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Cobalamin Deficiency 183

• In some cases, antibiotic therapy may be prognosis is excellent. Prognosis may also be Technician Tips
discontinued as long as the high-fiber diet related to underlying disease if Clostridium is • Clinical signs related to systemic illness, such
VetBooks.ir • Probiotics may also be useful. PEARLS & CONSIDERATIONS • Supportive care and hygiene are the most Diseases and Disorders
is maintained.
as dehydration and fever, should be noted.
a secondary condition.
important aspects of patient management.
• Anecdotally, fecal transplant (p. 1105) has
had some success in otherwise healthy dogs.
It should be attempted only after other causes Comments Client Education
of disease have been ruled out and standard • There is no gold standard on how to treat In most cases, signs associated with this disease
treatments have failed. this disease; treatment is customized based on subside with supportive care, but some patients
specific abnormalities identified on physical may be chronically affected.
Nutrition/Diet exam and diagnostic testing.
High-fiber diets reduce clinical signs and speed • There is still some question about whether SUGGESTED READING
recovery. Koch’s postulates have been fulfilled regarding Weese JS, et al: The roles of Clostridium difficile and
causality of C. perfringens and this form of enterotoxigenic Clostridium perfringens in diarrhea
Recommended Monitoring enteritis. in dogs. J Vet Intern Med 15:374-378, 2001.
Based on the presence or absence of diarrhea AUTHOR: Steven L. Marks, BVSc, MS, DACVIM
and signs of systemic illness Prevention EDITOR: Rance K. Sellon, DVM, PhD, DACVIM
• Environmental exposure is a risk factor.
PROGNOSIS & OUTCOME • High-fiber diets may promote enteral health
and be preventive.
The prognosis depends on the presenting
condition of the patient. In most cases, the

Cobalamin Deficiency

Clinical Presentation
BASIC INFORMATION sources. Cobalamin is an important cofac-
DISEASE FORMS/SUBTYPES tor for a variety of biochemical reactions
Definition • Congenital (rare): defect in receptors for (e.g., amino acid metabolism, DNA
A reduced serum concentration of the B uptake synthesis).
vitamin cobalamin is usually secondary to insuf- • Secondary (common): caused by EPI, • Dietary cobalamin binds to intrinsic factor,
ficient intestinal uptake due to malnutrition/ intestinal dysbiosis (small intestinal bacte- which in dogs and especially in cats is
malabsorption. rial overgrowth [SIBO]/antibiotic-responsive mainly produced in the pancreas, serving
diarrhea [ARD]), chronic enteropathies (e.g., as a transporter for absorption at the distal
Synonym inflammatory bowel disease [IBD], lym- small intestine.
Vitamin B 12 deficiency, Imerslund-Gräsbeck phoma, histoplasmosis), any form of chronic
syndrome (congenital form) malabsorption/malnutrition; interference DIAGNOSIS
with ileal cobalamin uptake
Diagnostic Overview
Epidemiology HISTORY, CHIEF COMPLAINT Cobalamin deficiency is usually suspected as a
SPECIES, AGE, SEX • Congenital form: gastrointestinal (GI) possible secondary complication of GI disease
• Acquired form: dogs and cats (mean age for disorders, failure to thrive, hematologic and or exocrine pancreatic insufficiency. Measure-
cats: 7 years) biochemical abnormalities, proteinuria, seizures ment of serum cobalamin levels is the clinical
• Congenital form: young kittens and puppies • Acquired form: clinical signs of GI disease diagnostic test of choice.
(6-12 weeks old) most common
Differential Diagnosis
GENETICS, BREED PREDISPOSITION PHYSICAL EXAM FINDINGS • Chronic GI disease: IBD, intestinal dys-
Chinese Shar-pei, giant schnauzer, beagle, • Most dogs and cats with cobalamin deficiency biosis/SIBO/ARD, intestinal lymphoma,
Border collie, Australian shepherd show only clinical signs of GI disease (chronic histoplasmosis
diarrhea, vomiting, weight loss, poor body • EPI
RISK FACTORS condition), depending on the underlying cause.
• In theory, a pure vegetarian diet may cause • Neurologic signs have been reported Initial Database
cobalamin deficiency (reported in humans); occasionally in dogs and cats with selective CBC, serum biochemistry profile: to rule out
unlikely in dogs and cats eating commercial cobalamin deficiency (i.e., hyperammonemic other systemic disease
pet food encephalopathy, organic acidemia). • With congenital disease: normocytic non-
• Surgical resection of the ileum (main site of • Neutropenia and anemia (usually normo- regenerative anemia/pernicious anemia,
cobalamin absorption) cytic) are usually features of the congenital neutropenia
• Exocrine pancreatic insufficiency (EPI): form and occur rarely in acquired disease. • Panhypoproteinemia often identified with
in dogs and cats, the pancreas is a maldigestion/malabsorption
major source of intrinsic factor, which Etiology and Pathophysiology
is necessary for ileal absorption of • Cobalamin (vitamin B 12 ) is a water-soluble Advanced or Confirmatory Testing
cobalamin. vitamin produced exclusively by microor- • Measurement of serum cobalamin
• Severe and chronic small-intestinal disease ganisms. Animals are unable to synthesize ○ Reference range established at the GI
may damage ileal cobalamin receptors. cobalamin and depend on nutritional Laboratory at Texas A&M University

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