When the numbers get worse

What do I do when my CKD cat suddenly gets worse?

If this is happening right now, the short version: phone your vet today. Not the next recheck, today. Then read the rest of this.

The reason for the urgency isn't that a crisis means the end. It's the opposite. A sudden decline in a kidney cat very often has something reversible sitting on top of the chronic disease, and the reversible things have a clock on them.

What a crisis actually looks like

It's rarely dramatic. That's what makes it hard.

The usual picture is that she stops eating, she goes quiet, she hides somewhere she doesn't normally hide, and she looks like she aged a year in a week. Her coat goes rough because she's stopped grooming. She sits hunched in front of the water bowl without drinking. She licks her lips, or drools a little. She may vomit, and she may not.

This is uremia: waste products accumulating faster than the remaining kidney function can clear them. It's a whole-body sick feeling, and it's the reason she's withdrawn rather than in obvious pain.

Two specific things worth checking with your hands, because owners consistently miss both. Feel her ears and paws against your own cheek, because a cat who has gone cold is in trouble now. And lift her lip, because gums should be bubblegum pink, not pale and not yellow.

The question that decides everything: what's layered on top?

Here's the frame I use, and it's worth having in your head before you're on the phone.

A kidney cat who crashes has two things going on: the chronic disease, which is permanent, and usually something acute, which often isn't. The whole job of the next 48 hours is finding the second thing.

If your vet finds one of these, the crisis has a name and a treatment, and the odds change completely.

Hospitalize, or treat at home?

This is the decision most people find hardest, partly because it arrives with a cost attached at the worst possible moment. Here's the honest trade.

What hospitalizing buys is intravenous fluids, and they are not the same thing as fluids under the skin. An IV rehydrates faster, more completely, and in a controlled amount, which is exactly what a properly dehydrated cat needs. It also buys injectable anti-nausea and pain medication, and bloodwork repeated over two or three days so you can watch the numbers move instead of guessing.

What home treatment buys is a cat who isn't frightened, in her own house, with you. That's worth real weight, and for a mildly off cat who's still eating it's often the better choice.

The way I'd split it: if she's dehydrated and not eating, two or three days on a drip is the fairest test anyone can give her. If she's picking at food and still herself, treating at home and rechecking in a couple of days is reasonable.

And ask the two questions that actually matter: which category is she in, and what changes if we wait until tomorrow.

Reading the first 48 to 72 hours

This is the window that tells you what you're dealing with, and it's worth knowing what to watch for so the information isn't wasted.

Rehydration reveals her real baseline. Her creatinine on the day she came in dry is not her true number. After two days of fluids it settles to where it actually belongs, and that settled number is the one that means something.

Nausea control reveals whether the appetite is coming back. A cat given a proper antiemetic who starts eating within a day or two was nauseated, not finished. That's a very different situation from a cat who has good nausea control and still won't eat.

Then look at her, not the sheet. Is she sitting up. Is she grooming. Did she come to the front of the cage. Has she used the box.

A cat who's brighter and eating by day three has bought real time, and I've seen that turn into months and sometimes years. A cat who's had good fluids, good nausea control, and is still flat and not eating is telling you something else, and it deserves to be heard rather than argued with.

When it's the disease moving, not a detour

Sometimes the workup is clean, the treatment is right, and she still doesn't come back. That happens, and it isn't a failure of anyone's effort.

The signs that this is the disease itself rather than a reversible detour: the numbers barely shift on good fluids, she stops eating and stays stopped despite proper nausea control, she's losing weight fast, she's becoming anemic, and the crises are arriving closer together. The third crisis in two months is different information from the first crisis in two years.

At that point the question quietly changes from "how do we fix this" to "what do her days look like now, and are they still good ones". That's not giving up. It's the same care pointed at a different target.

The page for that decision, including the three-things test and what I do and don't tell families, is knowing when it's time. It's worth reading before you need it rather than at two in the morning.

What to do tonight if you're waiting for morning

If you've spoken to your vet and the plan is to come in tomorrow, or you're waiting on a callback:

• Keep water within reach of wherever she's chosen to lie. Don't carry her to it.
• Don't force food into her. A nauseated cat learns to hate whatever you push, and you'll need her willing later.
• Keep her warm. A blanket, a warm room, off the cold tile. A cat who has gone cold needs the vet, but warmth helps while you wait.
• Write down the times. When she last ate, last drank, last used the box, last vomited. Your vet can do a great deal with that list.
• Leave the litter box unscooped so somebody can see what's in it, or not in it.

Don't give her anything from your own medicine cabinet. Not ibuprofen, not acetaminophen, not aspirin. Those are catastrophic in cats and they're given with the best intentions more often than you'd think.