Friskie is a 1.5 year old, male, neutered, Ragdoll cat. He has been generally healthy. Preanesthetic lab work was normal when he was neutered about a year ago. He is current on vaccines and is strictly an indoor cat. He is an only pet. He presents with about a 36 hour history of vomiting frequently. Initially, the vomiting was food but has become yellow fluid. He has not had diarrhea. He has become increasingly lethargic and is not interested in drinking or eating. No toys are missing and he does not tend to get into anything. On physical examination he is very depressed, body condition score 6/9 and estimated to be about 10% dehydrated. He appears otherwise normal. As there is no explanation for his vomiting and dehydration based on physical examination, you perform abdominal radiographs along with blood work. You could not get urine because the bladder was empty. The abdominal radiographs are considered normal. The blood work shows severe dehydration and extremely elevated kidney values.

What is Friskie's problem and how do you treat him?

Friskie is in renal failure. A cause is not initially known. The previously normal labs suggest strongly against a problem he was born with but does not rule it out. We need a urinalysis to try to get a bit more information. Other considerations include toxins, cancer, severe dehydration, and infectious causes. Intestinal obstruction seems unlikely with the radiographs being normal.

With the labs now suggesting a direction to look you question the owners further. He does not go to the garage to get into antifreeze. No medications have been dropped recently and they are stored where he cannot get to them. They do not have any plants in the house. However, four days ago he got her a fresh flower arrangement and Friskie was sniffing it. He was not seen to eat any of it though.

They pulled up a picture of the flowers on her smart phone. You recognize roses and lilies. When the owners got home they checked and discovered that one of the lilies had parts missing and chewed on.

All members of the lily family (Lilium (lilies) and Hemerocallus (daylily)) are considered highly toxic to cats. All parts of the flower, including the pollen are considered toxic, even in tiny amounts. The toxic chemical is not known, but it causes the death of the renal tubular cells (cells in the kidneys that help filter wastes from the blood).

Symptoms often include hypersalivation, vomiting, anorexia, depression and dehydration. Initial symptoms often appear in 6 to 12 hours. The kidney function starts to deteriorate after about 24 to 72 hours. Death often occurs in 3 to 7 days after exposure.

If the lily exposure is recognized early, before symptoms start the prognosis with treatment is good. Once symptoms start the prognosis declines as the symptoms progress. In other words, as the kidney function worsens and the lab values increase, the prognosis worsens. If the kidneys stop producing urine, the prognosis is very bad.

Treatment consists of intravenous fluid therapy (to hydrate and flush the toxins and wastes from the body) coupled with supportive and symptomatic care. Most patients receive medications to control nausea, and to protect/treat the gastrointestinal tract irritation. If presented in the first few hours after exposure they are made to vomit and then administered activated charcoal to remove the toxin from the GI tract.

Given the evidence of severe kidney problems, Friskie is given a very poor prognosis. The owners request that we start treating and see if he responds to initial treatment before they give up on him. He has a rehydration planned over 18 hours and is given medications for the vomiting and GI irritation.

After 18 hours he seems clinically hydrated and has gained approximately 14% of his body weight. During this time he has not urinated and his bladder is still not palpable. He seems to feel somewhat better, although he refuses to eat or drink.

By this time and with the water weight gain, Friskie should have produced at least enough urine to have a palpable bladder, even if he has not urinated. Even without rechecking his labs, we know that the kidneys are in extremely bad shape. Friskie is anuric (meaning his kidneys will not produce urine). This decreases his prognosis to grave.

At this point the owners requested euthanasia.

Lilies are so toxic to cats that it is recommended to never have lilies in the house with a cat. There are even reports of cats that have died from being in an empty box that had contained lilies. Just the small amount of pollen in the box was enough to severely damage the kidneys.

If you have cats, please keep lilies away from them. Cats like to chew on plants and even the small amount of pollen they consume from grooming themselves can be deadly.  

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