Cat with Urethral Obstruction
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Cat with Urethral Obstruction
Cat with Urethral Obstruction
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Sugie is a 4 year old, male neutered feline. He has been brought to the clinic because he
has been going back and forth to the litter box since last night and has had one bowel movement.
He is depressed, lethargic, and will not eat.
Physical Exam Findings:
Weight: 4.5
Temperature: 98.0
Heart Rate: 84 bpm
Respiration: 48 bpm
MM/CRT: dark/2sec
General appearance: Skin is tented
Ears: Normal
Gastrointestinal: Normal
Cardiovascular: Rate is decreased
Respiratory: Rate is increased
Lymph nodes: Normal
Oral Cavity: Normal
Musculoskeletal: Normal
Nervous System: Normal
Urinary/Reproductive: painful upon palpation, bladder is full and distended
Upon clinical exam skin tenting is noted, animals are 5% dehydrated when the skin
returns to its resting position just barely detectably slow (Macintyre, Drobatz, Haskins, & Saxon,
2005). Prior to exam Sugie’s respiratory rate was 48 bpm, once the veterinarian begins to palpate
his abdomen it elicits a pain response and the respiratory rate increases. A cat’s normal resting
heart rate is between 150 and 210 bpm. In a cat with urethral obstruction it is not uncommon for
the heart rate to be Bradycardic due to hyperkalemia. A hyperkalemic cat will have ECG
changes, such as tented T waves, widened QRS complexes, atrioventricular conduction blocks,
accelerated idioventricular rhythm, sinoatrial block, ventricular fibrillation, and asystole
Cat with Urethral Obstruction
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(Odunayo, 2014). The veterinarian may also order an i-STAT electrolyte panel to evaluate renal
function and confirm the hyperkalemia. The results show an elevated potassium level of 8.7
mEq/L and Sodium Bicarbonate is ordered at dose of 0.5 to 1mEq/kg given IV over 5 to 15
minutes to lower plasma potassium concentration by raising pH and driving potassium into the
cells (Norkus).
Urethral obstruction is an emergency condition that can result in death and treatment
should begin immediately (Kahn, 2005). Urethral obstructions usually occur in male cats
between 2 and 10 years of age. It is far less common in female cats because of the wider, shorter
formation of the urethra (Sabino, Boudreau, Mathews, 2010). The first step is to establish
patency of the lower urinary tract by placing a urinary catheter (Tracy, 2000). The veterinary
technician will need to gather the necessary supplies to allow the veterinarian to place the urinary
catheter. You will need clippers, Chlorhex solution soaked gauze, alcohol soaked gauze, sterile
gloves, sterile lubricant, open end tomcat catheter, sterile saline and syringes (for flushing
catheter), a 3.5 or 5 French red rubber urinary catheter, t-port, closed collection system, nylon
suture, needle drivers, and scissors (Herold, 2011). Once the urinary catheter is in place it is
important to obtain a urine sample for urinalysis. The urinalysis indicates a urine pH of 7.5 and
the urine sediment reveals struvite crystals. Due to the high pH and struvite crystals it is
recommended to reduce the urine pH to <6.0 and the urine magnesium by feeding magnesium
restricted diets (Kahn, 2005) such as Hill’s Prescription Diet s/d. Dissolution may take 4 to 8
weeks. Follow progress with radiographs taken every 2 to 4 weeks and continue the diet 1 month
Cat with Urethral Obstruction
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after uroliths disappear from radiographs (Summers, 2002). Long term management can include
a Hill’s diet of c/d or w/d.
It is the technician’s job to place an intravenous catheter to have vein access for sedation
as well as IV fluids while the patient is hospitalized. When placing the IV catheter it is important
to use aseptic technique by clipping the area of placement and use a disinfectant to wipe the area
before placing the IV catheter and securing it to the leg using tape to reduce movement of the
catheter. It will need to be monitored for any signs of phlebitis, or local venous inflammation,
swelling at catheter site, redness, pain, pitting edema, and general irritation of the vessel (Sirois,
2013). The catheter will need to be kept clean and dry and prevent the patient from chewing or
licking at it by placing an e-collar.
The veterinary technicians job after the urinary catheter has been placed is to monitor the
collection system for any kinks, blood clots, keeping the prepuce and vulva clean with an
antiseptic (Sirois, 2013) and most importantly monitoring urine output. You will be monitoring
the color and the amount of urine that is collecting in the urine bag every four hours. Normal
urine output is 1-2 ml/kg/hr. To determine the urine output you need to know their weight, the
amount of urine produced, and the amount of time it took to produce it. The formula for getting
urine output is as follows: Urine output= (amount of urine/number of hours)/ weight of patient in
kg (Brashear, 2014). Next you will compare the urine output with the total volume infused, the
goal is to have the two numbers relatively close to each other (Brashear, 2014). Fluid therapy
Cat with Urethral Obstruction
will increase renal perfusion resulting in polyuria. Sugie’s IV fluid therapy will need an
additional 180-270 mL of fluid a day to maintain his hydration status. The technician will also
need to periodically flush the urinary catheter and collection system with saline to ensure it is
flowing and there are no kinks or blood clots.
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Cat with Urethral Obstruction
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REFERENCES
Brashear, Megan. (2014) Urine Output. https://www.atdove.org/articles/Urine-Output.
Herold, Lee. (2011). Unblocking a Cat. https://www.atdove.org/videos/Procedure/Unblocking-aCat
Kahn, C. M. (Ed.). (2005). The Merck Veterinary Manual (9th ed.). (pg 1286). Whitehouse
Station: Merck & CO., INC.
Macintyre, D. K., Drobatz, K. J., Haskins, S. C., & Saxon, W. D., (2005). Fluid Therapy. Manual
of Small Animal Emergency and Critical Care Medicine. (pg 64). Philadelphia:
Lippincott Williams & Wilkins.
Norkus, C. Feline Urethral Obstructions. Retrieved October 22, 2015, from
https://www.vetlearn.com/veterinary-technician/feline-urethral-obstructions.
Odunayo, A. (2014, March) Management of Potassium Disorders. Retrieved October 22, 2015,
from http://www.cliniciansbrief.com/article/management-potassium-disorders.
Sabino, C., Boudreau, A., Mathews, K. A., (2010, September). Emergency Management of
Urethral Obstruction in Male Cats. Retrieved October 22, 2015, from
http://www.cliniciansbrief.com/article/emergency-management-urethralobstruction-male-cats.
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Sirois, M. (2013). Animal Care and Nursing. Veterinary Assisting Textbook. (pg 241,242). St.
Louis: Mosby.
Summers, A. (2002). Diseases of the Urinary System. Common Diseases of Companion Animals.
(pg 333). St. Louis: Mosby
Tracy, D. L., (2000). Surgical Emergencies. Small Animal Surgical Nursing. (3rd ed.). (pg366).
St. Louis: Mosby.