Subcutaneous fluids (sub-Qs or subcuts) are fluids given via an injection under the skin
rather than via a vein. This means they can
be given at home.
In the
USA and Canada, it is common to give sub-Qs to CKD cats to maintain hydration. Unfortunately, sub-Qs are not routinely offered in most
other countries.
This page provides an overview of the basics of sub-Qs, including when to start them, how much to
give and how often.
Subcutaneous
means under the skin; so subcutaneous fluids, commonly known as sub-Qs
in the USA and subcuts in the UK,
are a way of hydrating the cat by carefully introducing fluids under the skin. Instead of placing a slow drip
of fluids into the cat's vein, as happens with
intravenous (IV) fluids, the fluid is injected
just under the skin with a needle. The fluid then gradually disperses
throughout the cat's body, and helps him or her to maintain hydration at
the correct level.
The
fluids used are particular types of fluid with the correct balance
of electrolytes (salts). There are various types of fluids available (see
Tips on Giving Subcutaneous Fluids) and your vet can select
the fluid most suitable for your cat.
Giving sub-Qs only takes about five minutes and can be easily done by a
trained layperson, so if your cat needs them, your vet should be able to
teach you how to give them at home.
Why Use
Subcutaneous Fluids?
The cat is
an unusual animal in that it has the ability to concentrate its urine, a
little like a camel; this is believed to be a legacy of its African
heritage. However, in cats with CKD, this ability gradually disappears,
and cats then produce a very dilute urine: the urine looks weaker in
colour, has little odour, and the cat will often produce copious
amounts.
This increase in urination leads the cat
to drink more and more in order to maintain hydration; and for a time the
cat can manage to maintain some kind of balance. Eventually, however, the
cat simply cannot drink enough to keep up with his or her urination rate, and dehydration (which doesn't only mean a loss of body fluids,
but also of electrolytes necessary for proper function) occurs. Sometimes this becomes so
severe that the cat crashes (i.e. becomes dehydrated enough to need IV
treatment at the vet's), as happened to Thomas.
Even if your cat does not suffer such a crisis, the ongoing low-level
dehydration that accompanies CKD can be debilitating and uncomfortable; can
cause toxin levels in the blood to rise; reduces blood flow
through the kidneys, and the kidneys deteriorate even more.
Evidence-based step-wise approach to managing chronic
kidney disease in dogs and cats
(2013) Polzin DJ Journal of Veterinary Emergency
Critical Care (San Antonio) 23(2) pp205-15 states that dehydration
"may promote deterioration in kidney function."
Not only that, but dehydration feels horrible. Human CKD
patients have described dehydration and the accompanying high levels of toxins
in the blood as feeling similar to a bad hangover. It can make you feel so
horrible that you stop eating and drinking, and according to
Evidence-based step-wise approach to managing chronic
kidney disease in dogs and cats
(2013) Polzin DJ Journal of Veterinary Emergency
Critical Care (San Antonio) 23(2) pp205-15, it may even
"precipitate a uremic crisis" and "predispose to
AKI [acute kidney
injury]."
Therefore the purpose of sub-Qs
is
to keep your cat nicely hydrated, which in turn should help maintain kidney function and
improve wellbeing by avoiding that hungover feeling.
You will note I don't mention "flushing" the kidneys as a reason for giving
sub-Qs. Flushing the kidneys is not the goal, because that is additional work
for them. The goal is to keep your cat properly hydrated and comfortable, nothing more, nothing less.
When To Use Subcutaneous Fluids
Although sub-Qs can be of great benefit to cats who need them, not all CKD
cats need them immediately. As mentioned above, the purpose
of sub-Qs is to keep the cat hydrated enough to avoid dehydration occurring. However,
cats with early stage CKD can usually drink enough to offset their increased
urination, and thus do not become dehydrated even without sub-Qs.
Processing sub-Qs in itself places an additional
workload on the kidneys, plus it can flush out certain nutrients, reduce
potassium levels and raise sodium levels. Sodium is a
particular concern. Sub-Q fluids contain sodium and
Staged management of chronic kidney disease in
dogs and cats (2009) Polzin D Presentation to the 34th World
Small Animal Veterinary Association World Congress
states "Because recent evidence suggests excessive sodium intake may
harm the kidneys, recommendations for long-term sodium administration in
any form should be carefully considered." The harm to which Dr
Polzin is referring is that high levels of sodium have to be removed by the
kidneys, which is additional work for them and in the process free radicals
are created.
Giving too many fluids or too soon may also
increase the risk of
overhydration. This is a particular risk for cats with
heart
problems. Therefore it is best not to begin fluids until the
advantages are likely to outweigh the disadvantages i.e. when a cat
would become dehydrated without them.
Dr Katherine James of the
Veterinary Information
Network believes that this tends to happen and that most
CKD cats will benefit from subcutaneous therapy once creatinine levels are
consistently over 3.5-4.0 mg/dl (USA) or 300-350
µmol/l (international). This equates to high Stage 3
of the IRIS staging system. If your vet thinks your cat's
CKD is less advanced than this, and your cat does not appear
dehydrated,
then it is probably better to hold off on sub-Qs for the moment.
The main exception to this general rule is cats who previously had a higher
creatinine
level, usually at diagnosis. So if, for example, your cat has creatinine of
6.0 mg/dl (USA) or 550 µmol/l (international) at diagnosis, but this gradually falls to 3.5
mg/dl (USA) or 300 µmol/l (international), s/he will probably
benefit from regular sub-Qs. Cats with
pancreatitis are prone to dehydration
and may need sub-Qs even if their creatinine level is lower than 3.5
mg/dl (USA) or 300 µmol/l (international).
Also, any
time more water is going out than is coming in, sub-Qs may be needed
short-term. Thus, a CKD cat who is
a bit below par because of
vomiting or
diarrhoea causing dehydration, or
who stops eating or drinking, may
benefit from sub-Qs as a one-off — my vet gave sub-Qs to my non-CKD cat
when she had severe vomiting and diarrhoea for this reason.
Amount of Subcutaneous Fluids
This is something you need to discuss with your vet, to decide what is
right for your cat. When you see recommendations regarding the amount of
fluid that a cat needs each day, be aware that often this is total fluid
amount. Cats obtain much of their daily fluid requirement from their food
and water (most canned food is around 80% water).
Here are a few of the recommendations for subcutanous fluid amounts from veterinary specialists:
Here is more information on those recommendations:
Dr Katherine James
of the
Veterinary Information Network
believes that generally speaking, cats do not need more than 100ml of
sub-Q fluids a day, though there are exceptions, for example if your cat
is particularly large or particularly small
(the latter
may need less).
Staged management of chronic kidney disease in dogs
and cats (2009) Polzin D Presentation to the 34th World Small
Animal Veterinary Association World Congress states:
"In patients with signs consistent with chronic or
recurrent dehydration, long-term subcutaneous fluid therapy may be
considered. Typically, a balanced electrolyte solution (e.g., lactated
Ringer's solution) is administered subcutaneously every one to three days
as needed. The volume administered depends upon patient size with a
typical cat receiving about 75 to 100 ml per dose."
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 "repeated subcutaneous fluid therapy
(75-150ml every 1-3 days) can be used on an outpatient basis or by owners
at home to maintain hydration."
International Cat Care
states "Generally around 10-20 ml/kg of
fluid can be given at a single SQ injection site."
Some people interpret this to mean it is safe to give 5-10 ml/lb to a
cat, but the link is referring to how much to inject in one place, not how
much to give generally, and goes on to say "around 60-100 ml for an
average sized cat."
What do I think?
Based on what I have seen over the years, the average 8-10lb (3.6-4.5kg) cat would
usually be given around
100ml a day. Larger cats might need 125ml, or even occasionally 150ml for
cats who weigh 15lb (6.8kg) or over, whilst smaller
cats need smaller amounts, 50-75ml a day. Be cautious with cats with
heart issues,
who may have problems processing sub-Qs, and who may need smaller amounts,
perhaps given more frequently, for example 50ml twice a day rather than
100ml once a day.
Since cats vary in their individual needs, you should seek your vet's advice on how much to give your cat, and start
off gradually, and aim for the lowest level that will comfortably maintain
hydration. If you live in a hot humid area without air conditioning, your
cat might need more fluid than a cat in a colder climate. If your cat has
a bout of vomiting or diarrhoea or is not eating, more fluids might be
required in the short term to offset the fluid lost as a result of the
crisis. Cats who are diagnosed following a severe crash may possibly
require more sub-Qs, but this is not always the case, particularly for
cats whose crash is causes by
acute kidney
injury, who may need no sub-Qs at all once they have recovered.
When
deciding on how much fluid to give, you need to monitor your cat for
dehydration and
check that the fluid is being
properly absorbed. A
pouch is normal, and it usually
takes 6-8 hours for the fluids to be absorbed, though some cats take
longer. Many people find the simplest way to monitor their
cat's need for fluids is by means of a
weighing scale: you can weigh your cat regularly and if his/her weight goes down,
this may indicate dehydration; if the cat's weight increases, the cat may
be retaining fluid and at risk of overhydration.
Coco's
Page has more information on how to do this.
If you have the
level of sub-Qs right, your cat will usually no longer drink massive
amounts of water, because s/he is not constantly bordering on dehydration.
If your cat's bloodwork worsens, this doesn't automatically mean that the
fluid amount should be increased. Giving more than
is needed to maintain hydration is a strain on the kidneys (see
When to use subcutaneous fluids),
can make a cat feel uncomfortable, and of course costs more.
If your cat's bloodwork improves, or your cat seems to stop absorbing the
fluids, it may be that s/he needs fewer or no fluids. Ask your vet about
reducing or stopping the fluids, but this should be done gradually so as
to give your cat's damaged kidneys time to adjust. The same applies if your vet
has prescribed fluids for a low numbers cat: ask about stopping fluids to
see how your cat manages, but do it slowly.
If Your Vet Recommends Large Amounts of
Fluid
Fluids are not a benign treatment and more is not always better; in fact, giving
too much fluid can be dangerous. Unfortunately I have noticed that some
vets recommend giving rather large amounts of fluid. In most cases this is
not necessary, and in fact carries risks: it increases the sodium load on
the kidneys, and
in the worst case it may cause overhydration. Some vets claim that it is
impossible to overhydrate a cat with sub-Qs, but if you give a 10 lb cat
300ml of fluids a day, that is the equivalent of giving a 150lb person 4.5 litres
of water a day, far in excess of the amount most people (or cats) can
process.
I have heard from a number of people who have learnt the hard way
about the risks of overhydration, and some of their cats sadly died as a
result. In
Chronic kidney disease
(2007), Dr
DJ Polzin
states
"Chronic subcutaneous fluid therapy can result in
fluid overload in some patients, particularly when fluid volumes in excess
of those recommended here are used. We have seen several cats given large
quantities of fluid (200 to 400 ml/day) present with severe dyspnea due
to pleural effusion. This condition can usually be avoided by reducing
the volume of fluids administered." He mentions that the
presence of metabolic acidosis increases the risk of pulmonary oedema in
cats receiving fluid therapy.
Don't panic over this but do keep an eye on your cat when administering
sub-Qs, weigh him or her regularly,
count respirations, and watch for the warning signs of
overhydration
and read about the treatment of overhydration
here.
See above for tips on gradually reducing the amount of fluid you give.
Coco's
Page has information on calculating how much fluid is necessary,
though please do not alter the amounts you give without your vet's
knowledge and approval.
Frequency of
Sub-Qs
This depends to a large extent upon your cat's individual needs. Here are
some veterinary recommendations:
Staged management of chronic kidney disease in dogs
and cats (2009) Polzin D Presentation to the 34th World Small
Animal Veterinary Association World Congress states:
"In patients with signs consistent with chronic or
recurrent dehydration, long-term subcutaneous fluid therapy may be
considered. Typically, a balanced electrolyte solution (e.g., lactated
Ringer's solution) is administered subcutaneously every one to three days
as needed. The volume administered depends upon patient size with a
typical cat receiving about 75 to 100 ml per dose."
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 "repeated subcutaneous fluid therapy
(75-150ml every 1-3 days) can be used on an outpatient basis or by owners
at home to maintain hydration."
International Cat Care
states "for most cats that require
fluid supplementation, they are given between once a week and once a day
(with 2-3 times weekly being most common)."
As you can see, the consensus seems to be that fluids
are usually given every 1-3 days. I would say that the majority of cats on
Tanya's CKD Support Group
receive sub-Qs every day. However, some cats on the group only need fluids 2-3 times a week; whilst a small
percentage, like
Thomas, become dehydrated very quickly without twice daily fluids (these
cats are often cats who have suffered a severe crash at diagnosis).
Discuss your cat's particular requirements with your vet, and aim for a
consistent, regular approach.
It is usually better to give smaller amounts more often, e.g. to give 100ml
every day rather than 200ml every other day. If you think about it, this makes
sense — if your goal is to drink eight glasses of water each day, it is better if you drink
eight each day rather
than sixteen on one day and nothing at all on the next day — the same principle
applies to sub-Qs.
I don't really understand why vets sometimes recommend sub-Qs once a week. It
seems too infrequent to make any real difference. However, it can certainly be
worth giving sub-Qs as a one-off to a cat who develops dehydration from
vomiting or diarrhoea, or if you experience a heatwave and don't have air
conditioning; but most CKD cats on sub-Qs will need fluids at least three
times a week.
Every now and then, you may have to skip a sub-Q sesssion, perhaps because
you are sick or your cat refuses to co-operate. Missing one session is not
cause for concern with most cats, but aim for consistency overall.
Will My Cat Always Need Subcutaneous
Fluids?
If
you start fluids at the right time, i.e. only when they are necessary to
prevent your cat from becoming dehydrated, which for most cats occurs once
creatinine levels are consistently over 3.5-4 mg/dl (USA) or 300 -350 µmol/L (international), then yes, your
cat will probably always need them. However, there are always exceptions. For
example, some
cats may only need fluids to help them after a crisis (such as when they have
severe diarrhoea or vomiting which makes them dehydrated),
particularly if they are young or if their bloodwork is normally reasonably
good.
If you do ever try to decrease or stop sub-Qs, it is very important to do this
slowly, because CKD kidneys cannot adjust to changes as easily as healthy
kidneys.
How to Give Subcutaneous Fluids
There are two main ways of giving sub-Qs, either via a giving set or via
syringe. Most people in the USA use the giving set method; people offered
sub-Qs in the UK (very uncommon) tend to be offered the syringe method. For
those who struggle with needles, another possibility is to use an implanted
catheter.
Giving Set Method
The giving set method is similar in some ways to an IV drip, except that you
are placing the fluid under the skin rather than into a vein. You are also
giving a smaller amount of fluid more quickly. You will need fluids, needles
and venosets (IV sets). You use the venoset to connect the bag of fluid to the
needle which is then inserted under the skin. The fluid bag is hung high, so
gravity makes the fluid drip through the venoset and the needle and into the
cat.
There are more tips on how to prepare and give sub-Qs
here.
Syringe Method
With this method, you also inject the fluid under the skin, but instead of
using a venoset (a tube which carries the fluid from the fluid bag to the
needle), you remove the fluid from the fluid bag with a syringe, then attach
a needle to the syringe and inject the needle under the skin, before gently squeezing
the syringe so the fluid goes into the cat. This method means it is easier to
know how much fluid you are giving and is also usually quicker.
If
you use this method, you will need fluids, needles and syringes.
There are more tips on how to prepare and give sub-Qs
here.
How to Cope with Giving Subcutaneous Fluids
If, like me, you have a needle phobia, you will be feeling sick at the
mere idea. Yet I stuck a needle into Thomas twice a day for several
months, and it honestly does get easier. I used to dread it in the early
days, far more than Thomas did; yet soon it became just part of everyday
life, like brushing teeth. We were used to it, he was used to it; it
took just ten minutes a day to give him his fluids and his medications.
Survey of owner subcutaneous fluid practices in
cats with chronic kidney disease
(2018) Cooley CM, Quimby JM, Caney SMA & Sieberg LG Journal of Feline
Medicine and Surgery 20(10) pp884-890 states "Overall, owners
reported administering fluids as a relatively low-stress experience for
both themselves and their cats. A large majority of owners (85%) said it
was either an easy, somewhat easy/no stress or okay experience for them,
and a large majority (89%) reported that the experience was easy/no
stress, somewhat easy or okay experience for their cats."
If you are worried about hurting your cat, remember, you are doing this to help
him or her. I'm really not in the business of torturing cats. See the
photos
here before you fear the worst. Cookie doesn't
look traumatised to me!
Cornell University College of Veterinary Medicine
has a video (Part 2) on how to give sub-Qs which states "This might be THE most
important thing that you can do at home to help your cat." If fluids are
necessary, they can make an amazing difference to how your cat feels —
it is like watering a plant in a drought and watching it bloom again.
Once you see the difference that fluids make, you should be able to find
the strength from somewhere. During the last twenty years I have heard
of literally thousands of people who have regularly given their cats
fluids; and I can only recall one person who was unable to overcome her
needle phobia (she did not even try to give sub-Qs). So read Sandi's
story below, check out the tips on how to give them
here, take a deep
breath and give it a go. If you'd like to have your hand held while you
get used to it, join
Tanya's CKD Support Group.
Some people are put off the idea of giving sub-Qs because their vet
charges them a ridiculous amount for their supplies. The most expensive I
heard of was US79 for one bag of fluid! Quite outrageous when you know that people
in the US
and Canada people can buy supplies very cheaply, paying only US$30-80 for
an entire case of twelve bags (and at the time this person was charged
US$78, you could get an entire case for US$16). The
Obtaining Supplies Cheaply
page gives tips on where to find fluids and other sub-Q supplies at reasonable
prices in the USA, UK and Canada.
If you absolutely cannot cope with giving sub-Qs to your cat, you should
be able to take your cat to the vet to have it done. Make sure they use
sharp needles, or buy some and take them with you for the vet tech or
nurse to use if necessary.
Sandi and Maz -
Learning to Cope with Fluids
Here Sandi describes how she overcame her needle
phobia and successfully gave Maz his fluids before she lost him.
"I know that some of you are really nervous/uneasy
about having to do SubQ's yourself, so I thought my story may help.
First, I have to say I am the world's biggest
needlephobic person (don't ask what's it's like when I need blood taken!). So
when Maz was diagnosed last October and I found out he had to be on Sub-Qs I
cried for a day, out of fear of doing SubQ's and also because I thought I was
losing Maz. Luckily a vet tech saw my tears and agreed to come to my house
three times a week (I paid her $45 including supplies).
This went on for about six months. During that time
though I would be the one to get Maz when she came over (he would always try
and
hide) and gently pet him while he was getting the fluids. I began to get used
to seeing the needle go in and also through this group started learning a
tremendous amount on making it more comfortable (warming etc). The tech
started telling me I knew as much as she did about giving fluids and Maz would
probably be more comfortable if I did it but I resisted, saying I just
couldn't stick my baby boy. Well, in April she got a new job and there wasn't
another vet tech who could come. So now, it would really be ALL UP TO ME! I
was petrified but with the help of the tech, I just did what I had to do. I
learned that heating the fluids made all the difference and that by giving Maz
some treats, other than the first needle poke, he forgets all about the fluids
and just likes getting treats (some Fancy Feast) and a lot of love. There are
times he even purrs now!
I have to admit, I still don't like poking him (I
take a minute or two to get myself psyched for it), then I gently let him know
I'm going to give him his treatment, take him into the bathroom where his
favorite towel and treats are waiting and go for it!
So please believe me when I say it's not as bad as
it seems, read the posts on the group and the info on Helen's website and you
will see in no time, you and your furbabies will be just fine!
Hope this helps!"
The Giftube and Other Subcutaneous Catheters
If you really cannot bear giving sub-Qs, or if your cat really fights them,
you may want to consider whether to use an implantable tube. These products
are implanted in the cat under anaesthetic, and thereafter the fluids are
basically just poured in (though you should not give too much, of course).
It can be hard to get your vet to agree to you doing sub-Qs at home in the UK,
but if your vet does agree, it is sometimes on the basis of using one of these
products.
The original is called the Giftube (Greta Implantable Fluid Tube, named after the patient
for whom it was invented). There is also a Subcutaneous Catheter Set
available. Having one of these products fitted costs around US$200-300.
The infection rate for these products is over 10%, which I
find worrying. Using them is also extremely expensive, because a bag of fluid
can only be used for one sub-Q session before it is thrown away (because of
the risk of infection); plus many cats have to have two or more tubes
implanted each year because of problems with the previous tube necessitating
its removal. This is usually because the cat's body considers the tube to be a
foreign body and may form a kind of membrane around it, which can prevent the
fluids entering the cat's body smoothly. In addition, many cats find the tube
irritating and scratch at it constantly, so they often have to wear a bandage
or little sweater to hold the tube in place.
Therefore I would strongly recommend using standard methods
and only using these products as a last resort. If you do decide to use one,
please ensure your vet knows what s/he is doing: some people have discovered
after the tube has been implanted that their vet has never implanted one
before and their cat has basically been a guinea pig; I'd prefer to know that
beforehand and be sure that my vet could help me deal with any problems that
might arise.
Subcutaneous fluid port-associated soft tissue sarcoma in a cat (2013) McLeland
SM, Imhoff DJ, Thomas M, Powers BE & Quimby JM Journal of Feline Medicine
and Surgery15(10) pp917-920 reports on a case of cancer in a cat
who had a fluid port for four years. The report concludes "Although
the cat’s owners were pleased with the 4 years of quality of life provided by
this device, this complication should be considered when a decision to place
ports for long-term management of disease is made." As an aside, the cat in
question was twenty years old and had had CKD for ten years, quite an
achievement.
Sub-Qs are not
always appropriate and in fact in certain circumstances can do more harm
than good. Do
NOT give sub-cutaneous fluids to your cat if:
Your cat is so severely dehydrated that your vet
considers
intravenous fluid therapy (IV) more appropriate. In certain circumstances
IV
is the only correct treatment. If your cat
has high bloodwork levels (creatinine over 7 mg/dl or 627 µmol/L), s/he might benefit more
from IV fluids initially, with sub-Qs provided once s/he returns home
as needed.
Your cat has a
heart condition. Fluid therapy may
still be possible but your vet must decide if it is appropriate for
your cat, and determine the amounts and frequencies to be
administered.
Your vet has refused to agree to the procedure on
other medical grounds.
Fluids from the previous session
have not yet been absorbed.
Your cat is
overhydrated. This may be obvious, or your cat may feel "squishy",
the way water in a plastic bag feels. Squishiness sometimes happens if a little air gets in with the fluids,
and is not normally a problem, but if it happens consistently, your cat may need less fluid. Other symptoms
of overhydration may include
sudden weight gain, coughing and nasal discharge. See
Symptoms
for more information. Overhydration
may be associated with a heart condition, but contrary to what some
vets claim it can still happen in a cat with a perfectly normal heart.
It is a good idea to
weigh
your cat regularly, to check for sudden or continous weight gain which
may give early warning of a problem.
Processing the extra fluids in itself places an additional workload on the kidneys which can make the
CKD
progress faster; plus it can flush out
certain nutrients, and giving fluids when they are not needed may
increase blood pressure; so it is best not to
begin fluids until the advantages are likely to outweigh the
disadvantages. Dr Katherine James of the Veterinary Information Network believes
that most CKD cats will benefit from sub-cutaneous therapy once creatinine
levels are consistently over creatinine levels are consistently over
3.5-4.0 mg/dl (USA) or 300 -350 µmol/l (international). If your vet
thinks your cat's CKD is less advanced than this, then it is probably
safer to hold off on sub-Qs for the moment.
My vet agreed to us doing fluids in part because she
felt Thomas would not find them too distressing. You and your vet do
need to take your cat's personality into account in deciding whether to
go this route; but do not necessarily assume your cat cannot cope, many
cats who ordinarily hate medication of any kind tolerate sub-Qs because
they make them feel so much better. I would suggest trying them for a
few weeks at least.
Many cats
appear happier (more active and alert, with a better appetite) after
sub-Qs. However, some may become lethargic for an hour or so
afterwards. This is probably nothing to worry about, but if it happens
frequently it may be that your cat is not processing the fluid very
well, so I would ask your vet to check your cat for possible heart
problems or
fluid
retention.
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.
If your cat
appears to be in pain or distress, do not waste time on the internet,
contact your vet immediately.
This site was
created using Microsoft software, and therefore it is best viewed in
Internet Explorer. I know it doesn't always display too well in other
browsers, but I'm not an IT expert so I'm afraid I don't know how to
change that. I would love it to display perfectly everywhere, but my focus
is on making the information available. When I get time, I'll try to
improve how it displays in other browsers.
This site is a labour of love, from which I do not make
a penny. Please do not steal from me by taking credit for my work.
If you wish to
link to this site, please feel free to do so. Please make it clear that
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