Potassium supplement suggestions needed - Very frustrated!

[Michelle and Doodle]

I hate to keep whining about Doodle and his potassium needs... but I swear this is more frustrating than his diabetes!
He needs 15mEq of potassium a day (that's six pills -cut either in 2 or 4, depending on the brand) and I have been having an increasingly difficult time getting it all in him.
Any suggestions would be appreciated.
I am particularly interested in any tips on syringe feeding a toothless cat, since this seems like my only option at this point.
I would never have thought not having teeth would have made a difference, but it is proving to be way more difficult than syringing my toothy civie.

Here's what doesn't work:
Powder or crushed pills in his food does not work any longer - he won't eat it.
Pill Pockets won't work - he eats the pill pocket part and spits the pills out or refuses them all together.
Even using dry food to tempt him into eating it no longer works.
Adding it to sub-q's will not work because he needs way too much. And Potassium chloride is not recommended for use orally as it may be contribute to the development of metabolic acidosis.
He will not eat the gel form (or a liquid my vet RX'd ) either. ( And even if he did, he would go thru a 5oz. tube every week, which would cost me almost $100.00 a month)
(Not that I wouldn't do it... but the constant vet bills are becoming a strain and I need to be frugal where I can)

So, unless someone has another suggestion that will work, I'm going to have to keep trying to syringe his meds in him (which has been not even close to successful so far)
Is there a particular syringe that is better? A certain angle that I should be holding his head?
My Civie seems to just swallow whatever I squirt in her mouth - whereas Doodle does NOT -- (maybe it's because it tastes so bad)

~~I also wonder if all that "salt" at once might hurt his tummy?? And if it might not be better to syringe him several times during the day ?
Again, any suggestions are appreciated.

 

[jt and trouble (GA)]

Hi ,
My Waldo does the same with pill pockets. BUT I take a portion of a pill pocket and cover his heart pills (plavix tastes NASTY) with it, scruff him, then pry open his mouth from the corner, I push the pill pocket in there quickly and before he even knows it, he swallows. The pill pocket helps him swallow it easier than a dry pill. I was amazed at how easily he swallowed.

He still doesnt like being pilled but it goes so fast he barely puts up a fight anymore. Then when he's finished I give him a small handfull of dry food as a treat.

He spends his day on a zipline that reaches into the house. All I have to do is rattle the dry food bag, drop a few kibbles in his dish and he comes a runnin. I scruff him, pill him, then put him down with his bowl. He's chowin down before he even knows what hit him.

Good luck I hope this helps some.

Jeanne

 

[WCF and Meowzi]

~~I also wonder if all that "salt" at once might hurt his tummy?? And if it might not be better to syringe him several times during the day ?

i've read that potassium does hurt, if given on an empty tummy :sad: try it yourself, take his dose on an empty tummy and see if it hurts. i'm not saying this out of malice, but that's the only way to find out. the person who tried it wrote that it did hurt; i can't find her thread anymore, but it was 2.5 years ago when i read it and it left an impression. (and i wasn't inclined to try it for myself after reading her experience).

 

[Jess & Earl]

Hi Michelle

He needs 15mEq of potassium a day (that's six pills -cut either in 2 or 4, depending on the brand)

Not if you use 550mg potassium gluc tablet from the drugstore. That'd be one tablet according to this converter thingy: http://www.nafwa.org/convert1.php

Pill Pockets won't work - he eats the pill pocket part and spits the pills out or refuses them all together.

You are slicing the pills into teeny bits then putting them in a small amt of pill pocket? When Dillon was on pills I would cut them into 4-8 pieces each (this would work if you use the 550mg pills) and smash a bit of pill pocket around it, not use the whole pocket. If you use the whole pocket they chew it, and then discover the nasty bit. I would give him the little pieces one at a time, quickly, so he'd gobble them. If Doodle has developed an aversion to the pill pockets, you can try a different flavor or use Flavor-Doh. (or laughing cow cheese, etc.)

Adding it to sub-q's will not work because he needs way too much.

I'd still do this, because every little bit helps and KCl is super cheap.

And Potassium chloride is not recommended for use orally as it may be contribute to the development of metabolic acidosis.

Do you have a reference for this? Chloride can be used to treat metabolic alkalosis in specific cases, but AFAIK KCl and KGluc are interchangeable. Some vets use the oral injectable KCl orally, though I've never seen that done personally. I researched K some time ago (our cardio patients need K supplementation sometimes) so perhaps there is some new info, but I doubt it. DKA cats (who are suffering sometimes with severe met. acidosis) are given extremely high doses of KCl IV if they are hypokalemic.

You could also try a liquid potassium supplement from a vitamin store, a lot of them are unflavored because people are supposed to be able to add it to food. They won't be as concentrated as the tablets, though. If he is a manic water drinker, you might be able to get away with it ... Supposedly some liquid supplements can cause less GI distress but I don't know if that's true.
edited to fix hyperlink

 

[wombat88]

I'm new here, but that's a heck of a lot of potassium!! Why so much? I'm most familiar with using potassium for renal failure but the usual dose for that is 2mEq twice per day per 4.5 kg of body weight.That would mean 4 mEq per day ,not the 15 mEq you mentioned. My cat had very low potassium after his renal failure, but the most we did for a short while was to give 1/4 tsp of Tumil-K powder TID. Once his blood levels got up, we dropped back to 1/4 tsp (2mEq) BID.

I have tried generic potassium gluconate capsules, but Tabriz hated food with that mixed in. I've had no problem getting Tumil-K powder in him though because it is flavored and I guess tastes better. I am talking about the powder though not the gel. I've been told the paste or gel forms are absolutely awful tasting and it is rare a cat would eat them without a fight.

A few things to consider:
[*] Potassium gluconate will upset the stomach, so it should be given WITH food. Giving it separately will likely lead to vomiting or gastric distress.
[*] Potassium in subQ fluids BURNS, so I wouldn't recommend that method either.

Giving 15 mEq of potassium in one sitting is likely why your cat is fighting you. The max I give Tabriz at a time is 2mEQ. If he needs more than that daily, I split it out throughout the day, and it s always given with food. My guess is Doodle's stomach is not happy, and that will just make him fight you harder because he'll associate the pilling with feeling nasty.

Note that I'm not a vet nor do I pretend to be, but are you sure about that potassium dose?

PS: There is an accupressure trick you can use to calm down a cat. Pictures and a description can be found here: http://www.felinecrf.org/giving_sub-qs_ ... _peg_trick.

 

[Jess & Earl]

Wendy, Doodle has refractory, symptomatic hypokalemia, most likely from hyperaldosteronism. She is supplementing Mg already as well. She is sure about the dose

Also, many cats tolerate KCl in fluids; 'burning' is dose-dependent.

 

[wombat88]

Wendy, Doodle has refractory, symptomatic hypokalemia, most likely from hyperaldosteronism. She is supplementing Mg already as well. She is sure about the dose Also, many cats tolerate KCl in fluids; 'burning' is dose-dependent.

Poor Doodle! Given all that, and given how much she has to give per day, if she can find a way to put it in fluids, that's what I'd try to do for as much as possible, assuming she can keep the dose to a level that won't cause burning or another reaction.

She has probably seen this page, and it is geared to CRF cats, but when I first started I found it was a great source of 9nformation so I could compare supplements: http://members.bellatlantic.net/~vze2r6 ... assium.htm.

 

[Michelle and Doodle]

Not if you use 550mg potassium gluc tablet from the drugstore. That'd be one tablet according to this converter thingy: http://www.nafwa.org/convert1.php?name=Calcium+(Ca)&oneserving=&meq=0&name=Chlorine+(Cl)&oneserving=&meq=0&name=Magnesium+(Mg)&oneserving=&meq=0&name=Phosphorus+(P)&oneserving=&meq=0&name=Potassium+(+K+)&oneserving=550&meq=0&name=Sodium+(Na)&oneserving=&meq=0&name=Sulfur+(S)&oneserving=&meq=0&name=Sulfate+(SO4)&oneserving=&meq=0&name=Zinc+(Zn)&oneserving=&meq=0

The problem is that the 595mg. tabs that you get from the drugstore (the ones I've been using) only have 99mg of "elemental" potassium -- And to change mg of elemental potassium to mEq, you take mg and divide it by 39.0983 (atomic weight of potassium). For example, 90 mg is equivalent to 2.30 mEq, 99 mg is equivalent to 2.53 mEq. etc...
So I end up needing 6 of those pills.

If you use the whole pocket they chew it, and then discover the nasty bit.
---you can try a different flavor or use Flavor-Doh. (or laughing cow cheese, etc.)

I only put a small coating around it and have tried different flavours and coatings , but I haven't tried laughing cow - so who knows, maybe that will do the trick

"And Potassium chloride is not recommended for use orally as it may be contribute to the development of metabolic acidosis."

Do you have a reference for this?

My vet said she wasn't comfortable using it for that reason - but mostly just what I've read online.
And Tanya's website mentions it here - http://www.felinecrf.org/treatments.htm#low_potassium
Also this site - (Scooters Supplies) - http://members.verizon.net/~vze2r6qt/su ... assium.htm
And also here - http://veterinarynews.dvm360.com/dvm/ar ... p?id=66395

 

[Lisa and Witn (GA)]

Do you give him fluids? When I had to give Witn fluids, my vet had me add a potassium supplement to the LRS bags. It was a small vial of fluid that I would extract with a syringe and add to the bag through the med port. That may be another option for you.

 

[Michelle and Doodle]

Thank you guys for trying to help
And yes Wendy, obviously I have seen that page :smile: (since we both linked to it)

But just to clarify - I don't try to give him all the potassium at once - I try to split it up throughout the day.
Even when I was crushing it in his food I was only giving him 3.8mEg at a time (which may still have been too much to not upset his tummy)

And Choy-Foong
I would never ever ever take anything you said to me and imagine even an ounce of malice.
As always I appreciate your input.

 

[Jess & Earl]

Hi Michelle

That comparison website is a great one, I actually think I came across it a few years ago when I looked into K stuff for our patients; for larger dogs, every little bit (2 vs. 2.5) helps when you're trying to avoid giving 15 KGluc tabs a day, that's why it came to mind. I forgot about the switch for elemental until I saw that site again, I only remembered the mg to meq stuff.


Your other options, besides some liquids which are concentrated and probably taste bad, include starting spironolactone and consideration of a feeding tube. Spironolactone is a poor, ineffectual diuretic which is never used when real diuresis (such as in cases of congestive heart failure) is needed. It is mostly used to block the aldosterone escape mechanism in CHF. You can try it, and if it's dehydrating you'll stop it. As simple as that.

(Side note: when debating a treatment for one of my animals, I always say, ok, what's my situation now, what's the benefit of this possible treatment and what's the worst case scenario if I do it? I also prod the newbie vets that do internships @ our hospital this way, as they can get paralyzed when considering using a drug they've not used before. For Doodle, you have a cat whose QOL is affected by his need for massive K supplementation. Spironolactone might make an incredible difference in this. The worst case scenario for use of spironolactone is --what? Mild transient dehydration? Anything else? )

The other thing, the feeding tube, I know sounds very dramatic but I'd keep it in mind. We've had a few CHF patients who got feeding tubes to keep them hydrated and to facilitate administration of frequent, life-saving medications and they all enjoyed months of good quality time with their tubes. Imagine being able to pour his meds into a tube a few times a day as he sits on your lap. Now I'm not advocating tubes to administer 'extras' like glucosamine supplements, etc. but for animals who need medications in order to live, and whose QOL is affected by their administration? Just consider it, at least, if you can't find any alternative.

I wonder with his Mg levels up if you could back up on the potassium. After a few weeks of Mg supplementation, you could retest and if his K is within normal limits, you could try to lower the K and lower but continue the Mg for a few days and see what happens. K is very fluid and will quickly drop if it's going to drop.

 

[Michelle and Doodle]

Hi Michelle

Your other options, besides some liquids which are concentrated and probably taste bad, include starting spironolactone and consideration of a feeding tube. Spironolactone is a poor, ineffectual diuretic which is never used when real diuresis (such as in cases of congestive heart failure) is needed. It is mostly used to block the aldosterone escape mechanism in CHF. You can try it, and if it's dehydrating you'll stop it. As simple as that.

(Side note: when debating a treatment for one of my animals, I always say, ok, what's my situation now, what's the benefit of this possible treatment and what's the worst case scenario if I do it? I also prod the newbie vets that do internships @ our hospital this way, as they can get paralyzed when considering using a drug they've not used before. For Doodle, you have a cat whose QOL is affected by his need for massive K supplementation. Spironolactone might make an incredible difference in this. The worst case scenario for use of spironolactone is --what? Mild transient dehydration? Anything else? )

ohmygod_smile The simplicity of that is just brilliant. I mean, seriously! I'll call my vet and talk to her again about trying it. I don't see how she can argue with that logic.

The other thing, the feeding tube, I know sounds very dramatic but I'd keep it in mind. We've had a few CHF patients who got feeding tubes to keep them hydrated and to facilitate administration of frequent, life-saving medications and they all enjoyed months of good quality time with their tubes. Imagine being able to pour his meds into a tube a few times a day as he sits on your lap. Now I'm not advocating tubes to administer 'extras' like glucosamine supplements, etc. but for animals who need medications in order to live, and whose QOL is affected by their administration? Just consider it, at least, if you can't find any alternative.

I was actually talking to DH last night about a feeding tube - and it does sound like a dramatic step... But it may be our only alternative...

I wonder with his Mg levels up if you could back up on the potassium. After a few weeks of Mg supplementation, you could retest and if his K is within normal limits, you could try to lower the K and lower but continue the Mg for a few days and see what happens. K is very fluid and will quickly drop if it's going to drop.

His potassium level was actually up to 4.1 on Wednesday and i asked about trying to lower the dose again, but my vet said since he didn't hold it last time... not to reduce it. I am still hoping though that things will change now that his Mg. level is up.
And for better or worse his potassium supplement has been lowered since I have not been able to get much in him for the last few days. :roll:

Thank you! Thank you Jess!

 

[Harley and Pattie]

Harley has had problems with low K+ for the last year. He is on 3 tabs RenaKare per day. They are great tabs. All I do is crush them with the bottom of a glass and mix them with the food. He gets 2 tabs with AM feeding and 1 tab with his evening meal. He must not notice it because he gobbles down his food. Finally, the last K+ test take in May 2010, he was normal at 4.0. I get the RenaKare through my vet.

Pattie

 

[Michelle and Doodle]

Harley has had problems with low K+ for the last year. He is on 3 tabs RenaKare per day. They are great tabs. All I do is crush them with the bottom of a glass and mix them with the food. He gets 2 tabs with AM feeding and 1 tab with his evening meal. He must not notice it because he gobbles down his food. Finally, the last K+ test take in May 2010, he was normal at 4.0. I get the RenaKare through my vet.

Pattie

Thanks Pattie,

I started out using RenaKare tablets - and I also crushed them and mixed them with food.
Unfortunately they are only 2mEq each, so Doodle would need 7.5 of them a day - which is why I stopped using them and went to the people ones (so I would have less pills to give him)
I'm really glad Harley doesn't mind and he's testing normal now though!!

 

[sugarpura]

Dear Michelle and Doodle,
I do not fully understand why he needs such a large dose of K but you and your vet know what you are doing and I noted several references I am familiar with (Scooter's website, etc.) so you must be correct about your dose conversion. I suggest you join Feline Assisted Feeding, a great Yahoo group with plenty of helpful information about syringe feeding (including best syringes), also many members there have CRF cats who need potassium and other meds daily and they have a number of hints about how to get the meds into Doodle. Several cat list members have been toothless and you are right, it is a challenge to syringe feed them. I give potassium twice a day (daily dose divided in half) powdered (pestle) and mixed with baby food. I get it into my cat by putting some of the baby food/potassium mix on my finger and scraping it into her hard palate just behind her upper teeth, allowing her to swallow before putting as many small fingerfull's as it takes to get the full dose in. I do it just before feeding so she will not have it sitting on an empty stomach, as others have said potassium is a salt and will cause puking. My cat's daily dose is approx 1-1/2 of the human size white oblong pill which says something about 99 on it. Below is link to feline assisted feeding. Best regards. Sugarpura

http://pets.groups.yahoo.com/group/Feli ... d=74800744

 

[Michelle and Doodle]

Sugarpura
Thank you very much! I have joined the group you mentioned and I'm sure I will find lots of helpful information there! I have already been checking it out .
I really appreciate it!

 

[Martica and Fred]

Hi Sugar Pura

What flavors and brand of baby food do you use? And what are the carb issues with those--or is the amount needed to feed the pill so little that it doesn't matter much?

As far as syringing goes--I think a toothless cat is B ETTER for syringing!! Fred has only one fang left and barely any teeth. I syringe water into him all the time since I can't give him subQ for his kidneys anymore because of his heart disease.

I bought a syringe from Duane Reade, just hanging up by the drug ounter. It is 10ml and has a thinner tube at the end--some are fatter and I think thinner is less instruvis. Fred is usially lying on his side but his head is up and I simply place the tip of the syringe on the side of his mouth--the side without the fang is better...and i squirt, it goes in--and I aim towards the FRONT of his mouth, not the back, so I don't choke him...he gets the liquid in and swallows.

A few times I've crushed the pepcid up and done this--and since I'm sure it tasted nasty I followed up with 2 syringes of clean water to clear any residue from his mouth.

When you syringe...give him a chance to swallow.And pause so it's not a force-feeding experience. You might simply start doing this with water, so it's not associated with a negative taste...maybe do it like this with water for one week---then add the medicine in, but keeping doing water because that way he won't know it's bad taste every time...perhaps.

I place a thing little clooth underneath his chin and chest to catch leakage..and he knows the water is coming when I put that on him.

And from a nutrient absorption point of view--for humans or animals--the gut only absorbs certain amounts at a time, so for all nutrients-in foods or supplements, it is better to have it split up during the day rather than all at once, for maximum absorption quotas....