What is the treatment protocol for a cat that ingested any part of a true lily including emesis and renal monitoring?

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The standard treatment protocol for true lily ingestion in cats is immediate gastrointestinal decontamination followed by 48 hours of intravenous (IV) fluid diuresis, with daily renal monitoring throughout. Mortality rates as high as 50–100% have been reported when treatment is delayed, but prognosis is excellent when fluid diuresis is initiated before anuric renal failure develops.12 Gastrointestinal decontamination should be performed as early as possible after ingestion. The entire plant — petals, stamens, leaves, and pollen — is toxic, and as little as 2 leaves or part of a single flower has caused death in cats.1 Emesis induction is the first decontamination step. Dexmedetomidine hydrochloride administered intramuscularly (IM) is a reliable emetic in cats; excessive sedation has been noted at doses of 10.68 µg/kg IM.3 Oral dexmedetomidine at 20 µg/kg is an alternative route: emesis was successfully induced in 5 of 6 cats using this protocol, with each cat vomiting once; all cats exhibited moderate to profound sedation, but no other adverse effects were documented.7 Activated charcoal is administered following emesis; the median dose used in hospitalized cats is 3 mL/kg (range 1–4 mL/kg).2 IV fluid diuresis is the cornerstone of treatment and should be initiated before anuric renal failure develops. The standard duration is 48 hours.2 The median maximum IV fluid rate used in hospitalized cats is 2 mL/kg/h.2 For cats managed as outpatients — a setting associated with worse outcomes — subcutaneous (SC) fluids have been used at a median dose of 15 mL/kg (range 9.9–31.6 mL/kg), though IV hospitalization is the standard of care.2 Once anuria develops, peritoneal dialysis or hemodialysis is the only previously described treatment option; however, one case report documents successful resolution of oligo-anuric acute kidney injury with furosemide administration and medical management alone.15 Renal monitoring consists of baseline and daily assessment of blood urea nitro