|
Table 1. The patient ' s biochemistry and blood gas analysis results.
Parameter
|
Patient ' s result |
Normal range for cats |
Sodium( Na +) |
147 mmol / l |
147 – 157 mmol / l |
Potassium( K +) |
8 mmol / l |
3.6 – 5.2 mmol / l |
Chloride( Cl –) |
108 mmol / l |
114 – 123 mmol / l |
Glucose |
10.9 mmol / l |
4.4 – 7.7 mmol / l |
Ionised calcium( iCa 2 +) |
1.11 mmol / l |
1.16 – 1.34 mmol / l |
Lactate |
1.3 mmol / l |
0.5 – 2.5 mmol / l |
pH |
7.263 |
7.310 – 7.460 |
Partial pressure of carbon dioxide( PCO 2) |
31.9 mmHg |
40.0 – 46.0 mmHg |
Partial pressure of oxygen( PO 2) |
47.6 mmHg |
50.0 – 60.0 mmHg |
Base excess( BE) |
– 11.5 mmol / l |
– 4.0 to + 4.0 mmol / l |
Anion gap |
32.8 mmol / l |
10 – 27 mmol / l |
|
Bicarbonate( HCO –
3
)
|
14.4 mmol / l |
21.0 – 24.0 mmol / l |
Creatinine |
1586 μmol / l |
71 – 212 μmol / l |
Urea |
63.3 mmol / l |
5.7 – 12.9 mmol / l |
Blood work was repeated at 12-hour intervals to assess hydration and the correction of metabolic abnormalities [ 1 ]. The patient ' s potassium and urea levels returned to normal 24 hours after treatment. The creatinine level did reduce significantly, but it was still elevated( 407 μmol / l) at the time of discharge, 36 hours after admission. Cooper et al. [ 15 ] also found that creatinine levels in cats improved following unblocking of the urethra with a urinary catheter but did not return to normal by the time of discharge.
The patient was stabilised before radiographs were taken and the procedure to unblock and place a urinary catheter commenced.
Treatment and nursing care
Before the unblocking procedure, the patient was given 0.2 mg / kg methadone( Comfortan, Dechra) and 0.2 mg / kg midazolam( Dormazolam, Dechra), both IV. These drugs were selected due to the patient ' s electrolyte imbalances and cardiovascular compromise [ 16 ]. IV alfaxalone( Alfaxan, Zoetis) was titrated dependent on the patient ' s response, with 4 mg / kg given in total. Flow-by oxygen was administered and a capnograph was used to monitor the patient.
The patient was placed in dorsal recumbency and the area around the prepuce was clipped and cleaned using diluted chlorhexidine. To unblock the urethra, a 22 G IV catheter, without a stylet, was passed through the prepuce while flushing with sterile saline. Although flushing the urethral plug back up into the bladder is not ideal, it is the most effective way of moving the plug before urinary catheter placement [ 14 ], and the plug debris will subsequently pass through the catheter.
A 3.5 Fr, 13 cm indwelling urinary catheter was inserted by the veterinary surgeon( VS) and sutured into place. A closed urinary collection system was used to facilitate accurate fluid monitoring [ 17 ]. An open urinary catheter can lead to urine scalding, and wearing an Elizabethan collar would hinder the patient in cleaning themselves, causing further complications and discomfort [ 18 ]. A closed indwelling urinary catheter is ideal, as it will prevent infection from being introduced [ 4 ]. It is also optimal for accurately measuring urine output [ 18 ]. Following the procedure, radiographs were taken to ensure correct placement of the catheter. It was decided to place an Elizabethan collar to prevent patient interference [ 16 ], but the patient was given time without the collar when supervised by his owner during visits.
Buprenorphine( Bupaq, Rafter) 0.01 mg / kg IV was administered every 8 hours to provide analgesia after the procedure. This provided adequate analgesia, as 4-hourly Colorado State University Feline Acute Pain Scale [ 2 ] scores remained under 2. Gabapentin( Gabavet, Vedmed Agri) 50 mg orally every 8 hours provided additional analgesia and helped to keep the patient calm. Patients can benefit from anti-anxiety medications following urinary tract unblocking and discharge [ 6 ]. Cats can develop re-obstruction if they become stressed after removal of the urinary catheter.
It is the policy of the author ' s practice that all cats be hospitalised in the cat ward, which provides a calm
52 Veterinary Nursing Journal