UT-VMC emergency room tails: blocked

UTVMC COLUMN HEADER  2By Dr. Amanda Rainey

It had been a busy Monday at the UT-VMC ER, but by the time I arrived for my evening shift things had quieted down a bit. The night intern and I rounded on the ICU cases with the departing day staff, and settled in with our students for the hours ahead. We didn’t have to wait too long for the excitement to begin however, because soon the overhead page sounded calling for the emergency service to triage a patient up front.

One of our students immediately headed in that direction, and returned quickly with a very sick looking cat contained within a carrier. He lay flat on his stomach, barely able to hold his head up, and when he did it trembled violently. I think as veterinarians you develop a slight sixth sense, and before the student started giving me a brief history on the cat I knew what was wrong.

His name was Gilbert, and his ailment is something that male cats are unfortunately famous for. The description the student gave me fit perfectly, in that he had begun acting strangely the day before, had been seen going back and forth to the litter box very often, and when the owners came home from work he had vomited and seemed very uncomfortable in his abdomen.

He was too weak to struggle as I pulled him out of his carrier and my hands immediately went to palpate his abdomen, where I predictively found what I knew was the trouble. His urinary bladder was huge and extremely firm, and even on gentle exploration of the area he groaned in obvious discomfort.

Gilbert was suffering from a urethral obstruction, or as we call it he was “blocked.” This disorder affects male cats almost exclusively, and can be caused by small stones, crystals, or even mucus that becomes stuck in the very narrow but long urethra that carries urine from the bladder to the outside world. Sometimes the condition is triggered by stress, or diet can play a role causing the formation of stones or crystals in the urine. No matter the etiology, urine cannot be voided due to the obstruction and the bladder enlarges.

The buildup of urine causes a dramatic increase in kidney values, as well as potassium. The potassium can climb to dangerous levels, and even cause cardiac issues which are most definitely life threatening. This was true in Gilbert’s case. His potassium and kidney values were sky high, and we immediately began working to address this.

We placed an intravenous catheter, and then administered a calcium solution to stabilize his heart, followed by insulin to drive potassium down. We then started him on a dextrose drip to prevent his blood sugar from dropping too low with the administration of insulin.

We gave Gilbert a sedative along with pain medication in order to relax him and next attempted to relieve the urethral obstruction by passing a urinary catheter. It took a little while and wasn’t easy, but finally the catheter slipped in as we pushed saline flush through it, sweeping the obstruction back into the bladder. We secured the urinary catheter with suture and began intravenous fluids to support his kidneys. Radiographs showed no evidence of stones, so he would not require any surgery.

Thankfully Gilbert did well and was able to have his urinary catheter removed after about two days, and was then discharged. It was a happy outcome for all of us, and a learning experience for not only our students but also Gilbert’s owners, who had no idea this type of problem occurred in cats.

(Dr. Amanda Rainey, DVM, is a clinical assistant professor in the small animal clinical sciences department at the University of Tennessee Veterinary Medical Center in Knoxville.)

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