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Today's Ve T erinary Prac T ice | s eptember/ o ctober 2016 | tvpjournal.com a c ase of c anine a cu T e Pancrea T i T is Peer r eviewed 54 Serum Biochemical Profile Results Decreases in total protein and albumin are common in dogs with severe acute pancreatitis and other causes of peritonitis due to albumin loss into the peritoneal effusion. However, the pathogenesis may vary and there are many other differential diagnoses for decreased albumin, including: • Decreased production due to pregnancy, lactation, intestinal malabsorption, malnutrition, cachexia secondary to neoplasia, exocrine pancreatic insufficiency, or chronic liver disease • Accelerated loss due to protein losing enteropathy or nephropathy, hemorrhage, severe exudative skin disease, burns, intestinal parasitism, or high- protein effusions • Acute tissue injury/inflammation as a negative acute phase reactant (eg, pancreatitis, peritonitis). The mildly decreased total calcium was attributed to hypoalbuminemia, while the mildly decreased magnesium may have been caused by decreased GI absorption. The mild to moderate increase in alkaline phosphatase activity was most likely due to cholestasis secondary to pancreatitis, based on history and other findings. This finding is common in dogs with acute pancreatitis. Elevated alkaline phosphatase activity in adult dogs can also be caused by: • Intrahepatic or extrahepatic cholestasis • Endogenous or exogenous glucocorticoids or other drugs • Bone lesions (lytic or proliferative) • Active bone resorption (primary or secondary hyperparathyroidism). Urinalysis & Urine Culture Results Isosthenuria (urine specific gravity, 1.012) with mild proteinuria (sulfosalicylic acid test result, 1+) was present but, otherwise, unremarkable. Isosthenuria may have resulted from IV fluid administration during hospitalization. The urine culture was negative; this result may have been affected by the antibiotic therapy initiated 2 days prior to presentation. The antibiotic was discontinued during hospitalization because there was no evidence of a urinary tract infection and the diarrhea was considered a potential side effect of antibiotic therapy. Coagulation Panel Results DIC was indicated on the basis of thrombocytopenia, mildly prolonged prothrombin time and partial thromboplastin time, decreased antithrombin III, and increased D-dimers, but there were no clinical signs of thrombosis or bleeding. Canine cPL Result • Abnormal SNAP cPL (Figure 1) indicated a value in the gray zone (200–400 mcg/L) or one consistent with pancreatitis (> 400 mcg/L). • Follow-up Spec cPL (idexx.com) was 1678 mcg/L (reference range, ≤ 200 mcg/L) and, thus, consistent with pancreatitis. Table 4. Results of Coagulation Panel VARIABLE REFERENCE RANGE RESULTS (DAY 1) RESULTS (DAY 5) RESULTS (DAY 7) Prothrombin time (s) 6–7.5 8.3 H 8.4 H 10.5 H Partial thromboplastin time (s) 7.1–10 15.6 H 11.7 H 16.3 H Antithrombin III (%) > 114 53.3 L 53.4 L 79.8 L D-Dimer (ng/mL) 116.2–371.5 > 5250 H > 5250 H > 5250 H H = high; L = low FIGURE 1. Positive result on a SNAP cPL test. The spot on the right (patient spot) is darker than the control spot on the left side, indicating a serum cPL concentration either in the gray zone or diagnostic for pancreatitis, and requiring a serum Spec cPL test to differentiate between them.