Q: Tobey just had a subtotal colectomy to get rid of his megacolon we've been dealing with for 3 years. Now he's showing some higher creatinine and subq fluids and a renal are our new ways of helping out my sweet dude. I watched your video, and loved it.

But a few questions: my human nurse friend said a bag of opened lactated ringers is only good for 48 hours. Is it ok that it's taking me weeks to get through a bag? I'm doing 100ml twice a week. Also, what happens if i give too much- the bags are so hard to read. Any other tips for kitties with renal issues? Tobey is 13. I asked my surgeon if i can have him for 5 more years..he says that's unlikely...i REALLY want to prove him wrong. My cat is amazing.

Ha ha! I love this. Don’t let anyone tell you what you can and can’t do dammit. Good for you. If you want him for another 5 years, then we treat him like we want him for another 5 years. Tobey will tell us what his true limitations are, as well as what his opportunities for health may be.

 Tobey

Tobey

There exist very different opinions with SQ fluids. I’m thousands of SQ fluids doses into it. I’ve given or prescribed enough SQ fluids to fill a large swimming pool. So here are my observations:

My human nurse friend said a bag of opened lactated ringers is only good for 48 hours. Is it ok that it's taking me weeks to get through a bag?

This is good advice for IV fluids, but it also really really depends on your technique when using the bag for SQ fluids. If the bag got touched the wrong way (i.e. any part that has contact with the fluid within the bag is contaminated), then it gets used once, then away it goes. See my SQ fluids video to see which parts not to touch:

If you are good with your technique, always put fresh needles on when you are finished your session (like shown in the video), and you are not using fluids with dextrose in them, then I’ve used bags for several weeks, up to a month on occasion if the technique is excellent. Past a month, I’d get a fresh bag I think.  

The concern of course is infection. Never seen it. Not even once. In a swimming pool’s worth of fluids.

Whenever in doubt, change the bag and tubing.  Is your cat immunocompromised? Maybe more frequent bag changes. Do you live in a really warm climate? Maybe more frequent again.

I'm doing 100ml twice a week. Also, what happens if i give too much - the bags are so hard to read.
  • IV fluids in incorrect amounts (too much) in a hypothermic cat = super big deal.
  • IV fluids with mild incorrect amounts given (too little or a little too much) in a stable cat = not ideal but you will probably be ok.
  • SQ fluids 50ml too much or too little, if only giving once a week in a cat above 3kg body weight = I’ve never seen a problem with this.
  • SQ fluids given to a cat with existing congestive heart disease = must be cautious to only give correct amounts or you will sodium overload them, making their heart disease worse.

So if your cat has no heart disease, a little bit over or under should be fine, if Tobey is like other cats.

BUT.

Tobey isn’t like other cats. He had a colectomy. The colon is an organ that effects water balance. So for Tobey, I would always err on the side of caution. Be as accurate as you can.

So see the “shebang” technique in the video I posted above - that way you can measure the right amount down to a ml.

Also, see this post on how I figure out how much, how often to give: http://www.iwillhelpyourcat.com/videos/#/sq-fluids-by-the-numbers-how-much-how-often/

I’ll have much more to talk about with CKD in 2017!!!!

Cheers,

Dr. Kris