Subcutaneous fluids (also known as sub-Q's or Lactated Ringer's solution) are fluids that are administered through a needle which is inserted under the cat's skin. Each bag contains 1000 ml. (one liter) of solution and must be prescribed by your veterinarian. While some cats in CRF may never need them, most eventually do. Sub-Q fluids are an essential and ongoing part of CRF management. As the disease progresses, the cat may stop drinking, not drink adequate amounts of water or vomit frequently and become dehydrated. Sub-Q fluids help with rehydration. Without adequate hydration, the blood flow through the kidneys is reduced which causes even more rapid deterioration of the kidneys. Subcutaneous fluid therapy will not repair the kidneys, but will help the remaining kidney tissue function as effectively as possible.
The fluids may be supplemented with potassium if your veterinarian feels it is appropriate for your cat's particular situation. CRF cats may be able to live for several additional years with sub-Q fluids and the proper diet. The need is generally determined by the creatinine and BUN numbers. Cats really do seem to feel better after hydration so it is well worth doing.
No treatment is perfect for all patients. While sub-Q fluids have extended the lives of countless CRF cats, cats with heart conditions can be put in extreme danger through the administration of sub-Q fluids. Also, excessive fluids can put pressure on the pleural cavity and temporarily collapse a lung.
Volume and Frequency
The amount of sub-Q's per injection is based on the cat's weight and the severity of the disease. The frequency can also vary depending on how much the disease has progressed. Never give your cat a greater volume of sub-Q fluids than your vet has specified. Some cats can do quite well on sub-Q fluids once a week while others who are farther along in the disease can benefit from daily injections. Some cats simply will not tolerate sub-Q fluid injections and quality of life versus quantity must be seriously considered. In later stages of CRF, your cat may reach a point where it can no longer absorb the sub-Q fluids.
The Water Pouch
The injection of sub-Q fluids may cause your cat to look somewhat lumpy and off-balance for a short time. The cat may carry the water pouch up to 24 hours until it's absorbed. It is normal for fluid (sometimes slightly blood-tinged) to leak from the injection site for a short time. After hydration, the water pouch usually slips down to the bottom of the abdomen, but occasionally it may slip down into one of the front legs. The pouch is not as noticeable on a long-haired cat as it is on a shorthair.
Administering Sub-Q's at Home
Administering sub-Q's can be done at home and your veterinarian or technician can train you. Practice at the veterinarian's office the first few times so you'll feel more competent doing it at home. Don't feel bad if you can't bring yourself to do it. Most vet's offices will give the fluids on a regular basis, but the cost will be quite a bit more than doing it yourself and the cat may be more stressed out by frequent trips to the veterinarian's office.
Lactated Ringer's, IV lines and needles may be purchased at lower prices through veterinary supply houses. A prescription from your veterinarian will usually be required.