Why do American vets allow cat owners to give Sub-Q injections while British vets don’t?

There is a culture difference between American and British veterinarians. According to Helen Fitzsimons, the internet’s expert on feline chronic kidney disease (felinecrf.org), a possible reason why this culture difference exists in respect of home treatments in using subcutaneous fluids is because British vets focus more on the what is good for the cat and less on what the client demands.

This translates to declawing cats in America because the client wants their cat declawed and it also means that British vets don’t want their clients to administer fluid injections at home because they believe the benefits are outweighed by the downside which is pain, possible infection and that Sub-Qs injections are often unnecessary; the cat should drink more water.

However, Helen Fitzsimons says that there comes a time in chronic kidney disease (CKD) when a cat cannot drink enough to keep hydrated and the electrolytes in balance as the disease causes excessive urination. It is argued that Sub-Qs can improve the lifespan of cats suffering from CKD and make their lives more pleasant.

It may also be the case that British vets don’t like cat owners to do their work other than give pills to their cats. I think too that Sub-Qs as a treatment for cats with CKD is less often used in the UK. I don’t recall my vet giving my late female cat Sub-Qs when she was dying of kidney failure. We certainly did not discuss it and there was no chance of me administering Sub-Qs at home.

Perhaps also British vets don’t feel that cat owners are able to administer subcutaneous fluids reliably without hurting their cat and causing other problems.

There may also be a policy decision to not allow home treatment of this kind as the internet nowadays provides lots of cat health information that can mislead. British vets may wish to minimise home treatments in the interests of cat welfare.

According to Helen, the reasons that British vets give for not allowing cat owners to administer Sub-Qs include the following:

• A cat can drink water (‘oral fluid’) to maintain hydration. The counter argument is that cats can’t drink enough when chronic kidney disease (CKD) is so bad. Helen says that most cats with CKD need Sub-Qs eventually.
• British vets prefer to give intravenous fluids (IV fluids) themselves to rehydrate a cat. The counter argument is that this process is more expensive for the client and more stressful and unpleasant for the cat.
• The argument that Sub-Qs are painful can be at least partially ameliorated by using very fine needles and by administering a full 100ml of fluids at one time rather than a series of 10ml injections as recommend apparently by British vets. When carried out correctly Sub-Qs need not be painful, Helen argues.
• Another reason for not recommending home administered Sub-Qs is the cost. They are too expensive. In the states vets sometimes write prescriptions allowing the client to purchase medications more cheaply. However, in Britain vets never write prescriptions.
• Helen Fitzsimons claims that infections and scar tissue from repeated injections are rare. And in administering relatively large doses of fluids there are less injections thereby minimising the potential for these negative side effects.
• Sub-Qs are inappropriate sometimes; for example cats with kidney stones “who need an IV flush” and cats who suffer from heart disease as well as CRK.
• Not all cats are able to put up with Sub-Qs at home. It depends on the cat’s personality.

The stark difference in opinion between American and British vets is interesting and perturbing. You’d have thought they’d have similar methods. It seems that American vets are more trusting of their clients. Or perhaps their clients demand to be involved and as the vet wants to keep their clients happy they agree to those demands where possible.

Have you given Sub-Q injections to your cat?