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Hyperkalemia in a blocked cat can feel like a five-alarm fire—until you remember what actually fixes the problem. We sit down with Drs. Stephanie Maciorowski and Elizabeth Rozanski to unpack fresh evidence showing that the simplest path is also the strongest: start IV fluids, give calcium gluconate to stabilize the myocardium, and prioritize rapid unobstruction. The headline finding is liberating for busy ERs and general practices alike—insulin with dextrose, terbutaline, or sodium bicarbonate did not outperform the foundational approach in lowering potassium or improving outcomes.

We walk through what this means at the cage-side level. Potassium often falls quickly once urine is flowing, so the early hours matter most. If a catheter won’t pass, decompressive cystocentesis can reduce pressure and buy time. We compare sedation choices, discuss monitoring strategies, and highlight which lab and ECG changes deserve your attention. The conversation also tackles a bigger theme: replacing ritual with proof. Many of us learned to stack drugs out of habit or anxiety; this study suggests we can streamline, reduce risk, and still deliver excellent survival—especially when teams move decisively to address the cause rather than chasing every downstream sign.

Along the way, we cover client education essentials—how to spot a block early, why immediate care matters, and what prevention looks like after discharge. For clinicians, we sketch out future research that could refine timing, trend analysis, and case stratification, including earlier potassium checkpoints and ionized calcium tracking. If you care about better outcomes, safer protocols, and fewer medication complications, this conversation offers practical, evidence-based steps you can use today.

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JAVMA article: https://doi.org/10.2460/javma.25.04.0258

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