Spike Feels Better After The Cerenia and Sub-q Fluids

@Suzanne & Darcy , do you feel that I should give Spike another 150 ml of sub-q fluids tonight? Also asking @FrostD and @Linda and Newman.

He doesn't want food and just stares at the water bowl, so I gave him another 8 mg of Cerenia and a 3/4" strip of Mirataz at 7pm cst.

Any suggestions would be great. I want to make him comfortable at this point. I did order the Phos Bind which claims to be here on Saturday. If I would have known that I couldn't get it from vets office, it would have been ordered weeks ago...but THATS all another story...
 
Fluids...150 ml at 7pm yesterday.

Cerenia...1/2 pill (8 mg) at 7pm tonite.

.25 unit Prozinc 7pm tonite

3/4" Mirataz 7pm tonite.
 
Lee Renfro said:
Fluids...150 ml at 7pm yesterday.

Cerenia...1/2 pill (8 mg) at 7pm tonite.

.25 unit Prozinc 7pm tonite

3/4" Mirataz 7pm tonite.
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You can definitely give 100 mL of sub-q fluid again tonight- or 150 if that is what you and your vet have agreed upon. Mirataz is once a day so no more tonight. Cerenia is also once a day - one milligram per pound of body weight (approximately) so no more until at least tomorrow. But yes to fluids tonight unless he still has a hump/bump of unabsorbed fluids from last night.
 
Suzanne & Darcy said:
You can definitely give 100 mL of sub-q fluid again tonight- or 150 if that is what you and your vet have agreed upon. Mirataz is once a day so no more tonight. Cerenia is also once a day - one milligram per pound of body weight (approximately) so no more until at least tomorrow. But yes to fluids tonight unless he still has a hump/bump of unabsorbed fluids from last night.
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I'm about to start his fluids now. He still won't eat and I feel the mirataz should have worked if it was going to at all.
 
Hopefully he will feel more like eating again tomorrow. Maybe he just overdid it with the Friskies Lil Soups. Fingers crossed here and positive thinking since I am really not qualified to give advice. Thank goodness for Suzanne. She keeps us going.
 
Linda and Newman said:
Hopefully he will feel more like eating again tomorrow. Maybe he just overdid it with the Friskies Lil Soups. Fingers crossed here and positive thinking since I am really not qualified to give advice. Thank goodness for Suzanne. She keeps us going.
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He actually ate a entire lil soups while he was getting 150 ml of sub-q fluids. I'll see if he wants some more in a few minutes and check again when I have to get up in the middle of the nite...lol. He's decided to hang out and cuddle with me now that I'm out of the shower and ready for bed. A good outcome tonite I think.
 
Lee Renfro said:
He actually ate a entire lil soups while he was getting 150 ml of sub-q fluids. I'll see if he wants some more in a few minutes and check again when I have to get up in the middle of the nite...lol. He's decided to hang out and cuddle with me now that I'm out of the shower and ready for bed. A good outcome tonite I think.
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I am happy to read that he ate. I think you will definitely find that giving him fluids daily instead of every other day will make him feel better. Is he absorbing the fluid bump pretty quickly? I usually try to feed a favorite food while giving fluids. For some cats that was kibble (a no no for Spike although at this point anything he will eat is most important) for other cats it was baby food or a fancy feast. Forti Flora sprinkled on top of food is also something that will really get a lot of cats to eat.
 
And I know that your vet has been resistant, but you will find that if the Cerenia cannot do the job of controlling his nausea adequately, adding in Ondansetron (Zofran) can be a real game changer. They feel so much better and are hungry. So whatever you do, if he won’t eat then don’t give up until you have tried the Ondansetron.
 
Next up: my needle lecture :)

What kind and size of needles did they give you for giving fluids? Most likely the Monoject harpoons. Terumo needles are the sharpest and have the best flow rate (you really can notice a difference.) 19 gauge is good and I also keep 20 gauge on hand. I decide which size to use based on the cat’s size, skin condition, if they’re really skinny, etc. Also some cats are really restless during fluids so I will use the 19 gauge because it’s faster. Here are the needles that you should get:

https://thrivingpets.com/products/t...f-100?_pos=1&_psq=terumo+needles&_ss=e&_v=1.0
 
Are you warming the fluids? This definitely will make receiving fluids more comfortable for Spike. Just put the bag in a bowl or pot of hot water for a bit. Obviously you leave the ports out of the water and don’t submerge the whole bag. When it’s warm, drain out the cool fluid from the line - which you will have to do anyway to remove air bubbles- and test the water on the inside of your arm to make sure it feels warm but obviously not hot. This makes it feel so much less of a shock when fluids that are room temperature hit under their skin at a cat’s body temperature or 100-101 degrees or so.
 
The Cerenia seems to be doing the trick at 1 mg per lb of weight...ie; 8mg. He seems to get hungry about 30 to 45 minutes after I pill him. And yes, he even accepts being pilled like a little trooper. I have zero idea why vet wanted me to give him a whole 16 mg tablet when he's a 9, or more likely an 8.8 lb kitty. I will try to get him some Ondansetron prescribed and pick it up tomorrow am.

I was given 18 Guage needles and Spike doesn't seem to even notice the poke or the bump. I hang the bag about 3 to 4 feet up on a ceiling fan and was letting the central heater blow onto the bag with like 99° air for a good long while b4 putting him onto my bed under the bag and starting his fluids. He totally didn't seem to even notice anything except the friskies lil soups skipjack tuna senior formula in his favorite blue saucer...go figure.

He ate 3 Lil soups last nite and 2 lil soups this am. I left him a medley of foods out for him this am and put all my other kitties outside since they wanted to go prowl anyways. Only Minnie, his cudddle-buddy is inside with him and Minnie tends to love on Spike. I call her our little "nurse kitty" because she's always checking on Spike.

I'm holding up well with lots of prayer and talking to Jesus about giving me strength both emotionally and physically.....and it's working.
 
Lee Renfro said:
The Cerenia seems to be doing the trick at 1 mg per lb of weight...ie; 8mg. He seems to get hungry about 30 to 45 minutes after I pill him. And yes, he even accepts being pilled like a little trooper. I have zero idea why vet wanted me to give him a whole 16 mg tablet when he's a 9, or more likely an 8.8 lb kitty. I will try to get him some Ondansetron prescribed and pick it up tomorrow am.

I was given 18 Guage needles and Spike doesn't seem to even notice the poke or the bump. I hang the bag about 3 to 4 feet up on a ceiling fan and was letting the central heater blow onto the bag with like 99° air for a good long while b4 putting him onto my bed under the bag and starting his fluids. He totally didn't seem to even notice anything except the friskies lil soups skipjack tuna senior formula in his favorite blue saucer...go figure.

He ate 3 Lil soups last nite and 2 lil soups this am. I left him a medley of foods out for him this am and put all my other kitties outside since they wanted to go prowl anyways. Only Minnie, his cudddle-buddy is inside with him and Minnie tends to love on Spike. I call her our little "nurse kitty" because she's always checking on Spike.

I'm holding up well with lots of prayer and talking to Jesus about giving me strength both emotionally and physically.....and it's working.
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You’re doing great, Lee!!

Minnie sounds sweet!
 
Lee Renfro said:
@Suzanne & Darcy @Diane Tyler's Mom @Lisa and little @FrostD
It's not going too good tonite. No appetite, bg 327 and I'm scared to dose as he won't touch a thing. He lapped at some albacore tuna water that I opened just for him. I haven't given any sub-q fluids yet tonite. He had 150 ml last night. Mirataz and Cerenia haven't seemed to have taken effect yet tonite.
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I would give the fluids tonight. Hopefully you already did since this message was about 2 hours ago.
 
I'm getting the ondansetron filled right now and the vet gave me another 4 pill 16mg pill pack of Cerenia for spike. The Phos Bind should be delivered by 9pm today according to UPS & Amazon.

He ate some senior stew today and drank a little water and seemed to be feeling OK. Its drizzling rain here today and we stood on the porch for awhile today watching it rain. He seems to be comfortable and doing OK. After I bought several friskies lil soups, he decided that he didn't like them now......CATS!♡!

The ondansetron are 4 mg tablets and label says 1 each every 12 hours. Does this sound correct? Does he continue to take the Cerenia once daily also or ???

@Suzanne & Darcy @Diane Tyler's Mom
 
Lee Renfro said:
I'm getting the ondansetron filled right now and the vet gave me another 4 pill 16mg pill pack of Cerenia for spike. The Phos Bind should be delivered by 9pm today according to UPS & Amazon.

He ate some senior stew today and drank a little water and seemed to be feeling OK. Its drizzling rain here today and we stood on the porch for awhile today watching it rain. He seems to be comfortable and doing OK. After I bought several friskies lil soups, he decided that he didn't like them now......CATS!♡!

The ondansetron are 4 mg tablets and label says 1 each every 12 hours. Does this sound correct? Does he continue to take the Cerenia once daily also or ???

@Suzanne & Darcy @Diane Tyler's Mom
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@Lee Renfro
Hi Lee I did a search on here and found this about ondanserton posted by one of our members. I will tag a few members for you to see if 4 mg is too much or if you have to break them in half and also about the Cerina if you can give that also

Cerenia is given once a day and zofran can be given 3 times a day every 8 hours Zofran ( ondansetron) is a human medication that can be given to cats

@tiffmaxee

@Suzanne & Darcy

@Wendy&Neko

@Bron and Sheba (GA)
 
Diane Tyler's Mom said:
@Lee Renfro
Hi Lee I did a search on here and found this about ondanserton posted by one of our members. I will tag a few members for you to see if 4 mg is too much or if you have to break them in half and also about the Cerina if you can give that also

Cerenia is given once a day and zofran can be given 3 times a day every 8 hours Zofran ( ondansetron) is a human medication that can be given to cats

@tiffmaxee

@Suzanne & Darcy

@Wendy&Neko

@Bron and Sheba (GA)
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I found 2.mg for small cat and 4 mg for large cat. Per the internet vet...lol
 
Ondansetron can be given as often as every 8 hours but a lot of cats don’t need it that often. I’ve had cats who only needed it once a day and some who needed it twice a day and some three times a day. Use the lowest effective dose. Yes, it can be given concurrently with Cerenia since they work in different ways it can be beneficial to give both.
 
Sorry for my delay in replying. Since I was last here I went out to feed feral cats in the pouring rain, came home and cooked dinner. Centrally monitored fire alarm went off for the second night in a row and the fire department came out for the second night in a row. Spent time on the phone trying to get help from the ADT people who will send a tech on Monday between 8 and 12. Soooo… anyway, did you get the 4 mg orally dissolving tablets? Those are pretty small and may be hard to split. But I would definitely try to use the lowest effective dose. I have given 4 mg to my cats. Darcy was a big boy though. I’m copying the section on Onsansetron from felinecrf. There is quite a variety of dosing schemes.

Ondansetron Dosage Amount

A commonly used dose on Tanya's Support Group is 1 mg each time it is given, so one pill contains four doses. This ties in with Pet Place, which mentions that the usual dose for cats is 0.11mg per pound bodyweight, i.e. 1.1mg for a 10 lb (4.5kg) cat, given 2-3 times a day.



Plumb's Veterinary Drug Handbook mentions an empiric dose of 0.5mg per kg bodyweight twice daily, so a 10 lb (4.5kg) cat would be given 2.25mg, so a higher dose.



Oral, subcutaneous and intravenous pharmacokinetics of ondansetron in healthy cats (2014) Quimby JM, Lake RC, Hansen RJ, Lunghofer PJ & Gustafson DL Journal of Veterinary Pharmacology and Therapeutics 37(4) pp348–353 states that "twice daily administration at 0.5 mg/kg is likely inadequate to maintain serum concentrations within the therapeutic range; higher or more frequent doses may be needed." It further states that "the postulated therapeutic range - extrapolated from a previously published pharmacodynamic study - may not be accurate particularly if applied to repeated administration for chronic disease states."



Pet Place mentions that the usual dose for cats is 0.11mg per pound bodyweight every 8-12 hours, i.e. 1.1mg for a 10 lb (4.5kg) cat given 2-3 times a day.



ISFM consensus guidelines on the diagnosis and management of feline chronic kidney disease (2016) Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I, Langston C, Lefebvre H, White J & Quimby J Journal of Feline Medicine & Surgery 18pp219-239 recommend a dosage of 0.5–1.0 mg/kg given subcutaneously every 6–8 hours, so a 10 lb (4.5kg) cat would receive 2.25- 4.5mg subcutaneously three or four times a day.



The problem is that cats seem to vary widely in their ability to utilise ondansetron. Oral, subcutaneous and intravenous pharmacokinetics of ondansetron in healthy cats (2014) Quimby JM, Lake RC, Hansen RJ, Lunghofer PJ & Gustafson DL Journal of Veterinary Pharmacology and Therapeutics 37(4) pp348–353 says that "Poor bioavailability should be taken into account when determining a route of administration for a patient as individual oral bioavailability ranged from 11 to 50% in the cats used in this study." You may therefore need to experiment to find the optimum dose and frequency for your cat.



For acute vomiting, such as in a cat with pancreatitis, higher dosing may be necessary. For chronic nausea in CKD cats, however, many people find a dose of 1mg is fine, but needed at least twice daily, and if that doesn't work, then three times daily. Very occasionally, cats need ondansetron four times a day.



I would start with a dose of 1 mg twice a day, and if you find this is not enough, speak to your vet about increasing the frequency initially, and if necessary, the dose.

 
I THINK I got about 1.5 mg or so into him. He didn't wanna pill this afternoon. It started dissolving in his mouth and he foamed at the mouth and drooled out some of it. It started off as a 2 mg 1/2 a 4 mg pill tho. It hadn't taken effect as of 20 mins ago. Next dose I'm gonna think it thru a little better.
 
Lee Renfro said:
I THINK I got about 1.5 mg or so into him. He didn't wanna pill this afternoon. It started dissolving in his mouth and he foamed at the mouth and drooled out some of it. It started off as a 2 mg 1/2 a 4 mg pill tho. It hadn't taken effect as of 20 mins ago. Next dose I'm gonna think it thru a little better.
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Yeah, it’s best to order some gelatin capsules to put the meds into so the pills don’t dissolve and make him foam at the mouth.
 
Size 4 gelcaps (available on Amazon) will fit half a Cerenia (which is a very bitter medication) and it should fit an Ondansetron too. Those taste weird. They’re designed with a weird flavor for humans - the orally dissolving tablets. A friend of mine tasted them and said they were bad!
 
I have the 4mg Ondansetron pills not dissovable. My sugar boy who is also on doxycycline & Cerenia (one 8mg pill a day)he gets 1/4 of a pill 2xs a day Ondansetron & my non sugar boy was getting 1/4 Ondansetron a day but I just recently increased him to twice a day. I put there pills in Greenies chicken flavored pill pockets. Not sure if you could do that with a dissovable pill but I'm sharing how much I give & what I put the pills in.My sugar boy eats the pill pockets out of my hand & my other boy I have to drop it on the floor in front of him & he eats it. I hope the meds help your boy & he continues to get better, your in really good hands here :bighug:
 
Suzanne & Darcy said:
Yeah, it’s best to order some gelatin capsules to put the meds into so the pills don’t dissolve and make him foam at the mouth.
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I'm not sure that it'll be necessary. I'm just trying to ease his pain and make him comfortable at this point.he hasn't given up, I can tell, but not sure he can go on only eating a teaspoon or two of gravy and a couple shreds of chicken per day. Just gave him a 1/4 ondansetron and maybe that'll ease his tummy and he will want to eat. At this point he is getting anything he mite want.

I haven't given his sub-q fluids yet today. That mite makd him feel better. I brought his water to him and he did wash that 1/4 pill down with a nice, long drink from his bowl.
 
Lee Renfro said:
I'm not sure that it'll be necessary. I'm just trying to ease his pain and make him comfortable at this point.he hasn't given up, I can tell, but not sure he can go on only eating a teaspoon or two of gravy and a couple shreds of chicken per day. Just gave him a 1/4 ondansetron and maybe that'll ease his tummy and he will want to eat. At this point he is getting anything he mite want.

I haven't given his sub-q fluids yet today. That mite makd him feel better. I brought his water to him and he did wash that 1/4 pill down with a nice, long drink from his bowl.
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Well I only mentioned it because you said he was foaming at the mouth from the taste of the pill.
 
Lee Renfro said:
We are still hanging in there. His BG was 225 this am, so I gave a .25u shot. He took 1/2 a ondansetron and was hungry about 30 mins later and told me to feed him.....so he ate a good bit this am b4 his prozinc. We cuddled all nite.
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It's good to hear he was eating this morning and that he's responding to the Ondansetron.
 
Suzanne & Darcy said:
It's good to hear he was eating this morning and that he's responding to the Ondansetron.
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Got home at 5pm today and he didn't want food. I gave 100ml sub-q fluids, think I got about 1 mg of ondansetron into his system using feeding syringe and 1/2 a pill dissolved in stew gravy, and his bg was 323 so gave .25u prozinc. Then just now at 9:45pm cst he decided to eat most of a pouch of stew with phos bind a d miralax in it....lol

With such small quantities of the Delectable Stew, I just add a pinch of both powders to it and stir it in.....I'm not sure on dosage for those powders, but a pinch looks about right in the food....your advice would be great.....we are talking about like 2 teaspoons of food and not a lot.

He seems to be pain free and not in any kind of distress. He jumped up on my high bed twice tonite like he's always done. The Mirataz does seem to make him want to cuddle though...lolol
 
FrostD said:
I don't know about dosing, but glad he's otherwise acting ok!
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I came home early today to check on him and he ate a little bit when I offered it to him. I think the ondansetron is working. I'm only giving .25u prozinc shots because he's eating so few calories. It seems to be effective at keeping him out of dangerous highs and lows. Ur advise is welcomed.
 
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