Hi everyone, Smokey is doing much better now. Iíve been confused about his fluids though, and I think I need some help figuring out what the best option is, and how to communicate with my vet.
As you might recall, on October 22nd Smokey had a sort of mini-crisis were he refused to eat, became very lethargic and nauseous, and was generally acting quite sick. His blood test showed Creatinine 414, BUN 21. He received IV fluids for 2 days, then came home, and received subqís every day up until October 29th, when Smokey had his follow up blood test. His test results from that day showed that his creatinine went back to down to 185, and his BUN back down to 15. So good news there.
After this, weíve encountered some confusion about how best to continue with the fluids. I decided to switch to fluids every other day, which was between what he was getting before, which was twice a week, and the one week period after his mini-crisis, where he had it every day.
My reasoning for this is that he evidently was not doing well enough on twice a week, due to the fact that he stopped eating, was nauseous, acting very sick, and had to be put on IV fluids, and had elevated numbers, about twice what they had been a few months ago.
What Iím confused about that is the vet wants to do fluids every 72 hours, which is very nearly the same as twice a week, which we were doing on Tuesday and on Friday. I suppose there will be less time between each session, but not really a big difference, since there were 2 days between Tuesday and Friday and 3 days between Friday and Tuesday, whereas now thereíll be 2 days between each session. This change doesnít seem significant enough to me to compensate for how Smokey was behaving and the rise in his numbers, and how much they dropped after we gave fluids more often.
However, the most confusing part is the vetís rationale for this. She says that over-hydration can be harmful. Of course this I know, having read about it. But Iím not seeing any signs of over-hydration, and she hasnít indicated that sheís seen any either. Heís not sluggish or lethargic after fluids, quite the contrary. He doesnít feel squishy. The water hump doesnít take longer than a few hours to disappear. Heís not peeing more than usual. In fact, I can clearly see a difference in how heís behaving now, having been receiving more fluids for a while, compared to how he was behaving in the few weeks before his mini-crisis. It seems to me that if his numbers were twice as high, then surely he wasnít receiving enough fluids at that point? In other words, the degradation of his kidneys must have progressed to the point where he was becoming dehydrated sooner?
The vetís explanation for this is that the mini-crisis may have been caused by stomach irritation/acid, so in fact it may not be necessary to increase his fluids very much. But I donít understand this. How could stomach irritation CAUSE his higher numbers on the blood work? Isnít it the other way around? That is, doesnít stomach irritation, acid, nausea, etc, arise BECAUSE the kidneys are working less well, and thus filtering out fewer waste products (represented in creatinine numbers, for example)? Iíve never understood the causal relationship to flow in the other direction from my reading on the topic. It sounds like the vet is suggesting that Smokeyís kidneys are more or less the same as they were before, and so he doesnít need more fluids. He just needed to get over his stomach upset. But if that were the case, why even put him on IV fluids? Why was there such an obvious and dramatic improvement in his behaviour after getting fluids more often? If he was/is suffering from more stomach irritation, nausea, etc, doesnít this basically show that his kidneys are continuing to degrade, and that he might therefore need more fluids?
Was his mini-crisis caused by stomach upset, or by worsening numbers? If itís the former, then why did blood tests show worsening values? How can stomach upset by itself cause a 200% increase in creatinine, without there being worsening kidney functioning that justifies increased fluids?
I fully admit that I may not know what Iím talking about, and could just be confused. I donít want to give the impression that I donít trust my vet, and I obviously have to defer to her expertise. But I donít quite understand her interpretation of whatís been going on lately, and I want to understand without stepping on her toes. Any advice? Sorry for the really long rant.