TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

ORAL FLUID THERAPY

 

ON THIS PAGE:


Benefits of Oral Fluid Intake


Oral Fluid Requirements


Fluid Choices


Tips on Increasing Oral Fluid Intake (Including Water Fountains)


If Your Cat Stops Drinking


Feeding Tubes


 

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TREATMENTS


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Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


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FLUID THERAPY


Intravenous Fluids


Subcutaneous Fluids


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How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


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Home > Fluid Therapy > Oral Fluid Therapy

 


Overview


  • Oral fluids are the ideal way to maintain hydration.

  • Eventually CKD cats may need additional treatments, such as intravenous or subcutaneous fluids.

  • This page has tips on helping your cat maintain his or her oral fluid intake.


Benefits of Oral Fluid Intake


 

There is a saying in medicine, if the gut works, use it. Obviously this is particularly true of maintaining hydration, where it is a lot easier and less stressful for everyone if a cat takes in sufficient fluids orally and thus avoids the need for more proactive fluid management such as intravenous or subcutaneous fluids. This is also the most natural way for cats to take in fluids.

 

When we talk about oral fluid intake, we are not only referring to drinking. Cats obtain quite a lot of their fluid needs from the food they eat. Canned food contains about 80% water, so it is a good choice for a CKD cat.

 


Oral Fluid Requirements


 

In order to maintain hydration, a cat generally needs around 24-30ml of water per pound bodyweight per day (though this amount will be affected by activity levels and climate). This means that a 10lb (4.5kg) cat would require 240-300ml of water a day (a cat in congestive heart failure may need less). Daily water requirements and needs for cats (2011) Peterson ME says "A normal catís daily water requirement ranges from 5 to 10 fluid ounces per day (or an average of 60 ml/kg/day)."

 

The cat does not need to obtain this by drinking alone. If you are feeding canned food, which contains a lot of water, that will make a sizeable contribution to total intake.

 

CKD cats may need more fluid because they lose more through the increased urination caused by CKD. Never restrict a CKD cat's access to water (unless your vet has advised you to do so for a brief period prior to surgery).

 


Fluid Choices


Some people give their cat bottled water. The taste of chlorine in normal tap water doesn't taste too good to cats, so this is worth considering but not essential.

 

Some people like to use distilled water, though I can't say I'm a fan. Some types of distilled water have a low pH level, and the extra acidity in these products is not appropriate for CKD cats, who tend towards acidity anyway. Distilled water may also cause potassium imbalances.

 

You also do not want to give alkalinised water, because this may increase the risk of calcium oxalate stones.

 

My cats' favourite water is rain water. Normally though we give them filtered water, at room temperature, and when we were using a bowl, we changed it several times a day (such frequent changes are not necessary with water fountains).

 

You should never syringe the bags of fluid used for sub-Qs into your cat's mouth - these fluids are for injection only, not for oral use. Similarly you cannot inject ordinary water into your cat, you should only use fluids approved for this purpose and prescribed by your vet.

 


Tips on Increasing Oral Fluid Intake


 

Cats are not known for drinking a lot, a legacy of their desert heritage. Therefore the more you can do to encourage them to increase their oral fluid intake, the better.

 

Cats in the wild do not eat and drink in the same place. Therefore it is better not to put the water bowl next to the food bowl. Some cats don't like a narrow bowl where their whiskers touch the side, so experiment, and also consider using a water fountain.

 

Some people find placing ice cubes made from low sodium tuna water in their cat's water bowl encourages their cat to drink more. You may also wish to give your cat homemade chicken broth to drink.

 

With a CKD cat, it makes a lot of sense to have more than one water source. We used to just have one bowl of water out but once Thomas was diagnosed we switched to three, including one placed upstairs so Thomas didn't have to go too far for a drink in the night.

 

You can also add water to your cat's food. One teaspoon of water is 5 ml, so if you can add 10 tsp a day to your cat's food, you are increasing fluid intake nicely. However, you do not want to overdo it, so your cat's calorie and nutrient intake reduces, so start slowly and make sure your cat still eats sufficient food.

 

If your cat is in mid-stage CKD and needs help with hydration but your vet refuses to allow you to give sub-Qs, you could consider syringing water into your cat's mouth instead. Discuss this possibility with your vet. You have to be careful because cats can only swallow a tiny amount at a time, and you should always syringe from the side of the mouth, never from the front - see syringe feeding for more information. Don't give too much because if you do, your cat may feel full and then not eat enough.

 

Effects of feeding frequency on water intake in cats (2005) Kirschvink N, Lhoest E., Leemans J. Delvaux F, Istasse L, Gustin P, Diez M Journal of Veterinary Internal Medicine 19 p476 found that cats fed more frequently increased their fluid intake. Frequent feeding can also help with excess stomach acid.

 

Hill's Pet Tails Monthly Newsletter (2011) explains why cats may prefer running water and gives tips on increasing your cat's water intake.

Pet Education has some tips on how to get your cat to drink more.

About Cats Online has tips on how to get your cat to drink.

 

Water Fountains


Many people find water fountains increase their cat's water intake. Effect of water source on intake and urine concentration in healthy cats (2010) Grant DC Journal of Feline Medicine and Surgery 12(6) pp431-4 found that cats drank a bit more from a water fountain but there was not a massive difference. This was a short study though. I found my cats needed time to get used to the fountain, but that they do like it and drink more from it. In fact when the water fountain is in the dishwasher, we get indignant complaints until it is returned to its rightful place.

 

There are three main types of water fountain:

My cats have used the large (deluxe) version of the Fresh Flow for several years and they love it (see photo left; I have no idea why Karma clambered over the tapestry frame rather than approaching it from the front or left, but hey, she's a cat and she has her reasons). Some people find the Catit easier to clean. Any of them should be fine for most cats.

 

When you first get a fountain, leave it out without water in for a few days to allow your cats to get used to it. Then add water, but don't turn it on. Once your cats are drinking from it, turn it on. Be sure to leave other water sources available until you know your cats are willing to use the fountain.

 

Instructables tells you how to build your own water fountain.

Sixerdoodle Electronics has in

 

Water Fountains Sources


 

USA


Pampered Pet Mart sells the Drinkwell for US$34.95.

Valley Vet sells the Petmate Freshflow Water Fountain in the USA for US$33.95 or US$37.95 for the larger model.

Miles Kimball sells a small water fountain for US$19.99.

Drs Foster & Smith sell a variety of water fountains with prices starting around US$20.

Amazon sell the Pioneer stainless steel model for US$54.30.

Drs Foster & Smith sell the Drinkwell stainless steel model for US$99.95.

Glacier Point sells a variety of ceramic fountains.

Bottle Babies sells freestanding water bottle holders, similar to the water supplies designed for hamsters etc.

 

UK


Pet Planet sells the Deluxe Freshflow Fountain for £51.49.

Pet Planet also sells the Cat-It water fountain for £22.99.

Amazon UK sells a variety of water fountains.

 

Canada


Real Canadian Superstore sells the Petmate Freshflow Water Fountain in Western Canada for CAN$29.98.

Dino Direct sells freestanding water bottle holders, similar to the water supplies designed for hamsters etc. Some cats like this sort of fountain

 

Oral Rehydration Sachets: Lactade, Pedialyte, Dioralyte


Normally a cat relying on oral fluid intake simply needs water. However, if a cat is clinically dehydrated, perhaps from vomiting or diarrhoea, s/he needs electrolytes (body salts) in addition to water. In such cases your vet may recommend oral rehydration sachets - my vet gave me some of these for use when my cat was recovering from dental surgery.

 

Veterinary Rehydration Products


 

Lectade


Lectade is a veterinary oral rehydration product available in the UK. However, it does contain glucose so is not suitable for diabetics. It is also quite expensive. It is not really intended for ongoing use, the manufacturer advises that you can give your cat 100ml of the mixture each day for up to 36 days, but if your vet refuses to allow you to give sub-Qs, s/he may perhaps agree to using Lectade.T

 

hese sachets contain citrate, which should not be mixed with phosphorus binders containing aluminium hydroxide because citrate can increase aluminium absorption.

 

Pet Meds sells Lectade in the UK.

Vet UK sells Lectade in the UK.

Vet UK sells a similar product called Glutalyte which can be used for up to seven days.

 

Royal Canin Rehydration Support


Royal Canin sells a product called Rehydration Support.

 

Human Rehydration Products


 

Pedialyte or Dioralyte


Pedialyte is a popular brand used in the USA, and is designed to rehydrate children with vomiting or diarrhoea.

 

Dioralyte is a similar popular which is popular in the UK

 

Only use the unflavoured variety of these products. Do not use without checking with your vet first, and be guided by him/her re dosage.

 

Vet Info discusses the use of Pedialyte in cats.

 


If Your Cat Stops Drinking


 

CKD cats who are not receiving sub-Qs regularly will drink a lot in an effort to keep themselves hydrated. I sometimes hear from people who are worried because their cat has started sub-Qs and is now hardly drinking at all. This is not normally something to worry about - cats who are receiving subcutaneous fluids regularly may drink much less, because some of their hydration needs are being met through the sub-Qs. 

 

Many CKD cats struggle with appetite, but they will usually continue to drink. Whether your cat is on sub-Qs or not, if s/he stops both drinking and eating, or if severe vomiting or diarrhoea or pancreatitis are present, it is possible that your cat is crashing or at the very least needs some veterinary support, so please contact your vet. Depending upon the situation, your vet may offer sub-Qs or intravenous fluids to help your cat through the crisis. The fluid that your vet uses in such situations is not only water, it also contains electrolytes (body salts) such as potassium, which may be lost in vomiting and diarrhoea.

 

You may well be able to stop giving sub-Qs once the crisis is over. Eventually, however, most CKD cats will not be able to drink take in enough fluid orally to maintain hydration, at which point they will probably need sub-Qs. In principle, this tends to happen when creatinine levels are consistently over 3.5-4.0 mg/dl (USA) or 300 -350 Ķmol/l (international).

 


Feeding Tubes


 

Feeding tubes are inserted for various reasons but one advantage of them is that you can give water (not the fluids usually used for sub-Qs) orally rather than having to give sub-Qs. The International Renal Interest Society states that feeding tubes should be considered for Stage 4 cats, for whom "Feeding tubes can be used to administer fluids as well as food."

 

 

 

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This page last updated: 25 July 1016

Links on this page last checked: 25 July 2016

 

   

*****

 

TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

 

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