else $125!
  4. Keep up w/ the fluids! I think that has generally made her feel better by flushing out toxins and as a result she is eating much better. She is even gaining weight back!:joyful::joyful::joyful:
Finally, :bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug::bighug:
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Thank you, all good things to know. A couple of ???s. Is R insulin the regular insulin he said they are giving Jack there at hospital? What are bolus and basal? Want to have my questions ready when I pick him up.
 
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Yes, R insulin is also called Regular insulin. It is what they add to the IV to bring numbers down. Basal insulin is your main insulin, a bolus insulin is used as a booster when numbers are too high. So, Lantus is your basal insulin and R can be used as a bolus.
 
Ann & Tess said:
Yes, R insulin is also called Regular insulin. It is what they add to the IV to bring numbers down. Basal insulin is your main insulin, a bolus insulin is used as a booster when numbers are too high. So, Lantus is your basal insulin and R can be used as a bolus.
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Okay, got it. I thought that might be it. Thank you.;)
 
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