# Help getting a sick cat to eat.



## Livin1naZoo (May 26, 2010)

A little background: I have a 16 1/2yr old tabby. She was diagnosed with kidney failure in November, had only 25% functioning. We left her at the vet for a week and they did continuous IV fluids and rechecked her blood work and told us she was better and to bring her back in 6 months. So we took her back yesterday (her actual follow up was supposed to be next Tuesday) because she wasnt eating and had been vomiting a lot recently. They did her labs and when we went to pick her up they said it was not good. They sent her home on 4 meds twice a day and twice a day IV fluids. Well the issue I am having is I cannot get her to eat. This morning because she wouldnt eat we crushed her meds and used a syringe to give them to her but it was so hard, she didnt want them. So tonight I tried to put it on tuna fish. She still wont eat. And tuna fish is by far her favorite even the first time when she was sick we got her to take her antibiotic by putting it on tuna fish. There are only 2 meds in the tuna tonight her antibiotic and a nutrition suppliement. Can anyone give me any ideas on how to get her to eat? We are only doing this for about 4 days before her blood work is rechecked to see if she has had any improvements and if there isnt a big enough improvement they recommend putting her down. I understand it may be her time but we brought her home because we dont want to give up with out at least trying. Any advice or suggestions would be greatly appreciated. Thank you so much!!


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## laurief (Jun 22, 2008)

Welcome to the Cat Forum. I'm sorry for the circumstances that have brought you here but am glad you found us. Several of us here have dealt with chronic renal failure in our cats. For my part, I've cared for three CRF cats, so I've been dealing with this disease on and off for a couple of decades.



Livin1naZoo said:


> we took her back yesterday (her actual follow up was supposed to be next Tuesday) because she wasnt eating and had been vomiting a lot recently. They did her labs and when we went to pick her up they said it was not good.


As you'll quickly learn if you haven't already, CRF involves a very steep learning curve. It's a complex disease that affects all body systems in one way or other. Knowledge is a very powerful tool in the management of this disease and its associated conditions, and there are many strategies that may help improve and maintain a good quality of life for your cat for a significant period of time.

That said, in order to make sense of CRF information you find online and in order to solicit the most useful advice and guidance from forums such as this one, you really need to get copies of all of your cat's test results from your vet so that you can reference them and put acquired information into appropriate perspective for your particular cat. Without knowing exactly what your cat's labs are right now and exactly which meds she's receiving at what doses and frequencies, we really can't offer much specific input or advice. I urge you to get copies of her test results ASAP and post them here so that we can really see what's going on with her. If you do post her test results, please post ALL values (those out of normal range AND those in normal range), and include the lab's reference ranges.



> They sent her home on 4 meds twice a day and twice a day IV fluids.


Again, we need to know exactly which meds, at what doses, and at what frequencies she is receiving them.

When you say "twice a day IV fluids", I assume you really mean subQ fluids administered twice daily at home. Or are you taking her to the vet twice a day for actual IV fluid administrations? Either way, what type of fluid is she receiving, and how much at each admin?



> Well the issue I am having is I cannot get her to eat. This morning because she wouldnt eat we crushed her meds and used a syringe to give them to her but it was so hard, she didnt want them.


This may be causing more harm than good, depending on the meds she's receiving. Some meds must be given with food, like potassium, phosphorus binder, and some antibiotics. If these meds are given on an empty stomach, they may either cause significant stomach upset or they may be ineffective. Other meds should be given on an empty stomach. And of course some meds can interfere or interact with each other if given too close together, so you need to know about those possible issues.

But disregarding the meds for the moment (since I don't know what they are), here are several links to sources with lots of tips, tricks, and techniques to get nourishment into your girl (which is critically important), whether or not she's willing to eat on her own:

http://www.felinecrf.org/persuading_cat_to_eat.htm
http://www.assistfeed.com/
http://www.yahoogroups.com/group/Feline ... ed-Feeding



> We are only doing this for about 4 days before her blood work is rechecked to see if she has had any improvements and if there isnt a big enough improvement they recommend putting her down.


I urge you to take the time to access the online CRF resources and study up on the various management options before making an irreversible decision like euthanasia. There is so much to learn about this disease and so much that can be done for cats living with it that you really need some time to get a handle on at least the basics. You will likely be overwhelmed at first as you start to read the available materials, but stick with it. The more you read, the more will "stick" and sink in. The rest can be absorbed over time. Here are two invaluable resources that many of us CRF caretakers consider to be our lifelines of information and support:

http://www.felinecrf.org/ - Tanya's Feline CRF Info Centre (our "bible")
http://groups.yahoo.com/group/Feline-CRF-Support/ - Feline CRF Support Mailing List

Please post again with any specific questions and/or when you have her test results.

Laurie


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## Livin1naZoo (May 26, 2010)

Laurief-Thank you so much for the info. I am trying to read it now. I have done her regular food (prescription diet k/d) wet it warmed it everything, then we tried tuna fish, by far her fave thing ever and still nothing we are going to try the other things tomorrow. I will post her labs when I get them from the vet in the morning. I do know her BUN, CREATINE and PHOSPHORUS were dangerously high. Here are the meds she is on and reasoning for the ones that seem odd. 

SubQ IV fluids:Normosol (mainly normal saline with electrolytes)-75-100ml twice daily
Pepcid AC- 1/4 pill twice daily for nausea and increase stomach acids and to help with possible ulcer
Enelapril 5mg-1/4pill once a day to help with new found heart murmur and to help increase blood flow to kidneys
Clavamox 62.5mg/ml- 0.5ml twice a day for 10 days
Epakitin-1/2 spoon twice a day 

They prefer her to eat her kidney diet food but I am just trying to get anything in her at the moment. I am going to go get the stuff tomorrow and try the suggestions from the links you sent me. Thank you!!


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## Livin1naZoo (May 26, 2010)

also we are giving the IV fluids at home.


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## laurief (Jun 22, 2008)

Livin1naZoo said:


> Laurief-Thank you so much for the info.


You're welcome. CRF has become a bit of an unwelcome specialty for me. I know a lot more about it that I ever wanted to. But at least my experience with it has provided me with the resources to share with other folks dealing with this disease.



> I have done her regular food (prescription diet k/d) wet it warmed it everything, then we tried tuna fish, by far her fave thing ever and still nothing we are going to try the other things tomorrow.


None of my CRF cats would go anywhere near canned K/D. They found the stuff absolutely repugnant. There are other companies that make prescription renal diets, so you might check around at other vet practices and see if you can pick up a can or two of other renal foods to try. That said, the rule of thumb with CRF cats is that if they won't eat what you want them to eat, then feed them whatever they WILL eat. Nourishment is critical, even if it's not an ideal renal diet.



> I will post her labs when I get them from the vet in the morning. I do know her BUN, CREATINE and PHOSPHORUS were dangerously high.


High phos can REALLY make them feel sick and nauseous, so that's likely a big part of why she's not eating on her own right now.



> SubQ IV fluids:Normosol (mainly normal saline with electrolytes)-75-100ml twice daily


That's quite a bit of fluid. CRF cats more typically receive 100 ml daily, but perhaps your vet has you administering more temporarily to try to bring her numbers down. Keep an eye on her breathing. If it becomes at all labored, she may be retaining fluid and not processing that volume quickly enough through her system. If she does any open-mouth breathing, get her to a vet immediately. I only mention this because I once overhydrated one of my CRF cats administering a vet-prescribed amount of fluids (300 ml daily) and nearly killed him. I'm now very cautious about overhydration.

Most CRF cats are given Lactated Ringer's Solution rather than Normosol-R, though the latter is more appropriate under some circumstances. You can read about the differences between fluids here:

http://www.felinecrf.org/fluid_therapy.htm#fluid_types



> Pepcid AC- 1/4 pill twice daily for nausea and increase stomach acids and to help with possible ulcer


That's a higher dose of Pepcid AC than is recommended on Tanya's site. You can read the suggested dosing guidelines and possible drug interactions here:

http://www.felinecrf.org/treatments.htm#famotidine



> Enelapril 5mg-1/4pill once a day to help with new found heart murmur and to help increase blood flow to kidneys


I've never used Enalapril, but there's a good bit of info about ACE inhibitors on Tanya's site here:

http://www.felinecrf.org/treatments.htm#ACEI



> Clavamox 62.5mg/ml- 0.5ml twice a day for 10 days


Clavamox makes a lot of cats quite nauseous and inappetant, esp. when administered on an empty stomach. You might want to ask your vet for a different antibiotic - perhaps amoxicillin - that isn't quite as likely to cause as much stomach upset.



> Epakitin-1/2 spoon twice a day


I do wish vets would get off the Epakitin kick. It's nowhere near as effective a phosphorus binder as aluminum hydroxide, and if your girl has very high phos, she needs to be on a binder that will bring it down as quickly as possible. Read these links:

http://www.felinecrf.org/treatments.htm#ipakitine
http://www.felinecrf.org/treatments.htm#high_phosphorus

That should keep you up and reading for the rest of the night. ;-)

Laurie


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## laurief (Jun 22, 2008)

Here's more information for you about Enalapril:

http://www.marvistavet.com/html/body_enalapril.html

Laurie


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## Jader (May 27, 2010)

So sorry to hear! =( My cat was 20years old when her Kidneys failed. She's 22 now and more active than ever! Unlike your Tabby though, we never used IV fluids and brought her home the same day. She was on Clavamox for just a few days until I took her off. She vomited often for the first week, then everything cleared up on its own.

It's been 2 years, and she's starting to vomit again, but that's likely due to her eating too fast sometimes. Or too much. I know it's hard to watch, but give her a little longer! Get her some comfy blankets, and shower her with love and affection much as possible. Try hand/spoon feeding her super moist food. Maybe mix tuna with water some more. If all else fails, try taking her off the meds/IV for a day and see if she'll eat without the IV/med side effects. Very risky, so it really depends on if she's able to move on her own and is holding her bladder.

I'm no vet, so be careful with the path you choose! The vet told us to put her down the day we went in to get her checked out. I took that day and the next off, and have never regretted keeping her.


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## Livin1naZoo (May 26, 2010)

She is not moving around much on her own maybe a few feet at the most. We made all water and food as accessable as possible. Mixed tuna in with it as well. Her food is dry so we crushed it smaller for her. Still nothing. We have been using a syringe and giving her chicken broth against her wishes, she hates it. And we are only able to get about 10ml in. Last night we realized she is also unable to hold her bladder. She knows she has to go right when she starts going. The dr is faxing my husband all her labs so he will have them in the morning. When she was originally diagnosed she seemed to completely recover after her meds and such and then really went down hill these last few weeks. She just really seems to be suffering now and it's so hard to watch. But we are holding out hope she will take a turn for the better. All of the information I have received from yall has really helped!


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## laurief (Jun 22, 2008)

Livin1naZoo said:


> We have been using a syringe and giving her chicken broth against her wishes, she hates it.


If she's not eating any sort of solid food on her own, you need to be syringe feeding canned cat food blended with a little water in your kitchen blender - not just chicken broth. Keep the food slurry as thick as possible. Add just enough hot water to the blender so that the slurry will pass through your syringe. It's much easier to syringe feed a thick slurry than a thin soup, and your girl MUST get some real calories into her body immediately. In fact, you should pick up some A/D prescription food from your vet. It's formulated to be smooth going through a feeding syringe when mixed with a little water, and it's packed with extra calories for debilitated animals. It's not an ideal choice for a CRF cat, but in your cat's case, it's the best option right now.



> And we are only able to get about 10ml in.


I don't mean for this to sound harsh or accusatory, just factual. If the only calories your girl is taking in are from 10 ml of chicken broth, her body is being starved. She can not survive without adequate food. Unless you are ready to euthanize her, you must get food into her - 5-6 oz of canned food a day. You simply mustn't allow her body to starve to death. 

I'm very concerned about the meds that you're giving on an empty stomach. Clavamox, as I noted in an earlier response, can cause significant stomach upset, esp. when given on an empty stomach. Why is she getting an antibiotic? Does she have an active infection? If not, Clavamox is likely causing more problems than it's worth. Even if she does have an active infection, amoxicillin may be a better choice with less stomach upset for her.



> The dr is faxing my husband all her labs so he will have them in the morning.


I'll be interested in seeing them.



> When she was originally diagnosed she seemed to completely recover after her meds and such and then really went down hill these last few weeks.


[/quote]

Given the most recent description of her behavior that you posted, it sounds like she's in more trouble than I was assuming. If you want to try to stabilize her, I think it may be necessary to put her back into the hospital for another round of IV fluid treatments. SubQs might not hack it in her current crisis. And she must get food into her system. Food and water are the two most critical necessities to sustain life. Without them, she can not survive.

Laurie


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## Darkcat (May 27, 2010)

Sorry yo hear about your kitty. 

When my little guy caught a respiratory infection, all he would eat was his dry food mashed with warm water. He loved it so much, it's now considered a treat. You can try it, it's worth a shot.


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## Livin1naZoo (May 26, 2010)

Here are her labs that were abnormal. I am sorry I am posting from my phone so it's easier to just post abnormals right now. 

BUN-130 H (16-36)
CREATININE-13.5 H (0.8-2.4)
PHOS-16.1 H (3.1-7.5)
NEUTROPHILS- 91.8 H
LYMPHOCYTES-6.3 L
PLATELETS-13.5 L
AMYLASE- 1949 H (1500 MAX HIGH)

Like I said this is what I have for now. My husband said this were the abnormals and I will look @ the normals when I get home tonight. These labs were drawn monday.


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## laurief (Jun 22, 2008)

Oh boy, with numbers that high, I would have my own cat hospitalized on IV fluids for up to a week. Either that, or I would euthanize. I recommend you get her back to the vet today for another renal panel to see if the subQ fluids have had any effect on those numbers, which I don't expect they will. SubQs are great for maintaining a stable cat, but they usually can't stabilize a cat during a major crash, which appears to be your cat's current state.

Laurie


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## jusjim (Jun 30, 2009)

I'm terribly sorry to hear about your cat. Having recently lost Zenobi I know how heart-wrenching it is to see them so sick and feel so helpless even though you're doing everything in your power to help them and make them comfortable. I made my final judgment based on what I thought I miight want if I were a cat. Heartfelt sympathy.


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## Livin1naZoo (May 26, 2010)

We took her back to the vet yesterday and they rechecked her blood and she has gotten worse. Her BUN has gone from 130 to 148 and creat from 36 to 40. I think that's right if not I will post a clarification. Our vet said even if she had eaten there's little chance it would have done much. We got a second opinion from another vet who said the same thing. It's just now going on 2wks that she has been acting sick and just this week has it been bad. Our vet said unless you have dealt with it before there usually aren't any real symptoms especially when you have 2 cats that eat out of each others bowls and use the same litter box as ours do. We brought her home yesterday so her last night could be with her family and not in a strange vet office. We didn't give her any of the meds last night, just held her and loved on her. We just wanted it to be as easy as possible on her. Thank you Laurie for all the wonderful information! We tried several of the suggestions to get her to eat and none worked. But now I know what to do if this ever happens again, which I pray it never does. I know not to blindly trust a vet to know what to do over what I think I should do. And to def question things more. The vet we see has a new dr who is really amazing. She had a cat of her own die of CRF last year so she knows what we are going through. Again thank you so much!


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## laurief (Jun 22, 2008)

Livin1naZoo said:


> We took her back to the vet yesterday and they rechecked her blood and she has gotten worse. Her BUN has gone from 130 to 148 and creat from 36 to 40. I think that's right if not I will post a clarification. Our vet said even if she had eaten there's little chance it would have done much.


Eating wouldn't have made any difference in her numbers. 



> We brought her home yesterday so her last night could be with her family and not in a strange vet office.


I'm so sorry you and your girl have had to suffer through this illness.



> We didn't give her any of the meds last night, just held her and loved on her.


That's the way to do it if you know the end is imminent.



> Thank you Laurie for all the wonderful information!


You're welcome.



> now I know what to do if this ever happens again, which I pray it never does.


This is the legacy of the disease and those who struggle with it. I have always felt it important to honor what my CRF cats have gone through by learning everything I can from their illness and its management so that I can do better next time I am faced with it. Each experience with CRF builds on the last, so that each new CRF cat can hopefully benefit from my broadened base of knowledge. 



> I know not to blindly trust a vet to know what to do over what I think I should do.


Absolutely correct. Vets may (or may not) know more about a particular disease than we do, but no vet on this earth will ever know as much about our own animals as we do. Ultimately, the responsibility for the care of our animals lies with us. Vets are advisors, and the best ones are partners with their clients. They should never be dictators, and they certainly are not infallible.



> And to def question things more.


Knowledge is power. You certainly know more about CRF now than you did a couple of weeks ago, and you have the resources to learn even more, if you're so inclined. A well-informed caretaker can strongly and intelligently advocate for the best possible veterinary care for their animals, and a vet whose ego doesn't get in the way will appreciate a client who knows what they're talking about. 

Again, I am so sorry for the pain this disease has caused your family, both human and feline.

Take care,

Laurie


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## Livin1naZoo (May 26, 2010)

L.B.'s last day was Friday. It was much easier to watch than having watch her suffer all week. It was probably the single hardest decision I have ever made, but I know it was for the best for her. The dr. offered to admit her give her continuous IV fluids and see what happens from there but said it would only give her another few days. I didnt want to put her through any more. She had been too good of a cat to do that to. Once it was over I felt relief for her. I hope that would have been the decision she'd want me to make. We have another cat who is 3 and already suffers from chronic kidney stones. I am taking all of this info and doing what I can to related it to the kidney stones. Because they seem to be more obvious when she has a flare up of them we already manage them fairly well. Its been about a year since she has had one. But I dont want her to go through what LB did so I am getting more proactive in her care now. Again Laurie thank you for the amazing amount of information you have given me! 

This is a picture of LB taken in March.


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## laurief (Jun 22, 2008)

Aw, LB was such a pretty girl. "Bugs Bunny color", as one of my young friends would call it. I know how heartwrenching a decision yours was. I had to make the same one for my CRF cat, Billy, a couple of weeks ago. Yes, there is relief releasing them from their failing bodies. That ameliorates but doesn't eliminate the pain of our losses.

I hope your other girl has no further problems with kidney stones.

I wish you a peaceful grief.

Laurie


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