Page 298 - Problem-Based Feline Medicine

290 PART 5 CAT WITH ACUTE ILLNESS

LILY POISONING* Diagnosis
The diagnosis of acute poisoning relies on history of
Classical signs ingestion or a high index of suspicion.
● Acute lily poisoning should be considered in any
● Acute depression and anorexia.
cat at risk with acute depression and vomiting.
● Vomiting.
Indoor cats with access to newly introduced plants
are at highest risk.
Pathogenesis ● Vomitus should be examined for plant material.
Plants should be examined for evidence of having
Lily poisoning is caused by ingestion of plants in the
been chewed.
genera Lilium and Hemerocallis, and all plants within
these genera should be considered potentially toxic. A hemogram typically reveals hemoconcentration and
Plants with proven toxicity include the Easter lily a stress leukogram.
(L. longiflorum), tiger lily (L. tigrinum), rubrum lily
Acid-base and osmolality values in the acute phase of
(L. speciosum), Japanese show lily (L. lancifolium),
poisoning have not been well characterized. In the later
Lilium hybrids and daylilies (all Hemerocallis spp.).
phase of poisoning serum chemistry findings are typi-
Calla lilies (Zantedeschia aethiopia) and peace lilies
cal of acute renal failure, but there may be a dispro-
(Spathyphyllum wallis) are not toxic.
portionate elevation in creatinine compared to urea.
Leaves, flowers and stems are toxic; only small quan- Liver enzyme and creatinine kinase values may also
tities have to be ingested to result in intoxication. The increase.
flowers are most toxic.
Urinalysis will reveal isosthenuria to minimally con-
The toxic principles have not been fully characterized centrated urine. Glucosuria and proteinuria may be
and it is not known if Lilium and Hemerocallis toxins present.
are the same.
Ultrasound may reveal hyperechoic renal cortices.
Poisoning results in acute renal failure, which initially The kidney may feel very firm when advancing a per-
is non-oliguric. cutaneous biopsy needle.
Dehydration appears to be a critical factor in the pro- Kidney biopsy will reveal acute tubular necrosis and
gression of non-oliguric to oliguric renal failure. intact basement membranes. Low numbers of birefrin-
gent crystals may be present.
Clinical signs
Differential diagnosis
Signs of acute lily poisoning (< 24 hours) are probably
Other causes of acute renal failure.
due to direct effects of the uncharacterized poison and
include depression, anorexia, polyuria with or with- Other causes of acute vomiting.
out polydipsia, hypersalivation and acute vomiting. ● Both cats with acute pancreatitis and cats with
Hypersalivation and vomiting typically begin within acute lily poisoning may have acute depression and
3 hours of ingestion and lasts for 4–6 hours. Cases vomiting, but cats with lily poisoning will have
have been presented without a history of vomiting. minimally concentrated urine, while cats with
Polyuria typically begins within 12–30 hours and lasts acute pancreatitis should have well-concentrated
for 12–24 hours. Ataxia, tremors and seizures have also urine unless there is a concurrent disorder causing
been reported . dilute urine, such as chronic renal failure.
Later signs (> 24 hours) are due to acute renal failure
Treatment
and include persistent depression and anorexia,
hypothermia, recurrent vomiting, painful and swollen Induction of emesis, activated charcoal and cathar-
kidneys, and polyuria, oliguria or anuria. sis if recent ingestion.