Severe Hyperkalemia Secondary to Urethral Obstruction by a Plug in a Female Cat – Case Report

Severe Hyperkalemia Secondary to Urethral Obstruction by a Plug in a Female Cat – Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Severe Hyperkalemia Secondary to Urethral Obstruction by a Plug in a Female Cat – Case Report Beatriz Aline Migotto, Brisa Miranda Santos, Ana Flávia Silva Pereira, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7661275/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The urethral obstruction is a common urological emergency in feline medicine, typically associated with male cats due to their narrower urethral anatomy. In females, this condition is rare and usually linked to uroliths, with urethral plugs being uncommon. This report discusses a case of urethral obstruction in a 2-year-old female Brazilian Shorthair cat caused by a urethral plug associated with Feline Idiopathic Cystitis (FIC). The cat had a history of chronic stress related to environmental management issues, presenting clinical signs of periuria, pollakiuria, and hematuria for 15 days, which worsened over 24 hours. This progression led to lethargy, intense vocalization, urinary tenesmus followed by anuria, as observed by the owner. Consequently, the patient was referred to the intensive care unit (ICU), where alterations in vital parameters were noted, including 10% dehydration, hypothermia, mild hypotension, severe hyperkalemia, severe azotemia, hyperlactatemia, a feline grimace scale score of 5/10, and intense abdominal pain localized in the hypogastric region. The diagnosis of urethral obstruction was confirmed using abdominal ultrasonography, which revealed proximal urethral dilation and a material resembling dense organized sediment or a forming urolith, measuring approximately 4 mm x 2.1 mm. Following stabilization of the emergency condition, the patient underwent general anesthesia and epidural block, allowing immediate relief of the obstruction and placement of an indwelling urinary catheter. Post-procedure, the cat was maintained in intensive care, with significant improvement in renal biochemical and electrolyte abnormalities. Urethral obstruction in female cats is considered rare due to the distensible and wider nature of the urethra in this gender. When present, it is usually caused by uroliths and only rarely by urethral plugs. Therefore, this case highlights the importance of ultrasonographic diagnosis in female cats presenting with lower urinary tract signs and urinary tenesmus. ischuria pollakiuria creatinine potassium feline idiopathic cystitis Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Urethral obstruction in felines is a severe urological emergency characterized by the interruption of urinary flow and renal filtration, leading to systemic alterations that can be fatal if not promptly corrected 1 – 2 – 3 . Mortality can reach 26%, especially in recurrent cases 2 – 3 . The main causes include urolithiasis, infectious or inflammatory cystitis, urethral plugs, anatomical abnormalities, and, less frequently, neoplasms 4 . The most common underlying cause is Feline Idiopathic Cystitis (FIC), responsible for approximately 54% of cases in male cats due to their narrower urethral anatomy 5 . FIC is a chronic inflammatory disorder with a multifactorial etiology, associated with environmental stressors that activate autonomic, endocrine, and immune responses, resulting in bladder inflammation and pain 5 , 6 . Although urethral obstruction is predominantly observed in males, it can also occur in females, albeit rarely 7 . In these cases, obstruction is generally caused by uroliths or bacterial cystitis and only occasionally by urethral plugs, which are typically dense and mineralized. In females, obstruction is most often associated with urolithiasis and infectious cystitis, while plugs, when present, tend to be characterized by dense mineralized material and are typically linked to chronic, severe forms of FIC 8 . Due to the shorter and wider urethra in females, initial catheterization can be challenging but may, in some cases, facilitate management compared to males. FIC can predispose to plug formation, particularly in chronic or severe inflammatory episodes 9 – 10 . Risk factors include stress, multi-cat households, indoor confinement, obesity, and dry-food diets 11 – 12 . The condition is self-limiting in most cases, but recurrence occurs in 40–60% of cats, highlighting its chronic nature 13 . The pathophysiology of FIC involves stress-induced activation of the hypothalamic–pituitary–adrenal axis and sympathetic nervous system, resulting in increased bladder permeability and local inflammation 14 – 15 . The compromised urothelial barrier allows ion influx and nociceptor activation, perpetuating inflammation and pain 16 . Chronic stressors such as inter-cat conflict, environmental restriction, and abrupt changes in routine can trigger clinical signs like dysuria, periuria, pollakiuria, and hematuria 11 , 17 . Emergency management follows the same general principles applied to male cats, prioritizing stabilization of hemodynamically unstable patients, which often present with circulatory shock, hypothermia, hypotension, bradycardia, and hypoperfusion. Intravenous fluid therapy is essential to restore perfusion compromised by decreased renal blood flow 18 . Additionally, correcting electrolyte imbalances, especially hyperkalemia, is crucial, as it affects myocardial stability and can trigger fatal arrhythmias 1 . Urethral catheterization in female cats may be technically challenging due to the small urethral diameter and associated inflammation, requiring delicate catheters and precise technique 19 . This report describes a rare case of urethral obstruction by a plug in a female cat associated with FIC. The case highlights the clinical, biochemical, and ultrasonographic findings, the emergency management applied, and the importance of recognizing stress as a predisposing factor for severe obstructive episodes in female cats. CASE REPORT A female, intact, two-year-old Brazilian Shorthair cat (PCB) was admitted to the UFLA Veterinary Hospital with a history of pollakiuria, ischuria, followed by vocalization while maintaining in urinary tennesm, as well as an absence of urination for 24 hours. It was reported that the condition had begun approximately 15 days prior, with the animal manifesting hematuria, pollakiuria, periuria, and polydipsia. Despite these alterations, the cat remained normorexic and normoqueic. The owner also reported that the patient had exhibited a similar condition about 3 months earlier, and the clinical signs had resolved spontaneously. The owner was questioned about changes in routine and environmental management and reported a multi-cat household where the patient lived with three other feline contactants, which exhibited agonistic behaviors amongst themselves. She added that there were four more intact male cats in another room of the house, which had no direct contact with the patient. She also reported that these contactants exhibited territorial marking by urination in the environment. During triage, the patient was observed to have intense prostration, severe dehydration (7%), prolonged capillary refill time (CRT) > 2 seconds, hypothermia (36.4°C), and severe abdominal pain in the hypogastric region. Consequently, the patient was referred to the intensive care unit (ICU) for emergency care and stabilization. The observed parameters were: HR: 188 bpm, RR: 36 bpm, blood glucose: 152 mg/dL, lactate: 4.8 mmol/L (0.39–2.87 mmol/L) (REDAVID et al., 2016), systolic blood pressure (SAP): 80 mmHg, and a Feline Grimace Scale (FGS) score of 5/10. Due to hyperlactatemia, dehydration was estimated at 10%. A-FAST (Abdominal Focused Assessment with Sonography for Trauma) revealed a distended bladder and a moderate amount of free fluid in the cysto-colic region. A relief cystocentesis was performed using a needle and a three-way tap in a closed system, draining intensely hemorrhagic urine. Analgesia was then administered with 0.2 mg/kg methadone, and laboratory tests, abdominal ultrasonography, and radiography were requested. The complete blood count showed erythrocytosis (HCT 50%), leukocytosis of 30,450/mm³ due to absolute and relative neutrophilia, relative eosinopenia, and relative lymphopenia. Biochemistry revealed severe azotemia with creatinine 10.1 mg/dL, urea > 130 mg/dL, and severe hyperkalemia (8.0 mmol/L). A urine sample was collected by cystocentesis, showing low USG 1.030 (> 1.035) and uncountable red blood cells on sedimentoscopy; sediment evaluation was not possible due to the intense hematuria (Fig. 1 ). Based on the history, clinical examination, and laboratory findings, the differential diagnoses associated with the suspicion were: ureteral obstruction, acute renal failure, pyelonephritis, chronic kidney disease, bacterial cystitis, urolithiasis, feline idiopathic cystitis, and urethral obstruction. The diagnosis of urethral obstruction was made with the aid of abdominal ultrasonography, which revealed dilation of the proximal urethra containing dense, hyperechoic material forming mild posterior acoustic shadowing, suggestive of dense sediment occupying the entire lumen. A focal, organized area of hyperechoic material was identified, possibly indicating a forming calculus (0.40 cm x 0.21 cm), associated with twinkling artifacts on color Doppler (Figs. 2 and 3 ). The kidneys showed rare bilateral hyperechoic cortical foci, compatible with dystrophic mineralization or fibrosis. Mild bilateral renal pelvic dilation was observed (left: 0.28 cm; right: 0.21 cm), with no signs of ureteral dilation. Additionally, a moderate to marked amount of free abdominal fluid (FF) was identified, likely of inflammatory origin, raising suspicion of possible uroperitoneum. Associated with the described findings were hepatic hypoechogenicity and diffuse peritonitis. Due to suspicion of uroperitoneum and bladder rupture, peritoneal fluid analysis was performed. The fluid was classified as a hemorrhagic effusion, with cellularity predominantly consisting of red blood cells and neutrophils. The creatinine level of the peritoneal fluid was similar to the serum creatinine (12.1 mg/dL), ruling out bladder rupture. To manage severe hyperkalemia (8.0 mmol/L), four boluses of 50% glucose were administered at 1 ml/kg every 2 hours, reducing potassium to 6.3 mmol/L. Calcium gluconate was administered via continuous infusion over 30 minutes due to the risk of sudden death from hyperkalemia. This infusion was initiated in the ICU and completed during anesthesia due to the urgency of relieving the urinary obstruction. Regular insulin was not added to the therapy as the patient was normoglycemic. Given the post-renal azotemia, the patient was transferred to the surgical department for urethral deobstruction under general anesthesia. The surgical plan included general anesthesia combined with an epidural block, followed by an attempt at urethral catheterization. Due to the high degree of difficulty associated with this procedure in female cats, attributed to the extremely narrow urethral canal, a cystotomy with retrograde catheterization was planned if initial attempts failed. The anesthetic protocol included premedication with methadone (0.3 mg/kg IM) due to the patient's critical condition. Induction was achieved with propofol (4 mg/kg IV, titrated to loss of reflexes), and a sacrococcygeal epidural block was administered using bupivacaine (1 mg/kg) combined with morphine (0.2 mg/kg). General anesthesia was maintained with isoflurane. Minutes after anesthesia induction, the patient spontaneously urinated, eliminating a white, mucoid urethral plug with a firm core, thus avoiding the need for cystotomy (Figurre 4). Prior to deobstruction, an increase in T-wave amplitude (similar to R-wave amplitude) was observed on electrocardiography, indicative of persistent hyperkalemia. Following urination, T-wave amplitude progressively decreased. A urethral catheter was successfully placed and secured to the vulva with 3 − 0 nylon suture to prevent dislodgement. Postoperatively, the patient required continuous norepinephrine infusion for 12 hours to maintain systolic arterial pressure at 110 mmHg. Fluid therapy with Lactated Ringer's solution was administered over 12 hours to address dehydration (10%). Analgesia was maintained with methadone (0.2 mg/kg SC) and warm saline bladder lavage. Biochemical reevaluation 24 hours post-deobstruction revealed normalized creatinine and urea levels. Potassium was mildly low (3.1 mEq/L; reference: 3.5–5.8 mEq/L) but not supplemented immediately due to clinical improvement and spontaneous intake of food and water. The urethral catheter was expelled the following day due to urethral spasms. Meloxicam (0.03 mg/kg IV for 3 days) was initiated to manage associated urethritis. Clinical progression was satisfactory, with normalized urination and resolution of dysuria and pollakiuria. Final laboratory results at discharge were within normal limits: creatinine 1.4 mg/dL, potassium 3.6 mEq/L. Urinalysis showed USG 1.029, full-field hematuria, and bilirubinuria (+). Analgesia during hospitalization included methadone (0.2 mg/kg SC TID), gabapentin (6 mg/kg PO BID), and meloxicam (0.05 mg/kg IV SID) for 5 days. Hematuria and pollakiuria resolved gradually over 3 days, and urinary flow was fully reestablished without signs of obstruction by the end of hospitalization. Ultrasonographic reevaluation confirmed resolution of abdominal free fluid. The patient was discharged with significant clinical improvement and prescribed home-based care. The treatment plan emphasized multimodal environmental modification (MEMO) to reduce agonistic behaviors, including environmental enrichment such as increased provision of litter boxes, resting areas, scratching posts, and interactive play. Hydration was encouraged through the introduction of wet food. Ovariohysterectomy was recommended to mitigate chronic stress, a known trigger for feline idiopathic cystitis (FIC). Analgesia included tramadol (2 mg/kg PO BID) for 7 days and gabapentin (6 mg/kg PO BID) for 30 days, followed by a gradual 3-week tapering protocol. Based on the history of chronic stress, clinical manifestations, pre- and post-obstruction laboratory findings, and therapeutic response, the presumptive diagnosis was urethral obstruction due to a plug associated with Feline Idiopathic Cystitis (FIC). DISCUSSION This report describes an unusual case of urethral obstruction in a young, unspayed, non-obese female cat, which deviates from the epidemiological profile most frequently described for feline lower urinary tract disease (FLUTD). Most studies point to a greater predisposition in adult, neutered, overweight, sedentary males fed exclusively dry food 11 . There are no national epidemiological studies on Feline Idiopathic Cystitis (FIC), and the available data are predominantly North American, indicating an average prevalence of 8% and an incidence between 0.34 and 0.64% 20,21 . Thus, this case contributes to expanding knowledge about atypical presentations of the disease in young females, emphasizing that the pathophysiology of FIC depends not only on anatomical factors, but also on environmental and emotional factors. The patient presented with urethral obstruction caused by a dense, mineralized plug, a rare finding in females, in whom obstruction is usually associated with the presence of urethral stones 8 . The obstruction was triggered by chronic stress in an inappropriate environment, a condition associated with FIC, which can predispose both to the formation of plugs and uroliths. Factors such as water restriction, low water intake, and lack of wet food in the diet can promote crystal precipitation and the development of these structures 22 . Urethral plugs, composed of mucoproteins, cellular debris, and crystals, agglutinate to form obstructive masses within the urethral lumen 9 , 10 , which was observed in this case. The diagnosis was linked to FIC due to the patient's history of prolonged environmental stress, which significantly contributed to the development and severity of the disease 6 – 16 . Additionally, the initial clinical manifestations (hematuria, pollakiuria, and periuria) are typical of FIC but not exclusive to it, as they may also occur in other feline lower urinary tract diseases, such as bacterial cystitis and other forms of urolithiasis. The patient exhibited clinical and laboratory findings consistent with urethral obstruction, including severe dehydration, azotemia, hypothermia, hyperlactatemia, and hyperkalemia, indicating impaired urinary flow. Given the rarity of urethral obstructions in female cats due to their anatomical particularities, differential diagnoses such as acute renal failure, ureterolithiasis, and pyelonephritis were considered. Imaging findings allowed these to be ruled out, particularly given the immediate recovery post-deobstruction. Ultrasonography identified dense sediment and hyperechoic material in the proximal urethra compatible with a urethral plug, along with urethral dilation, indicating proximal obstruction. These findings underscore the importance of rapid diagnosis, as this constitutes a clinical emergency requiring intensive hemodynamic stabilization and immediate desobstruction, directly impacting patient prognosis 1 , 2 , 3 . Although free fluid (FF) was observed in the cysto-colic region, bladder rupture was ruled out via ultrasonography due to the integrity of the bladder wall, supported by fluid analysis confirming hemorrhagic and inflammatory effusion. Paired analysis of FF creatinine (12 mg/dL) and serum creatinine (10 mg/dL) revealed similar values, i.e., FF creatinine did not exceed twice the serum value, eliminating the possibility of bladder rupture 23 . It is worth noting that some cats may develop uroperitoneum without wall rupture, negating the need for abdominocentesis or surgical correction 24 – 25 . This finding is attributed to microlesions from wall fragility and severe tissue inflammation caused by FIC. The observed azotemia was associated with severe dehydration and urinary flow obstruction, reflecting significant hemodynamic and metabolic imbalance. Bladder distension increases intravesical pressure, leading to urine reflux into the ureters and kidneys 25 . This distension releases inflammatory prostaglandins, causing afferent arterial dilation in an attempt to maintain renal filtration and flow. These changes recruit leukocytes to the renal tubules and activate the renin-angiotensin-aldosterone system, resulting in arteriolar vasoconstriction 26 . The pressure differential compromises renal filtration, leading to the reabsorption of filtrate into the bloodstream and increasing nitrogenous compounds, electrolytes, ions, and toxins in circulation. Prolonged obstruction may result in bilateral hydronephrosis 27 . The patient exhibited hemodynamic alterations, with dehydration estimated at 10% due to signs of vasoconstriction (dry mucous membranes, prolonged capillary refill time > 3 seconds, decreased skin turgor, enophthalmos) associated with hyperlactatemia and hypotension 18 . Hypovolemia from dehydration can reduce cardiac output, causing tissue hypoperfusion (28). Post-renal azotemia leads to acid-base imbalance, resulting in metabolic acidosis 26 . Acidosis impairs oxygen delivery by erythrocytes to tissues, leading to tissue hypoxia. This hypoxia triggers an energy deficit, culminating in anaerobic metabolism and hyperlactatemia. Serum lactate is a marker of tissue perfusion used to assess disease severity; elevated levels indicate hypoperfusion and may infer prognosis 28 . Hypovolemia and hyperlactatemia can lead to hypotension, a compensatory response to circulating volume loss. Volume correction should be achieved with crystalloid fluid therapy 29 , as performed in this case. Due to the combination of hypovolemia and hypotension, a vasoactive agent was necessary. Norepinephrine was administered at a low dose to shift blood flow from the splanchnic region to vital organs, attempting to maintain perfusion. The patient responded satisfactorily, maintaining borderline normotension until full hydration was restored. Hyperkalemia caused clinical and electrocardiographic changes, including increased T-wave amplitude, hypothermia, and hypotension 1 . Excess extracellular potassium reduces the resting membrane potential of myocardial cells, promoting depolarization and resulting in arrhythmias 25 . Atrial myocardium is more sensitive to hyperkalemia than ventricular myocardium and the sinoatrial node. Thus, as potassium levels rise, electrocardiographic changes occur sequentially: increased T-wave amplitude, reduced P-wave amplitude, prolonged QRS interval, and eventually atrial standstill 30 . Hyperkalemia correction is only indicated when myocardial alterations, such as bradycardia and electrocardiographic changes, are present 30 . Calcium gluconate infusion, as performed in intensive care, aims to reduce the deleterious effects of extracellular potassium. With elevated potassium, the Na/K pump is disrupted, activating the Na/Ca²⁺ antiporter, which maintains cardiomyocyte contraction without altering the resting membrane potential, thus preserving cardiac function 25 . Additionally, intravenous 50% glucose boluses help translocate extracellular potassium into cells until urinary flow is reestablished 24 . Insulin therapy may be added to this protocol, particularly in hyperglycemic animals, though hypoglycemia must be monitored 1 . Current guidelines do not recommend regular insulin in normoglycemic patients; in such cases, glucose boluses alone are advised. Post-deobstruction, the patient experienced rebound hypokalemia due to post-obstructive diuresis and osmotic diuresis from glucose administration. Urethral catheterization in females is generally challenging due to the small caliber and associated inflammation 19 . However, in this case, catheterization was possible without the need for cystotomy, which was decisive for initial therapeutic success and avoided a more invasive surgical procedure. The use of general anesthesia and a delicate technique allowed for effective unblocking, reducing the risk of urethral trauma and ensuring the restoration of urinary flow. Methadone caused no adverse effects and provided satisfactory analgesia throughout treatment, as assessed by the Feline Grimace Scale (FGS). Sacrococcygeal epidural blockade and general anesthesia were essential for pain control and relaxation of the urethral musculature, facilitating spontaneous deobstruction and urethral catheterization 31 . The excreted organic material was consistent with a urethral plug, and catheterization enabled bladder lavage to remove dense sediments. Clinical studies have shown that bladder lavage may improve hematuria and reduce hospitalization time in cats with urethral catheters 32 – 33 . Spontaneous resolution of the obstruction during anesthesia indicated that bladder distension and urethral spasms contributed to the obstructive crisis, as the plug was dense rather than a calculus. Successful urethral catheterization and subsequent clinical stabilization demonstrate the efficacy of the adopted protocol and the operator's technical expertise. The use of meloxicam for post-obstructive urethritis management is supported by studies, though its administration must be cautious, and patients should be adequately hydrated 34 . Maintenance treatment, including opioid analgesia with tramadol and gabapentin, was implemented to control pain and prevent recurrence, while multimodal environmental modification was recommended to minimize chronic stress, the primary trigger for FIC 15 – 17 , 35 , 36 , 37 . Ovariohysterectomy was also appropriately recommended, considering its potential to reduce reproductive stress. CONCLUSION This case illustrates the complexity of managing urethral obstructions associated with Feline Idiopathic Cystitis (FIC), emphasizing the critical importance of identifying and mitigating environmental stressors. The rarity of urethral obstruction in a female cat necessitated a multidisciplinary approach to deobstruction. Rapid clinical stabilization and effective relief of the obstruction were pivotal to the successful outcome, highlighting the value of structured protocols and precise technical execution. The combination of intensive clinical management including correction of dehydration and hyperkalemia, multimodal analgesia with opioids, anti-inflammatories, and analgesic adjuvants along with well-planned anesthetic interventions, ensured the patient’s recovery. The association between obstructive signs and FIC underscores the necessity of addressing not only the immediate obstruction but also underlying factors such as environmental mismanagement. The therapeutic plan was reinforced by multimodal environmental modifications (MEMO) and a recommendation for ovariohysterectomy, both essential for preventing recurrence and improving long-term quality of life. The satisfactory clinical progression and return to normal laboratory parameters demonstrate the efficacy of the implemented protocol and underscore the importance of accurate clinical assessment, timely diagnosis, and continuous monitoring in patients with a history of FIC, who remain at risk of recurrent urinary obstruction. This report contributes to the clinical understanding of severe obstructive manifestations of FIC in female cats and reinforces the need for a holistic approach that integrates emergency intervention, metabolic stabilization, environmental management, and long-term preventive strategies. Abbreviations AINEs : Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) A-FAST: Abdominal Focused Assessment with Sonography for Trauma BID: Twice Daily (every 12 hours) bpm : Beats per minute CIF: Feline Idiopathic Cystitis (FIC) cm: Centimeter CRT: Capillary Refill Time CTI: Intensive Care Unit (ICU) TID: Three Times Daily (every 8 hours) FC : Heart Rate FGS: Feline Grimace Scale FR: Respiratory Rate GAGs: Glycosaminoglycans IM: Intramuscular IV: Intravenous FF: Free Fluid PAS: Systolic Arterial Pressure PO: per oral administration SC: Subcutaneous SID: Once Daily (every 24 hours) UFLA: Federal University of Lavras USG : Urine Specific Gravity Declarations FUNDING The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. COMPETING INTERESTS The authors have no relevant financial or non-financial interests to disclose. AUTHOR CONTRIBUTIONS All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Maira Souza Oliveira Barreto, Rodrigo Bernardes Nogueira, and Ruthnéa Aparecida Lázaro Muzzi. The first draft of the manuscript was written by Beatriz Aline Migotto, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. ETHICS APPROVAL AND CONSENT TO PARTICIPATE Ethical approval was not required for this study, since it describes a single clinical case attended at the Veterinary Hospital of Universidade Federal de Lavras (UFLA). Written informed consent was obtained from the animal’s owner for participation and for publication of the clinical details. CONSENT FOR PUBLICATION Informed consent was obtained from the owner for both printed and electronic publication. DATA AVAILABILITY The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. References Lee JA, Drobatz KJ (2003) Characterization of clinical characteristics, electrolytes, acid–base, and renal parameters in male cats with urethral obstruction. J Vet Emerg Crit Care 13(4):227–233. 10.1111/j.1534-6935.2003.00100.x Bradley AM, Lappin MR (2014) Intravesical glycosaminoglycans for obstructive feline idiopathic cystitis: a pilot study. J Feline Med Surg 16(6):504–506. 10.1177/1098612X13510918 Jones E, Palmieri C, Thompson M, Jackson K, Allavena R (2021) Feline idiopathic cystitis: pathogenesis, histopathology and comparative potential. J Comp Pathol 185:18–29. 10.1016/j.jcpa.2021.03.006 Buffington CAT (2011) Idiopathic cystitis in domestic cats—beyond the lower urinary tract. J Vet Intern Med 25(4):784–796. 10.1111/j.1939-1676.2011.0732.x Westropp JL, Delgado M, Buffington CAT (2019) Chronic lower urinary tract signs in cats: current understanding of pathophysiology and management. Vet Clin North Am Small Anim Pract 49(2):187–209. 10.1016/j.cvsm.2018.11.001 Horwitz DF, Rodan I (2018) Behavioral awareness in the feline consultation: understanding physical and emotional health. J Feline Med Surg 20(5):423–436. 10.1177/1098612X18771204 Osborne CA, John MK, Jody PL (1996) Feline lower urinary tract disorders: definition of terms and concepts. Vet Clin North Am Small Anim Pract 26(2):169–179. 10.1016/S0195-5616(96)50200-7 Houston DM, Moore AE, Favrin MG, Hoff B (2003) Feline urethral plugs and bladder uroliths: a review of 5484 submissions 1998–2003. Can Vet J 44(12):974 Buffington CAT, Blaisdell JL, Binns SP, Woodworth BE (1996) Decreased urine glycosaminoglycan excretion in cats with interstitial cystitis. J Urol 155(5):1801–1804 Pereira DA, Aguiar JA, Hagiwara MK, Michelacci YM (2004) Changes in cat urinary glycosaminoglycans with age and in feline urologic syndrome. Biochim Biophys Acta 1672(1):1–11. 10.1016/j.bbagen.2004.02.002 Cameron ME, Casey RA, Bradshaw JWS, Waran NK, Gunn-Moore DA (2004) A study of environmental and behavioural factors that may be associated with feline idiopathic cystitis. J Small Anim Pract 45(3):144–147. 10.1111/j.1748-5827.2004.tb00216.x Defauw PA, Van de Maele I, Duchateau L, Polis IE, Saunders JH, Daminet S (2011) Risk factors and clinical presentation of cats with feline idiopathic cystitis. J Feline Med Surg 13(12):967–975. 10.1016/j.jfms.2011.08.001 Markwell PJ, Buffington CAT, Chew DJ, Kendall MS, Harte JG, DiBartola SP (1999) Clinical evaluation of commercially available urinary acidification diets in the management of idiopathic cystitis in cats. J Am Vet Med Assoc 214(3):361–365. 10.2460/javma.1999.214.03.361 Westropp JL, Buffington CAT (2004) Feline idiopathic cystitis: current understanding of pathophysiology and management. Vet Clin North Am Small Anim Pract 34(4):1043–1055. 10.1016/j.cvsm.2004.03.002 Westropp JL, Kass PH, Buffington CAT (2006) Evaluation of the effects of stress in cats with idiopathic cystitis. Am J Vet Res 67(4):731–736. 10.2460/ajvr.67.4.731 Buffington CAT, Westropp JL, Chew DJ (2014) From FUS to Pandora syndrome: where are we, how did we get here, and where to now? J Feline Med Surg 16(5):385–394. 10.1177/1098612X14530212 Heath S (2019) Common feline problem behaviours: unacceptable indoor elimination. J Feline Med Surg 21(3):199–208. 10.1177/1098612X1983120 Pardo M, Spencer E, Odunayo A, Ramirez ML, Rudloff E, Shafford H et al (2024) 2024 AAHA fluid therapy guidelines for dogs and cats. J Am Anim Hosp Assoc 60(4):131–163. 10.5326/JAAHA-MS-7444 Aubrecht AM, Lulich JP (2023) Resolution of urethral obstruction using temporary urethral stents in two female cats. J Feline Med Surg Open Rep 9(1). 10.1177/20551169221149677 Reche A Jr, Hagiwara MK, Mamizuka E (1998) Estudo clínico da doença do trato urinário inferior em gatos domésticos de São Paulo. Braz J Vet Res Anim Sci 35:69–74. 10.1590/S1413-95961998000200004 Thumchai R, Lulich J, Osborne CA, King VL, Lund EM, Marsh WE et al (1996) Epizootiologic evaluation of urolithiasis in cats: 3,498 cases (1982–1992). J Am Vet Med Assoc 208(4):547–551 Segev G, Livne H, Ranen E, Lavy E (2011) Urethral obstruction in cats: predisposing factors, clinical, clinicopathological characteristics and prognosis. J Feline Med Surg 13(2):101–108. 10.1016/j.jfms.2010.10.006 Aumann M, Worth LT, Drobatz KJ (1998) Uroperitoneum in cats: 26 cases (1986–1995). J Am Anim Hosp Assoc 34(4):315–324. 10.5326/15473317-34-4-315 Gerken KK, Cooper ES, Butler AL, Chew DJ (2020) Association of abdominal effusion with a single decompressive cystocentesis prior to catheterization in male cats with urethral obstruction. J Vet Emerg Crit Care 30(1):11–17. 10.1111/vec.12914 Pimenta MM, Horta P (2024) Obstrução uretral em felinos. Manual de emergências em pequenos animais, 2– edn. Editora dos Editores, ed. São Paulo, pp 445–449 Gouvea FG, Crivellenti LZ (2024) Lesão Renal Aguda. In: Rabelo, R.; Ribeiro, C. Manual de Emergências em Pequenos Animais 2ª ed. São Paulo: Editores dos Editores, cap 158 pp. 799–806 Schaer M, Ackerman N, Ellison G, Spencer C (1992) Bilateral pyonephrosis, hydroureter, renal failure, and urethral obstruction in a cat. Feline Pract 20:19–23 Fantoni DT, Ambrósio AM (2001) Choque hipovolêmico. In: Fantoni DT, Cortopassi SR (eds) Manual de emergências em pequenos animais, 2– edn. Editora dos Editores, ed. São Paulo, pp 229–233 Drobatz KJ, Cole SG (2008) The influence of crystalloid type on acid–base and electrolyte status of cats with urethral obstruction. J Vet Emerg Crit Care 18(4):355–361. 10.1111/j.1476-4431.2008.00328.x Santilli R, Moïse NS, Pariaut R, Perego M (2018) Electrocardiographic changes secondary to systemic disorders and drugs. Electrocardiography of the dog and cat: diagnosis of arrhythmias, 2nd edn. Edra, Milan, p 314 O’Hearn AK, Wright BD (2011) Coccygeal epidural with local anesthetic for catheterization and pain management in the treatment of feline urethral obstruction. J Vet Emerg Crit Care 21(1):50–52. 10.1111/j.1476-4431.2010.00609.x Dorsey TI, Monaghan KN, Respess M, Labato MA, Babyak JM, Sharp CR et al (2019) Effect of urinary bladder lavage on in-hospital recurrence of urethral obstruction and durations of urinary catheter retention and hospitalization for male cats. J Am Vet Med Assoc 254(4):483–486. 10.2460/javma.254.4.483 Seitz MA, Burkin-Creedon JM, Drobatz KJ (2018) Evaluation for association between indwelling urethral catheter placement and risk of recurrent urethral obstruction in cats. J Am Vet Med Assoc 28(2):150–159. 10.2460/javma.252.12.1509 Wallius BM, Tidholm AE (2009) Use of pentosan polysulphate in cats with idiopathic, non-obstructive lower urinary tract disease: a double-blind, randomised, placebo-controlled trial. J Feline Med Surg 11(6):409–412. 10.1016/j.jfms.2008.09.003 Steagall PV, Robertson S, Simon B, Warne LN, Shilo-Benjamini Y, Taylor S (2022) 2022 ISFM consensus guidelines on the management of acute pain in cats. J Feline Med Surg 24(1):4–30. 10.1177/1098612X211066268 Taylor S, Gruen M, KuKanich K, Lascelles BDX, Monteiro BP, Sampietro LR et al (2024) 2024 ISFM and AAFP consensus guidelines on the long-term use of NSAIDs in cats. J Feline Med Surg 26(4). 10.1177/1098612X241241951 Dorsch R, Zellner F, Schulz B, Sauter-Louis C, Hartmann K (2016) Evaluation of meloxicam for the treatment of obstructive feline idiopathic cystitis. J Feline Med Surg 18(11):925–933. 10.1177/1098612X1562160 Additional Declarations No competing interests reported. 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08:47:45","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":114031,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7661275/v1/639d9b4d0d7bf728e42a1956.html"},{"id":98746613,"identity":"f0d836a0-f9f0-4fc1-a89e-4af702862a35","added_by":"auto","created_at":"2025-12-22 08:47:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":92469,"visible":true,"origin":"","legend":"\u003cp\u003ePhysical and sedimentoscopic evaluation of urinalysis from a female, intact, 2-year-old Brazilian Shorthair cat (PCB) with hematuria. In A, a large quantity of red blood cells can be observed under 40x objective microscopy. In B, centrifugation reveals a hemorrhagic sediment. Source: Images provided by the UFLA Clinical Pathology Laboratory, 2024.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7661275/v1/9f2fe8b3dcc9325b843fbd4c.png"},{"id":98777325,"identity":"e8ab1644-bc69-42f7-8505-cc8135bb81fa","added_by":"auto","created_at":"2025-12-22 12:26:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":121922,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasonographic image of the dilated proximal urethra in the patient, a female, intact, 2-year-old Brazilian Shorthair cat (PCB), measuring 0.40 cm x 0.21 cm. \u003cstrong\u003eSource:\u003c/strong\u003e Images provided by the Diagnostic Imaging Service, UFLA Veterinary Hospital, 2024.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7661275/v1/e69376299912430e82d39b0d.png"},{"id":98777060,"identity":"1b14dde6-73c4-4464-980a-519b2d95578a","added_by":"auto","created_at":"2025-12-22 12:25:18","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":100139,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasonographic image of the dilated proximal urethra in the patient, a female, intact, 2-year-old Brazilian Shorthair cat (PCB), with color Doppler twinkling artifacts. \u003cstrong\u003eSource:\u003c/strong\u003e Diagnostic Imaging Service, UFLA Veterinary Hospital, 2024.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7661275/v1/949baa730995e55fb51d7978.png"},{"id":98746619,"identity":"b6a0297d-bdd9-4e54-81fb-6b65ce5b37dd","added_by":"auto","created_at":"2025-12-22 08:47:45","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":508683,"visible":true,"origin":"","legend":"\u003cp\u003ePosterior region of the patient showing lumbosacral trichotomy for epidural block. The mucoid urethral plug excreted by the feline patient is visible alongside. \u003cstrong\u003eSource:\u003c/strong\u003e Author, 2024.\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7661275/v1/410343053137f5b7d2b2849b.png"},{"id":99789263,"identity":"ae78b306-9312-4d58-9da9-c88613b3c052","added_by":"auto","created_at":"2026-01-08 12:49:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1354492,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7661275/v1/42cf4c1b-3807-48af-a427-6646af1b0d7e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Severe Hyperkalemia Secondary to Urethral Obstruction by a Plug in a Female Cat – Case Report","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eUrethral obstruction in felines is a severe urological emergency characterized by the interruption of urinary flow and renal filtration, leading to systemic alterations that can be fatal if not promptly corrected\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Mortality can reach 26%, especially in recurrent cases \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The main causes include urolithiasis, infectious or inflammatory cystitis, urethral plugs, anatomical abnormalities, and, less frequently, neoplasms \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. The most common underlying cause is Feline Idiopathic Cystitis (FIC), responsible for approximately 54% of cases in male cats due to their narrower urethral anatomy\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. FIC is a chronic inflammatory disorder with a multifactorial etiology, associated with environmental stressors that activate autonomic, endocrine, and immune responses, resulting in bladder inflammation and pain\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough urethral obstruction is predominantly observed in males, it can also occur in females, albeit rarely\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. In these cases, obstruction is generally caused by uroliths or bacterial cystitis and only occasionally by urethral plugs, which are typically dense and mineralized. In females, obstruction is most often associated with urolithiasis and infectious cystitis, while plugs, when present, tend to be characterized by dense mineralized material and are typically linked to chronic, severe forms of FIC\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Due to the shorter and wider urethra in females, initial catheterization can be challenging but may, in some cases, facilitate management compared to males.\u003c/p\u003e \u003cp\u003eFIC can predispose to plug formation, particularly in chronic or severe inflammatory episodes\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Risk factors include stress, multi-cat households, indoor confinement, obesity, and dry-food diets\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. The condition is self-limiting in most cases, but recurrence occurs in 40\u0026ndash;60% of cats, highlighting its chronic nature\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe pathophysiology of FIC involves stress-induced activation of the hypothalamic\u0026ndash;pituitary\u0026ndash;adrenal axis and sympathetic nervous system, resulting in increased bladder permeability and local inflammation\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. The compromised urothelial barrier allows ion influx and nociceptor activation, perpetuating inflammation and pain\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Chronic stressors such as inter-cat conflict, environmental restriction, and abrupt changes in routine can trigger clinical signs like dysuria, periuria, pollakiuria, and hematuria\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eEmergency management follows the same general principles applied to male cats, prioritizing stabilization of hemodynamically unstable patients, which often present with circulatory shock, hypothermia, hypotension, bradycardia, and hypoperfusion. Intravenous fluid therapy is essential to restore perfusion compromised by decreased renal blood flow\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Additionally, correcting electrolyte imbalances, especially hyperkalemia, is crucial, as it affects myocardial stability and can trigger fatal arrhythmias\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Urethral catheterization in female cats may be technically challenging due to the small urethral diameter and associated inflammation, requiring delicate catheters and precise technique\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis report describes a rare case of urethral obstruction by a plug in a female cat associated with FIC. The case highlights the clinical, biochemical, and ultrasonographic findings, the emergency management applied, and the importance of recognizing stress as a predisposing factor for severe obstructive episodes in female cats.\u003c/p\u003e"},{"header":"CASE REPORT","content":"\u003cp\u003eA female, intact, two-year-old Brazilian Shorthair cat (PCB) was admitted to the UFLA Veterinary Hospital with a history of pollakiuria, ischuria, followed by vocalization while maintaining in urinary tennesm, as well as an absence of urination for 24 hours. It was reported that the condition had begun approximately 15 days prior, with the animal manifesting hematuria, pollakiuria, periuria, and polydipsia. Despite these alterations, the cat remained normorexic and normoqueic. The owner also reported that the patient had exhibited a similar condition about 3 months earlier, and the clinical signs had resolved spontaneously. The owner was questioned about changes in routine and environmental management and reported a multi-cat household where the patient lived with three other feline contactants, which exhibited agonistic behaviors amongst themselves. She added that there were four more intact male cats in another room of the house, which had no direct contact with the patient. She also reported that these contactants exhibited territorial marking by urination in the environment.\u003c/p\u003e \u003cp\u003eDuring triage, the patient was observed to have intense prostration, severe dehydration (7%), prolonged capillary refill time (CRT)\u0026thinsp;\u0026gt;\u0026thinsp;2 seconds, hypothermia (36.4\u0026deg;C), and severe abdominal pain in the hypogastric region. Consequently, the patient was referred to the intensive care unit (ICU) for emergency care and stabilization. The observed parameters were: HR: 188 bpm, RR: 36 bpm, blood glucose: 152 mg/dL, lactate: 4.8 mmol/L (0.39\u0026ndash;2.87 mmol/L) (REDAVID et al., 2016), systolic blood pressure (SAP): 80 mmHg, and a Feline Grimace Scale (FGS) score of 5/10. Due to hyperlactatemia, dehydration was estimated at 10%. A-FAST (Abdominal Focused Assessment with Sonography for Trauma) revealed a distended bladder and a moderate amount of free fluid in the cysto-colic region. A relief cystocentesis was performed using a needle and a three-way tap in a closed system, draining intensely hemorrhagic urine. Analgesia was then administered with 0.2 mg/kg methadone, and laboratory tests, abdominal ultrasonography, and radiography were requested.\u003c/p\u003e \u003cp\u003eThe complete blood count showed erythrocytosis (HCT 50%), leukocytosis of 30,450/mm\u0026sup3; due to absolute and relative neutrophilia, relative eosinopenia, and relative lymphopenia. Biochemistry revealed severe azotemia with creatinine 10.1 mg/dL, urea\u0026thinsp;\u0026gt;\u0026thinsp;130 mg/dL, and severe hyperkalemia (8.0 mmol/L). A urine sample was collected by cystocentesis, showing low USG 1.030 (\u0026gt;\u0026thinsp;1.035) and uncountable red blood cells on sedimentoscopy; sediment evaluation was not possible due to the intense hematuria (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBased on the history, clinical examination, and laboratory findings, the differential diagnoses associated with the suspicion were: ureteral obstruction, acute renal failure, pyelonephritis, chronic kidney disease, bacterial cystitis, urolithiasis, feline idiopathic cystitis, and urethral obstruction.\u003c/p\u003e \u003cp\u003eThe diagnosis of urethral obstruction was made with the aid of abdominal ultrasonography, which revealed dilation of the proximal urethra containing dense, hyperechoic material forming mild posterior acoustic shadowing, suggestive of dense sediment occupying the entire lumen. A focal, organized area of hyperechoic material was identified, possibly indicating a forming calculus (0.40 cm x 0.21 cm), associated with twinkling artifacts on color Doppler (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The kidneys showed rare bilateral hyperechoic cortical foci, compatible with dystrophic mineralization or fibrosis. Mild bilateral renal pelvic dilation was observed (left: 0.28 cm; right: 0.21 cm), with no signs of ureteral dilation. Additionally, a moderate to marked amount of free abdominal fluid (FF) was identified, likely of inflammatory origin, raising suspicion of possible uroperitoneum. Associated with the described findings were hepatic hypoechogenicity and diffuse peritonitis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDue to suspicion of uroperitoneum and bladder rupture, peritoneal fluid analysis was performed. The fluid was classified as a hemorrhagic effusion, with cellularity predominantly consisting of red blood cells and neutrophils. The creatinine level of the peritoneal fluid was similar to the serum creatinine (12.1 mg/dL), ruling out bladder rupture.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTo manage severe hyperkalemia (8.0 mmol/L), four boluses of 50% glucose were administered at 1 ml/kg every 2 hours, reducing potassium to 6.3 mmol/L. Calcium gluconate was administered via continuous infusion over 30 minutes due to the risk of sudden death from hyperkalemia. This infusion was initiated in the ICU and completed during anesthesia due to the urgency of relieving the urinary obstruction. Regular insulin was not added to the therapy as the patient was normoglycemic.\u003c/p\u003e \u003cp\u003eGiven the post-renal azotemia, the patient was transferred to the surgical department for urethral deobstruction under general anesthesia. The surgical plan included general anesthesia combined with an epidural block, followed by an attempt at urethral catheterization. Due to the high degree of difficulty associated with this procedure in female cats, attributed to the extremely narrow urethral canal, a cystotomy with retrograde catheterization was planned if initial attempts failed.\u003c/p\u003e \u003cp\u003eThe anesthetic protocol included premedication with methadone (0.3 mg/kg IM) due to the patient's critical condition. Induction was achieved with propofol (4 mg/kg IV, titrated to loss of reflexes), and a sacrococcygeal epidural block was administered using bupivacaine (1 mg/kg) combined with morphine (0.2 mg/kg). General anesthesia was maintained with isoflurane. Minutes after anesthesia induction, the patient spontaneously urinated, eliminating a white, mucoid urethral plug with a firm core, thus avoiding the need for cystotomy (Figurre 4). Prior to deobstruction, an increase in T-wave amplitude (similar to R-wave amplitude) was observed on electrocardiography, indicative of persistent hyperkalemia. Following urination, T-wave amplitude progressively decreased. A urethral catheter was successfully placed and secured to the vulva with 3\u0026thinsp;\u0026minus;\u0026thinsp;0 nylon suture to prevent dislodgement.\u003c/p\u003e \u003cp\u003ePostoperatively, the patient required continuous norepinephrine infusion for 12 hours to maintain systolic arterial pressure at 110 mmHg. Fluid therapy with Lactated Ringer's solution was administered over 12 hours to address dehydration (10%). Analgesia was maintained with methadone (0.2 mg/kg SC) and warm saline bladder lavage. Biochemical reevaluation 24 hours post-deobstruction revealed normalized creatinine and urea levels. Potassium was mildly low (3.1 mEq/L; reference: 3.5\u0026ndash;5.8 mEq/L) but not supplemented immediately due to clinical improvement and spontaneous intake of food and water. The urethral catheter was expelled the following day due to urethral spasms. Meloxicam (0.03 mg/kg IV for 3 days) was initiated to manage associated urethritis.\u003c/p\u003e \u003cp\u003eClinical progression was satisfactory, with normalized urination and resolution of dysuria and pollakiuria. Final laboratory results at discharge were within normal limits: creatinine 1.4 mg/dL, potassium 3.6 mEq/L. Urinalysis showed USG 1.029, full-field hematuria, and bilirubinuria (+). Analgesia during hospitalization included methadone (0.2 mg/kg SC TID), gabapentin (6 mg/kg PO BID), and meloxicam (0.05 mg/kg IV SID) for 5 days. Hematuria and pollakiuria resolved gradually over 3 days, and urinary flow was fully reestablished without signs of obstruction by the end of hospitalization. Ultrasonographic reevaluation confirmed resolution of abdominal free fluid.\u003c/p\u003e \u003cp\u003eThe patient was discharged with significant clinical improvement and prescribed home-based care. The treatment plan emphasized multimodal environmental modification (MEMO) to reduce agonistic behaviors, including environmental enrichment such as increased provision of litter boxes, resting areas, scratching posts, and interactive play. Hydration was encouraged through the introduction of wet food. Ovariohysterectomy was recommended to mitigate chronic stress, a known trigger for feline idiopathic cystitis (FIC). Analgesia included tramadol (2 mg/kg PO BID) for 7 days and gabapentin (6 mg/kg PO BID) for 30 days, followed by a gradual 3-week tapering protocol. Based on the history of chronic stress, clinical manifestations, pre- and post-obstruction laboratory findings, and therapeutic response, the presumptive diagnosis was urethral obstruction due to a plug associated with Feline Idiopathic Cystitis (FIC).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis report describes an unusual case of urethral obstruction in a young, unspayed, non-obese female cat, which deviates from the epidemiological profile most frequently described for feline lower urinary tract disease (FLUTD). Most studies point to a greater predisposition in adult, neutered, overweight, sedentary males fed exclusively dry food\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. There are no national epidemiological studies on Feline Idiopathic Cystitis (FIC), and the available data are predominantly North American, indicating an average prevalence of 8% and an incidence between 0.34 and 0.64%\u003csup\u003e20,21\u003c/sup\u003e. Thus, this case contributes to expanding knowledge about atypical presentations of the disease in young females, emphasizing that the pathophysiology of FIC depends not only on anatomical factors, but also on environmental and emotional factors.\u003c/p\u003e \u003cp\u003eThe patient presented with urethral obstruction caused by a dense, mineralized plug, a rare finding in females, in whom obstruction is usually associated with the presence of urethral stones\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. The obstruction was triggered by chronic stress in an inappropriate environment, a condition associated with FIC, which can predispose both to the formation of plugs and uroliths. Factors such as water restriction, low water intake, and lack of wet food in the diet can promote crystal precipitation and the development of these structures\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Urethral plugs, composed of mucoproteins, cellular debris, and crystals, agglutinate to form obstructive masses within the urethral lumen\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, which was observed in this case.\u003c/p\u003e \u003cp\u003eThe diagnosis was linked to FIC due to the patient's history of prolonged environmental stress, which significantly contributed to the development and severity of the disease\u003csup\u003e\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Additionally, the initial clinical manifestations (hematuria, pollakiuria, and periuria) are typical of FIC but not exclusive to it, as they may also occur in other feline lower urinary tract diseases, such as bacterial cystitis and other forms of urolithiasis.\u003c/p\u003e \u003cp\u003eThe patient exhibited clinical and laboratory findings consistent with urethral obstruction, including severe dehydration, azotemia, hypothermia, hyperlactatemia, and hyperkalemia, indicating impaired urinary flow. Given the rarity of urethral obstructions in female cats due to their anatomical particularities, differential diagnoses such as acute renal failure, ureterolithiasis, and pyelonephritis were considered. Imaging findings allowed these to be ruled out, particularly given the immediate recovery post-deobstruction. Ultrasonography identified dense sediment and hyperechoic material in the proximal urethra compatible with a urethral plug, along with urethral dilation, indicating proximal obstruction. These findings underscore the importance of rapid diagnosis, as this constitutes a clinical emergency requiring intensive hemodynamic stabilization and immediate desobstruction, directly impacting patient prognosis\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough free fluid (FF) was observed in the cysto-colic region, bladder rupture was ruled out via ultrasonography due to the integrity of the bladder wall, supported by fluid analysis confirming hemorrhagic and inflammatory effusion. Paired analysis of FF creatinine (12 mg/dL) and serum creatinine (10 mg/dL) revealed similar values, i.e., FF creatinine did not exceed twice the serum value, eliminating the possibility of bladder rupture\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. It is worth noting that some cats may develop uroperitoneum without wall rupture, negating the need for abdominocentesis or surgical correction\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. This finding is attributed to microlesions from wall fragility and severe tissue inflammation caused by FIC.\u003c/p\u003e \u003cp\u003eThe observed azotemia was associated with severe dehydration and urinary flow obstruction, reflecting significant hemodynamic and metabolic imbalance. Bladder distension increases intravesical pressure, leading to urine reflux into the ureters and kidneys\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. This distension releases inflammatory prostaglandins, causing afferent arterial dilation in an attempt to maintain renal filtration and flow. These changes recruit leukocytes to the renal tubules and activate the renin-angiotensin-aldosterone system, resulting in arteriolar vasoconstriction\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. The pressure differential compromises renal filtration, leading to the reabsorption of filtrate into the bloodstream and increasing nitrogenous compounds, electrolytes, ions, and toxins in circulation. Prolonged obstruction may result in bilateral hydronephrosis\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe patient exhibited hemodynamic alterations, with dehydration estimated at 10% due to signs of vasoconstriction (dry mucous membranes, prolonged capillary refill time\u0026thinsp;\u0026gt;\u0026thinsp;3 seconds, decreased skin turgor, enophthalmos) associated with hyperlactatemia and hypotension\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Hypovolemia from dehydration can reduce cardiac output, causing tissue hypoperfusion (28). Post-renal azotemia leads to acid-base imbalance, resulting in metabolic acidosis\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Acidosis impairs oxygen delivery by erythrocytes to tissues, leading to tissue hypoxia. This hypoxia triggers an energy deficit, culminating in anaerobic metabolism and hyperlactatemia. Serum lactate is a marker of tissue perfusion used to assess disease severity; elevated levels indicate hypoperfusion and may infer prognosis\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHypovolemia and hyperlactatemia can lead to hypotension, a compensatory response to circulating volume loss. Volume correction should be achieved with crystalloid fluid therapy\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e, as performed in this case. Due to the combination of hypovolemia and hypotension, a vasoactive agent was necessary. Norepinephrine was administered at a low dose to shift blood flow from the splanchnic region to vital organs, attempting to maintain perfusion. The patient responded satisfactorily, maintaining borderline normotension until full hydration was restored.\u003c/p\u003e \u003cp\u003eHyperkalemia caused clinical and electrocardiographic changes, including increased T-wave amplitude, hypothermia, and hypotension\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Excess extracellular potassium reduces the resting membrane potential of myocardial cells, promoting depolarization and resulting in arrhythmias\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Atrial myocardium is more sensitive to hyperkalemia than ventricular myocardium and the sinoatrial node. Thus, as potassium levels rise, electrocardiographic changes occur sequentially: increased T-wave amplitude, reduced P-wave amplitude, prolonged QRS interval, and eventually atrial standstill\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHyperkalemia correction is only indicated when myocardial alterations, such as bradycardia and electrocardiographic changes, are present\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Calcium gluconate infusion, as performed in intensive care, aims to reduce the deleterious effects of extracellular potassium. With elevated potassium, the Na/K pump is disrupted, activating the Na/Ca\u0026sup2;⁺ antiporter, which maintains cardiomyocyte contraction without altering the resting membrane potential, thus preserving cardiac function\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Additionally, intravenous 50% glucose boluses help translocate extracellular potassium into cells until urinary flow is reestablished\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Insulin therapy may be added to this protocol, particularly in hyperglycemic animals, though hypoglycemia must be monitored\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Current guidelines do not recommend regular insulin in normoglycemic patients; in such cases, glucose boluses alone are advised. Post-deobstruction, the patient experienced rebound hypokalemia due to post-obstructive diuresis and osmotic diuresis from glucose administration.\u003c/p\u003e \u003cp\u003eUrethral catheterization in females is generally challenging due to the small caliber and associated inflammation\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. However, in this case, catheterization was possible without the need for cystotomy, which was decisive for initial therapeutic success and avoided a more invasive surgical procedure. The use of general anesthesia and a delicate technique allowed for effective unblocking, reducing the risk of urethral trauma and ensuring the restoration of urinary flow.\u003c/p\u003e \u003cp\u003eMethadone caused no adverse effects and provided satisfactory analgesia throughout treatment, as assessed by the Feline Grimace Scale (FGS). Sacrococcygeal epidural blockade and general anesthesia were essential for pain control and relaxation of the urethral musculature, facilitating spontaneous deobstruction and urethral catheterization\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. The excreted organic material was consistent with a urethral plug, and catheterization enabled bladder lavage to remove dense sediments. Clinical studies have shown that bladder lavage may improve hematuria and reduce hospitalization time in cats with urethral catheters\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Spontaneous resolution of the obstruction during anesthesia indicated that bladder distension and urethral spasms contributed to the obstructive crisis, as the plug was dense rather than a calculus. Successful urethral catheterization and subsequent clinical stabilization demonstrate the efficacy of the adopted protocol and the operator's technical expertise.\u003c/p\u003e \u003cp\u003eThe use of meloxicam for post-obstructive urethritis management is supported by studies, though its administration must be cautious, and patients should be adequately hydrated\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. Maintenance treatment, including opioid analgesia with tramadol and gabapentin, was implemented to control pain and prevent recurrence, while multimodal environmental modification was recommended to minimize chronic stress, the primary trigger for FIC\u003csup\u003e\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e. Ovariohysterectomy was also appropriately recommended, considering its potential to reduce reproductive stress.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis case illustrates the complexity of managing urethral obstructions associated with Feline Idiopathic Cystitis (FIC), emphasizing the critical importance of identifying and mitigating environmental stressors. The rarity of urethral obstruction in a female cat necessitated a multidisciplinary approach to deobstruction. Rapid clinical stabilization and effective relief of the obstruction were pivotal to the successful outcome, highlighting the value of structured protocols and precise technical execution.\u003c/p\u003e \u003cp\u003eThe combination of intensive clinical management including correction of dehydration and hyperkalemia, multimodal analgesia with opioids, anti-inflammatories, and analgesic adjuvants along with well-planned anesthetic interventions, ensured the patient\u0026rsquo;s recovery. The association between obstructive signs and FIC underscores the necessity of addressing not only the immediate obstruction but also underlying factors such as environmental mismanagement.\u003c/p\u003e \u003cp\u003eThe therapeutic plan was reinforced by multimodal environmental modifications (MEMO) and a recommendation for ovariohysterectomy, both essential for preventing recurrence and improving long-term quality of life. The satisfactory clinical progression and return to normal laboratory parameters demonstrate the efficacy of the implemented protocol and underscore the importance of accurate clinical assessment, timely diagnosis, and continuous monitoring in patients with a history of FIC, who remain at risk of recurrent urinary obstruction.\u003c/p\u003e \u003cp\u003eThis report contributes to the clinical understanding of severe obstructive manifestations of FIC in female cats and reinforces the need for a holistic approach that integrates emergency intervention, metabolic stabilization, environmental management, and long-term preventive strategies.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAINEs\u003c/strong\u003e: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA-FAST:\u003c/strong\u003e Abdominal Focused Assessment with Sonography for Trauma \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBID:\u0026nbsp;\u003c/strong\u003eTwice Daily (every 12 hours) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ebpm\u003c/strong\u003e: Beats per minute\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCIF:\u0026nbsp;\u003c/strong\u003eFeline Idiopathic Cystitis (FIC)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ecm:\u0026nbsp;\u003c/strong\u003eCentimeter\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRT:\u0026nbsp;\u003c/strong\u003eCapillary Refill Time\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCTI:\u0026nbsp;\u003c/strong\u003eIntensive Care Unit (ICU)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTID:\u0026nbsp;\u003c/strong\u003eThree Times Daily (every 8 hours)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFC\u003c/strong\u003e: Heart Rate \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFGS:\u0026nbsp;\u003c/strong\u003eFeline Grimace Scale\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFR:\u0026nbsp;\u003c/strong\u003eRespiratory Rate\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGAGs:\u0026nbsp;\u003c/strong\u003eGlycosaminoglycans\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIM:\u0026nbsp;\u003c/strong\u003eIntramuscular\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIV:\u0026nbsp;\u003c/strong\u003eIntravenous\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFF:\u0026nbsp;\u003c/strong\u003eFree Fluid\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePAS:\u0026nbsp;\u003c/strong\u003eSystolic Arterial Pressure\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePO:\u0026nbsp;\u003c/strong\u003eper oral administration\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSC:\u0026nbsp;\u003c/strong\u003eSubcutaneous\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSID:\u0026nbsp;\u003c/strong\u003eOnce Daily (every 24 hours)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUFLA:\u0026nbsp;\u003c/strong\u003eFederal University of Lavras\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUSG\u003c/strong\u003e: Urine Specific Gravity\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFUNDING\u003c/strong\u003e\u003cbr\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETING INTERESTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Maira Souza Oliveira Barreto, Rodrigo Bernardes Nogueira, and Ruthn\u0026eacute;a Aparecida L\u0026aacute;zaro Muzzi. The first draft of the manuscript was written by Beatriz Aline Migotto, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was not required for this study, since it describes a single clinical case attended at the Veterinary Hospital of Universidade Federal de Lavras (UFLA). Written informed consent was obtained from the animal\u0026rsquo;s owner for participation and for publication of the clinical details.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT FOR PUBLICATION\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the owner for both printed and electronic publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLee JA, Drobatz KJ (2003) Characterization of clinical characteristics, electrolytes, acid\u0026ndash;base, and renal parameters in male cats with urethral obstruction. J Vet Emerg Crit Care 13(4):227\u0026ndash;233. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1534-6935.2003.00100.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1534-6935.2003.00100.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBradley AM, Lappin MR (2014) Intravesical glycosaminoglycans for obstructive feline idiopathic cystitis: a pilot study. J Feline Med Surg 16(6):504\u0026ndash;506. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1098612X13510918\u003c/span\u003e\u003cspan address=\"10.1177/1098612X13510918\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones E, Palmieri C, Thompson M, Jackson K, Allavena R (2021) Feline idiopathic cystitis: pathogenesis, histopathology and comparative potential. J Comp Pathol 185:18\u0026ndash;29. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcpa.2021.03.006\u003c/span\u003e\u003cspan address=\"10.1016/j.jcpa.2021.03.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuffington CAT (2011) Idiopathic cystitis in domestic cats\u0026mdash;beyond the lower urinary tract. J Vet Intern Med 25(4):784\u0026ndash;796. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1939-1676.2011.0732.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1939-1676.2011.0732.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWestropp JL, Delgado M, Buffington CAT (2019) Chronic lower urinary tract signs in cats: current understanding of pathophysiology and management. Vet Clin North Am Small Anim Pract 49(2):187\u0026ndash;209. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.cvsm.2018.11.001\u003c/span\u003e\u003cspan address=\"10.1016/j.cvsm.2018.11.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHorwitz DF, Rodan I (2018) Behavioral awareness in the feline consultation: understanding physical and emotional health. J Feline Med Surg 20(5):423\u0026ndash;436. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1098612X18771204\u003c/span\u003e\u003cspan address=\"10.1177/1098612X18771204\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOsborne CA, John MK, Jody PL (1996) Feline lower urinary tract disorders: definition of terms and concepts. Vet Clin North Am Small Anim Pract 26(2):169\u0026ndash;179. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0195-5616(96)50200-7\u003c/span\u003e\u003cspan address=\"10.1016/S0195-5616(96)50200-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHouston DM, Moore AE, Favrin MG, Hoff B (2003) Feline urethral plugs and bladder uroliths: a review of 5484 submissions 1998\u0026ndash;2003. Can Vet J 44(12):974\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuffington CAT, Blaisdell JL, Binns SP, Woodworth BE (1996) Decreased urine glycosaminoglycan excretion in cats with interstitial cystitis. J Urol 155(5):1801\u0026ndash;1804\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePereira DA, Aguiar JA, Hagiwara MK, Michelacci YM (2004) Changes in cat urinary glycosaminoglycans with age and in feline urologic syndrome. Biochim Biophys Acta 1672(1):1\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bbagen.2004.02.002\u003c/span\u003e\u003cspan address=\"10.1016/j.bbagen.2004.02.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCameron ME, Casey RA, Bradshaw JWS, Waran NK, Gunn-Moore DA (2004) A study of environmental and behavioural factors that may be associated with feline idiopathic cystitis. J Small Anim Pract 45(3):144\u0026ndash;147. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1748-5827.2004.tb00216.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1748-5827.2004.tb00216.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDefauw PA, Van de Maele I, Duchateau L, Polis IE, Saunders JH, Daminet S (2011) Risk factors and clinical presentation of cats with feline idiopathic cystitis. J Feline Med Surg 13(12):967\u0026ndash;975. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jfms.2011.08.001\u003c/span\u003e\u003cspan address=\"10.1016/j.jfms.2011.08.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarkwell PJ, Buffington CAT, Chew DJ, Kendall MS, Harte JG, DiBartola SP (1999) Clinical evaluation of commercially available urinary acidification diets in the management of idiopathic cystitis in cats. J Am Vet Med Assoc 214(3):361\u0026ndash;365. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2460/javma.1999.214.03.361\u003c/span\u003e\u003cspan address=\"10.2460/javma.1999.214.03.361\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWestropp JL, Buffington CAT (2004) Feline idiopathic cystitis: current understanding of pathophysiology and management. Vet Clin North Am Small Anim Pract 34(4):1043\u0026ndash;1055. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.cvsm.2004.03.002\u003c/span\u003e\u003cspan address=\"10.1016/j.cvsm.2004.03.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWestropp JL, Kass PH, Buffington CAT (2006) Evaluation of the effects of stress in cats with idiopathic cystitis. Am J Vet Res 67(4):731\u0026ndash;736. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2460/ajvr.67.4.731\u003c/span\u003e\u003cspan address=\"10.2460/ajvr.67.4.731\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuffington CAT, Westropp JL, Chew DJ (2014) From FUS to Pandora syndrome: where are we, how did we get here, and where to now? J Feline Med Surg 16(5):385\u0026ndash;394. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1098612X14530212\u003c/span\u003e\u003cspan address=\"10.1177/1098612X14530212\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeath S (2019) Common feline problem behaviours: unacceptable indoor elimination. J Feline Med Surg 21(3):199\u0026ndash;208. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1098612X1983120\u003c/span\u003e\u003cspan address=\"10.1177/1098612X1983120\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePardo M, Spencer E, Odunayo A, Ramirez ML, Rudloff E, Shafford H et al (2024) 2024 AAHA fluid therapy guidelines for dogs and cats. J Am Anim Hosp Assoc 60(4):131\u0026ndash;163. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5326/JAAHA-MS-7444\u003c/span\u003e\u003cspan address=\"10.5326/JAAHA-MS-7444\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAubrecht AM, Lulich JP (2023) Resolution of urethral obstruction using temporary urethral stents in two female cats. J Feline Med Surg Open Rep 9(1). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/20551169221149677\u003c/span\u003e\u003cspan address=\"10.1177/20551169221149677\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReche A Jr, Hagiwara MK, Mamizuka E (1998) Estudo cl\u0026iacute;nico da doen\u0026ccedil;a do trato urin\u0026aacute;rio inferior em gatos dom\u0026eacute;sticos de S\u0026atilde;o Paulo. Braz J Vet Res Anim Sci 35:69\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1590/S1413-95961998000200004\u003c/span\u003e\u003cspan address=\"10.1590/S1413-95961998000200004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThumchai R, Lulich J, Osborne CA, King VL, Lund EM, Marsh WE et al (1996) Epizootiologic evaluation of urolithiasis in cats: 3,498 cases (1982\u0026ndash;1992). J Am Vet Med Assoc 208(4):547\u0026ndash;551\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSegev G, Livne H, Ranen E, Lavy E (2011) Urethral obstruction in cats: predisposing factors, clinical, clinicopathological characteristics and prognosis. J Feline Med Surg 13(2):101\u0026ndash;108. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jfms.2010.10.006\u003c/span\u003e\u003cspan address=\"10.1016/j.jfms.2010.10.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAumann M, Worth LT, Drobatz KJ (1998) Uroperitoneum in cats: 26 cases (1986\u0026ndash;1995). J Am Anim Hosp Assoc 34(4):315\u0026ndash;324. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5326/15473317-34-4-315\u003c/span\u003e\u003cspan address=\"10.5326/15473317-34-4-315\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGerken KK, Cooper ES, Butler AL, Chew DJ (2020) Association of abdominal effusion with a single decompressive cystocentesis prior to catheterization in male cats with urethral obstruction. J Vet Emerg Crit Care 30(1):11\u0026ndash;17. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/vec.12914\u003c/span\u003e\u003cspan address=\"10.1111/vec.12914\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePimenta MM, Horta P (2024) Obstru\u0026ccedil;\u0026atilde;o uretral em felinos. Manual de emerg\u0026ecirc;ncias em pequenos animais, 2\u0026ndash; edn. Editora dos Editores, ed. S\u0026atilde;o Paulo, pp 445\u0026ndash;449\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGouvea FG, Crivellenti LZ (2024) Les\u0026atilde;o Renal Aguda. In: Rabelo, R.; Ribeiro, C. Manual de Emerg\u0026ecirc;ncias em Pequenos Animais 2\u0026ordf; ed. S\u0026atilde;o Paulo: Editores dos Editores, cap 158 pp. 799\u0026ndash;806\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchaer M, Ackerman N, Ellison G, Spencer C (1992) Bilateral pyonephrosis, hydroureter, renal failure, and urethral obstruction in a cat. Feline Pract 20:19\u0026ndash;23\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFantoni DT, Ambr\u0026oacute;sio AM (2001) Choque hipovol\u0026ecirc;mico. In: Fantoni DT, Cortopassi SR (eds) Manual de emerg\u0026ecirc;ncias em pequenos animais, 2\u0026ndash; edn. Editora dos Editores, ed. S\u0026atilde;o Paulo, pp 229\u0026ndash;233\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDrobatz KJ, Cole SG (2008) The influence of crystalloid type on acid\u0026ndash;base and electrolyte status of cats with urethral obstruction. J Vet Emerg Crit Care 18(4):355\u0026ndash;361. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1476-4431.2008.00328.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1476-4431.2008.00328.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantilli R, Mo\u0026iuml;se NS, Pariaut R, Perego M (2018) Electrocardiographic changes secondary to systemic disorders and drugs. Electrocardiography of the dog and cat: diagnosis of arrhythmias, 2nd edn. Edra, Milan, p 314\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO\u0026rsquo;Hearn AK, Wright BD (2011) Coccygeal epidural with local anesthetic for catheterization and pain management in the treatment of feline urethral obstruction. J Vet Emerg Crit Care 21(1):50\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1476-4431.2010.00609.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1476-4431.2010.00609.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDorsey TI, Monaghan KN, Respess M, Labato MA, Babyak JM, Sharp CR et al (2019) Effect of urinary bladder lavage on in-hospital recurrence of urethral obstruction and durations of urinary catheter retention and hospitalization for male cats. J Am Vet Med Assoc 254(4):483\u0026ndash;486. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2460/javma.254.4.483\u003c/span\u003e\u003cspan address=\"10.2460/javma.254.4.483\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeitz MA, Burkin-Creedon JM, Drobatz KJ (2018) Evaluation for association between indwelling urethral catheter placement and risk of recurrent urethral obstruction in cats. J Am Vet Med Assoc 28(2):150\u0026ndash;159. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2460/javma.252.12.1509\u003c/span\u003e\u003cspan address=\"10.2460/javma.252.12.1509\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWallius BM, Tidholm AE (2009) Use of pentosan polysulphate in cats with idiopathic, non-obstructive lower urinary tract disease: a double-blind, randomised, placebo-controlled trial. J Feline Med Surg 11(6):409\u0026ndash;412. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jfms.2008.09.003\u003c/span\u003e\u003cspan address=\"10.1016/j.jfms.2008.09.003\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteagall PV, Robertson S, Simon B, Warne LN, Shilo-Benjamini Y, Taylor S (2022) 2022 ISFM consensus guidelines on the management of acute pain in cats. J Feline Med Surg 24(1):4\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1098612X211066268\u003c/span\u003e\u003cspan address=\"10.1177/1098612X211066268\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaylor S, Gruen M, KuKanich K, Lascelles BDX, Monteiro BP, Sampietro LR et al (2024) 2024 ISFM and AAFP consensus guidelines on the long-term use of NSAIDs in cats. J Feline Med Surg 26(4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1098612X241241951\u003c/span\u003e\u003cspan address=\"10.1177/1098612X241241951\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDorsch R, Zellner F, Schulz B, Sauter-Louis C, Hartmann K (2016) Evaluation of meloxicam for the treatment of obstructive feline idiopathic cystitis. J Feline Med Surg 18(11):925\u0026ndash;933. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1098612X1562160\u003c/span\u003e\u003cspan address=\"10.1177/1098612X1562160\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ischuria, pollakiuria, creatinine, potassium, feline idiopathic cystitis","lastPublishedDoi":"10.21203/rs.3.rs-7661275/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7661275/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe urethral obstruction is a common urological emergency in feline medicine, typically associated with male cats due to their narrower urethral anatomy. In females, this condition is rare and usually linked to uroliths, with urethral plugs being uncommon. This report discusses a case of urethral obstruction in a 2-year-old female Brazilian Shorthair cat caused by a urethral plug associated with Feline Idiopathic Cystitis (FIC). The cat had a history of chronic stress related to environmental management issues, presenting clinical signs of periuria, pollakiuria, and hematuria for 15 days, which worsened over 24 hours. This progression led to lethargy, intense vocalization, urinary tenesmus followed by anuria, as observed by the owner. Consequently, the patient was referred to the intensive care unit (ICU), where alterations in vital parameters were noted, including 10% dehydration, hypothermia, mild hypotension, severe hyperkalemia, severe azotemia, hyperlactatemia, a feline grimace scale score of 5/10, and intense abdominal pain localized in the hypogastric region. The diagnosis of urethral obstruction was confirmed using abdominal ultrasonography, which revealed proximal urethral dilation and a material resembling dense organized sediment or a forming urolith, measuring approximately 4 mm x 2.1 mm. Following stabilization of the emergency condition, the patient underwent general anesthesia and epidural block, allowing immediate relief of the obstruction and placement of an indwelling urinary catheter. Post-procedure, the cat was maintained in intensive care, with significant improvement in renal biochemical and electrolyte abnormalities. Urethral obstruction in female cats is considered rare due to the distensible and wider nature of the urethra in this gender. When present, it is usually caused by uroliths and only rarely by urethral plugs. Therefore, this case highlights the importance of ultrasonographic diagnosis in female cats presenting with lower urinary tract signs and urinary tenesmus.\u003c/p\u003e","manuscriptTitle":"Severe Hyperkalemia Secondary to Urethral Obstruction by a Plug in a Female Cat – Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-22 08:47:37","doi":"10.21203/rs.3.rs-7661275/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"424f07c4-96bf-491a-9f36-fbd0a66f4736","owner":[],"postedDate":"December 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-02T16:54:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-22 08:47:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7661275","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7661275","identity":"rs-7661275","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}