Page 286 - Problem-Based Feline Medicine

278 PART 5 CAT WITH ACUTE ILLNESS

● Supplemental B vitamins should be considered. laparotomy reveals abnormal pancreatic tissue. For
Specifically, cobalamin treatment should be given cats with a non-surgical presumptive diagnosis of pan-
(0.5–1 mg SC q 2–3 weeks) if serum level is low. creatitis, similar to dogs, surgery should be consid-
● Antiemetics. Metoclopramide, ondansetron, prochlor- ered if the cat is not improving with conservative
perazine and chlorpromazine given at standard management, if there are worsening pancreatic
doses may be used to control vomiting. The latter changes on ultrasound examination, or if peritoneal
two should not be given if the cat is hypotensive. effusion is an exudate, but there are no firm guidelines.
● Analgesics. Although many cats do not show evi- Closed therapeutic abdominal lavage may also be con-
dence of abdominal pain, it is likely present, and sidered if peritoneal effusion is an exudate. Therapeutic
may contribute to depression. Opioid analgesics abdominocentesis should be considered if there is
should be considered at standard doses. large-volume ascites, and it should definitely be per-
● Antibiotics are not indicated in most cases. formed if there is a problem secondary to a volume
Antibiotics are recommended if there is a marked effect (e.g. dyspnea from diaphragmatic compression),
inflammatory leukogram or fever (blood culture is but the benefit of the procedure on the course of the
recommended), or evidence of pancreatic infec- disease is not known.
tion on biopsy (pancreatic and liver biopsies
should be cultured). Empirical choices include
ampicillin, cefazolin and cefoxitin at standard Prognosis
doses.
The true prognosis is not known because of under-
● Corticosteroids should only be used if needed to
diagnosis, mortality due to concurrent disorders, and
treat a concurrent disorder (e.g. inflammatory
euthanasia because of the prevailing attitude that feline
bowel disease). They may be considered if the cat is
pancreatitis carries a poor prognosis. Prognosis is
presented in shock, but the value of such therapy
related to the severity of the pancreatitis.
has been overstated.
● Fresh-frozen plasma (10–20 ml/kg) has been Cats with mild acute pancreatitis probably have a
advocated in acute pancreatitis to replenish coagu- good prognosis, while cats with severe pancreatitis and
lation factors and anti-thrombin III consumed in an associated disorder have a poor prognosis. Chronic
DIC, and to replenish α-macroglobulins, which are pancreatitis may be subclinical.
involved in clearing pancreatic enzymes from the
In one series of 13 cats with acute pancreatitis and
circulation. There is no evidence of a beneficial
hepatic lipidosis, recovery rate was 20%, versus 50%
effect in humans, and there are too few reports in
for cats with hepatic lipidosis alone. In another series of
dogs or cats to make an assessment. Transfusions
40 cats with severe acute pancreatitis, all cats died or
are expensive, and any benefit is probably as a col-
were euthanized. Successful management of acute pan-
loid solution. (It should be noted that α-macroglob-
creatitis has been anecdotally reported and reported in
ulins and anti-thrombin III are stable in regular
individual case reports and small case series.
plasma. The main difference in regular plasma and
fresh-frozen plasma are the concentrations of factor
VIII and von Willebrand’s factor. Fresh-frozen
ACUTE RENAL FAILURE*
plasma is potentially more beneficial in DIC only if
the aPTT is prolonged.)
Classical signs
● Dopamine 5 μg/kg/min as a constant rate infusion
is beneficial in experimental acute pancreatitis ● Progressive depression and anorexia.
when given within the first 12 hours of injury, but ● Vomiting.
not after that time. Most cats with naturally occur- ● Polyuria, oliguria or anuria.
ring disease are presented after 12 hours, and it is
unknown if there is any benefit.
● Vitamin K – see The Bleeding Cat (page 499). Pathogenesis
Surgical debridement of grossly necrotic tissue and Acute renal failure is a syndrome characterized by an
abdominal lavage may be performed if a diagnostic abrupt reduction in glomerular filtration rate and result-