Multiple Organ Dysfunction Syndrome in Cats

Multiple organ dysfunction syndrome (MODS) in cats is a complication or critical illnesses that are well-recognized as the failure of one or more organ systems. In felines, multiple organ dysfunction can affect the gastrointestinal and neurologic systems, and the blood, kidneys, liver, heart and lungs. The causes of MODS in cats are an endless list of systemic disease and infections that cause the organ to be damaged, resulting in failure. The symptoms your cat could display mimic clinical signs of other common feline diseases and could be any clinical sign from vomiting to a coma. Multiple organ dysfunction in cats is a fatal disease and it is vital your cat receives veterinary medical attention immediately. 

The clinical signs a feline presents in the case of multiple organ dysfunction (MODS) in cats is associated with the specific organ affected. The symptoms your cat displays are associated with organ damage in the following systems: 

Gastrointestinal

• Melena (black, tar-colored feces of digested blood. A sign of stomach bleeding) 
• Diarrhea 
• Hematemesis (blood in vomit) 
• Vomiting

Neurologic 

• Coma 
• Depression 

Coagulation 

• Gingival hemorrhage 
• Epistaxis 
• Petechia 
• Ecchymoses 
• Thrombocytopenia 
• Decreased antithrombin 
• Elevated D-Dimers
• Elevated fibrin degradation 
• Prolonged activated clotting time   
• Activated partial thromboplastin time 
• Prothrombin time 

Renal 

• Proteinuria 
• Glycosuria 
• Renal tubular casts
• Anuria 
• Oliguria 

Hepatic 

• Icterus
• Hypoalbuminemia 
• Decreased antithrombin 
• Bilirubinuria 
• Elevated total bilirubin 

Cardiac

• Bradycardia
• Tachycardia 
• Pale mucous membranes
• Hypotension 
• Decreased cardiac output
• Global hypothermia 
• Peripheral hypothermia 
• Pulse volume 
• Arrhythmias 
• Respiratory 
• Cough 
• Frothy, bloody pulmonary edema fluid
• Cyanosis 
• Pulmonary crackles
• Orthopnea
• Tachypnea

Multiple organ dysfunction syndrome (MODS) in cats is the result of critical illness and the underlying cause of the condition varies according to the specific organ affected. In MODS, the cats hematological, hepatobiliary, gastrointestinal, respiratory, nervous, cardiovascular and renal systems are affected by different elements. 

Kidneys

• Acute kidney injury 
• Acute tubular necrosis 
• Ischemia 
• Antibiotic use 
• Sepsis 
• Pigment nephropathy (heat stroke/rhabdomyolysis) 

Respiratory System

• Acute lung injury 
• Acute respiratory distress syndrome 
• Damage to the pulmonary endothelium 
• Pulmonary contusion 
• Damage to the alveoli 
• Cytokine-mediated inflammation 
• Noncardiogenic pulmonary edema 
• Pulmonary capillary leak 

Gastrointestinal System

• Bacterial infection 
• Sepsis 
• Endotoxemia 
• Hypoperfusion of Splanchnic circulation 

Neurologic 

• Neurologic deterioration 
• Hypoglycemia 
• Metabolic encephalopathy 
• Microthrombosis 
• Hypovolemia 
• Hypotension 

Cardiovascular 

• Cardiac failure
• Pain
• Hypovolemia 
• Hypoxemia 
• Acid disturbance 
• Ectopy
• Myocardial dysfunction 
• Hypotension 
• Circulating cytokines 
• Systemic inflammation 

Hematologic 

• Microvascular thrombosis 
• DIC 
• Endothelial damage 
• Widespread inflammation 

Hepatic 

• Encephalopathy 
• Hypoglycemia 
• Coagulopathy 
• Hepatic failure 
• Acute hepatocellular necrosis 
• Endotoxin 
• Ischemic injury 

The veterinarian’s focus in diagnosing MODS in cats, is differentiating organ dysfunction from other critical illnesses. Identifying clinical and laboratory evidence of one or more dysfunctional organs can be obtained by performing the following diagnostic exams: 

Laboratory Testing

• Thromboelastography 
• Fibrinogen 
• Coagulation profile (PT, aPTT) 
• Urinalysis 
• Blood gas analysis 
• Serum biochemistry profile 
• Complete blood cell count with platelet count

Imaging

• Echocardiography 
• Abdominal ultrasound
• Abdominal radiographs 
• Thoracic radiographs 

Other Diagnostic Tests  

• Aerobic cultures (wounds, blood, peritoneal, urine) 
• Electrocardiogram: used to identify cardiac arrhythmias  
• Blood pressure: used to identify hypotension 
• Pulse oximetry: used to identify hypoxemia 

The goal of treating MODS in cats is to identify the targeted organ and the underlying disease that is causing the organ to become dysfunctional. Your veterinarian will treat your cats multiple organ dysfunction depending on the organ affected. Possible treatment plans for feline MODS are listed below: 

Gastrointestinal

• Feeding tube placement to start enteral feeding
• Administration of prokinetics, antiemetics and gastroprotectants. 

Renal

• Treat oliguria with mannitol or fenoldopam
• Maintain renal perfusion  

Cardiovascular & Hematologic 

• Anticoagulation therapy 
• Blood and/or plasma transfusions
• Use of a vasopressor or positive inotropes if refractory hypotension is found.

Respiratory

• Positive pressure ventilation 
• Supplemental oxygen therapy 

Multiple organ dysfunction in cats is a severe and complicated disease that has a poor to guarded outcome for cat owners. The mortality rate for felines is roughly 70 percent of all presented cases, as any patient diagnosed with MODS is in a critical state. Rapid treatment is vital in order to give the feline a positive chance for survival. Talk with your veterinarian about realistic expectations regarding risk factors associated with multiple organ dysfunction in cats.