Page 639 - Clinical Small Animal Internal Medicine

56 Pancreatitis in the Cat 607

Table 56.2 Medications commonly used in the management of severe pancreatitis in the feline patient
VetBooks.ir Class Drug Mechanism Main indication Dose and route

Analgesic Buprenorphine Opioid Acute, severe 0.01–0.02 mg/kg SC, IM, IV, TM
Fentanyl Opioid Acute, severe 25 μg/h patch,
5 μg/kg IV bolus, CRI 2–4 μg/kg/h
Butorphanol Opioid Acute, severe 0.1–0.5 mg/kg SC, IM, IV
Antiemetic Maropitant Neurokinin‐1 receptor Acute, severe 1 mg/kg SC q24h,
Antinausea antagonist chronic 2 mg/kg PO q24h
Dolasetron or 5‐HT 3 receptor Acute, severe 0.8–1.0 mg/kg IV q24h
ondansetron antagonist
Metoclopramide Dopamine D2 receptor Acute, severe 0.2–0.5 mg/kg PO, SC, IM q6–8h,
antagonist 1–2 mg/kg/24h CRI
Antacid Omeprazole Proton pump inhibitor Acute, severe 1.0–1.3 mg/kg PO q12h
Pantoprazole Proton pump inhibitor Acute, severe 0.7–1.0 mg/kg IV q12h
Ranitidine Histamine H2 receptor Acute, severe 0.5 mg/kg PO q12h
antagonist
CRI, constant rate infusion; IM, intramuscular; IV, intravenous; PO, by mouth (per os); SC, subcutaneous.

associated with shorter ICU and hospital stays, lower chronic management approach once they are eating vol­
total costs of care, and fewer complications during ini­ untarily and are able to be discharged.
tial management. With cats, the potential for develop­ Cats with a clinical suspicion of chronic pancreatitis
ment of hepatic lipidosis as a complication of severe are treated in essentially the same manner as cats with
pancreatitis and inadequate caloric intake must also be chronic enteropathies or diagnoses of idiopathic inflam­
considered. While currently there is limited informa­ matory bowel disease. There is no meaningful way to
tion in the veterinary literature regarding the use of distinguish between chronic pancreatitis as a solitary
early enteral nutrition in cats with severe pancreatitis, disease entity and the presence of multiorgan inflamma­
the author uses this modality regularly, and quite tory disease (so‐called feline inflammatory disease or
aggressively. In many cats, assisted feeding devices such “triaditis”). Initially, dietary modification, typically by
as esophagostomy tubes are placed during the first use of a novel protein source or hypoallergenic diet, is
24–36 hours of hospitalization to achieve early return suggested. In contrast to dogs, where fat restriction is a
to feeding. For both hepatic lipidosis and diabetic cornerstone of management for most cases of chronic
ketoacidosis, a return to caloric intake is critical to their pancreatitis, fat restriction is not recommended in the
successful management, and the presence of pancreati­ cat due to their high constitutive requirement for both
tis (either as an inciting disease or a complication) does fat and arachidonic acid intake. Many cats will respond
not alter the importance of a return to positive caloric to dietary manipulation; in those who fail to respond to
balance in these diseases. dietary manipulation, it is rational to consider antiin­
flammatory or immune modulatory therapies, assuming
that no other co‐morbidities are present that would con­
Outpatient Management of Cats with traindicate the use of these medications.
Chronic Pancreatitis
A common additional finding in cats with chronic
Cats presenting with less severe clinical signs, perhaps pancreatitis, particularly in those with significant gastro­
with histories of vomiting, weight loss or other gastroin­ intestinal disease accompanying their pancreatic disease,
testinal signs but without significant abnormalities on is the presence of hypocobalaminemia. Cats with hypoc­
screening biochemical panels, can typically be treated on obalaminemia (low vitamin B 12 ) are known to be less
an outpatient basis. In these patients, collection of sam­ responsive to treatment for other diseases, such as
ples for specialized testing (Spec‐fPL) is recommended, chronic inflammatory bowel disease, if this hypocobala­
but there is less utility to the patient‐side testing, as these minemia is not addressed via supplementation.
patients will be treated on an outpatient basis in the same Supplementation of cats with cobalamin is straight­
manner regardless of the initial patient‐side test result. forward, and can be carried out using injectable or oral
Cats that had originally presented with a suspicion of supplementation regimes. In some cats, particularly
severe pancreatitis should also transition to this more those with diffuse small intestinal disease, serum folate