24 Hour Treatment Without 24 hour Care - Risky?

If your pet needs to have overnight treatment, are there any other options apart from transferring their care to a dedicated emergency clinic. The costs involved can soon add up so what are the risks of choosing an option where the level of care is not so thorough?

 
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Moving onto question four, we've got a cat who has kidney disease with really high levels of creatinine, urea and SDMA in their blood. Those are parameters or markers of the kidneys potentially not working very well, certainly with SDMA. We can get a high urea and creatinine with a dehydrated cat.

Overnight vet care

But anyway, their cat's been diagnosed with kidney disease. She's going on intravenous fluids to try and flush out the system, to try and get those levels down, and the vet is anticipating that this is going to take four or five days to happen. The big issue is that the vet doesn't have overnight care.

So what are the options for this cat? What's the likelihood of another vet taking her on where the owners won't have to spend extortionate amounts of money? And certainly after hours care or care overnight can cost an awful lot in some situations.

Is treatment essential?

So let's start with the fact that IV fluids are often needed for a cat with kidney failure when they become unwell. This can sometimes be the first presentation and the first hint that there is a problem with the kidneys not functioning as they should be. Now, so long as the damage is not too advanced, then these cats can do very well with this treatment. The IV fluid flushes the system; it flushes all these toxins out of the blood, it gets a cat eating again, they feel a lot better, they start eating, they get put on an appropriate treatment long term.

This treatment is often dietary management and can also include treatment to control blood pressure, to stop protein leaking out through the kidneys, control nausea, anemia, all these other complications that cats with kidney failure can face. Because they can do so well after being on a fluid drip, it's definitely something that's appropriate and worth pursuing.

Intravenous fluid risks

Now, intravenous fluids are not completely risk free, especially if a cat is left unattended. If too much fluid is administered too quickly, then ultimately they can effectively drown a cat. The excess fluid builds up in the lungs, compromises their ability to breathe and the cat will effectively drown. We also need to know that a cat with kidney failure is more sensitive to these excess fluids. In a normal, healthy patient, while they can still get what we call fluid overloaded, the kidneys are much better able to cope. They're able to pump out and get rid of this extra water that's being administered through the IV drip line. In a cat with kidney failure, that's something that they're not able to do.

Despite this, the risks of this happening is still very low so long as caution is taken. So we want to give fluids at a rate that is re-hydrating the patient, but we don't want to overdo things. And really this fluid overload, it's very unlikely if an appropriate rate has chosen and a fluid pump is used compared to just using a gravity fed drip line, unless of course there's an equipment failure. Really, the likelihood of a fluid pump braking and starting to pump excessively fast is really, really slim.

The most likely thing if a cat is left overnight, is that the fluids will become blocked and so the cat doesn’t get the benefit of those fluids until the blockage is cleared in the morning. This is not ideal but, depending on how sick your cat is, in itself isn't necessarily a dangerous situation.

Hospital care options

Really, when it comes to overnight care options, you need to talk to your vet about what the local options are. They may be happy for your cat to stay in their hospital overnight, so long as you accept the fact that there is a risk, albeit a very small risk, involved with that. I currently work in an area where there's no 24-hour emergency clinic, where there's no overnight emergency clinic, and so this is what routinely happens to patients in this area. They are left overnight, they are left on an appropriate rate of fluids and it's a very similar situation to what this cat may be going through. Really, apart from the catheter becoming blocked overnight, I’ve never had any problems with this approach at all.

Now, that's not to say that complications are never going to happen, but the chance of that is very slim.

Your vet may also be able to advise you on a different low cost option for your area where your cat can be transferred overnight. There might be different options that doesn’t involve going to an expensive emergency clinic.

Home care

But then the other option, or the only other option that doesn't involve an overnight expensive stay or transfer, is accepting that your cat might only be able to be on fluids over the day and then has to go home at night. Is it ideal? No, it's not ideal, but it's certainly something to think about, and then when you’re at home, if you are doing this, there are a number ways other than IV fluids that you can try and increase water intake in cats.

One thing to think about, certainly in kidney disease patients when they may not be eating very well, is actually giving subcutaneous fluids. That's something that can be done at home with very little training needed. It's a case of giving fluids under the skin and it can work reasonably well in this situation. It's nowhere near as ideal as intravenous fluids, but it's definitely something to consider.

So really the take home point is talk to your vet about the different options. There are definitely other options out there. They may not be quite ideal, they may come with a slight risk or they may not give the full benefit, but there are definitely other options if you're not able to afford or not wanting to afford the high cost that can be involved with 24 hour care. Make no mistake though, if you want the best care for your pet, and can afford it, then 24 hour supervision by professionals is always going to be the best option.


The above is a transcript taken from “The Dr Alex Answers Show”.

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