Renal failure

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Boxer Insane
Thanks everyone and thanks for the info Heather. Diva spent four and a half days on IV fluids at the vet as well as antibiotics etc. I brought her home on last Saturday around lunchtime. She did well for two days and ate, although not as much as usual, but that is to be expected. What I'm finding is that she seems to be nauseous alot. Previously she was on maxolon for this, but this doesn't seem to be working anymore. Last night I took her to the vet for a shot to relieve the nausea and this seemed to work, but by mid afternoon today she was obviously feeling nauseous again. She is now taking a human grade drug called Ondansetron - apparently given to human cancer patients. She won't eat tonight, but does appear relaxed.

She has a follow up with the vet tomorrow and her levels will be tested again. I just fear that for a dog her age, that it is all getting a bit much. I will definitely look into the k9kidney group you mentioned.
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Boxer Booster
nausea in kidney dogs

One of the biggest things that can make them feel nauseous is when the phos gets elevated. Getting and keeping the phos down is very key to keeping them eating. You don't want them not eating as then their body starts breaking down muscle for energy and this puts even more work on the kidneys.

You want to feed her a low phos diet. This is going to naturally limit the protein, but you want to make sure the protein she is getting is high quality and highly bioavailable. Then you want to use a phos binder. This binds to the phos eaten and makes the molecules larger so that they don't go through the kidneys. The kidneys can't filter the phos so it builds up in the blood. The binder takes the new phos through the intestines and it's eliminated there. Here in the states we use aluminum hydroxide and we order it from I'm not sure about NZ?

This is the first site that I spent hours and hours on and helped me with diet, supplements and a number of other things Health: Kidney Disease in Dogs

Did your vet send you home with fluids that you can administer at home? Sub/q fluids post IV are very important. If there are heart issues, you may need to go with the lower dosing. The fluids help flush more toxins.

Ondansetron is an anti nausea med. In addition to anti nausea medication, you also want to give them something to prevent acid build up as the kidneys are no longer doing this for them. We give Maggie 15 mg of pepcid (famotidine) every 12 hours. It's an over the counter med here. We also use slippery elm bark, which coats the tummy. It's good for both nausea and keeping the acid down in the tummy. If we don't control the acid they end up with ulcers. There are also appetite stimulants. Mirtazopine is the most commonly used one here.

Every dog is different, but I have seen hundreds of dogs pull out of the crisis and live comfortably for longer than expected. I've been able to personally witness Maggie's transformation. March 1st I thought we were about to lose her. Today she is scarfing her food down, has no nausea and is thrilled to go for her walks. We don't know how old she is, but it's guesstimated that she's somewhere around 11. Could be as young as 10 or as old as 12. Kidney failure is not always a death sentence in the short term.

When you join the k9kidney group you can upload Diva's labwork and the mods will help you understand what everything means and point you in the right direction of what will help Diva the most. One of the first things they post for new members are some links on phos binders and fluids. I'm posting it below. Let us know what Diva's labs say and give her a snuggle from us.

Boxer hugs and kisses,

Heather, mom to
Maggie/boxer/63 lbs/11 yrs/ CKD, chronic pancreatitis, hypothyroidism, arthritis and newly diagnosed with adult onset epilepsy and likely IBD.
Gabby/boxer/ 45 lbs/6 mos/CaOx crystals and crazy puppy syndrome :) Orange County, CA

For our new members and anyone who still questions whether your kidney pup needs
a phosphorus binder, please read the following link. This site is for humans
with kidney disease, but the same rule applies to our kidney pups. I think it
does an EXCELLENT job of explaining it. When it refers to a patient on dialysis,
the same applies to our pups who are receiving subQ fluids.

Phosphate Binders: What Are They And How Do They Work? (Renalife)

If, after reading this, it brings any questions to mind, please let us know.
Giving our kidney pups a phosphorus binder is an essential treatment when
trying to continue their quality of life and to improve their appetite. You
might consider asking your vet if they are familiar with Dr. Nagode and his work
with parathyroid and Aluminum Hydroxide binders?? According to him, you may
sometimes have to double the AH amounts to get the phos down, and then reduce
the dosing once it's there. Elevated phosphorus throws the body off, and once
it causes mineralization, the damage is done. It can cause bleeding in the GI
tract, ulcers and the obvious lack of appetite. Your vet could always contact
Dr. Nagode at Ohio State for a consult.
Phone: (614) 292-4262 ; Email: nagode.1@...

For information regarding specific binders:

About Phosphorus Binders - CRF Supplies
About Phosphorus Binders - CRF Supplies
About Phosphorus Binders - CRF Supplies

The above will give you the technical information...the following are my
opinions: Years ago vets were recommending Maalox too (hopefully not anymore
due to the magnesium content) but these were the products that they knew about
(many still have never heard of Aluminum Hydroxide Gel Powder) and would tell
patients to use them for their pups. My thinking is that vets don't know/talk
about the Gel Powder because they don't sell it! They're not going to tell
clients to go on-line to buy something...certainly not something this
expensive. Little do they realize the mark-up they could have on the Gel Powder
product!! Imagine selling 1/4 lb for the smaller pups and still charging $50.00
for it? It'll catch on at some point, IMO or we'll skip right to another human
phos binder that they WILL sell, like phoslo.

According to Ian, at Home page - Thriving Pets (& I DO trust/respect his input), the
only thing that the Gel Powder should not be mixed with (at the same time) is
primarily tetracycline antibiotics and acid reducers such as ranitidine (Zantac)

and cimetidine (Tagamet), but Pepcid is OK. Those medications should be
separated by 2 hours from the Gel Powder.

Alternagel should be separated from anything else by 2 hours....some may say 1
hour before anything else or 2 hours after anything else but I may be more
conservative...haven't found anything in writing that tells exactly what/when to

give so I follow the 2 hour rule....unless someones schedule can't accommodate
everything and then I might say "OK" about the 1 hour before...sometimes we have

to make compromises -- I don't want to see people tearing their hair out trying
to have an exact schedule with 10 different meds. :)

The Gel Powder will ONLY work when it's given with may (there are
varying opinions about this) help to bind to the phos molecules in stomach
fluids even if a pup hasn't eaten. Basically, the aluminum hydroxide molecules
will adhere to the phos molecules in the food/stomach thus becoming one larger
molecule which will be too large to pass through the system into the kidneys for'll then pass through the only other option -- the stool. The
aluminum hydroxide in Alternagel will do the same thing. The Gel Powder is only

aluminum hydroxide where Alternagel is many other things as well.

The Gel Powder does not coat the stomach the way Alterngel was designed to
do....Alternagel may inhibit some vitamin absorption...haven't researched that
though. The Gel Powder is designed to be a phosphorus binder...period.
Alternagel is designed for humans to treat heartburn. So they aren't the same
thing at all....just manage to both act as a phos binder.....I believe this is
why the Gel Powder is so much more effective, but that's just my
opinion...mostly based on what we've seen here with all the kidney pups that
pass through our lives over the last many years -- every day.


Boxer Insane
Thanks Heather, I really appreciate the info and I'm glad that your girl is doing well.

Unfortunately, today Diva went to the rainbow bridge. She was in multi organ failure and I made one of the most hardest decisions of my life - to put her to sleep. She was put to sleep by a very caring vet and vet nurse at home on the deck in the winter sun. She went very peacefully and I really do think that she knew.

I will write a tribute to Diva in the rainbow bridge forum when I feel up to it.
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