JFMS review updates a practical framework for feline emergencies

Version 2

A new Journal of Feline Medicine and Surgery review is offering general practitioners a concise playbook for some of the feline emergencies they’re most likely to see, but not necessarily often enough to feel fully comfortable managing from memory. In “Rational approach to feline medical emergencies: part 2,” Nicki Reed focuses on seizures, urethral obstruction, acute kidney injury, and diabetic ketoacidosis, framing the paper as a practical aid for clinicians who need to make rapid decisions when emergency cases disrupt the normal flow of practice. (journals.sagepub.com)

The paper follows Reed’s companion article, published online on April 29, 2026, which covered triage and stabilization, shock, dyspnea, feline aortic thromboembolism, and anemia. Together, the two-part series is aimed primarily at general practitioners, though Reed notes that out-of-hours clinicians may also find it useful. The review emphasizes that while much of the core emergency approach is established, it also incorporates literature and clinical techniques that have emerged over the past five years. (journals.sagepub.com)

In the new installment, Reed highlights several practical decision points. For blocked cats, the review notes that urethral obstruction accounts for about 0.5% of feline cases in general practice and 5.7% to 9% of emergency caseload in emergency settings. It stresses that bradycardia below 120 beats per minute and hypothermia below roughly 35 to 35.9°C should raise immediate concern for severe hyperkalemia, and it recommends early database testing, ECG and blood pressure monitoring, analgesia, and fluid therapy with a balanced electrolyte solution rather than sodium chloride alone. The article also favors atraumatic, aseptic catheterization and use of a closed collection system for indwelling catheters. (journals.sagepub.com)

For acute kidney injury, the review points clinicians toward cause-based management layered onto supportive care. It specifically flags lilies and ethylene glycol as toxic causes in cats, noting that by the time many azotemic patients present, opportunities for gastric decontamination or early antidotal therapy may already have passed. In ureteric obstruction, Reed summarizes medical management options such as analgesics, diuretics, and antispasmodic approaches, but notes that if no improvement is seen within 48 to 72 hours, ureteral stenting or subcutaneous ureteral bypass should be considered to preserve nephron function. That practical framing is likely to resonate in first-opinion and emergency settings where early referral decisions matter. (journals.sagepub.com)

One of the most current sections deals with diabetic ketoacidosis in the era of feline SGLT2 inhibitors. Reed warns that cats receiving drugs such as velagliflozin, bexagliflozin, or dapagliflozin may develop euglycemic diabetic ketoacidosis, with blood glucose below 14 mmol/L, potentially obscuring the diagnosis if clinicians don’t know the medication history. The review says this is most likely within the first two weeks of starting therapy and recommends concurrent glucose supplementation with insulin when treating eDKA. That aligns with broader guidance in the 2025 iCatCare feline diabetes consensus statement and with FDA safety messaging on Bexacat, which warns that use in insulin-dependent cats, or switching cats off insulin onto bexagliflozin, is associated with increased risk of DKA, euglycemic DKA, and death. (journals.sagepub.com)

There does not appear to be a separate institutional press release or a large volume of public commentary tied specifically to this review article, which is typical for clinically oriented narrative reviews. But the themes Reed pulls forward are consistent with recent expert and regulatory attention. A 2025 systematic review of non-insulin antidiabetic drugs in cats found that newer SGLT2 inhibitors showed strong efficacy signals but were also associated with a meaningful risk of euglycemic diabetic ketoacidosis, while a velagliflozin clinical trial reported DKA in 4 of 61 treated cats compared with none in the insulin comparator arm. (pubmed.ncbi.nlm.nih.gov)

Why it matters: For veterinary teams, this article is useful because it translates a broad emergency literature into bedside priorities for feline patients, while also surfacing newer risk patterns that may be easy to miss in practice. The eDKA discussion is especially timely: as more pet parents seek alternatives to insulin injections, emergency clinicians may increasingly see cats on SGLT2 inhibitors whose acid-base crisis is not accompanied by dramatic hyperglycemia. More broadly, the review reinforces that feline emergency care often diverges from canine assumptions, and that structured triage, medication history, and early referral thresholds can materially affect outcomes. (journals.sagepub.com)

What to watch: The next practical shift may be whether these recommendations, especially around SGLT2 inhibitor-associated eDKA and referral timing in urinary and renal emergencies, become more explicitly embedded in GP protocols, continuing education, and feline-focused consensus guidance over the next year. (journals.sagepub.com)