Background

Ethylene glycol intoxication is associated with a grave prognosis, once azotemia is present. Cats are at increased risk of dialysis dysequilibrium syndrome and hypovolemia during hemodialysis. This report describes the successful management with hemodialysis of acute kidney injury in a cat after suspected ethylene glycol intoxication.

Case Description

A 6-year-old, 5.6 kg, male neutered domestic shorthair cat was presented 6 days after exposure to antifreeze. Initial examination revealed polypnea (56/min), hypothermia (37.8°C) moderate overhydration, painful kidneys, urine production of 1 mL/kg/h, and severe azotemia (creatinine 2,034 µmol/L [0–169 µmol/L]; urea 98 mmol/l [5–11 mmol/L]). Diagnosis of ethylene glycol-induced acute kidney injury was based on history, calcium oxalate monohydrate crystals in the urine and hyperechoic inner renal medulla. Supportive treatment consisted of tube feeding, antiemetics, gastric protectants and buprenorphine. Intermittent hemodialysis was initiated and continued for 10 sessions over a 16-day period with a Fresenius 4008 platform equipped with pediatric tubing, FXPaed dialyzer and heparin anticoagulation. Hemodialysis sessions lasted 4–5 hours and resulted in a processed blood volume of 2.7–6.2 L. Monitoring consisted of non-invasive blood pressure, ECG and pulse oximetry. Due to restless and aggressive behavior, sedation with gabapentin, butorphanol and alfaxalone was required for 7 hemodialysis sessions. During 7 hemodialysis sessions, bradycardia and mydriasis as signs of dialysis dysequilibrium were observed and controlled with mannitol, hypertonic saline and reduction of blood flow. Thus, hypertonic saline was subsequently administered every 30 minutes to reduce the risk of dialysis dysequilibrium. The initial hematocrit of 0.28 L/L decreased to 0.20 L/L despite darbepoetin therapy, resulting in the need for 4 blood transfusions in total. When urine production started to increase on day 18, fluid therapy was initiated. The cat was discharged after 41 days with a creatinine of 340 µmol/L. Four weeks after discharge serum creatinine decreased to 262 µmol/L.

New/Unique Information

Despite a generally grave prognosis, cats can survive ethylene glycol intoxication even with severe azotemia, if urine production is still present. This requires highly motivated owners and intensive treatment including hemodialysis and blood transfusion over a period of several weeks.

Disclosures

No disclosures to report.