Tuesday, January 22, 2013

Tips for Syringe Feeding your Dog with Chronic Renal Failure

Standard Disclaimer:
I am not a vet.  I am not a health professional.  Consult your vet.  Any advice you find here that is helpful, is merely intended to be that.  Help.

I keep mentioning that "Chronic Renal Failure" simply because as a part of the progression of the disease, the patient will slowly stop eating.  They basically starve themselves to death.

This is what happened with my own Lettie two weeks ago.   She survived because we realized we needed prompt professional veterinary attention.

What happens is that when the illness flares up, the dog gets nauseous and stops eating.  Nobody will last without food and when you're not metabolizing it correctly because the kidneys are failing, there's a very short period of time that you can act.

Sunday she stopped eating and drinking, utterly.   Monday she was in the vet.   They rehydrated her with intravenous solutions, and that continued through Thursday.   Her blood numbers for the various chemicals were extremely high, the hydration helped flush that all out.  When the week was done her numbers were either normal or very slightly "elevated".

Now it is Monday as I write this, a week later.  She's just taken her first bit of solid food from me and has more energy.   Clearly she is improving.

Chronic Renal Failure means for as long as she remains alive, she will continue to have these episodes and eventually hydration will not allow her to recouperate.  She must be on a prescribed diet that is low Potassium, low Protein, and low Salt.  The prescription food is pretty much despised by dogs so they won't eat it without being tricked.

Since she's refusing food, how do you combat that?

I was told after four days of intravenous fluids that if I couldn't feed her she's at her end.   I wanted to fight for her but how?  The vet tech Danielle at the excellent Family Pet Center in Fort Lauderdale gave me a can of prescription diet and two syringes.  I was to use these syringes to insert the food into Lettie's mouth and basically make her eat. 

She is a 47 pound dog, or at least she was before she started losing weight as a result of this disease.   As a result she will need one can of prescription diet a day.   You will want to feed twice a day.   Larger dogs get more food, smaller get less.  Ask your vet how much you should feed.

The first trial I used a fabric Muzzle.   That was overkill.  Here is the list of supplies that I use:

Feeding syringes - five.  35 ML in capacity.  The opening at the end is about the size of a common drinking straw.  35 ML is about an Ounce and about a quarter.  Even if the dog or cat in question is small, you will need a large opening because dog (or cat) food is thick and won't "inject" easily.  Five syringes will fill with 6 ounces of food by weight with enough "wiggle room" so you can work with the syringes to get them filled comfortably.  For larger dogs, you can get a larger syringe to make your work easier.

Microwave safe Large Coffee mug or mixing bowl of 16 ounces or more.  

Tablespoon to blend the food until all large clumps have been smoothed out - or alternately use a blender.  I found a tablespoon and a large latte or coffee mug to be perfect.

Microwave - you will warm the food to around "body temperature".   Warm food that is around 100F or 40C will be easier flowing.   Colder food tends to be more firm.

Large light color plastic mat.   You will be feeding the dog on the mat and you will be on the floor.  Why?  Psychology.  You are big, the pet is small.   If you are "on their level" they will be more relaxed.  It really is all about the pet.  Your comfort is secondary, you are saving their lives.  The goal is to be at eye level or close to it with your pet.

Oh the light color is so that you can find any mess later.  A towel can be used but washing a towel after every meal twice a day gets tedious.

Sandwich sized Plastic Bag with a corner cut out.  You want a small, drinking straw sized hole cut in the corner of the plastic bag so that you can work with it like a pastry bag.

Scissors to cut a hole in the plastic bag.

Bowl of water.   The dog may need water during feeding.  You would have a beer or soda with your pizza right?

Dog Collar and Leash.  I find my own Lettie tries to wander off.   Keeping a leash "at hand" slows her down.  When she wanders, you can gently guide her back to task.  She doesn't really want to eat, you have to help her along.  I basically sit on the leash and reel her in when need be.

Any medicines or pills that need to be added to the food.  

Assembly and Process:

Open the can of food.  I'm currently using Hill Diet I/D food.  She also has Pancreatitis on top of her kidney problems.   The food looks like a pate or a chopped liver paste.

Spoon 6 ounces (1/2 can) into the coffee mug.

Warm the mug and food for approximately 20 seconds.  It should feel warmish to the touch, but not hot.  Remember, you will be working with the food and you don't want to burn your pet's mouth as well as your hands.  The food will thin out a little bit and make it easier to work with.

Use the tablespoon to mix the food and break down any large clumps.  It should be smooth when you are done.

Spoon the food into the plastic bag and seal the bag. 

Tamp the food down toward the opening that you cut.   You will be using the plastic bag like a pastry bag.

If you are adding a pill to the food, you can add it after partially filling a syringe, then dropping the pill in the syringe, then finishing the fill.   Make sure the pill is broken small enough to easily run down the nozzle of the syringe.  You're killing two birds with one stone here by sneaking the pills in the food.

Fill the syringes until you have a little more than one ounce in each syringe.  You will do this by squeezing the plastic bag and letting the food run into the body of the syringe.  Basically you're decorating a cake.  

Tamp the food down to remove air bubbles.  Squeeze more food into the syringe if you have any leftover room.   I find that 6 ounces fill 4 1/2 35ML syringes.  Place the syringes on the mat.  Make sure the first syringe you feed is the one with any medicine.

Put the collar and leash on the dog and walk her over to the mat near the water and the syringes.  Place the muzzle near the syringes.

Sit down and talk to her.  Most importantly you will want to make sure your "energy" is calm and cool.   If you are hyper and bouncing around, your pet will definitely be the same way.

The muzzle may be used at this point if you have a bitey dog.  My own Lettie is fearful and she is a fear biter, but I was able to do this without using the muzzle and no biting.   If you do use the muzzle, remember to leave it loose enough that the dog's mouth can be slightly opened.   You will need to get the opening of the syringe in that little gap.

Since I am not using a muzzle, here's how I do it.

Seated on the ground, I gently hold Lettie's head from under the jaw.  I show her the syringe and tell her "Hungry" as she understands that to say it is time for food.  Aiming the syringe, I get her to open the lips on the side of her mouth. 

There is a spot directly behind the main Canine teeth, the fangs, that there is a gap. 

Placing the opening of the syringe at that gap, I squeeze a little bit of food into the gap.   At this point the dog's reflexes will take over.   If your dog really truly hates this process, she'll clamp her mouth shut or snap at you prompting you to use the muzzle.   In my case, she opens her mouth slightly.   This was the signal for me to push the plunger on the syringe so that she got a slow but steady stream of food into her mouth.  

At this point she would begin chewing and accepting the food.   If you are pushing too quickly, the food will gather in the cheeks and she'll back away.  This is one of those things in life that you have to "finesse" and find the right speed.   Watch your dog closely. 

I am able to actually get the syringe into the cavity of the mouth and empty each syringe one at a time while she's eating.   This is after about 3 days of twice a day feedings.

After five days her energy is improving.  She won't ever be perfect again, she's just not going to recover.   This will buy some time with her but I understand that there will be another relapse and eventually The Final Decision will have to be made when I walk her to The Rainbow Bridge.

At least this gives us time to adjust.


  1. I'm going thru that right now. He is fighting the syringe feeding

  2. Rita, they do have their minds about them. Lettie never got to where she fought me, but at the end she certainly did tell me in her own way. There is always peanut butter, but be careful if you do go that route not to get xylitol in the ingredients.

  3. My 16 yr old , rat terrier , Aggie, was diagnosed with renal issues by the ER vet on Sunday. She wanted me to put her down and when I didn't agree, she sent me home with medication for her nausea and iron supplements. I will say they did give her subcutaneous IV fluids. I was provided a leaflet and told not to feed her protein....try oatmeal. I took her to my vet today and we have a plan. She is end stage, but at least he is trying to see if we can get her numbers down. I am feeding her via syringe with Hills A/D. He has started her on a phosphorous binder, antibiotic and more fluids.

    Thank you for your article. It's calming to listen to others who understand the love we share for these creatures who only love us unconditionally.

  4. Holly, I want to thank you. I was going to just put together a comment but this really needed something more. Yes, do try, even if it works, you will know that you did at least that. Not every dog will accept it.

    More importantly, you gave me a chance to revisit my memories of the time, and another visit with my old girl, Lettie.

    I'm repeating the blog posting that I followed up with and the link is below.


  5. Thank you for sharing. I've just tried syringe feeding my dog although I only have 10ml syringe. Still, it's all I've got her to have today so I'll be trying another shortly. Otherwise she would have had nothing. We are also end stage on Valium, phosphate binder and two meds for kidney blood flow just for the last week as she suddenly went down hill.

  6. my dog has kidney failure i think i have been giving camomile tea in his water and for food a pate and water mix

  7. I know this was a while ago for you but I was wondering how similar my current situation with my dog is to yours. My sheltie has had kidney readings in the stage 3 to stage 4 levels over the last week and will not eat anything on her own. I had her in the vet for 2.5 days on iv fluids and the numbers came down a little but still stage 3 numbers. I'm now syringe feeding her kidney diet wet food and subq fluids 3 times a day. How bad were your dogs kidney numbers when she still had a year left? And did you do subq fluids at home too? And was her quality of life pretty good? I appreciate how much effort and care you put to extend your dogs life, but so far my dog has not really been doing well the first day being back home.

  8. I would say that you have the numbers I do not have. I was more passive, when she started to show issues, she went into the Vet. At a year prior, we were able to flush her system, and then begin the regimen above. She was not to the point where she was racing around the yard but we were able to walk the block three times a day. By that time, she was an older dog, although this took her early. A McNab should get 14-16 years, she only had 12.

    Your dog will tell you when it is time. Lettie did, dramatically by putting her paw on my hand when I went to reload the syringe. They know. They know better than I did. A Sheltie is a very active dog, if you watch the behavior you will know.

  9. My 19 yr old Chihuahua/terrier mix vomited his first only meal from the syringe then collapsed and died while tried to hold him up, but nothing, he was gone. Chronic renal failure, but he had a good 3 yrs with the condition, I just never thought the last day would come. At least he went quickly without any pain it seemed, but it completely crushed my heart and sole.

  10. I'm sorry to hear about your loss. It can be very dramatic when they do go. When Lettie put her paw in my hand in a feeding session, I knew it was time to stop. With smaller dogs, it can be very difficult to know how much to feed at a given time, so do remember to go slowly and feed to the front of the mouth. Aspiration of food can be dangerous.