Friday, May 13, 2011

Worst Mother's Day present ever.

I had a heart-wrenching case last night.

A fat, sleek kitty was brought into our clinic 48 hours prior. At that time, he'd eaten his owner's Mother's Day bouquet. Shortly afterwards, he started to vomit. The owners contact the florist and were told a list of flowers *possibly* in the bouquet. None of them were toxic per our consultation with Animal Poison Control. The kitty was treated for gastritis and sent home with a good prognosis.

Fast forward to this evening. Archie the cat came in for neurological abnormalities, twitching, and possible seizures. We conducted bloodwork first which showed that Archie was in severe, severe kidney failure. It was so bad that I didn't believe my initial bloodwork results. We collected fresh blood and ran it again. Still the same - severe kidney failure. It was not what I expected to find.

I went to speak with the owners about things he could have ingested in the house, since he was a totally indoor kitty. They had no ibuprofen or other medications he could have eaten. There was nothing. Just the flowers. At that point, the woman pulled out her Iphone and handed me a picture of the beautiful arrangement. Smack in the middle were 3 or 4 huge day lilies. Archie had eaten lilies.

In case not everyone knows this, lilies are incredibly toxic to feline kidneys. We don't know why, but something in the lilies leads to acute renal failure in cats. It wipes out the cells that make up the urine making part of the kidneys (called renal tubular cells). If caught early (within the first 8-12 hours), treatment can be successful. It had been 48+ hours however.

The owners were extremely dedicated to their kitty, and they wanted to try. Over the course of the next 12 hours, I pumped kitty full of fluids. It was to no avail. His kidneys refused to make urine. After 6 hours on fluids, nothing. His bladder was small and soft. His skin however, was starting to feel gelatinous. This occurs when the kidneys can't make urine. Since there is nowhere else for the fluid to go, the body starts to push the excess fluids outside of the veins - into the tissue under the skin and the lungs. It's called "3rd spacing."

I tried to force his kidneys to make urine, pumping him full of diuretics and mannitol. Nothing happened. His kidneys had officially left the building. This sad state of affairs is called anuria ("without/no urine").

The only option in the face of complete anuria is dialysis. Dialysis for a cat costs $10,000-20,000. The owner, a very sweet middle-aged guy, wanted to do everything he could for his kitty - but he didn't want Archie to suffer. He decided, after much agonizing, to let Archie go. This was the right decision given that Archie's kidneys were absolutely and completely failed. It was still heartbreaking, especially to know that had we known about the lilies on Tuesday - we might have been able to save him.

Watching a tall, tough man weep over his cat was about the most depressing thing I've seen this month. I had to step into the bathroom and compose myself at least once, or I thought that the combination of that and pregnancy hormones might push me over the edge. It's always the people with unlimited funds who haves the pets I cannot fix.


VetVoyeur said...

How incredibly sad. So sorry. VV

The Nurse said...

"It's always the people with the unlimited funds who have the pets I cannot fix"......ain't that the truth. I was willing and able to buy the moon for my beloved dog, but no vet could save him either. Perhaps there is some consolation (for you, anyway) in knowing the cause of the renal failure. Even a necropsy on my dog failed to provide a satisfactory answer for my vet and me (a diagnosis, yes, but no "why").

My condolences to both you and your client.

Tammy said...

Oh such a sad situation! :( I'm sorry it worked out that way for both you and your client.

Knowing my cat Oscar's inclincation to eating plants/flowers, I just don't have lilies in the house anymore. It's not worth worrying about! He has been known to get up on counters to get at flowers - crazy cat.