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Dr. B.
Dr. B., Cat Veterinarian
Category: Cat
Satisfied Customers: 22484
Experience:  I am a small animal veterinarian with a special interest in cats and am happy to discuss any questions you have.
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I have a 13 year old Persian cat, about 2 months ago he stopped

Customer Question

I have a 13 year old Persian cat, about 2 months ago he stopped eating, and lost weight. We took him to the vets, he had injections and blood tests, which proved negative. He improved after the injections.

For the past 4 days he has been listless, his mouth smells, not eating much. When we took him to the vets, 2 months ago they said his teeth were fine.
Submitted: 3 years ago.
Category: Cat
Expert:  Dr. B. replied 3 years ago.

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

Do you know what injections he had (ie antibiotics, anti-inflammatories, etc)?

What does his breath smell like (ie pus, ammonia, sweet/nail polish remover)?

Any drooling, lip licking, hard swallowing, retching, or vomiting from Enoch?

Has he been pawing at his mouth at all?

You noted that Enoch has had blood tests to rule out kidney disease?

But did they check a urine sample?

Customer: replied 3 years ago.

Hello, thank you for your reply.


Enoch had anti-biotics and as he was not eating a injection which I think was a vitamin injection. After about two days he

Expert:  Dr. B. replied 3 years ago.
Hi Elizabeth,

I have just gotten your reply and it looks like it was cut off part way. I see what injections he had but nothing regarding the other questions I had asked. If you can try to send the rest of your reply again, this will give me a better idea of what is exactly getting wee Enoch down.

Speak to you soon,
Dr. B.
Customer: replied 3 years ago.

Hello Dr B


I am sorry I keep trying to send emails but I do not think they are getting through.


When Enoch was at the vets 2 months ago, he had antibiotic and vitamin injections. I seem to vaguely remember him being slightly anaemic.


He has a typical Persian face, so he always had problems with snuffling. His brother does not have a Persian face, so has no problems.


His breath does not smell sweet, but more of a rotten smell. His eyes are watery, but he is not sneezing. He seems to be having problems eating. His teeth were examined but nothing was found.


The only time he vomits is when it is fur, I try to prevent fur balls, but they have been moulting lately.


Blood tests were carried out at the vets but nothing could be found, then some blood was sent to a laboratory, which were also inconclusive. I cannot remember him having a urine test.


Thank you


Expert:  Dr. B. replied 3 years ago.

Thank you Elizabeth,


Your answer seems to have made it past that odd computer glitch (the mixed blessing of technology).


Now the reason for question about is a breath odor is because this can sometimes give us a hint of what is causing issue. For example, sweet pear drop or nail polish remover types scents have been linked with unstable diabetes. Pus or infection type odors often suggest dental disease, tooth decay, or oral trauma or ulceration. Ammonia scented breath (which does smell quite rotten or sharp like a dirty litter box) can be a sign of the issue I am most concerned may be afoot here especially if he drinking more then he used to and if urine wasn’t checked -- kidney troubles.


And while I do understand that he did have a blood sample was normal 2 months ago, we have to appreciate that any blood sample can only reflect the state of the organs at that point in time. Therefore, we do have to appreciate that if he had had borderline or early stage kidney disease then it could have progressed since that time. Furthermore, and the reason why I asked about urine samples, is that that it takes 75% of kidney dysfunction to occur before we appreciate changes in the blood. So, it is possible for bloods to still appear normal in the early stages of kidney troubles. And I must say this is my concern with your lad.


Now in any case, to have a cat off his food with an odd odor to his breath, we can assume that the root of his troubles is either oral discomfort or nausea (even without vomiting). Now we will put oral discomfort to the side for the moment (since you noted he had lovely teeth before, and didn't note any pawing or drooling) and focus on nausea.


Now we can see nausea arise with a range of issues, but with out concerns, I do have to note that we can see anorexia due to GI upset associated with kidney disease. And this is very common in kidney kitties. This is because the the urea can make them nauseous and cause oral ulcers, making them too sick and sore to eat properly.


Still no matter the cause of nausea, I would note that we try to settle his stomach with an antacid. There are a number of antacids that can be used to help kitties in this situation (ie Pepcid (More Info/Dose) or Zantac (More Info/Dose)) and can just make eating and drinking easier for them.

Furthermore, if he just refuses to eat, then we do need to tempt him (as I am sure you have). Just to note some common light diet options we use for anorexic cats, we often will offer boiled chicken, white fish, scrambled egg, and even meat baby food (as long as its free of garlic/onion powder). If we are really struggling to get them to have solid food (or think we may need to syringe feed) then we can also use a liquid supplement called Clinicare (LINK) that can be useful for getting nutrition and fluid into these kitties (and if he likes it, then it would be a sneaky way to get more nutrition and fluid into him now). It is actually by the same people who make Ensure, but is formulated to meet out pet's dietary needs. Your vet should be able to order it for you but it is available without a prescription (some pet stores and even Amazon stock it). They make one specifically for older cats with kidney troubles, and this would be one that we could use if necessary for Enoch (I tend to use it with any anorexic elderly cat).


So, these would be the main focus of supportive care for Enoch and what I would suggest tonight. If you find that he is still down come Tuesday, I would advise that it'd be ideal to follow up with his vet, perhaps bringing in a urine sample (which can be collected by leaving him in overnight with an empty litterbox in a non-carpeted room). They will be able to check the urine sample and tell you if he is concentrating urine as he should or if his kidneys are suspect after all.


As well, at the same time , they can recheck his mouth. And if your vet has suspects that Enoch may have oral ulcerations secondary to kidney disease or a sudden dental issue, then they will be able to provide cat safe pain relief (ie Bupenorphine) to make his mouth comfortable enough to eat for you.

Finally, if you try the above and he is still resistant to eating for you, then do consider speaking to his vet about having them dispense an appetite stimulant drug (ie Cyproheptadine, Mirtazapine/ Mertazipine, etc) to encourage him to start eating for you again properly.


Overall, appetite issues with rotten breath and increased thirst are very suspicious of early stage kidney disease of the cat. Therefore, this is something that needs to be looked into for Enoch. Otherwise, for tonight, do try him with an antacid to settle his stomach and try to tempt him with those bland diet options to get him eating for us again.


I hope this information is helpful.

If you need any additional information, do not hesitate to ask!

All the best,

Dr. B.


If you have any other questions, please ask me – I’ll be happy to respond. Please remember to rate my service once you have all the information you need. Thank you and hope to see you again soon! : )

Customer: replied 3 years ago.

Hello Dr B


Thank you very much for your reply. I am very grateful for your advise.


I knew underneath Enoch was quite poorly, although he has always been quiet, more so lately.


Could you just tell me if or not kidney disease is imminently fatal, or could Enoch survive for a while longer with medication?


Kind regards




Expert:  Dr. B. replied 3 years ago.
You are very welcome, Elizabeth.

That is always the dilemma with our kitties. Where dogs make their being unwell quite apparent, cats are much more subtle and quiet about any issues they face (which creates quite a challenge for both owners and vets).

In regards XXXXX XXXXX prognosis if kidney disease is confirmed, this is not an instant death sentence for our kitties at all. I would say that this is actually one of the most common issues that our elderly kitties face (even my cat in my icon is a kidney kitty and has been managed with treatment for over 2 years now). His individual situation does depend on how severe his state is (though hopefully not terribly advanced since we know that at least his bloods weren't showing any hints 2 months back). And I would say that even if repeat bloods did show active kidney disease (>75% dysfunction), he would still have a chance of responding to treatment for his kidneys.

Now if he is off his food, feeling very poorly, and his urea/creatnine/phosphorus blood levels are elevated, then it would be ideal for his vet to put him on IV fluids to flush these accumulating metabolites out. This should help settle the trigger for his nausea (from uremic gastritis) alongside anti-nausea supportive care from his vet.

If he responds to being flushed out, you can then discuss home treatment options for him with your vet. We will often put these cats on special diets (ie Hill's K/D (here), Royal Canin Renal (here)) that are low in protein, phosphorus, and sodium. If he isn't keen on diet changes, then we'd likely leave this (since it doesn't matter how amazing a diet is if the kitty says they won't eat it). Further to this, we will often treat with drugs to support kidney function (ie Semintra, Fortekor) +/- phosphate binders (if this is high on his bloods). Furthermore, if you are keen and Enoch amenable, you could even treat him regularly with subcutaneous (under the skin) fluid therapy (more info).

Finally, I wanted to include a link for you to the Feline Advisory Board's (FAB) guidelines on kidney disease in cats (here) just for a bit more information on managing his condition should his kidneys be confirmed our suspect for his signs.

Please take care,
Dr. B.
Customer: replied 3 years ago.

Hello Dr B


Thank you very much for your email, I really am grateful for your information.


We will take Enoch to the vets in the morning, as I really am worried for him.


If that is alright I will email you again just to let you know how he got on.


I will leave your feedback then.


Thank you again


Kind regards


Expert:  Dr. B. replied 3 years ago.

No worries, Elizabeth. Our conversation will stay open for at least a week (whether you leave feedback at this stage or not) and we can continue to communicate about Enoch (who's name does make me wonder if he is from central Glasgow) as long as you wish. Do let me know how you two get on tomorrow and I wish all the best for your wee lad.
Take care,
Dr. B.