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• Supplement hypocobalaminemic patients • Ultimately, attempt to wean the patient off • In dogs, negative prognostic factors include
with PO or SQ vitamin B 12 (p. 183). immunosuppressive therapy. If this is not hypoalbuminemia, hypocobalaminemia, and
VetBooks.ir • Noninfectious colitis may respond to interval regimen that achieves reasonable • Prognosis is guarded for dogs with moderate Diseases and Disorders
feasible, find the lowest-dose/longest dosing
severe mucosal lesions in the duodenum
• Address any infection (especially important
for granulomatous colitis [p. 395])
(endoscopy).
control of clinical signs.
sulfasalazine 10-30 mg/kg PO q 8h for 2
weeks, then taper to same dose q 12h for 2 Nutrition/Diet to severe IBD, and treatment failures are
common. This may be due to incorrect
weeks, then one-half dose q 12h for 2 weeks, • An elimination diet with novel proteins diagnosis, severe disease, concurrent disease,
and so on. Alternatively, olsalazine 10-20 (requires detailed nutritional history) or or poor owner compliance.
mg/kg PO q 12h. Monitor tear production hydrolyzed peptides is recommended in • In cats, lack of response to treatment should
(risk of keratoconjunctivitis sicca with sulfa most dogs and cats with IBD and is often motivate the clinician to reconsider the
drugs). successful as a sole treatment in mild cases. possibility of alimentary lymphoma. IBD
• In severe IBD, in dogs with PLE, or in cases • Alternatively, an easily digestible diet with in cats may progress to GI lymphoma.
in which empirical approaches have failed, low fat content (<20% metabolizable energy
immune suppression with glucocorticoids as fat) may be preferable in cases of severe PEARLS & CONSIDERATIONS
is indicated. IBD and PLE.
○ Prednisone (dog) or prednisolone (cat) 2 • Consider adding soluble fiber (psyllium 1-2 Comments
mg/kg PO initially q 12h for a few days, teaspoons/10 kg body weight per meal) for • IBD is a diagnosis of exclusion that requires
then q 24h for 2-4 weeks. After remission colitis. a systematic approach. In mild cases, dietary
of signs is achieved, decrease the dose by elimination trial is frequently successful.
25%-50% at 2-4 week intervals. Treatment Possible Complications Severe cases require a more intensive
and weaning period usually lasts for at • High doses of glucocorticoids may cause approach.
least 8-12 weeks. multiple systemic side effects (e.g., polyuria/ • Many cats may show only nonspecific signs.
2
○ Budesonide (dog 3 mg/m PO q 24h [p. polydipsia, panting). Differentiating IBD from small cell alimen-
609] for body surface area conversion]; cat, • Side effects reported with cyclosporine use in tary lymphoma in cats can be challenging.
1 mg/CAT PO q 24h) can be substituted dogs include decreased appetite and vomit-
for prednisone. Budesonide undergoes ing. Administering frozen capsules may help. Technician Tips
some first-pass hepatic metabolism, and • Azathioprine has been associated with After intestinal parasites have been ruled out,
low systemic drug concentrations may acute pancreatitis and hepatotoxicosis in many dogs with mild IBD respond within
cause fewer side effects. dogs and may cause bone marrow suppres- 2 weeks to an elimination diet. Obtain a
○ Addition of metronidazole to glucocorti- sion. Avoid use in patients with previous very detailed diet history, and emphasize the
coid treatment does not appear beneficial. history of pancreatitis and liver disease. As importance of a very strict diet. Avoid anything
• In glucocorticoid-refractory cases with chlorambucil, regular monitoring of other than the trial diet by mouth.
○ Cyclosporine 5 mg/kg PO q 12-24h (dog, CBC is advised, and monitoring of serum
cat); or liver enzyme levels is recommended at the Client Education
○ Dogs only: azathioprine 2 mg/kg PO beginning of treatment. • A realistic goal for treatment is to manage
q 24h for 2 weeks, then q 48h (can be • Immunosuppressive medications predispose the intestinal disease. Because a definitive
decreased to 1 mg/kg q 48h), or animals to secondary infections. cure may not be attainable, the goal is to
○ Chlorambucil: may be used as supplemental control clinical signs while limiting the side
immune-suppressive therapy in cats 2 mg/ Recommended Monitoring effects of treatment.
cat PO q 48h and in dogs with associated Regular evaluation of the body weight and • Because diet is of central importance to
2
PLE 4-6 mg/m PO q 24h for the first overall clinical condition is essential to adapt treatment, every effort should be made to
7-21 days, then taper to q 48-72h, or treatment. Recheck abnormal laboratory adhere closely to dietary recommendations.
○ Mycophenolate mofetil 10 mg/kg PO q parameters (e.g., serum albumin, cobalamin)
12h may also be used in dogs, although to evaluate treatment success. SUGGESTED READING
the author does not recommend it for this Dandrieux JRS: Inflammatory bowel disease versus
indication. Up to 20% of dogs develop PROGNOSIS & OUTCOME chronic enteropathy in dogs: are they one and the
diarrhea and other GI signs. same? J Small Anim Pract 57:589, 2016.
• Dogs with PLE at increased risk for throm- • Good for dogs and cats with mild forms AUTHOR: Frédéric Gaschen, Dr.med.vet., Dr.habil.,
boembolism; clopidogrel 1-2 mg/kg PO q that respond to an elimination diet DACVIM, DECVIM
24h after a loading dose of 10 mg/kg on • Guarded for dogs with idiopathic intestinal EDITOR: Rance K. Sellon, DVM, PhD, DACVIM
first day, or low-dose aspirin 0.5 mg/kg PO dysbiosis because they may require repeated
q 12h for prophylaxis long periods of antibiotic treatment

Influenza, Canine Bonus Material Client Education
Sheet
Online

BASIC INFORMATION evolved from an equine influenza and was Synonyms
first reported in Florida greyhounds in 2004. • Dog flu, canine influenza virus (CIV), H3N8
Definition H3N2 came from an Asian avian influenza and/or H3N2
Canine influenza is an uncommon but highly and was first reported in the Chicago area • Part of the canine infectious respiratory
contagious respiratory disease caused by type in 2015. disease complex (CIRDC) (layman’s term:
A influenza viruses that affect dogs. H3N8 kennel cough)

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