Wednesday, April 6, 2011

I forgot!

I forgot my last critical patient of the last night! (can you believe there's more?!)

In the early hours of the morning, two very nice clients brought in their 3 year old, male neutered indoor-only kitty for evaluation, "Joey".  He was found sleeping in the litterbox, had vomited, and was very lethargic.  The also noted that he was in the litterbox most of the day prior, and it looked like he was straining.

To anyone who is in the field, these are the classic signs for a kitty with a urinary obstruction, commonly referred to as a "blocked cat" or a "blocked tom".  My physical exam confirmed the above; he had a large, distended, painful, non-expressible urinary bladder.  More details are available here.  The kidneys function to filter blood and excrete waste products from the body, in the form of urine.  (It is interesting to note that some of the waste compounds excreted are so toxic that they are diluted with a large amount of water to reduce their direct toxicity, therefore resulting in the need for urine).  Urethral obstruction is the blockage of the ability of urine to escape from the body.  There are multiple different reasons for the blockage to occur, including urinary crystals, bladder stones, blood clots, mucous, narrowing of the urethra, cancerous masses, or urethral spasms.  Regardless of the cause, obstruction of the outflow of urine results in build-up of toxic waste products, metabolic disturbances, and elevated potassium.  As potassium climbs, arrythmhias, low heart rates, and even death can occur.

The severity of each blocked kitty depends heavily on how long they have been obstructed.  The first sign of urinary obstruction should prompt an immediate exam by a veterinarian, in order to prevent the sequelae of remaining obstructed for extended periods of time.

Joey had a low heart rate (100), was hypothermic at 94 degrees, and very lethargic.  An IV catheter was placed, bloodwork was initiated, he was provided with gentle heat support, pain medications, and fluids were started.  An ECG was placed on him, which revealed changes consistent with hyperkalemia (elevated potassium).  Blood results returned and confirmed a critically high potassium, severe elevations in his kidney values, and dehydration.

I counseled the owners on the best course of action.  Joey had a good chance for recovery, but also was in a critical condition, and immediate treatment was the only way to provide him with the best possible outcome. We could not be sure if he would have permanent kidney damage, or if he would have a full recovery; the only way to find out was to proceed with treatment.  His owners agreed to go forward with treatment.

Joey was given calcium gluconate to combat the effects of hyperkalemia, and I started the procedure of relieving his urinary obstruction.  The procedure typically requires sedation or general anesthesia, however Joey was so incredibly sick that pain medications alone were enough.  I quickly relieved his obstruction, and a urethral catheter was placed, which would remain for 24 hours.

Joey had a slow, steady recovery and was eating by the end of the day. We expect him to make a full recovery.   Blocked cats are one of my favorite emergencies -- usually, we're able to take a cat who is hours away from death, and pull them back to normal, potentially giving them many more years of happy, healthy life.

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