Oral fluids are
the ideal way to maintain hydration.
cats may need additional treatments, such as intravenous or subcutaneous
This page has
tips on helping your cat maintain his or her oral fluid intake.
Benefits of Oral
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.
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 Animal Endocrine Clinic Blog 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.
Unfortunately, in older cats generally there can be a reduced thirst
response, as mentioned by Dr E Ward in
Senior cat care: special considerations for cats (2008). This may be
the case even though
CKD cats tend to need more fluids because of what they lose 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).
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
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).
I would not recommend syringing the bags of fluid used for sub-Qs into
your cat's mouth. Your cat is unlikely to accept these fluids orally
because they taste salty and apparently rather oily. It is also far more
expensive than giving ordinary water.
You should never try to inject ordinary water into your cat because it is
not the correct composition for injection, you should only use fluids
approved for this purpose and prescribed by your vet.
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
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. Some people also use a water
dropper. Don't give too much because if
you do, your cat may feel full and then not eat enough.
Many people find water fountains increase their cat's
Effect of water source on intake and urine
concentration in healthy cats
(2010) Grant DC Journal of Feline Medicine and Surgery12(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.
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
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.
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
Veterinary Rehydration Products
Lectade Small Animal Rehydration Sachets is a veterinary oral rehydration product
made by Elanco that was available in the UK. It is currently out of stock
with most suppliers so I am wondering if it has been discontinued.
Lectade 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.
These sachets contain citrate, which should not be mixed with phosphorus
hydroxide because citrate can increase aluminium absorption.
Vet UK sells a similar product called
Glutalyte which can be used for up to seven days.
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
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
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
than having to give sub-Qs.
IRIS treatmentrecommendations for CKD
(2015) International Renal Interest Society
state that feeding tubes should be considered for Stage 4 cats, for whom "Feeding tubes can
be used to administer fluids as well as food."
ISFM consensus guidelines on the diagnosis and management of feline chronic
kidney disease (2016)
Sparkes AH, Caney S, Chalhoub S, Elliott J, Finch N, Gajanayake I,
Langston C, Lefebvre H, White J & Quimby J Journal of Feline Medicine &
Surgery18 pp219-239 state "Water can also be administered via
a feeding tube, and this may be preferable to subcutaneous fluids in many
cases. A feeding tube is suitable for long-term maintenance of hydration and
is a more physiological approach."
TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE
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.
If your cat
appears to be in pain or distress, do not waste time on the internet,
contact your vet immediately.
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