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Dr. B.
Dr. B., Board Certified Veterinarian
Category: Vet
Satisfied Customers: 21747
Experience:  General practice veterinary surgeon with extensive experience in a wide range of species.
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My 18 year old cat had kidney disease and has been on

Resolved Question:

Hi. My 18 year old cat had kidney disease and has been on lactated ringers sub q 100ml every other day except for the past week. He started benalipril ,2.5 mg a day ,10 days ago He was put on Amoxil for an oral infection and a bladder infection a week Friday. The fortekor put him a little off his food,but he was getting used to it when he was put on amoxil. That knocked his appetite for a loop
So the vet upped his fluids to 100ml a day. That helped his appetite until Wednesday. That day I noticed that his eyeballs appeared larger and glassier/ shinier.
Everyone I asked said it wasn't the fluids, except a vet tech who visits twice a week, who said it could happen and the pressure could build up. We cut back a bit on the fluids for a couple of days, but the eyes still seem enlarged.
Is this possible?
His medicine schedule got mucked up a bit,and that threw off his appetite again.
But hr was not too bad Thursday.
On Friday I started a new brand of ringers that seemed more watery than his old one. Also the ph was lower than the old,at 6.2 versus 6.5.
Today his appetite is worse.
Could it be the ringers or a combo of amoxil,fortekor and new dingers?
Submitted: 1 year ago.
Category: Vet
Customer: replied 1 year ago.
I just tried adding a few small bits of chicken to his royal canin renal support E,and he ate a couple of teaspoonsful,but then refused more. All he's had in meds today is his fortekor at noon and 50ml of ringers at 7am est.
Expert:  Dr. B. replied 1 year ago.

Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you with your wee one today.

First, I do have to note that the technician is incorrect, as fluids are not going to cause these changes to they eyeballs themselves. The pressure in the eyes are closely regulated by the body and fluids alone would not cause this. If anything, if he was getting a bit more fluid then usual, its possible that he became hydrated enough (or if he got too much he could be edematous in the skin around the eyes) that his eyes didn't look as sunken as usual.

Otherwise and most importantly is this appetite situation. This could be triggered by the medication (Amoxil is well known for causing nausea) but could also be related to building kidney toxins in the blood stream or kidney disease induced oral/throat ulcers. So, we have a few concerns for that. In any case, further to tempting him to eat, you could try an OTC antacid (ie Pepcid (More Info/Dose @http://www.petplace.com/article/drug-library/library/over-the-counter/famotidine-pepcid)) to counter nausea from any of these. As well, you could ring his vet for an anti-nausea treatment +/- kidney safe pain relief if uremic ulcers are suspect. Finally, the local vet should also be able to give you an appetite stimulant (ie Mirtazapine) +/- alternative kidney medication (ie Azodyl +/- phosphate binders if his phosphate is high) to help stabilize him and boost his appetite.

Kind regards,

Dr. B.

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Customer: replied 1 year ago.
Hi Dr.B.Thanks for your help! The amoxil was stopped yesterday, and his appetite picked up a bit today,but not a lot. He had 100 ml lacted ringers yesterday, and 50 so far today.
The amoxil was for both his bladder and mouth. The bladder may not have been infected because he had been constipated, and probably straining,and that had brought on infection-like symptoms before-decreasing urination that reversed itself. But they couldn't be sure,so he was put on amoxil for both. Would Convenia have been better? He tolerates it well.
He has some oral infection from tartar etc,but the vet won't do a cleaning under anesthesia because he's afraid to do more kidney damage.
He's been on fortekor for 10 days now to help with blood flow through the kidneys,and is going to be tested Tuesday to see if it has put up the urea and creatinine values.
His bun was 23.1 mmol/l and his creatinine was 466 umol/l on Aug.3.
Is fortekor any good for this? Could this add to the nausea?
Thanks!
He can't have mirtazepine because it spaces him out.
His phosphate was 1.62 mmol/l(1.1-2.74 range)
So far no mention of ulcers.
Customer: replied 1 year ago.
His pupils are sometimes uneven, but they've been like that for quite a while. They do even out when the light equalizes,but it seems a bit more noticeable now. And I'm not sure which eye may not behaving normally. What should I look for?
Any relation to the ckd?
Thanks.
Expert:  Dr. B. replied 1 year ago.

Hi again,

If he does tolerate the convenia, then that would be a better option in the face of this nausea. As well, if he doesn't tolerate Mirtazapine, then Cyproheptadine would be another option to consider. Though we would hole switching the antibiotics would help as well. Otherwise, we often use Fortekor for ckd with good effect. So that is good there and usually it is well tolerated. Though I would note the if his pupils are uneven suggesting possible retinal compromise, we'd want to think about having his vet check his retinas as well as his blood pressure. Especially since we can see eye function changes ( as opposed to pressure issues) with CKD induced high blood pressure and sometimes that needs to be treated for as well.

Best wishes,

Dr. B

Customer: replied 1 year ago.
I'll have them check the eyes out,too. They seem ok today, but will make sure.
What did you mean by retinal compromise? What could happen? Would the fortekor protect them there as well?
Thanks.
Customer: replied 1 year ago.
Here are a couple of pictures of Chumley. Mr.Big Eyes. The eyes in Chumley.unequal. pupils look a touch bigger than normal.
What do you think? Thanks.
Expert:  Dr. B. replied 1 year ago.

Hi again,

Retinas do age and sight can reduce with age, blood clots, or retinal damage. As well, the retinas can detach partially and wholly from the eye with high blood pressure. And I have to say that his left eye ( our right in the photo) looks to have a haze. This could be related to the retina but it could also be age related change to the lens ( cataract or lenticular sclerosis -which could affect light flow into the eye to cause the pupil variation). So as long as he has vision in the eye, we can monitor until his vet can check this. Though just to note, any blindness would be considered urgent in case the retina were to detach.

Please take care,

Dr. B

Customer: replied 1 year ago.
I totally forgot that the vet had mentioned he had a cataract when he saw him in February! Now it all makes sense.
How could I tell if he went blind in just one eye?
Expert:  Dr. B. replied 1 year ago.

Hi again,

Ah, well that is good to know and that could be playing a role in the unevennesses as it affects the light passing into that eye. Otherwise, in regards ***** ***** blindness in one eye, it can be tricky and often subtle since the do cope with the other one. Your vet will be able to on exam but you can try dropping.a cotton ball ( as it has no odor or sound to let him sense it) to the side of the affected eye to see if he can see it fall.

Please take care,
Dr. B
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Customer: replied 1 year ago.
I'll try that, although Chumley's the worst cat to try and make look where you want.
He does the "Birman Stare", where he looks into your eyes to beg for something.
(See picture).
Can they do cataract surgery? Without anaesthesia?Any suggestions on how to get him to gain some muscle tissue?
He's getting to be skin and bones. Are there any safe supplements?
Thanks.
Expert:  Dr. B. replied 1 year ago.

Hi again,

No cataract surgery requires a specialist and needs anesthesia. But if that is what is present, then its fine for him to live with it and use his other senses to cope. Otherwise, there aren't really any supplements we'd use with the exception of managing his kidney issues (the source of his protein losses). Otherwise, we run the risk of supplementing protein and then stressing the kidneys more for them.

Kind regards,

Dr. B.

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If you have any other questions, please ask me – I’ll be happy to respond. **Afterwards, I would be grateful if you would rate my service by clicking on the "Rate my Expert' button at the top of the page as this is the only way I am credited for helping you. Thank you for your feedback!: )

Customer: replied 1 year ago.
Thanks. Will the fluids that he receives today and tomorrow affect the bloof tests hr's having tomorrow,?
Customer: replied 1 year ago.
He's been on 100 ml daily for 10 days to help with his appetite loss,and has had 40 so far today, with another 60 due later today.
Is that ok?
Expert:  Dr. B. replied 1 year ago.

Hi again,

The fluids will effect the bloods a bit, but not in a negative way. Basically, his kidney parameters could be a wee bit lower then they'd be without fluids. But he is fine to have them as usual since we are better to flush out the toxins then let them linger if we can help it.

Take care,

Dr. B.

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If you have any other questions, please ask me – I’ll be happy to respond. **Afterwards, I would be grateful if you would rate my service by clicking on the "Rate my Expert' button at the top of the page as this is the only way I am credited for helping you. Thank you for your feedback!: )

Customer: replied 1 year ago.
Does a urinalysis help supplement the bloodwork?Thanks.
Expert:  Dr. B. replied 1 year ago.

Hi again,

It certainly can since it tends to be the most representative of kidney function (as urine is the product of the kidneys). Though for advanced or long term cases, we do use both urine and bloods to determine the severity of the condition.

Best wishes,

Dr. B.

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