Cat vs Normosol? Anyone seen this

[shiloh]

I have an elderly kitty who was diagnosed in February of this year with several things - she has a mass on her left kidney, the right kidney is scarred and atrophied, her liver is damaged, she has hyperthyroidism, and CRF. So, not a candidate for either surgery or chemo, the poor little thing.

She is on fluid therapy of 100 ml Normosol sub-cutaneous once a day and she is currently taking no other meds. My question involves this situation: If I feed her in too close proximity to her receiving her fluids she vomits til there is nothing left in her. I started off feeding her in first in the AM, then since I was in the bathroom (to keep other cats from eating her food) I would give fluids. Well, that didn’t work - up everything came within seconds of fluids finishing. So I would feed her, wait an hour or so then give fluids. That worked for awhile, then she started vomiting again. Changed to fluids first, then feed. Nope, vomiting. Fluids first, wait an hour or more - vomiting. There is an established pattern of vomiting within 5 minutes of receiving fluids. Otherwise, she doesn’t vomit.

Concened about this, I took her to the vet on Thursday. Vet was puzzled and said she had never heard of this happening. Ran a blood panel and cat’s red blood count was slightly elevated (though a huge improvement over initial vist when it was completely pegged out way high), liver panel slightly elevated but within normal range, only thing up was BUN and bilirubin. Cat plainly feels ill, but my feeling is that she feels sick because she is not really eating and because she is not eating well she feels sick.

Has anyone else had this happen or even heard of this kind of reaction to Normsol? Any suggestions? I’m really concerned for my little girl. Don’t feel it’s time to go yet - though, I know what “train” I’m on and where we’re headed - she is still interested in things, still gets around, still interested in personal grooming and still looks pretty good. It’s just this apparent correlation between the Normosol and the vomiting episodes.

This cat is my little pal. She has been with me since she was born. We have been through thick and thin and it’s going to kill me when she dies. It makes me upset to see her miserable.

Also, any suggestions for a natural stool softener?

[lovey1121]

Poor kitty!
I’ve got an ancient kitteh who is hyperthyroid, hypertensive, and has one shrunken lil’ kidney, and who knows how long the other one will hold out. He’s on Amylopidine, tapazole, and a powder caled Tumil-K, a potassium gluconate supp. that I sprinkle on his food. Before we got the K powder, we had to give subQ fluids EOD, and when he was dehydrated, his stool was hard. It was tough to keep him dehydrated. Back to Vet, who then had us try the K powder, since he was losing K from the BP med. All I know is, within a couple wks we noticed he was staying hydrated–no more subQ, not for over a yr. He eats voraciously about 4x/day and is skin and bones, but he’s hydrated and happy, and tho occasionally his poops get hard, they go back to normal fairly quickly. I dont know if any of this might help you–Is Normosol different that lactated ringer’s sol’n?

[MeghanDACVA]

If you are going to actually try to get this kitty feeling better (not cure her), you need alot more than you are doing.

In chronic kidney disease, red counts go DOWN, not up. They are chronicly anemic since the kidney is the organ that makes erythopoetin, which tells the bone marrow to make new red blood cells. Failing kidneys don’t make it.

The liver stuff can all be secondary to her not feeling good, or to the hyperhthroidism. Hepatic lipidosis occurs in cats that are not meeting their caloric requirment. It can be fatal if not treated by making sure they get enough calories. This usually means some sort of a tube.
Also by not knowing the other values (ALT, ALKP, Albumin, etc) it is hard to say much too. Cats get liver/gallbladder infections too and those need fluids and antibiotics.

Kidneys: as sick as she sounds (you dont’ give me BUN/Creat/Phos levels so I am guessing) she needs IV fluids, not SQ. Esp in the face of the other stuff. Does she have a bladder infection too? What does her urinalysis look like?

Thyroid: Why didn’t she start Methamizole? What is her HR and BP? She may need a beta blocker too like atenolol to get her heart down.

All 3 of these can be feeding on each other. If you want to try to get her back to feeling better you need to get after it, or stop diddling around and prolonging it.

I can’t answer the vomiting associated with the SQ fluids but NormR can burn in some patients when going SQ.

She needs major hospital care, not mild home care.

[Pancakes]

Norm-R is different than LRS in the composition (ratios of electrolytes, pH slightly). I’ve heard anecdotally from MULTIPLE people (and on our vet info boards) that Normosol stings when given subQ to cats. Maybe your cat is reacting to that?

Ask your vet for LRS instead and see if it makes a difference. They’re basically equal in terms of what they’ll do for your cat’s hydration.

(Edit: Meghan is right that your cat has multiple issues which need to be controlled before home care starts. Hospitalization for a few days can get her back on track.)

[MeghanDACVA]

The only really significant difference between NormR and LRS is the bicarb precursor. LRS has Lactate as it. NormR has acetate and gluconate. If you smell NormR it smells like viniger due to the acetate. This is what burns.
Some critters have no problem with it. Others do.

Choices for SQ fluids are: any isotonic, balanced electrolye solution that does not contain dextrose or supplemental potassium. Most all fluids contain potassium though; you just want a minimal amount like 4, 5, 6 mEq/L.
0.9% NaCl works, as does LRS, plain ringers, NormR, Plasmalyte R, etc. All you are after is the water. But it needs to be ISOTONIC water. Without dextrose.

[shiloh]

Thanks everyone for input.

I did not know that Normosol burned. My original, referring vet told me that saline solution burned, but Normosol did not. But based on what you are saying I’m betting that is not the case. I am willing to bet money now that she is reacting to the “burn.” My new specialist vet says that if she continues to vomit she wants to switch her to normal saline solution. Vet specifically does not want her on LRS.
I’ll fill in some background. She originally was seen in August 2010 because she just wasn’t right; I knew there was something wrong. Vet pulls blood, tells me later she is fine. She returns in October of 2010 for same thing. Labs are repeated. Again, I am told she is fine. We return again in February of this year and I get vet that is new to practice. She pulls labs and this time I am told that her liver enzymes are extremely high and she wants me to go to a specialist. I take her to specialist, who does ultrasound on her and we find the mass on her kidney and the damage to other kidney and liver. Vet feels outcome is terminal, so not wanting to get too aggressive, but does want to keep her comfortable and for lack of a better word - functioning for as long as the cat tolerates it. Vet feels she is in early CRF and just entering hyperthyroidism. Cat doing well on sub-cu fluids now. I didn’t find out about high RBC count until specialist mentioned it and that it was concerning to her. I was furious that I had not been told this earlier, because I would have followed up on it or at the very least, asked what a high value meant.

My big fear is the hepatic lipidosis. No UTI, no high WBC indicating infection. I didn’t ask about thyroid meds, but I will and also ask about heart meds. I think you are onto something when you say all three things may be feeding on each other. She has a murmur and a gallop rhythm (does that help or just confuse the issue?). Despite all this, with the exception of the vomiting, kitty is doing surprisingly well. Kitty did not vomit today and tolerated several small meals well.

Meghan: may I send you a PM?

[MeghanDACVA]

[QUOTE=shiloh;5661941]
Thanks everyone for input.

I did not know that Normosol burned. My original, referring vet told me that saline solution burned, but Normosol did not. But based on what you are saying I’m betting that is not the case. I am willing to bet money now that she is reacting to the “burn.” My new specialist vet says that if she continues to vomit she wants to switch her to normal saline solution. Vet specifically does not want her on LRS.
I’ll fill in some background. She originally was seen in August 2010 because she just wasn’t right; I knew there was something wrong. Vet pulls blood, tells me later she is fine. She returns in October of 2010 for same thing. Labs are repeated. Again, I am told she is fine. We return again in February of this year and I get vet that is new to practice. She pulls labs and this time I am told that her liver enzymes are extremely high and she wants me to go to a specialist. I take her to specialist, who does ultrasound on her and we find the mass on her kidney and the damage to other kidney and liver. Vet feels outcome is terminal, so not wanting to get too aggressive, but does want to keep her comfortable and for lack of a better word - functioning for as long as the cat tolerates it. Vet feels she is in early CRF and just entering hyperthyroidism. Cat doing well on sub-cu fluids now. I didn’t find out about high RBC count until specialist mentioned it and that it was concerning to her. I was furious that I had not been told this earlier, because I would have followed up on it or at the very least, asked what a high value meant.

My big fear is the hepatic lipidosis. No UTI, no high WBC indicating infection. I didn’t ask about thyroid meds, but I will and also ask about heart meds. I think you are onto something when you say all three things may be feeding on each other. She has a murmur and a gallop rhythm (does that help or just confuse the issue?). Despite all this, with the exception of the vomiting, kitty is doing surprisingly well. Kitty did not vomit today and tolerated several small meals well.

Meghan: may I send you a PM?[/QUOTE]

First off, yes you can PM me.

Fluids: If you are talking SQ fluids in particular, which clear stuff it is you are puttuing under the skin does not matter a hill of beans. As long as it is isotonic and does not contain glucose (or extra K). People get way too hung up on TYPE of fluid. 99% of the time what we are after is just VOLUME in the patient.
Unless you are repeatedly measuring electrolytes AND NEED TO MAKE MAJOR ADJUSTMENTS, which fluid type DOES NOT MATTER!!!
LRS: I am betting your vet is all hinky about the lactate. I will try to this “lecture” as short and sweet as possible.
Lactate does not = lactic acid. Lactate is what is leftover when lactic acid has done its acid thing. If anything, lactate will reverse an acidosis (not at the mammalian body’s pH but in a beaker). It will not, cannot, never will be able to CAUSE an acidosis. Acidosis is the accumulation of Hydrogen ion. Lactic acid is lactate + Hydrogen ion. I repeat: Lactate is what is left over!!!
So, even if the patient can’t metabolize the lactate, for some really biazare reason, they will NOT become acidotic. I get so tired of saying of this over and over (to vets, not you guys).

Food is essential if you are going to keep her comfy. It will need to started slowly and increased to her caloric requirement over about 3 days. If she vomits, you can either suction her stomach to get the nasty stuff out and/or give her something like reglan about 30 mins before feeding.

The gallop and murmur go with the hyperthyroidism, and more than “early”. Do you know what her T4 level was (and what their normals are)? It is not uncommon either to see increases in liver enzymes in hyperthroid cats.

[Armani]

Kidney failure

First off I never knew the cat had kidney failure it was 3 wks old when I rescued it…then it started to drink way to much and I thought it was because it was not fixed…So I bring the cat to be fixed only to find out it has one testicle which is ascended…and one which is not…leaving no other solution than to spay instead of a neuter and we could not do that …that surgery would have killed the cat…and then we found out he had kidney failure…so they gave him saline…and azodyl and then changed it to normosol…Since Ive been giving him that his values have gotten higher…and he cries when I administer it to him…I clean the area with alcohol since he likes to lick himself to much…and now he is on KD dry and sometimes KD wet…he is hard to keep weight on…but he did go from 4 pds to 9 pds…and now he is 3…Is there a reason he cries when I I.V. him and is there other supplements I can give him…this kidney problem is tough since he doesn’t even like to go in his litter box…but I have come up with a solution for that…has anyone ever hear of rebounce?? I need other solutions before his time runs out…I was told recently that protein is not good for the cats…wish they got their medical evaluation straight here…

[SquishTheBunny]

Meghan is 100% bang on.

Another possible option is a PEG tube, if you want to go that route. Often times when cats dont want to eat, and in cases where hepatic lipadosis is at high potential for developing, this will help kitties get over their hump of not eating (pending her renal values and hyperthyroidism can be controlled). Often times because you can get enough enteral nutrition into them, they do not require SQ fluids. If hospitalization is not an option for you, this can be a higher step in homecare.

I also think discussing thyroid meds with your vet would be a good next step, often times the arrhythmias disappear once the thyroid is better controlled.