Feline Medicine Q&A 24

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A 6-year-old neutered male Birman is presented with acute onset of depression, lethargy, weakness, and vomiting. The owner has observed the cat chewing on leaves of a plant.

Question	Answer		Article
What is this plant and the likely result following ingestion of it?	The plant is a Tiger Lily and both the leaves and flowers are known to be toxic to cats causing severe ARF, although the precise toxin is unknown. Although highly toxic, recovery is possible in many cases with adequate supportive care.		Link to Article
What general supportive treatment should be provided for this toxicity and how should the likely major complications be addressed?	Aggressive treatment of ARF involves intravenous fluid administration, with mild volume overload to promote urine production and diuresis. If oliguria persists (<1–2 ml/kg/hr) then furosemide (2–6 mg/kg IV) and/or mannitol (0.25–0.5 g/kg IV) can be administered to promote urine production. Other supportive care such as H2- antagonists, antiemetics, and nutritional support may be required. The major metabolic consequences of ARF are hyperkalaemia and acidosis which can be profound. Mild changes may respond to intravenous fluid therapy but severe changes need prompt therapy. Severe hyperkalaemia (>8 mmol/l [>8 mEq/l]) requires 0.5–1.0 ml/kg 10% calcium gluconate slowly IV to provide cardioprotection. Sodium bicarbonate (typically 1–2 mmol [mEq] per kg) given slowly IV will help address both acidosis and hyperkalaemia. Additionally 1 g/kg 20% glucose can be given IV with or without approximately 0.2 U/kg soluble insulin to cause cellular uptake of potassium. Careful monitoring of response (potassium, glucose, and acid–base status) is required. Severe acidosis (pH <7.15) requires bicarbonate therapy using 1–2 mmol or mEq per kg slowly IV or calculated from: 0.3 × bodyweight (kg) × (desired bicarbonate – measured bicarbonate). Half of the calculated dose is given IV over 20–30 minutes and the remainder added to the intravenous fluids. The dose required varies between cases though, and should be adjusted according to response.		Link to Article