Treatment of acute pancreatitis
Acute necrotizing pancreatitis in cats can be a significant therapeutic challenge. As with the treatment of dogs, the therapy
is supportive and aimed at restoring circulating blood volume while allowing the pancreas to "rest". If an inciting cause
can be identified, it should be corrected; however, greater than 90% of cases are idiopathic. The mainstay of treatment is
aggressive fluid therapy, and if the cat is vomiting, withholding food and water for 2-3 days. Colloid support can be obtained
with hydroxyethyl starch (Hetastarch) or plasma if it is available. If the cat is unable to tolerate water or food after the
2-3 day period, alternative routes of nutritional support must be considered to prevent development of hepatic lipidosis or
protein/calorie malnutrition and immunosuppression. If the cat is not vomiting, placement of an esophagostomy (E) or percutaneous
endoscopic gastrostomy (PEG) tube are reasonable alternatives – especially in cats with known or suspected hepatic lipidosis
as a concurrent problem. In vomiting cats, either parenteral (IV) nutrition or placement of a jejunal feeding tube is optimal.
The key point is this: you can't starve cats with pancreatitis. In cats with chronic, low grade pancreatitis this is even
a more important aspect of long term management. Another important aspect of therapy that must be considered in cats with
pancreatitis is pain management (whether or not they show overt pain this is important). Careful palpation in most cats will
reveal cranial quadrant pain in cats with significant pancreatic inflammation. Pain relief can be achieved with buprenorphine
(0.005-0.01 mg/kg IV, or IM q 4-8 hr), meperidine (1-2 mg/kg IM q2-4 hr), or butorphanol (0.2-0.4 mg/kg IM q2-4 hr). In addition,
low dose CRI ketamine or lidocaine infusions are effective in reducing somatic pain, and lidocaine at these low doses has
prokinetic activity. Morphine should be avoided as it can cause pancreatic duct spasm. The other aspects of supportive therapy
to consider are antibiotic therapy, control of vomiting, and anti-coagulants (for cats in DIC). Antibiotic therapy is generally
indicated in all cats with severe pancreatitis, or in cats with systemic inflammatory response syndrome (SIRS) as the risk
of bacterial translocation and secondary sepsis are considerable. In general, broad spectrum antibiotics that cover intestinal
aerobes and anaerobes should be chosen. Cefotaxime at a dose of 50 mg/kg administered intramuscularly every eight hours prevents
bacterial colonization of the pancreas.
Therapy of chronic pancreatitis is somewhat controversial because there are no evidence based studies yet available reporting
specific therapeutic approaches that are beneficial. Many have advocated the use of steroid therapy, and in some cats with
chronic pancreatitis this may be reasonable, where LP inflammation is the primary problem causing clinical signs. However,
in end stage cats where fibrosis and pancreatic degeneration, not inflammation, is occurring, steroids would be expected to
be counterproductive. At this time, appetite stimulation (using cyproheptadine) and pain control (buprenorphine) are the most
commonly recommended therapeutic approaches. Pancreatic biopsy is the most effective means of providing the information needed
to determine the best course of therapy in these cats. At this time, fluid therapy to maintain hydration, appetite stimulation
and a highly digestible or hypoallergenic diet, pain control, and judicious use of steroids are the mainstay of therapy. Further
work on the underlying causes of this disease are needed to better define therapy.
Nutritional therapy of pancreatitis
The diet chosen should be highly digestible and palatable, but the concept of low fat diet to reduce stimulation of pancreatic
secretions is not recognized as an important aspect of therapy (as it is in dogs) due to the different causes and histologic
types (LP) pancreatitis. Ultimately, the goal is to find an appropriate diet for the cat that is highly digestible, commercially
available and acceptable to the cat. An important point about feeding cats during this period is to avoid force feeding –
not only because it is very difficult to achieve the appropriate level of caloric intake by this method, but also because
it can induce food aversion.
Steiner, J. Feline Pancreatitis. Vet Clin N Am, 2003.
Washabau, R. Feline Pancreatitis. August's Consultations in Feline Internal Medicine, 2006.