Today we feature a really interesting nursing case study from our ECC nurse Leonie McColl. Here, Leonie tells us about the care provided for a lovely cat called Teddy…
Teddy presented to Cave for ongoing investigations and management of his suspected acute kidney injury of unknown aetiology, following a period of inappetance and severe lethargy at home. Initial blood work showed extreme elevation in his kidney parameters, phosphate and potassium levels.
Upon admission he was bright and alert but his pupils were miotic (constricted). His mucous membranes were tacky (dry) with a prolonged capillary refill time of two seconds but otherwise his vital parameters were within normal limits. Blood work carried out here showed a metabolic acidosis with mild respiratory compensation and physical examination identified mild discomfort on renal palpation. He underwent an abdominal ultrasound and urinary catheter placement. His sedation was not very stable and required specialist intervention to bring him round. After being hospitalised at Cave it was confirmed he was anuric, meaning his kidneys were not producing urine. This is likely to have contributed to his abnormal blood work and was one of the main factors in us being able to get his potassium levels under control.
Acute kidney injury (AKI) refers to the sudden onset of kidney damage, with or without loss of function. Severity can range from mild to severely life-threatening, depending on cause and clinical manifestations. Causes range from dehydration, toxin ingestion and obstruction and are categorised according to cause and severity. AKI can cause a wide range of body disruptions and requires prompt aggressive treatment. While prognosis for some patients is poor, many animals do recover.
While hospitalised, Teddy deteriorated and required one-on-one nursing care and constant monitoring. He was initially responsive but took a turn for the worse, likely due to renal encephalopathy, becoming comatose and unresponsive to all stimuli.
His pupils were miotic and unresponsive and it appeared he was brain dead,however on EMG brain activity was observed. All hands were on deck to try to save his life. During this time, he received lots of medical intervention to include central venous catheter placement, additional intravenous catheter placement, close monitoring of vital signs, various drug therapies and peritoneal dialysis. At this point his prognosis looked poor, however his response to peritoneal dialysis was remarkable and within an hour of receiving his first lot of dialysis there was evidence of kidney function due to urine production.
He was still in a serious critical condition and required ongoing supportive treatment and two successive rounds of dialysis. However, over this period, his mentation improved and he continued to surprise us all with his miraculous recovery. By the next day, he was back to acting and looking like a normal cat and all involved with his care were relieved, surprised and very happy.
Peritoneal dialysis is the process of instilling sterile saline into the abdomen and then, after a time, removing the instilled fluid from the abdomen. While the fluid is in the abdomen it causes fluid to move and enables harmful substances, which have built up from lack of kidney function, to be removed from the body. This prevents further reabsorption into the body. It is indicated in acute kidney injury that is refractory/unresponsive to fluid therapy.
After a few more days of monitoring of his vital signs, urine production and blood parameters, Teddy was sent home to continue his recovery, where he has continued to improve at home. He still needs regular blood tests to keep an eye on his kidney values but we are all happy he is doing well. He showed incredible resilience and will to live and is one of our best success stories.