pony's renal insufficiency

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eliseandpony

eliseandpony

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would someone with renal insufficiency experience please take a look at these values and let me know how bad this is and what a starting treatment might be?

the general situation: pony is 12 years old, with acromegaly and diabetes. she is not insulin resistant. recently she would not eat for a week and i took her to the vet for bloodwork. i was advised to give 75 units of sub q's once a day and to give a quarter of a pepcid ac tablet twice a day. within a day of that treatment she started eating again with a ravenous appetite. i discontinued the pepcid a day after she started eating again and she has kept her appetite. several days after starting fluids i had my first hypo scare ever. pony's bg's have never gone below the mid 200's in the two years she has had diabetes. but on that day she went down to 84 several hours before her nadir. i started stuffing her with high carb foods, skipped her next insulin injection and discontinued the fluids for now. i should be speaking with my vet in the next few hours about all of this. also, pony's poop has lightened in color and become a bit yellow/greenish and oily with a bad stench.

the recent bloodwork:
-vet said her phosphorus was good
-BUN was 64
-creatinine was 3.7
-vet said she was anemic with only 21% red blood cells

the bloodwork was more comprehensive than that, but those were the numbers she was highlighting to explain the renal insufficiency.

FYI: my finances are becoming drained. my vet offered a variety of treatments that would be costly such as leaving her there for a few days for IV, and also suggested getting her blood pressure tested. she was trying to explain some of my options, but thought it would be okay for pony to start with the fluids and pepcid. was that too much fluids? how have your cats BG's been influenced by fluids?

pony is extremely easy to handle, so i have no problem hometesting, giving injections, and giving fluids.

i know that my vet will be happy to help me move in any direction i want with this, so long as it is evidence based. what kinds of things should i suggest to her?

DIET: before the renal insufficiency hunger strike pony had been eating canned wellness chicken variety twice a day given just before her insulin. for about 3 weeks before she stopped eating altogether, her appetite had slowed and i was coaxing her to eat. when she stopped eating i was offering her a wide variety of foods but it was finally fancy feast chicken and gravy that got her eating again. now she has been wolfing down these gravy fancy feast flavors and does not want to eat wellness food. these gravy formulas are probably very high in carbs and not good for the diabetes. but because she lost a pound and a half (making her a 10 pound cat) during her week fast, i have just been letting her pig on FF gravy formulas.

lots of info here and i am sure you will all have many more questions. i am aware that pony's being on vetsulin is something that we could all do a lot of talking about- however, if possible, for right now could we focus on the renal insufficiency topic, please? i have been reading a lot on this subject, but am still brand new to it.

okay, so i just talked to my vet. she said she didn't think it was the fluids making her drop so low and she thought that maybe pony was not about to hypo the other day but was actually doing good. errr....i don't know. she said her advising me to give 75 subq's a day was intended only until pony started eating. now she says that i should do 75 subq's just 3 times a week. the vet said it was okay to let her have the fancy feast gravy foods 3 times a day.

alright, this should be enough info to get the discussion started!
 
CRD just sucks; I am definitely not an expert, but Boo has similar issues. WFC & Meowzi (Lantus) does a TON of research into CRD. I can't really answer questions, but just wanted to list what Boo was on, in case it helps.

Bun 56
Creatinine 4.2
HCT 25% (Becoming anemic)
PC Ratio 1.5
USG 1.024

Currently, Boo is on Benazepril for proteinurea, Calcitriol, and she'll be starting fluids this week (150 units, 2-3 times per week).
There was a very, very long discussion on anemia drugs on Health: viewtopic.php?f=28&t=18533
Here are some links on CRF: viewtopic.php?f=28&t=18354

You might look into phosphorous binders if you are feeding her FF or Wellness.

I believe that fluids can cause BGs to drop, but you will need to use them. I don't think you were giving too much - it's pretty comparable to what my vet is recommending, although you vet recommended daily (which I hear is better). You can get fluids cheap if you buy a case. See http://members.verizon.net/~vze2r6qt/su ... re.htm#Top

Sorry I can't really discuss anything, but hopefully some of this information will help.
 
Hi Elise,
I have 2 kitties I've been treating this year for CRF - neither have acro tho - but the lab results you posted look very similar to one of my kitties who was just rechecked.

Nellie gets subq fluids every other day. That's all she's needing right now. She's 17 years old. We also give her Vitamin B12 injections. And we feed foods that are lower in phosphorus content. She doesn't need any other meds right now.

I joined the yahoo CRF groups and read the updates everyday to get info and learn more. I don't really post - just do some reading.

I also read all the CRF links that Heather gave you too. I hope this helps you a little.
 
I get my Hospira brand LRS from Sams Club for $26 /case. I go pick it up- no shipping cost. I still need to buy the needles & tubing online, but try to buy a lot at once, to avoid the shipping cut. If you don't belong to a warehouse club, maybe try Walmart Pharmacy, the bigger the better.

I think the LRS helps the sugar slightly. It may help the kidneys flush out high sugar levels, but once you get to lower numbers I doubt it continues to bring it down. As I recall, it lowers high numbers by "osmosis"

Daily fluid requiremnents are based on weight. Normal "Maintenence" is something like 30ml/pound, so a healthy 10 pound cat needs 300ml water /day. Normally they get this from drinking and in their food, (and in our case supplemented by fluids.) Cody gets about 150ml LRS everyday for his megacolon because the miralax draws a lot of his water into his bowel.

75 ml does not sound like a lot to me, but how big is Pony? It may be a lot for a little cat who's eating and drinking normally.

ON the yellow green poop// Is Pony jaundice? When you look in her ears is the skin yellow, or in the white of her eye? The fluids helps flush that out- or maybe it is green from the Pepcid? I dont know. Not eating can cause fatty liver- which causes jaundice. and its nothing to mess with. Thats what Tenderfoot was so sick with when you prayed for him last month, (thanks BTW) he's doing much better now- and I'm still giving fluids 2x/week.
 
The sudden drop could have been an acro tumor rev down, or (and

I know you don't want to hear this) , the same thing happened to me the last month on vetsulin, sudden low number out of nowhere after years of 250-400. From what I remember of what I read, that was the reason it was recalled, because the proportion of long and short acting crystals was "off" in some batches, and folks were seeing sudden hypo type events. I have the link to the article/press release somewhere if you want it. It was probably on their website.
 
i have been reading all the links. i did a little experiment to try and verify that it was , as i thought, the fluids bringing the BG's way down. i gave her the fluids when she had passed her insulin nadir so i knew that her sugars should be rising. but, just like what happened before, her numbers dropped 200 points within an hour. so i don't think it was the vetsulin.

her eyes and ears aren't yellowing, but the green, greasy poop continues. she seems to be feeling pretty well. any other jaundice warning signs i should look for? three more cheers for tenderfoot!

pony weighs 10 pounds now.

why do you give the vitamin b injections?

thanks for the supply buying tips.

this might sound morbid, but i am wondering what happens to a cat when their renal insufficiency becomes really bad.
 
You need to stagger the times you give shots and give SQuids so that the drops of the two don't happen at the same time.
 
I actually try to time it to help (when I can), for example ideally I give fluids near preshot so they are absorbing at +1, +2, +3 when the insulin hasn't kicked in yet. Lev is a really slow starter for Cody. we apparently haven't reached the correct dose yet.

Are you sure that the late drop only happens when you give fluids? I haven't looked at your ss

Regarding Vetsulin Nadir
The product that was out of spec had a greater proportion of the long acting crystals, so the sudden drop occurs later than what clients were used to.

This was from the the letter sent to vets: here's the link to the whole thing
http://www.vetsulin.com/vet/Vet_ProductAlert.aspx

Vetsulin contains two insulin components: crystalline insulin, the longer-acting component, and amorphous insulin, the short-acting component. This finding regarding the crystalline component could potentially result in your patients experiencing a delay in the onset of action, a delay in peak activity, and an overall extension of the duration of activity, although at this time, this occurrence has not been documented.

We take all out-of-specification results very seriously and deemed it appropriate to notify you of this situation. Accordingly, we request that you continue to closely monitor your patients receiving Vetsulin for any changes in onset or duration of activity, or for any signs of hyperglycemia or hypoglycemia.
Click to expand...

Hope this helps- I just want Pony to be safe
 
Hi Elise,

Vitamin B12 is a water soluble vitamin and oftentimes when you are giving fluids they can lose this vitamin. There's more info on this on the crf links. Right now I'm at a friends house and don't have the direct link. I'll get it for you later if that's ok. Also Nellie is older and in another reference - it's been said that Vitamin B12 is good for ALL older kitties - because everything slows down in them - it's also good for the gut and helps with food absorption. Again I have to find my reference for you. I promise to get it.

We get our fluids from KV vet.com. If you order >$50 - shipping is free and you can order up to 13 bags of fluids at a time. We get the tubing and needles too. We have found them to be the cheapest for us. And we live in a smaller rural town so it's nice having things like this delivered.

I'll work now on the references for you. :smile:

edited to add:http://www.felinecrf.org/nutritional_requirements.htm
above is the link where the basics are about vitamin B12 - what I forgot too is that it helps with anemia

also - I probably have missed some of your info here so please forgive me. You have brought up jaundice - and I know you are talking about greasy stools here. Does Pony have some liver dysfunction? Have you had liver function tests checked? I only ask because quite recently one of our kitties was extremely ill with this. Truthfully if it hadn't been for Lynee and Max from LL - I don't know that Simba would be with us yet. But a very easy supplement that you could think about giving is Denosyl - it is not a prescription - it supports the liver tho - and it's something you could start sooner than later. I hope you don't mind me suggesting things.

I'll look forward to updated on your Pony
 
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