Medically reviewed by Dr Sam Kovac BVSc (Merit) – Southern Cross Veterinary Clinic
Lily poisoning at a glance
About: Lilies are a popular flower in bouquets but are deadly to cats. Ingestion causes nephrotoxicity (acute kidney failure). All parts of the plant are toxic.
Symptoms: Early symptoms include increased thirst and urination, vomiting, drooling, loss of appetite. Later symptoms include absent urination, abdominal pain, bad breath, and weakness.
Treatment: Early intervention is vital before irreversible damage to the kidneys occurs. Gastric decontamination, intravenous fluid therapy and if kidney failure has developed, peritoneal dialysis or hemodialysis may be necessary.
Prognosis: Good for cats who receive treatment before kidney damage occurs.
Lilies are popular in floral arrangements, but while we may admire their beauty, they are deadly to cats. Cat owners need to be aware that having these flowers in your home can prove fatal. Lilies are a nephrotoxin, which are toxins affecting the kidneys, causing acute kidney failure due to the death of the renal epithelial cells.
Although any cat is at risk, indoor cats and kittens are particularly vulnerable. The exact toxin isn’t known, but what is understood is that it is water-soluble and ingestion leads to the death of the renal tubular epithelial cells through a mechanism which isn’t yet understood.
If you suspect your cat has eaten any, immediate veterinary attention is vital.
Which parts are toxic?
All parts of the plant are poisonous including the leaf, stamen, pollen, flowers and as little as 2 leaves or part of a single flower have resulted in deaths.
Lilies of the genera Lilium and Hemerocallis are toxic to cats. Below are images of some common toxic lilies to make identification easier.
Common species include:
There are two stages of lily poisoning in the cat; the first stage occurs due to gastrointestinal upset followed by acute kidney failure.
Early clinical signs
- Vomiting which may contain parts of the ingested plant in the vomit
- Loss of appetite
- Increased urination
Vomiting usually subsides a few hours after exposure, although anorexia and depression typically remain. Kidney failure occurs 12-72 hours post-ingestion.
Clinical signs associated with kidney failure
- Abdominal pain
- Bad breath
- Once the kidneys have become damaged, urination will be absent
- Increased or decreased thirst
If urination decreases, hyperkalemia (high blood potassium) can develop as it is the kidney’s role to remove excess potassium from the blood via the urine.
Clinical signs of hyperkalemia
- Cardiac arrhythmias
- Muscle weakness
There are no specific tests available to diagnose lily poisoning. The veterinarian will perform a thorough physical examination which may reveal painful and enlarged kidneys. A thorough medical history will include onset of symptoms and exposure to toxins. A timeline is important to determine how long ago ingestion occurred.
- Chemistry panel: Groups of tests of a sample of the cat’s blood which may reveal elevated blood urea nitrogen (BUN) and creatinine, both of which are indicative of kidney failure.
- SDMA test: This new rapid blood test can evaluate for early kidney damage, for biochemistry tests to pick up kidney failure, 70% of kidney function must be lost, by which time irreversible kidney damage has occurred.
- Urinalysis: A sample of urine can provide additional information on the extent of kidney damage and urine-concentrating ability.
- Kidney ultrasound: This enables the veterinarian to evaluate the size of the kidneys and evaluate for concurrent problems such as kidney stones, infection (pyelonephritis), tumours and blood clots which may complicate recovery. Where available CT scanning is much faster than ultrasound to diagnose concurrent problems.
- Kidney biopsy: A small sample is taken from the kidney to evaluate the cells.
- Blood pressure: It is important to check the cat’s blood pressure as hypertension can occur in cats who have ingested lilies.
Prompt medical treatment is vital; the sooner your cat sees a vet, the better his chances of recovery. A high mortality rate is reported if treatment is not initiated before onset of anuric renal failure, which occurs 18–24 hours after exposure. Even with medical treatment, there is no guarantee the cat will survive, but the chances greatly decrease if treatment doesn’t commence before renal failure.
There is no antidote for lily poisoning and treatment is aimed at removing any remaining plant material, preventing further absorption and providing supportive care.
- Gastrointestinal tract decontamination by inducing vomiting and giving activated charcoal to bind to the toxins in the gastrointestinal tract and must be performed within 1-2 hours of ingestion.
- Intravenous fluid therapy to maintain urine production is the mainstay of treatment, which will continue for 48-72 hours. The purpose of fluid diuresis to maintain urine production to speed up the removal of toxins in the blood (uremic poisoning) as well as treating dehydration.
Once the kidneys have stopped working, dialysis is necessary to remove toxins from the blood, there are two types of dialysis.
- Peritoneal dialysis is carried out by placing a tube (catheter) into the peritoneal cavity and using the peritoneal membrane as a filter. Dialysis solution enters the peritoneal cavity via the catheter, excess fluids and waste products from the blood pass through the peritoneal membrane and into the dialysis solution. After some time, the solution is drained out of the peritoneal cavity.
- Hemodialysis uses a dialysis machine which performs the functions of the kidney. Blood is passed out of the cat’s body and into the dialysis machine where it is cleaned and then goes back into the body.
- Anti-nausea medication for cats who are vomiting.
- Blood pressure monitoring.
- Monitor urine output.
- Feed a low-protein, low mineral diet to place as little load on the kidneys as possible during recovery.
Prognosis is good for cats who receive treatment before anuria (absent urination) has occurred, but it is poor once the kidneys stop producing urine.
Cat owners need to be aware of the dangers of keeping lilies in their house and garden and avoid having these extremely dangerous plants around cats.
When ordering flowers for friends or relatives, make sure they do not contain lilies of the genera Lilium and Hemerocallis if a cat is living in the household.