Fluid Therapy Flashcards
What are the most common presentations of FLUTD and hat are the most common aetiologies
-Common presentation: young to middle age cats (2-6 years), more commonly males (obese, ginger cats predisposed), intact or neutered, obstructive or non-obstructive
-Aetiologies: 55% idiopathic obstructions, 20% urethral plugs, 20% urolithiasis, 5% mechanical obstructions (strictures, neoplasia)
What are some predisposing factors for FLUTD
-Longhaired
-Moving (stress)
-Decreased drinking
-Low level of activity
-Little outdoor access
-Litter box situation
-Multicat household
-Obesity
-Stressed owners
-Changes in lifestyle
What are clinical signs of FLUTD
-Overgrooming
-Stanguria (straining and vocalizing due to pain)
-Dysuria (pollakiuria, hematuria, periuria)
-Mucus plugs (males)
-Anuria (distended bladder) blocked cat EMERGENCY
How do non-obstructive FLUTD patients present
-Normal physical exam/doing well
-Hematuria
-Dysuria: pollakiuria, periuria
-Presentation: males more common than females, acute onset, often self-limiting after 5-7 days, frequent relapse >50%, recurrence intervals
What are differential diagnoses of non-obstructive FLUTD
-Idiopathic cystitis(FIC)
-Urolithiasis
-Infectious cystitis (bacterial, fungal)
-Urethral stenosis (congenital, iatrogenic from catheterization, PU)
-Anatomical anomaly
-Neoplasia
-Prostatic diseases
How do patients with obstructive FLUTD present
-Almost always male
-Dysuria progressing to anuria
-Pain
-Post-renal acute kidney injury (life threatening condition, emergency)
-Recurrence >50%, once obstructed much more likely to occur again
What are differential diagnoses for obstructive FLUTD
-Urethral plug, mucus plug
-Urethral lithiasis
-Urethral spasm (FIC)
-Urethral stenosis
-Urethral neoplasia
What diagnostic investigations should be done for FLUTD
-Urinalysis and urine C+S, ideally with hematology and biochem with electrolytes
-Abdominal rads and abdominal ultrasound
-Avoid repeating blind treatments (ABs, can make it worse with resistance)
How do you diagnose feline interstitial cystitis as the cause of FLUTD and what are the suspected causes
-Diagnosis of exclusion, must rule everything else out, do urinalysis and C+S and have a negative culture
-Suspected causes: defective bladder lining with an area of necrosis/inflammation and ulceration, neurogenic inflammation caused by abnormal neuronal stimulation leading to chemokine release, abnormal response to stress leading to only catecholamine released from adrenal and no cortisol in cats with FIC
What treatments can you use for non-obstructive FLUTD caused by FIC
-Treat outpatient to limit stress
-Analgesia + anxiolytic: gabapentin for analgesia and mild sedation
-Urethral relaxant: alpha antagonist (Prazosin) and striated muscle relaxant (Dantrolene)
-Careful use of NSAIDs: well hydrated patient on fluids and renal monitoring, 3-5 days max and implement not on day 1 to ensure stable
-NO ANTIBIOTICS IF NEGATIVE URINE CULTURE
How soon after obstruction does phase 1 of obstructive nephropathy begin and what happens in this phase
-Begins 1-2 hours after obstruction
-Increased pressure in tubules and decreased GFR
-Vasodilation via PGE and NO to maintain blood flow
-Inflammatory cells infiltration (4h), tubular damages/necrosis
When does phase 2 of obstructive nephropathy begin and what happens during it
-Phase 2 begins at 3-4 hours
-Decreased renal blood flow
-Continued increase pressure in ureters and tubules
What happens in phase 3 of obstructive nephropathy
-Loss of renal function (40% 24 hours after initial insult)
-Continued decrease in renal blood flow and increase in ureteral pressure
What should the shock bolus be for treating FLUTD with fluids
-5ml/kg because you dont want to risk overload risk if not urinating and if GFR decreased
-If mild dehydration, calculate volume and replace over 24 hours
How should you treat hyperkalemia caused by FLUTD
-10% calcium gluconate under ECG monitoring as a cardio protective
-Insulin (regular) and 50% dextrose to drive K+ Intracellularly
-Dextrose CRI afterwards if needed
