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A Beautiful Evil
by Melissa Rotella, DVM

Charlie is a seven year old domestic short hair cat that was recently seen at Route 516 Animal Hospital. Charlie’s owners had noticed that he had been more lethargic lately and started to vomit. The owners had received a floral arrangement that contained lilies and with closer inspection the owners noticed some bite marks in the leaves. As the owners had some knowledge of the danger of lilies, they made a wise decision in bringing Charlie in for an exam.

Despite being a very common and seasonal household flower, lilies can be quite dangerous to cats. These flowers are known to cause acute kidney disease in cats. In dogs, however, only mild gastrointestinal upset is expected. There is a range of different species of lilies that are considered toxic including Daylilies, Easter lilies, Japanese lilies, Stargazer lilies and Tiger lilies. Lily toxicosis is most prevalent during the Christmas and Easter holiday season, as they are a popular decoration. Despite their name, Lilies of the Valley and Peace lilies are not true lilies and therefore, do not cause kidney disease.

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All parts of the lily are considered toxic, including pollen. It is a common myth that removing the stamens from the flowers renders them nontoxic. The most toxin is found in the flower but even drinking the water in the

> vase can cause clinical signs in cats. Owner’s usually first notice vomiting in affected animals, with signs starting within 2 hours to 5 days of ingestion. Increased thirst, frequent urination, and kidney disease develop within 36 to 72 hours. There is no definitive test to confirm exposure to lilies and the diagnosis is made based on clinical signs and known exposure to the plant. Often plant material can be seen in the vomit.

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The basis of treatment is decontamination. This is achieved by inducing vomiting, followed by activated charcoal to bind the remaining toxins from the gastrointestinal tract and limit absorption. This procedure is best achieved prior to any clinical signs developing in the patient. The second phase of treatment is to try and slow or prevent kidney failure. IV fluid therapy for a minimum of 48 to 72 hours is needed. Fluid therapy can be longer in situations where kidney values are already elevated. Additional treatments such as anti-nausea and pain medications are added in on a case by case basis. Blood work is repeated at 24, 48 and 72 hours and then as needed to monitor kidney values.

Usually if treatment is started within 18 hours of exposure, before the onset of kidney disease, the prognosis is good. After kidney disease has developed, the prognosis become guarded to poor. Therefore, any known exposure to lilies requires immediate attention by your veterinarian.

In Charlie’s case, his initial lab work revealed elevated kidney values and he stayed in the hospital for 7 days before the values came back down. Due to the lily ingestion, he has suffered permanent kidney damage. He is currently doing well at home, however he is now on a kidney friendly prescription diet and requires subcutaneous fluids two times a week to help manages his mild disease.

The take home message for this case of the month is: With Easter and Spring approaching, if you are a pet owner, take special care in making sure any holiday decorations or floral arrangements do not contain lilies.