Tom was a three-year-old male castrated Siamese mix. When I first met him he was very nearly dead.
His owners reported that Tom had suffered from several days of lethargy and poor appetite, leading to complete collapse. There were several cats in the house and they were not able to say whether he had been producing urine.
Anyone who has any experience as an emergency vet immediately becomes suspicious of urinary obstruction in any male cat, especially a young one, who suffers from collapse. Urinary obstruction is a condition in which cats are unable to urinate. They suffer great pain, and when the bladder is full to maximum capacity the kidneys shut down. Death occurs due to kidney failure and electrolyte disturbances, especially high blood potassium.
When I met Tom, the first thing I did was palpate (feel) his bladder. It was palpable but small, a finding not compatible with urinary obstruction. Cats with urinary obstruction are expected to have large, firm, painful bladders. This left the diagnosis open. Tom looked terrible in every way. His body temperature was low. He was moribund and barely arousable. He was morbidly dehydrated. Ominously, his heart rate was low — a finding that often preceeds death.
Emergency treatments commenced. A diagnostic blood sample was drawn. Warmed intravenous fluids were administered. Radiographs (X-rays) were taken, and they showed that Tom likely had fluid in his abdomen. A brief ultrasound was performed, and it confirmed the presence of fluid in the abdomen. A sample of the fluid was collected — it was dilutely bloody. A sample of urine was collected by bladder tap. It, too, was slightly bloody.
We began thermal support while running tests on the blood, urine, and fluid samples. When the results were available, the diagnosis became clear.
Tom’s blood work showed that he was in kidney failure. Three values — blood urea nitrogen (BUN), creatinine, and potassium were markedly elevated. Tom’s urine showed substantial quantities of blood. Crystals known as struvites were present in the urine. The abdominal fluid’s creatinine and potassium levels were both sky high. The fluid in the abdomen was urine.
Tom was suffering from a highly atypical and especially severe case of urinary obstruction. His bladder was small because it had previously burst and released its contents into the abdomen. Incredibly, a clot evidently had then formed on the bladder wall, restoring the structure’s integrity.
In cases in which the bladder wall has suffered significant trauma, surgical intervention is indicated. I discussed this with the owners. After considering the circumstances (and especially the cost) of surgery, they stated that it would not be an option for them and Tom. We would have to try to treat Tom without surgery.
Tom would require a urinary catheter. However, he neeeded to be stabilized first. His potassium levels were the greatest threat to his immediate survival. Calcium gluconate was administered to stabilize his heart rhythm. Insulin and dextrose were administered to reduce potassium levels. When his bladder filled, we drained it using a needle and syringe inserted through the abdomen. Incredibly, although the bladder had previously burst, it maintained its integrity throughout this time.
Eventually Tom was sufficiently stable to attempt urinary catheterization. A urinary catheter is small tube that is passed through the urethra by way of the penis. It enters the bladder and allows urine to drain. Unfortunately, Tom’s urethra was much too swollen and inflamed for the catheter to pass.
This looked like a nearly hopeless situation. I called the owners and again recommended surgery to attempt to bypass the urethra. The owners reiterated that surgery wasn’t an option for them, but they didn’t want to give up. They asked if anything could be done.
I told them that with time, the urethral swelling and inflammation might decrease to the point that a catheter could be placed. An injection of prednisolone (an anti-inflammatory type of steroid) might also help the matter.
Tom got the prednisolone, and his bladder was checked and drained by tapping regularly for the next 12 hours. Tom’s condition improved during this time — he was much more bright and engaged with his environment, and his vital signs stabilized.
The next time I attempted to catheterize Tom, there was success — sort of. I was able to place a rigid, uncomfortable catheter, but not the soft type that I (and patients) prefer. It was progress, but Tom still had a long way to go. We upgraded his pain killers to address the discomfort of the catheter, and left it in place for 14 hours.
During that time Tom’s condition continued to improve. His BUN, creatinine, and potassium normalized. He produced copious urine through the catheter, which was a good sign. But Tom would require several days of catheterization, and the type of catheter in place simply was not acceptable. It would be necessary to try, for a third time, to place a soft catheter.
The third time was charmed. The inflammation of the urethra had resolved to the point that the catheter passed without a hitch. The next three days were uneventful. Tom consumed food and water and seemed to be in very good spirits. What had started as one of the worst cases of urinary obstruction I had ever seen had become just a standard urinary obstruction — which, mind you, is still a very serious thing.
No cat can remain catheterized forever. Tom had been in the hospital for five days when we removed his urinary catheter. Everyone then waited with baited breath. Would he be able to urinate?
Indeed. Tom was able to urinate without any difficulty whatsoever. He went home later that day with a special diet, pain killers, and a medicine to facilitate urination. His owners later reported that he was doing very well.
In 14 years of veterinary practice, I have never seen any other cat come so close to death and yet survive. I will remember Tom forever.
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