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Treatment tenets of pancreatitis in cats
Digest this advice from a feline expert on how to handle a common cat crisis.
Whether you, Fluffy or Fluffy's mom like it or not, once pancreatitis is diagnosed and you know the zymogens in there are running amok, there is no doubt that Fluffy is going to have to be hospitalized for treatment. But, says Elizabeth Colleran, DVM, MS, DAVBP (feline), “ Get them out of the hospital as fast as you can.” Meaning, get hospitalized cats home and back into their roles as loving companions for their owners as quickly as possible. How very two-thousand-sixteen!
Here are her recommendations on how to accomplish that modern yet noble goal in cats with pancreatitis:
1. Fluid replacement and electrolyte correction, a.k.a. “Gatorade ain't gonna cut it.”
Let's start out with a quick tip. To painlessly place a peripheral intravenous catheter, shave the leg, apply a topical lidocaine gel and a bio-occlusive dressing to the area, and wait 20 minutes for it to take effect before placing the catheter. Everyone-and we mean everyone-will thank you.
So now that the catheter is placed, correcting dehydration and meeting ongoing fluid requirements are in order. You're an expert at intravenous crystalloid fluid selection by now, but just remember not to choose lactated Ringer's solution if there is evidence of liver pathology or malfunction.
Regarding electrolyte imbalances, hypokalemia is common in cats with pancreatitis. Watch for it and correct it with appropriate potassium supplementation in the intravenous fluids.
Next up, calcium. The prognosis for cats with pancreatitis is directly related to the severity and duration of hypocalcemia. “Hypocalcemia needs to be corrected with calcium gluconate in the intravenous fluids during the first 12 to 24 hours.“ says Colleran.
2. Analgesia: “My pancreas is killing me!”
There's no doubt that no animal should be in pain if we can help it. Well, these cats generally have pretty painful pancreases. Colleran is concerned that pain is very common and often unrecognized in cats. She gives an example of a 2001 paper on treating pancreatitis in cats in which there is not a single mention of pain control. That just doesn't work in today's medical climate. You must control cats' pain if you can. Traditionally feline-friendly opioids are the cornerstone of pain control and, in this condition, she says you can consider maropitant a pain medication as well.
Quick tip! Dr. Colleran rarely uses tramadol because even when it is compounded well, her patients balk at its bitterness.
3. Other medications-cases where more can be better
Antiemetics. Colleran advises that you use maropitant (a neurokinin 1 receptor antagonist that blocks the action of substance P) and that if you add a 5-HT3 blocker, such as ondansetron or dolasetron, you will get a synergistic effect on emesis.
Vitamin B12. Even if you don't measure cobalamin and folate concentrations, Colleran recommends that all cats with pancreatitis receive injectable B12 treatment.
Antibiotics. Be aware that using antibiotics for treating pancreatitis is controversial. If you are going to use them, Colleran says cephalosporins are a good choice, as is amoxicillin (with or without enrofloxacin).
Appetite stimulation. If an appetite stimulant is needed, Colleran goes for mirtazapine.
Corticosteroids. Ah, the age-old question of whether or not to use corticosteroids. Don't discount using prednisolone in these cases because the inflammatory cascade plays an important part in chronic pancreatitis. They can be effective at stopping the process of fibrosis, which is beneficial in the long run. Colleran thinks that prednisolone administration has “a nice effect” on some of the cats that aren't really turning around during your initial treatment.
“Sometimes cats are on this medication regimen for a really long time, but they do get better,” says Colleran. “When they are eating and start to pick up on their weight, I start to taper them off everything.”
Check that vitamin K!
A proteins induced by Vitamin K antagonism (PIVKA) test indirectly detects vitamin K deficiency, which can occur in cats with pancreatitis with concurrent hepatopathy. If the vitamin K concentration is low, Colleran says you can administer vitamin K1 at 1 to 1.5 mg/kg subcutaneously every 12 hours for three doses before a planned invasive procedure. In conditions such as hepatic lipidosis, she often assumes the concentration will be low and won't necessarily test for deficiency before administering vitamin K1.
4. Adequate nutrition (remember when we used to NPO everybody?)
When managing cats with pancreatitis, up to a point, it's more important that cats eat than what they eat. Feed them quick and feed them often! It is important to place an esophagostomy tube early in the course of treatment. It's this simple: Stabilize them first, and if they are not getting better really quickly, you need to place an esophagostomy tube.
Quick tip! “If you see cats in your practice, learn how to place and use esophagostomy tubes and then use them in practice and you will save lives at a rate that is quite impressive.”
Colleran recommends performing a clotting profile or administering vitamin K1 before placing an esophagostomy tube (see "Check that vitamin K!").
Use a diet specifically formulated for recovery because these diets contain adequate amounts of protein, which is needed to heal. Feed this diet at the individually calculated amount until the esophagostomy tube is removed.
Quick tip! During treatment, don't forget to offer and measure the diet the cat eats at home every day. And yes, cats can swallow around the esophagostomy tube.
Don't remove the esophagostomy tube until a cat is ingesting an adequate amount of nutrients on its own. And sometimes you shouldn't even remove it then, says Colleran. If the cat is receiving many different medications several times a day, leaving in the esophagostomy tube can help facilitate and ensure appropriate treatment.
Dr. Elizabeth Colleran is the owner and Hospital Director of two exclusively feline practices and is an ABVP Diplomate in Feline Practice. She participated in the 2013 Bayer Veterinary Care and Usage Study 3 – Feline Findings. Prior to veterinary school, she worked in Sales and Marketing Management for IBM where she worked with Fortune 500 companies to streamline internal networks. Her passions are her crazy husband, two equally crazy Burmese cats, bicycling and Indian cuisine.
Shhh! Don't tell anyone: “l love road bicycling. My little secret admission is that, because I am a boss with all the responsibilities that involves, I love to ride the back of our tandem with my husband (a former bike racer and accomplished pro) at the helm. It means I get to relax fully without having to worry about speed, gear, braking, etc. I am free to provide pedal-power and yet give up power!”