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Friday, December 25, 2009

A sad case

A young, two year-old cat presented to me in severe and acute respiratory distress, severely hypotensive (low blood pressure), and vomiting clear fluid. The cat's gums were extremely pale and his temperature was a freezing 34.5 degree C (94.1 degrees F), indicating that the cat's extremities were very poorly perfused (no/little blood flow). The owner brought the cat in immediately after hearing the cat suddenly screech. There were no toxins to which the cat was exposed.

On examination, the cat's veins were hair-thin, so tiny that it was difficult getting an iv catheter in one of them - but we did. After giving the poor gasping cat a tiny dose of a sedative to calm him down, I administered a shock dose of iv fluids, which was touchy, as chest x-rays indicated that the lungs were full of fluid (could be blood, infection, edema, whatever), but I had to get his blood pressure up.
A presumptive diagnosis of anaphylactic shock or pulmonary embolus was made (the latter very difficult to diagnose in animals and people ante-mortem). I administered oxygen, injections of dexamethasone, epinephrine, famotidine (an antihistamine/H2 blocker for all you meddies out there), and Benadryl). Epinephrine was repeated twice in the next two hours.
Within ten minutes, the cat improved clinically with this treatment. The fluid rate was dropped, an injection of a diuretic was then given to relieve the fluid in the lungs, all the while the cat had watery fluid coming up from his lungs and pouring out from his mouth and nasal cavities.
Soon afterward, the cat turned blue indicating hypoxemia (low blood saturation in oxygen), so we gave him a low dose of milk of amnesia (propofol), intubated the cat, and manually ventilated him for over two hours. Watery fluid continued to pour from his nose. His gums returned to a normal pink with us manually ventilating him, but every time we extubated him to seet how he would do alone, he turned blue - not good.
We continued to intubate and extubate him but he could not ventilate on his own.
I advised the owners that he would need mechanical ventilation but such therapy in the ICU at the referral practice would have cost thousands, which he understandably didn't have. We extubated the cat, his breathing became severely labored so we put him out of his suffering and humanely euthanized him.
One of my technicians broke down crying... we were all so upset. I like to think that our efforts were noble. As vets, though, we always question ourselves: "Was my diagnosis correct?" "Did I do something wrong?" "Could I have saved this kitty?"
Fudge, this case didn't end well... but we tried.

Not the cat in question, but a cat receiving oxygen therapy.


Mel said...

PE, of course, is far and away the most likely, particularly given the history of acute & severe onset and crying out. I've seen thromboembolism as young as 8 months, and with pulmonary involvement they almost never survive. Sounds as though you did the best you could considering - these are pretty much always frustrating and very emotional cases.

Angus said...

I really don't know eher some people get the strength to face challenges such as this every day. Guess you're either born with the gift of strength or not. Seems to me you're a pretty well sorted guy to deal with this sort of thing every day with another rouind coming tomorrow.

GoLightly said...

That's part of the circle of life.
There is always going to be death.

You did a great, difficult job.

Cats are terribly difficult patients. They hide everything.

That sudden screech might have been building for weeks.

Did you do a PM?

martha said...

Second guessing is so cruel to
oneself.(and we can't help it-it is part of our nature) When you are in a "helping" profession,the most perfect outcome (healthy life) is the true goal& it's hard to accept anything less.
This experience will assist in the next emergency.
You did your very best.You did good.
I had the ? luck on Boxing Day to be in a HUGE Emergency Vet Clinic in the (far) west end. They do- emergencies & referals only. While I was there an eldery black Lab was brought in for his final visit,(renal and liver failure- it was a planned visit) our black lab was the very last dog he wagged his tail at (I am crying now as i think of it)
(but what a nice 'send-off"). Another 8 year old dog was brought in with 'seizures" (as reported by the owner)That dog had been dead for HOURS. All I can say is that I so admired how the staff handled each situation.They were kind and quick without being brisk. Full explainations were given for each case re: health care,follow-up and billing.(& no one rolled their eyes) They were awesome.

I might as well say who they are (you can can delete it) The Mississauga-Oakville Emergency Hospital and Referral Group.
It's decent to be able to have respect for someone who cares for you and your pet. We are so jaded about human care & hospitals.
sorry again i blather- just cut some out MR/Dr.Vet!

Eric said...
This comment has been removed by the author.
martha said...

please do a few lines on giardia and best way to treat this sometime elusive problem.
Seems to be a lot of it in T.O. the last few months.

veterinary hospital said...

My vet put Midgie on the Temeril and I now keep some handy in the frig at all times. He did that because of my concerns regarding overuse of prednisone.
He said low doses of pred are just fine with proper monitoring and said he has patients who have been on it for years. Still, I don't like it so when the Benedryl is no longer bringing her relief, we take the Temeril now. She feels better. I feel better.

- Mathew

Valerie said...

These cats are a heartbreak - possibly in a literal sense. I saw two in the last month that presented pretty much like yours, and both had developed acute decompensation of CHF. Even if it had pulled through this episode, the future for this poor cat was not good.