All too often, it seems, we see a member post that, suddenly, Kitty is not eating well and seems “off”. Kitty might seem lethargic, the blood glucose (BG) may have increased, he/she might be sitting in a meatloaf position, hiding, and/or generally does not seem “right”. Perhaps Kitty also vomits. With symptoms like these, it’s possible that kitty has pancreatitis and a vet visit is in order. Pancreatitis can be acute or chronic and can have a sudden onset. Pancreatitis often has no known cause; however, sometimes trauma, infection, viruses, or exposure to drugs can cause pancreatitis. Many cats have mild forms of chronic pancreatitis which may be associated with concurrent conditions, most notably inflammatory bowel disease (IBD), but also hypertriglyceridemia and/or hypercalcemia, triaditis, cholangitis, cholangiohepatitis, hepatic lipidosis, and/or diabetes. Very little is known about appropriate therapy in these circumstances and management is often limited to evaluation and treatment of the concurrent condition(s) and careful monitoring of the pancreatitis. Diagnosis Texas A&M University (TAMU) in conjunction with IDEXX has developed the Spec fPL test. Some veterinarians use the SNAP fPL which only indicates normal or abnormal results. The more definitive test, the Spec fPL, requires that a blood sample be sent to TAMU or IDEXX. It is important to note that a 6 - 12 hour fast is required for the most accurate results. It is also recommended to simultaneously have the blood checked for cobalamin and folate levels as these can be low in a cat with pancreatitis and supplements can aid in recovery. Symptoms Cats with pancreatitis, even when severe, often present with non-specific clinical signs. In one study of 40 cats with severe pancreatitis the following clinical signs were reported: • lethargy (100%) • anorexia (97%) • dehydration (92%) • hypothermia (68%) • vomiting (35%) • abdominal pain (25%) • a palpable abdominal mass (23%) • shortness of breath (dyspnea) (20%) • loss of muscle coordination (ataxia) (15%) • diarrhea (15%) In diabetic cats, BG levels often increase possibly in response to pain but also inflammation. Treatments Fluid Therapy: It’s important to ask your vet about administering subcutaneous (subq) fluids especially if the kitty has been vomiting and is dehydrated. Fluid therapy can also help restore any electrolyte imbalances. In some cases, your vet may want to administer IV fluid therapy at the clinic. This video on How to Give Subcutaneous Fluids to your Cat at Home will assist you if the vet believes subq fluids are warranted. Addressing Pain: Cats tend to hide pain well; however, pancreatitis is a painful condition and cats should be given some type of pain therapy. For diabetic cats, addressing pain often helps to lower BG levels. Buprenorphine (bupe) is most commonly used to address pain. It can be administered by the CG in a subcutaneous injection or it can be given as liquid applied to the gums or in the cheek pouch for quick absorption. • While compounding is not necessary, if oral bupe is compounded, the prescription should state “sugar and sweetener free” and can be flavored with chicken or fish to make it more palatable. • Dosing varies based on weight of the cat and usually has a fairly liberal range. • Bupe is normally dosed every 8 hours. If your cat becomes agitated or has a history of becoming agitated with narcotics, inform your vet. • Other forms of pain relief can include fentanyl patches and tramadol but these may come with more observable side effects. Antiemetics: Many cats with pancreatitis experience nausea (e.g., showing interest in food but just licking/sniffing and walking away, lip licking, lip smacking and teeth grinding). Dolasetron (Anzemet®) and ondansetron (Zofran®) are very effective for addressing nausea in cats. Shop around for the least expensive source for ondansetron or purchase with a prescription at an online pharmacy such as Thriving Pets. Ondansetron is typically administered at ¼ of a 4mg tablet twice daily. Dolasetron is acquired through the vet. Maropitant citrate (Cerenia® ) is also effective for controlling vomiting and nausea. It has become a popular and effective antiemetic in cats and can be administered in a subcutaneous injection if kitty is vomiting. Since it is a veterinary drug, the pill form can be obtained from your vet or with a prescription at online sources (such as Thriving Pets). Cerenia is generally administered at 0.5mg/lb (1mg/kg) and for a maximum of five days consecutive days. Injectable cerenia must be obtained from the vet. Nutritional Support: Previously, it was thought that cats with pancreatitis should be fasted or put on a low fat/high fiber diet. Current treatment has deemed this unnecessary. Some internal medicine specialists believe a cat with chronic, recurrent pancreatitis might benefit from a low-residue diet. It is important to discuss the dietary needs with the vet but it is typically trial and error. Every effort should be made to ensure the kitty eats even if the CG must assist feed. The Feline Assist Feeding Group is an excellent resource for any CG who needs to assist feed their kitty. Assist feeding involves syringe feeding, finger feeding, feeding on a baby spoon, etc. A great video for learning to assist feed is How to Assist Feed a Cat. If it is not possible to assist feed, the CG should discuss with the veterinarian the possible need for an esophageal tube (e-tube) in order to prevent hepatic lipidosis. Cats do quite well with feeding tubes. Appetite Stimulants: Cyproheptadine and Mirtazapine (Remeron®) are two effective appetite stimulants in cats that have an appetite and are not completely anorexic or nauseous. Also, remember that there are non-drug methods to entice a cat to eat. Discuss with your vet whether giving an appetite stimulant is appropriate for an anorexic cat. If your cat is nauseous, your vet can prescribe an anti-nausea drug as discussed above. It is possible that once the nausea is addressed, the kitty may regain his/her full appetite and not need an appetite stimulant. Steroids: Steroid treatment using such drugs as prednisone, prednisolone, or dexamethasone can be useful for treating chronic feline pancreatitis. Insulin needs “might” increase with the use of steroids if the veterinarian believes steroid therapy is required. Antibiotics: Antibiotics are not typically prescribed for pancreatitis as it is generally an inflammation as opposed to an infection. However, if bacterial infection of the intestinal tract or liver (cholangitis) is present, antibiotic therapy is appropriate and your vet should inform you as to the appropriate type of antibiotic and course of therapy. Some antibiotics can cause nausea and vomiting and diarrhea so it is important the CG work closely with the vet to determine the best antibiotic to address any infection. Antacids: Discuss the need for an antacid such as Pepcid AC 10mg (famotidine) with your vet. Many cats with pancreatitis do not require an antacid and, if there is no indication of an acid tummy such as clear, foamy vomiting or hunching over (which can also be a sign of pain), then antacids should generally not be given. The typical dosing for Pepcid AC is ¼ of a 10mg tablet at a maximum of twice a day, 30 minutes before food. Methylcobalamin Supplementation and SAME-e: If the kitty’s cobalamin is low as indicated by the cobalamin test, supplementation with methyl B12 is appropriate to discuss with your vet. Zobaline is the best form of methyl B12 for diabetic cats. For cats with pancreatitis or inflammatory bowel disease (IBD), malabsorption issues might prevent appropriate absorption of oral methyl B12. It is important to discuss with your vet whether B-12 (cyanocobalamin) injections would better address cobalamin deficiencies when pancreatitis or IBD is present. S-Adenosylmethionine (SAMe) may also be indicated as a supplemental treatment to consider in consultation with your vet. SAM-e is contained in veterinary products such as Marin™ (vitamin E and silybin), Denosyl® (SAMe) and Denamarin® (SAMe and silybin) which are available for cats. Monitoring: It’s important to closely monitor the kitty’s BG during treatment. As the kitty improves, the BG will most likely drop, perhaps quickly, and insulin needs will decrease. It is also important to monitor food intake and weight. Additional Resources These additional resources are provided for education; the veterinary articles may be printed and taken to the vet for further discussion. IDEXX Roundtable Discussion (2008) IDEXX Roundtable on Diagnosing and Managing Feline Pancreatitis IDEXX Treatment Recommendations for Feline Pancreatitis 2010 World Small Animal Veterinary Association Feline Outreach--Pancreatitis and Pancreatic Insufficiency MarVista Vet on Pancreatitis Tanya’s CRF Website on Pancreatitis Pharmalogical Control of Vomiting is a technical article written by a vet for vets on controlling nausea and vomiting in cats. IDEXX also now has an online learning center where you can view On Demand Educational Courses and Webinars. You must register for an IDEXX (free) account. It is free to view the courses and webinars. What you Need to Know about Feline Pancreatitis The Facts About Pancreatitis and your Feline Advances in Diagnosing and Treating Feline Pancreatitis Advances in Management of Pancreatitis Suggested Guidelines for Suspected Feline Pancreatitis ABCs of Feline Pancreatitis How to Interpret the Snap fPL Test How to Talk with Cat Owners About Feline Pancreatitis Sometimes Skinny, Sometimes Not: Chronic Pancreatitis in Cats The information in this post is in no way intended to substitute for veterinarian care and should not be used for home treatment of pancreatitis unless agreed upon by and under the supervision of your veterinarian. This information is strictly provided as reference material for discussions with the vet and to provide the CG with a basic knowledge to prepare specific questions for the veterinarian.