Q:
Our 16 year old Tortoiseshell was diagnosed last year with hyperthyroidism which we have managed to treat using transdermal ear gel. Recently, we received bloodwork confirmation that her kidneys were failing.

We have now added sub-q fluids and aluminum hydroxide (for her elevated phosphorus level) to her regimen, which also includes transdermal atenolol (the "other ear") for her heart murmur. I am having less success getting the Famotidine into her, even having it compounded into soft cat treats but I am hoping that the aluminum hydroxide will help someone with any gastric acidity issues.

With all of this going on, Chipper is quite resistant to being medicated (did I forget about the Adequan shots every three weeks?) and I have learned to "prioritize" her daily medications with the sub-q fluids at the top of the list.

I recently subscribed to the "Stress to Success" video series (http://iwillhelpyourcatcourses.com/stresstosuccess/;

There is a LOT to digest and I continue to refer back to the chapters to hone in on activities to retry as our journey evolves. The Shebang (syringe) technique has probably saved us in the short term; the ability to use a smaller needle and still speed up the process has made all of the difference in getting the fluids on board.

Our vet gave us Normosol-R for Chipper's fluid administration but I am reasonably sure we used lactated Ringer's for our late cat Snickers.

I have read that lactated Ringer's helps buffer the acidity and may sting less during administration.Our vet was non-committal and only stocks Normosol-R.

Do you have any guidance on one versus the other?

First off, thank you for being one of the first people to join STS! Good job discovering which technique Chipper was requesting for the fluids!

Let’s talk about fluids type and Chipper.

With heart and kidney issues, you have a balancing act to achieve. Which fluid type you select will reflect that balancing act.

In terms of safety, the first consideration in which how much sodium (Na+) is in the fluids. The more sodium there is, the greater the chance that hypertension can occur. And hypertension isn't ideal for a heart issues.

When you hear of cats with a normal temperature, in their home environment (i.e. not hypothermic cats under anesthetic with IV fluids) not doing well with SQ fluids, a major factor can be sodium. The fluids are in fact delivering sodium to the body, and there will be a response (good, neutral or bad).

So Ideally, you want something with reasonable sodium content for ongoing use.

Normasol R has more sodium that lactated ringers. They are both considered higher sodium fluids however.

So either might work, but the lactated ringers is theoretically better.

You are doing a great job thinking about these details to find the best way to treat Chipper!

Two points to leave you with:

Talk to your vet about injectable famotidine. You can put that into the shebang technique syringe shown in STS, and so everything is given in one step (so you can avoid the oral meds).
The ideal situation for your cat ultimately might be to use fluid mixtures. You won’t hear too much about that right now - it's a technique that hasn't been popularized as yet. If there demand for it, I might develop a in depth CKD course in the same format as STS, that will go over these less common but valuable techniques.

Thanks for your question and for joining STS!

Dr. Kris