Spot Check Tests Veterinarians' Knowledge of Acute Pancreatitis

This Spot Check is based on information from drip.vet’s continuing education: Acute Pancreatitis.

Signalment

• Chester, 5-year-old male neutered Miniature Schnauzer, 7.9 kg

Presenting Complaint

• Vomiting & acute anorexia

Relevant History

• 72-hour history of paroxysmal vomiting (3 episodes total, vomitus described a yellow bile), restlessness, and acute anorexia (no food ingestion for 24 hours)
• 1 other miniature schnauzer in home; has a history of chronic pancreatitis due to hyperlipidemia
• No travel history outside of Ohio
• No known toxin exposure, foreign body ingestion, or dietary indiscretion
• Regular diet: Hill’s Prescription Diet i/d low-fat (the other dog’s diet)

Physical Examination

• Lethargy
• 5% dehydrated
• Icterus (scleral, gingival, soft palate, dermal)
• Generalized abdominal splinting with no overt masses or positive ballottement

Diagnostic Tests

• Blood pressure: 137 mmHg systolic via Doppler
• CBC: HCT 57%, PLT 237 K/uL, neutrophils 18.3 K/uL, lymphocytes 0.67 K/uL
• CHEM: GLU 177 mg/dL, ALB 2.7 g/dL, ALT 341 U/L, ALP 367 U/L, TBIL 1.7 mg/dL, Na⁺ 158 mmol/L, K⁺ 3.3 mmoL/L, tCa²⁺ 7.9 mg/dL, CHOL 479 mg/dL, TRIG 1357 mg/dL
• UA: USG 1.053, pH 7.5, 1+ protein, inactive sediment
• 3v AXR: reduced serosal detail in cranial abdomen, generalized mild small intestinal gas distension without mechanical ileus
• SNAP cPL: 576 ug/L

Plan

You inform Chester’s family he is living with acute pancreatitis secondary to idiopathic familial hyperlipidemia. You recommend hospitalization for supportive care to include intravenous fluid therapy, multimodal analgesia, multimodal anti-emetic therapy, and appetite stimulation. Unfortunately, the family is unable to heed your recommendations for hospitalization, so you develop a logical outpatient treatment plan with the family that includes subcutaneous fluids, maropitant, gabapentin, and mirtazapine. You also instruct the family to continue to feed Hill’s Prescription Diet i/d low-fat or 50:50 mixture of boiled white meat chicken and rice.

B: Fenofibrate

Rationale

Acute pancreatitis is traditionally considered a sterile process, so routine administration of antimicrobials is not indicated. There are no controlled studies to show benefit of feeding pancreatic enzyme replacer to dogs without exocrine pancreatic insufficiency (EPI). Cyclosporine may be beneficial to some dogs with chronic pancreatitis; use for patients with acute pancreatitis is not recommended at this time. Fenofibrate activates peroxisome proliferator activated receptors that increase lipoprotein lipase levels and subsequently increases the clearance of very low-density lipoproteins and triglycerides.