Today's Veterinary Practice

SEP-OCT 2016

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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 58 • Because maropitant and the 5-HT 3 antagonists act on different receptors, we commonly use both types of drugs concurrently in patients with severe pancreatitis. • Metoclopramide (a dopamine inhibitor), which has been traditionally used, is not currently recommended due to its low efficacy as an antiemetic and its effect on splanchnic perfusion. 19 Plasma Transfusion The proposed advantage of using plasma in dogs with acute pancreatitis includes supplementation of alpha-2-macroglobulin (scavenger proteins for activated proteases in serum), coagulation factors, and anti-inflammatory factors. 20 Due to the high cost and lack of confirmed benefits in dogs, however, plasma transfusion is generally reserved for dogs suspected to have DIC. Antibiotics Bacterial complications are extremely rare in dogs with naturally occurring acute pancreatitis. Only dogs with overt bacterial infections or a strong suspicion for such an infection should be given broad spectrum antibiotics. Amoxicillin/clavulanate acid (12.5–25 mg/kg PO Q 12 H) or ticarcillin (33–50 mg/kg IV or IM Q 4–6 H) has been recommended as first choice antibiotics, if needed, but this recommendation is based on expert opinion rather than critical research. 21 Corticosteroid Therapy No prospective studies demonstrate beneficial effects of corticosteroid therapy in dogs with acute pancreatitis. Reserve corticosteroids for patients who have critical illness-related corticosteroid insufficiency causing refractory hypotension, even with aggressive fluid therapy. IN SUMMARY Canine acute pancreatitis is a reversible disease when diagnosed promptly and managed appropriately. Avoiding known risk factors and careful monitoring after the first episode are important in prevention of progression to chronic pancreatitis or recurrent acute pancreatitis. CBC = complete blood count; CECT = contrast- enhanced computed tomography; CE-MDCT = contrast-enhanced multidetector helical computed tomography; cPLI = pancreatic lipase immunoreactivity; CRI = constant rate infusion; DIC = disseminated intravascular coagulation; GI = gastrointestinal; RBC = red blood cell References 1. Mansfield CS, James FE, Robertson ID. Development of a clinical severity index for dogs with acute pancreatitis. JAVMA 2008; 233:936-944. 2. Tvarijonaviciute A, Garcia-Martinez JD, Caldin M, et al. Serum paraoxonase 1 (PON1) activity in acute pancreatitis of dogs. J Small Anim Pract 2015; 56:67-71. 3. Kylanpaa L, Rakonczay Z Jr, O'Reilly DA. The clinical course of acute pancreatitis and the inflammatory mediators that drive it. Int J Inflam 2012; 360685. 4. Talukdar R, Swaroop Vege S. Early management of severe Avoiding Risk Factors Table 5. Potential Risk Factors for Acute Pancreatitis in Dogs 19,22 • Canine babesiosis or leishmaniasis • Concurrent endocrine diseases, such as diabetes mellitus, hyperadrenocorticism, and hypothyroidism • Dietary indiscretion • Drugs, including azathioprine, potassium bromide, organophosphates, L-asparaginase, estrogen, furosemide, salicylates, sulfonamides, tetracycline, thiazide diuretics, zinc, and clomipramine • Hypertriglyceridemia (seen most commonly in miniature schnauzers) • Pancreatic ischemia (of any cause) • Reflux of duodenal fluid into the pancreatic ducts (secondary to abnormally high duodenal pressure resulting from vomiting or blunt trauma to the abdominal cavity) • s urgical manipulation and blunt abdominal trauma • s uspected genetic predisposition in certain breeds (eg, miniature schnauzer, s hetland sheepdog, Yorkshire terrier, miniature poodle) If identifiable, any risk factors should be discontinued or avoided when a patient has been diagnosed with pancreatitis (Table 5). Specifically, medications that have been shown to cause pancreatitis should be considered for discontinuation or replacement with another medication. Disclosure Statement Dr. s teiner is a paid consultant for Idexx Laboratories. Both the g astrointestinal Laboratory at Texas a & m University and Idexx Laboratories offer s pec cPL testing on a fee-for-service basis.

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