Train Wreck

There are always those cases that make you crazy...

Yesterday evening, an 11 year old neutered male cat presented to me.  He was covered in fleas, moderately dehydrated, had a huge / painful urinary bladder (blocked), and bilateral hydroneprhosis on physical exam.  His blood work showed the expected hyperkalemia, severe azotemia, and severe leukocytosis (53,000).  So, big question is are the kidney alterations just due to being blocked or did he have chronic kidney changes already??

I had to sedate the cat in order to unblock him.  He was started on IV fluids, given a light sedative and unblocked as quickly as possible.  Then I took a radiograph that shows his bladder is full of tiny little stones.  Next question is not just what type of stone in order to guide therapy but also the fact that they are just that size that miiiiigggghhhhtttt pass uneventfully but will more likely enter the urethra and cause a recurrence of the blockage.

And there is of course the need to balance the potassium which will now plummet with post-obstructive diuresis...

He survived the night which is a good sign.  We'll see where his blood values are tomorrow and decide if surgery is a good, bad, or non-option for the stones.  And, of course, this is a nice cat with nice owners and his "real" owner is a young lady who has Asperger's and this cat is her best friend.  I feel as if I'm trying to maneuver a train wreck through a field of land mines.