Sub Q Fluid Advice

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FurBabyMamma

FurBabyMamma

Member Since 2016
Hi all,

Looking for advice with Sub Q fluids.

My cat's diabetes is new and not controlled at all (see SS for details). She had a really awful day this Saturday and was terribly dehydrated (we could tell by her eyes, and her skin was so slow to return to normal when bunched), vomited, not eating. We bullied our now former vet into giving us the setup to do Sub Q fluids at home and have been giving her 100 units (I think ml) of fluid each day since then. She really perked up for 24 hours after that (despite still having out of this world glucose numbers), but then has gotten lethargic again, but she has a good appetite and hasn't thrown up.

However, she still is super dehydrated, even this AM. :(

The vet said to do it once a day (we're just trying to get to Wed when we see an internal medicine specialist who came highly recommended by one of my friends who is a vet) at the 100 unit mark. We are continuing to do this.

Finally to my question, any known adverse affects by increasing the amount of fluid (like to 200), or doing it twice a day? Would that make things better, or could I really muck things up and should leave it like it is?

Thankful for any wisdom that can be given,

Katie
 
Hi Katie, I don't have any wisdom on the SubQ's, except to keep doing it. If she's still looking dehydrated (tacky gums, loss of elasticity in skin, sunken eyes) I can't imagine that more would hurt, but I would advise to consult your vet first. Some heart conditions can be aggravated by too much fluids.
They (squids) really helped Pimp a lot when he was first dx'd and running super high.

Other than that, you can coax Sophie to drink more water by adding it to her food, and you can also use tuna water for this. Make sure it's 100% tuna without anything added if you're using human tuna.

Pimp can be coaxed to drink by adding the dust from freeze dried treats to water.:rolleyes:

I suggest you come over to the Lantus/Levemir group for dosing advice. It looks to me like Sophie's dose has been raised far too quickly and in too large of increments. We like to raise in 0.25 increments and hold the dose for at least 3 days, sometimes longer. An overdose of insulin can look like not enough. Edit to add: some night time tests can help to rule out overdose
 
Andy & Pimp said:
Hi Katie, I don't have any wisdom on the SubQ's, except to keep doing it. If she's still looking dehydrated (tacky gums, loss of elasticity in skin, sunken eyes) I can't imagine that more would hurt, but I would advise to consult your vet first. Some heart conditions can be aggravated by too much fluids.
They (squids) really helped Pimp a lot when he was first dx'd and running super high.

Other than that, you can coax Sophie to drink more water by adding it to her food, and you can also use tuna water for this. Make sure it's 100% tuna without anything added if you're using human tuna.

Pimp can be coaxed to drink by adding the dust from freeze dried treats to water.:rolleyes:

I suggest you come over to the Lantus/Levemir group for dosing advice. It looks to me like Sophie's dose has been raised far too quickly and in too large of increments. We like to raise in 0.25 increments and hold the dose for at least 3 days, sometimes longer. An overdose of insulin can look like not enough. Edit to add: some night time tests can help to rule out overdose
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Many thanks! I'll take a stroll to the Lantus/Levemir group. Appreciate the eyes on the dosing; I feel so out of my depth here!
 
I would not recommend increasing fluids to 200mls a day if you have not had a vet workup to determine the appropriate amount of fluids. The vet will check the heart to see if there are signs of heart conditions that preclude more fluids. The general rule of thumb is no more than 10mls per pound of weight at one time. I would either call the old vet and ask or wait to get in to the new one.
 
I have never given sub-q fluids to my cats but the first thing that came to mind was that you should really be mindful of not giving too much. It could throw off her electrolytes/acid-base balance. I would check, recheck, and then triple check with my vet before upping any dosages beyond the one she's already told you to give.
 
FurBabyMamma said:
Hi all,

Looking for advice with Sub Q fluids.

My cat's diabetes is new and not controlled at all (see SS for details). She had a really awful day this Saturday and was terribly dehydrated (we could tell by her eyes, and her skin was so slow to return to normal when bunched), vomited, not eating. We bullied our now former vet into giving us the setup to do Sub Q fluids at home and have been giving her 100 units (I think ml) of fluid each day since then. She really perked up for 24 hours after that (despite still having out of this world glucose numbers), but then has gotten lethargic again, but she has a good appetite and hasn't thrown up.

However, she still is super dehydrated, even this AM. :(

The vet said to do it once a day (we're just trying to get to Wed when we see an internal medicine specialist who came highly recommended by one of my friends who is a vet) at the 100 unit mark. We are continuing to do this.

Finally to my question, any known adverse affects by increasing the amount of fluid (like to 200), or doing it twice a day? Would that make things better, or could I really muck things up and should leave it like it is?

Thankful for any wisdom that can be given,

Katie
Click to expand...
Hi Katie,
I have given many SQ fluids and yes they do amazing things.. My Rico was DX at 11 and we started at fluids about 1x a week and now he is almost 17 and gets them every other day. Now my diabetic cat is getting them daily (he is almost 16)
For us we did what I call a "push" where initially I gave 100-150 1x a day for at least 1 week up to 10 days.... this will flush the kidneys-- then I reevaluate the cat.
I would suggest you get a case of fluids (walgreens 80$) and you can get the set up from KV Vet Supply at a reasonable cost. (lines and needles)
If your cat has no history of heart disease or any other disease that giving SQ would aggravate the benefits can make quality of life a million times better-as you have seen with just 1 administration.
The vomit is usually because the kidneys have toxins that are backing up and often will affect not only the tummy issues (nausea) but can cause mental confusion weakness. I am a huge proponent of SQ fluids as it has enhanced the life of at least 15 cats in my life (rescues as well)
that being said it is important to be sure your cat can assimilate them and there are not many cats that I have ever seen have a issue with them. Giving them SQ the body can use them as needed. If your giving at home remember the lactated ringer runs on gravity so hang it high (I sit on the floor with my boys) and I freeze the needle to dull the poke. 1 of mine doesn't mind the larger needle and it runs very fast we are done in about 3 minutes-the other prefers the smaller needle and sitting longer (about 6 minutes) I did have 1 cat that got them 2x a day as he did not like feeling water logged--he got 100-150 2x a day as he was pretty far along in renal disease ..... that being said he lived a happy life for another 2 years. We went thru tons of litter :cat:
Also--the fact that your kitty is already dehydrated again tells me that the fluids were used quickly so in my mind you need to catch up to where she gets the fluids before severe dehydration and can use them as needed throughout the day--you may be able to skip a day or 2 or 3 after she is flushed-
 
Katie- again, please don't increase the volume of fluids that Sophie is receiving without consulting the vet. Cats with unknown heart problems have died from too much fluids.
 
[.Do you have lab results? If s.c. is the only means, 300 mls/ day split 3-6 dose preference is often given for "dog"s over 12 lbs that have no significant problems with heart, respiratory disease.. I would find "why"the DVM only agreed to 100 mls./QUOTE]

Most recently labs are on my labs tab of my SS.

I'll definitely check with former vet that doesn't know they are former before increasing anything. Super grateful for all advice and perspective given here.
Click to expand...
 
Included too much in the quote (still getting the hang of things).

Most recently labs are on my labs tab of my SS.

I'll definitely check with former vet that doesn't know they are former before increasing anything. Super grateful for all advice and perspective given here.
 
Looking at your labs the creat. is good which is very good-
the BUN is slightly high and could benefit from fluids-you have the opportunity to slow the progression of CRF.
Dre was about the same on BUN a few months ago now he is almost normal (+4) after going to 1x a day-

Did the vet listen to her heart? I would imagine if the vet gave fluids they are not worried about a heart issue but it is always good to check if you are unsure.
If a heart condition is present it would be unlikely that a vet would administer SQ fluids.
Fluids will help appetite is she is holding toxins....
 
Phosphorous is high
Phosphorus 2.4-8.2 mg/dL 8.5
I would go with low phosphorous food or use a phosphorous binder.
Urine specific gravity 1.024 indicates kidney degradation.
However, I do not understand what the creatitine is only 1.3
 
FurBabyMamma said:
The vet said to do it once a day (we're just trying to get to Wed when we see an internal medicine specialist who came highly recommended by one of my friends who is a vet) at the 100 unit mark. We are continuing to do this.

Finally to my question, any known adverse affects by increasing the amount of fluid (like to 200), or doing it twice a day? Would that make things better, or could I really muck things up and should leave it like it is?
Click to expand...

Do not increase the fluids without veterinary advice. Even without a heart issue, there is the risk of over hydration which can result in congestive heart failure. If Sophie is that dehydrated, 24hour hospitalization on an IV is a better approach.
 
Thanks, all. Your perspectives are so good to hear; based on what many of you have said, I have added questions to my list for Wednesday.

The vet did listen to her heart, and she did say that there was little heart murmur, but she wasn't concerned about it.

Question about labs here- many of you have indicated that the lab values show kidney issues or CRF. Is it possible that her diabetes is just super out of control and that throws off the kidney labs? I also think there is kidney stuff going on, but wondered if there's a chance that the story of the labs is complete due to the high blood glucose readings.

I'm looking forward to Wednesday, but I'm also scared because everything went to crap hardcore after our last visit because she was so freaked out.
 
FurBabyMamma said:
Is it possible that her diabetes is just super out of control and that throws off the kidney labs? I also think there is kidney stuff going on, but wondered if there's a chance that the story of the labs is complete due to the high blood glucose readings.
Click to expand...
It's possible, but I don't like relying on an assumption that that's what's happening. I had exactly that happen with Rosa - she had a couple of elevated kidney values when she was diagnosed diabetic and we 'thought' it was down to the diabetes. Turns out it wasn't and we lost 6 months of treating the kidney issues because of that. Hopefully the IM specialist will be able to confirm one way or the other for you.
 
FurBabyMamma said:
Thanks, all. Your perspectives are so good to hear; based on what many of you have said, I have added questions to my list for Wednesday.

The vet did listen to her heart, and she did say that there was little heart murmur, but she wasn't concerned about it.

Question about labs here- many of you have indicated that the lab values show kidney issues or CRF. Is it possible that her diabetes is just super out of control and that throws off the kidney labs? I also think there is kidney stuff going on, but wondered if there's a chance that the story of the labs is complete due to the high blood glucose readings.

I'm looking forward to Wednesday, but I'm also scared because everything went to crap hardcore after our last visit because she was so freaked out.
Click to expand...
What happened with DVM appointment??? is FurBaby ok??
 
Hi all. I have been pretty upset and disconnected from the universe. Long post alert.

Sophie was hospitalized on Wednesday for dehydration and ketoacidosis (7.1). At that point the vet gave her a 50/50 chance, so I went about my day at work then had an "ugly cry" meltdown at home where I absolutely ruined my husband's shirt as I cried off my "waterproof" mascara (guess it's not "waterworks" proof). Ultrasound revealed that, indeed, her right kidney was very small and didn't look to be working, and her other kidney was inflamed. Sophie's kidney values were garbage, as expected.

Even the specialist was shocked that her previous lab values were so good considering the current state, absolutely agreed that the previous vet's insulin increases were way too much (not following recommended guidelines even) and asked me if I had heard of the Somogyi Effect (which caused me to launch into a little bit of a profanity ridden rant in the car home because previous vet said the Somogyi effect wasn't really a thing, she even smiled and shook her head and said that not all the info on the Internet is correct; my prayer that is if I see that woman in public, the good Lord will miraculously remove my ability to speak because otherwise, it will NOT be pretty). Oh, and other vet was going to charge me $800 for the ultrasound done here; you know what I got charged at the specialist? $400. It's just amazing the price difference. Okay, rant over. The specialist was also like completely confused that previous vet would suggest oral meds in addition to insulin, and she said she had never heard of that. The specialist was very professional when talking about the other vet, which was classy, despite her not understanding previous vet's clinical decision making skills.

Sophie will definitely be in the hospital until Saturday. Yesterday, we got a call that Sophie's behaviors were markedly better (including soliciting pets from the staff and purring because my baby girl is so sweet and adorable), and her kidney values still weren't normal, but they were moving in the right direction, and they felt they could be a little more aggressive with the fluid therapy. She believes the kidneys were in a forward feeding cycle that were/are causing the diabetes to be worse, hence causing the kidney problems to be worse. They did a urine culture because she believes there might be an infection they couldn't catch before because Sohpie's urine was so dilute. Should get the culture back in a couple of days. They did rule out pancreatitis. They have been unable to get the blood sugar under control (fast acting insulin was ineffective), but she said her tactic is to deal with the kidneys as the immediate issue and then really get a handle on the diabetes because she doesn't think she will be able to fully get a handle on the diabetes until the kidney stuff is resolved, which I think makes sense.

I think that's all I have the capacity to download right now.

I am so thankful for this board and the replies and people on it. Hugs to you all.

I hope Sophie makes it and continues to improve. I do feel we are finally in the right place with the right peole.



 
((((Katie)))) I'm so sorry that Sophie is in hospital, but she is in the best place possible. There are wonderful vets and staff there and it sounds as though they have Sophie well on the road to recovery at this point. I am so, so glad they were able to confirm to you that your vet was increasing the insulin too fast - I was concerned at the increases you'd been told to make so quickly and that they confirmed that the oral med is NOT the way forward. And if she has been getting too much insulin, remember it is only today at the earliest that her depot from the higher dose will be fully drained and they will be able to see the true action of the insulin. It is absolutely true that the kidney issues and diabetes can feed off each other, but they are clearly dealing with it for you and her kidney values are improving - that's a great start. And if she has been badly dehydrated, that will not be helping her glucose numbers at all.

Sophie's kidney ultrasound results sound similar to Rosa's - she too has one kidney that is very small and appears not to be working - but it can all be managed with the right treatment. And it sounds as though the specialist vet is going to get you on the right treatment for her. :bighug: :bighug: :bighug: :bighug: :bighug:
 
FurBabyMamma said:
Hi all. I have been pretty upset and disconnected from the universe. Long post alert.

Sophie was hospitalized on Wednesday for dehydration and ketoacidosis (7.1). At that point the vet gave her a 50/50 chance, so I went about my day at work then had an "ugly cry" meltdown at home where I absolutely ruined my husband's shirt as I cried off my "waterproof" mascara (guess it's not "waterworks" proof). Ultrasound revealed that, indeed, her right kidney was very small and didn't look to be working, and her other kidney was inflamed. Sophie's kidney values were garbage, as expected.

Even the specialist was shocked that her previous lab values were so good considering the current state, absolutely agreed that the previous vet's insulin increases were way too much (not following recommended guidelines even) and asked me if I had heard of the Somogyi Effect (which caused me to launch into a little bit of a profanity ridden rant in the car home because previous vet said the Somogyi effect wasn't really a thing, she even smiled and shook her head and said that not all the info on the Internet is correct; my prayer that is if I see that woman in public, the good Lord will miraculously remove my ability to speak because otherwise, it will NOT be pretty). Oh, and other vet was going to charge me $800 for the ultrasound done here; you know what I got charged at the specialist? $400. It's just amazing the price difference. Okay, rant over. The specialist was also like completely confused that previous vet would suggest oral meds in addition to insulin, and she said she had never heard of that. The specialist was very professional when talking about the other vet, which was classy, despite her not understanding previous vet's clinical decision making skills.

Sophie will definitely be in the hospital until Saturday. Yesterday, we got a call that Sophie's behaviors were markedly better (including soliciting pets from the staff and purring because my baby girl is so sweet and adorable), and her kidney values still weren't normal, but they were moving in the right direction, and they felt they could be a little more aggressive with the fluid therapy. She believes the kidneys were in a forward feeding cycle that were/are causing the diabetes to be worse, hence causing the kidney problems to be worse. They did a urine culture because she believes there might be an infection they couldn't catch before because Sohpie's urine was so dilute. Should get the culture back in a couple of days. They did rule out pancreatitis. They have been unable to get the blood sugar under control (fast acting insulin was ineffective), but she said her tactic is to deal with the kidneys as the immediate issue and then really get a handle on the diabetes because she doesn't think she will be able to fully get a handle on the diabetes until the kidney stuff is resolved, which I think makes sense.

I think that's all I have the capacity to download right now.

I am so thankful for this board and the replies and people on it. Hugs to you all.

I hope Sophie makes it and continues to improve. I do feel we are finally in the right place with the right peole.
Click to expand...
Katie... If I can help in any way regarding SQ fluids I am happy to offer my experience--I have had years and years of it and my 17 year old has been getting them since he was 11-- when he gets BW done they cannot detect and kidney issues because of out home regimen .... SQ has saved his and many of my others--
My FD kitty also gets them daily as his kidneys came out of normal ranges after DX--they are just about normal now (his BUN is 4 points over) everything else is good-
Definitely best to have th eIV a few days to flush then follow up with SQ at home.:bighug::bighug::bighug:
 
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