Pancreatitis is inflammation of the pancreas, a gland which assists with the
digestive process and controls the hormones which regulate blood sugar.
CKD cats sometimes also have pancreatitis. To confuse matters, pancreatitis may
sometimes cause elevated creatinine levels.
If your cat has relatively low creatinine (in the 2s USA, or below 200 international) yet seems lethargic and far more ill than that mild
level of kidney failure would suggest, ask your vet to rule out pancreatitis.
The pancreas is a gland located under
the stomach with two main roles:
endocrine (hormonal), i.e. it controls
the hormones (insulin and
glucagon) which regulate blood sugar levels.
exocrine, i.e. it assists with the digestive process
by producing digestive enzymes
Usually it is the exocrine function which is affected.
The pancreas becomes inflamed, and the enzymes which it would normally
release into the intestines are instead released into the pancreas itself,
causing pain and inflammation. The liver may also be
below). If the part of the pancreas responsible for endocrine function
also becomes damaged, diabetes may develop. During pancreatitis, toxins move
throughout the body, and in the worst cases, respiratory failure or brain
damage may result, though fortunately such severe effects are uncommon.
Pancreatitis can be either acute or
chronic. Acute cases often resolve completely, whereas cats with chronic
pancreatitis may have flare-ups at intervals.
Vista Vet has
a very helpful overview of feline pancreatitis.
There is also a condition called feline triaditis.
A cat with triaditis suffers from the triple whammy of inflammation of the
pancreas, the liver (usually in the form of cholangiohepatitis) and the intestines (IBD
or inflammatory bowel disease).
Often the cause is never discovered,
but cats with CKD who have
or cats with diabetes or
be at increased risk. Cats who suffer trauma, such as from an accident,
also at risk. Many cats with
hepatic lipidosis go on to develop
pancreatitis, and the prognosis is more guarded for such cats.
It is gradually becoming apparent that pancreatitis is far more prevalent in
cats than was previously thought.
Prevalence and histopathologic characteristics of
pancreatitis in cats (2007) De Cock
HEV, Forman MA, Farver TB & Marks SL Veterinary Pathology44
pp39-49 found that pancreatitis "is common in cats, with an overall study
prevalence of 67%, including 45% of apparently healthy cats." They also
found that chronic pancreatitis is more likely in older cats. If your cat
exhibits the symptoms described below, ask your vet to rule out
Unfortunately pancreatitis does not have a clear-cut set
of symptoms unique to the disease.
In one study, 100% of cats exhibited lethargy,
and 97% exhibited poor
appetite, and these symptoms have also been observed in other studies. Other common symptoms (seen in over 50% of
cats with pancreatitis) include rapid breathing, low
temperature and jaundice. Some cats may appear to be in
pain, and/or may not want to be touched. Others may vomit, or develop
ascites (fluid in the abdomen).
I have found that
some CKD cats who have relatively low creatinine levels (in the low 2s USA,
or below 200 in international values) but who act a lot sicker than you
would expect a cat with such low numbers to act actually have pancreatitis
in addition to CKD.
Idexx refers to cats with pancreatitis as ADR cats - cats who "ain't
doing right" (which their UK site describes as "under the weather"). If your
cat is off colour with no obvious cause shown in standard bloodwork,
Ultrasound is often used initially to see if there are
any changes in the pancreas. If so, the vet may order further tests. However,
it can be hard to detect the pancreas on
ultrasound, and ultrasound may
not detect pancreatitis in every cat with
This is the only definitive way to diagnose
pancreatitis, but it is invasive, and is usually no longer necessary in most cases since the
development of the spec fPL test.
There is now a special blood test for pancreatitis in cats (see
below) but your vet may
initially suspect pancreatitis from your cat's symptoms and certain results
in general bloodwork (known as blood chemistry).
Up to 50% of cats with pancreatitis have low
calcium levels (hypocalcaemia).
creatinine may be elevated because of
pre-renal azotaemia. White blood
cells are usually high.ALT and AST,
both liver enzymes, are often elevated, and
the cat may be anaemic.
In dogs with pancreatitis, amylase and lipase (pancreatic
enzymes) are often elevated, but unfortunately these will not necessarily be
elevated in cats with pancreatitis, so normal levels do not rule out
Pancreatitis in cats (2004) Williams D
Presentation to the World Small Animal Veterinary Association World Congress
explains that amylase and lipase are not useful in diagnosing pancreatitis
Spec fPL Test
This test was developed by Idexx Laboratories in conjunction with Texas A&M
University (TAMU) (TAMU developed the original test for pancreatitis in
cats). Although this test is slightly less accurate than the PLI test (see
it is available from Idexx laboratories around the world, it is probably
easier for most people to have this test done. Results are usually available
quickly, within a day. When a member of
Tanya's CKD Support Group
had it done in March 2011, it cost US$54.
In theory cats should be fasted for this test, but it is not essential.
Results are interpreted as follows:
If the level is below 3.5, the cat probably does not have pancreatitis and
other causes should be considered.
If it is between 3.6 and 5.3, the cat may have pancreatitis, and the test
should be re-run in two weeks.
If it is over 5.3, the cat probably does have pancreatitis.
There is also a less precise type of test called the Snap fPL test. This
basically tells you if your cat has a level above or below 3.5, i.e. whether
pancreatitis is likely to be present or not. The advantage of this test is
that it can be run in the vet's office with results within a few minutes.
However, since it is slightly less accurate, it is wise to have the Spec fPL
test run as well if you suspect pancreatitis.,
Idexx has detailed information about the
comparative accuracy of the two tests.
The Pancreatic Lipase Immunoreactivity (PLI) test
was the forerunner to the spec fPL test. It was
Texas A&M University
(TAMU) and could
therefore only be run by them. This test was slightly more accurate
than the spec fPL test at confirming pancreatitis in cats,
but the cat needed to fast for
12 hours before having blood drawn for the test,
and the results could take up to a week (although when we had it done for
Harpsie, it took a dreadful 17 days!). Texas A&M
no longer offers this test but instead use the
spec fPL test.
The trypsin-like immunoreactivity (TLI) test
is another older test, also devised by
Texas A&M University, which has also been superseded by the
spec fPL test.
This test measures two enzymes,trypsinogen and
trypsin, which are only produced bythe pancreas. A cat needs to fast for 12
hours before having blood drawn for this test. TLI is
notalways elevated in cats
with pancreatitis, so a normal TLI test does not rule outpancreatitis. If you have the spec fPL test run at TAMU,
however, they may ask that you have this test done together with a folate
Cobalamin (Vitamin B12) and
Up to 50% of cats with pancreatitis have below normal
levels of folate, particularly if they are also suffering from
Texas A&M University
can measure levels of cobalamin and folate, and explains why they are important.
It is difficult to treat pancreatitis in the sense of curing it, so the goal of treatment is
to keep the cat as comfortable as possible by treating whichever symptoms
are present. Fluid therapy, diet and pain control are the main focus.
Since cats with pancreatitis are often dehydrated,
therapy is often used to rehydrate them and make them feel better.
Intravenous fluids (IV or "a drip") at the vet's office may be used
initially, and thereafter you may need to give sub-cutaneous fluids at home.
A common part of treatment for pancreatitis in humans and
dogs is fasting However,
does not seem to be particularly effective for cats, who
have a physiological need to eat relatively frequently, and can be
problematic for CKD cats in particular because the lack of food may permit
levels of stomach acid
Feeding little and often is usually more effective,
unless the cat cannot stop vomiting, in which case the vet may wish to treat
the cat in hospital.
It is often recommended that humans and dogs with pancreatitis should
reduce their fat intake.There
is no evidence that reducing fat intake is essential for cats, but
some people do find that feeding a lower fat diet does seem to help their
Your vet may prescribe a prescription
food such as
Hill's i/d to help manage the condition.
The phosphorus level is a little high for a CKD cat at 0.86%, and it
is not low fat at 24.1%, but if your cat will eat it and can tolerate it, it
could be a good choice to help your cat through the crisis.
Treating feline pancreatitis (2009) is a
helpful article by Dr J Robertson DX ConsultWinter 2009
pp12-13 which explains why fasting is not recommended.
Feline GI pearls
(2001) is a presentation by Dr M Scherk to the World Small Animal
Veterinary Association World Congress 2001, which explains why fasting
and reducing fat is of little benefit to cats with pancreatitis.
Some cats cope better with pancreatitis
if they are given pain medications.
or Vetergesic) is commonly
used in cats with pancreatitis. If your cat appears dull, or is tender in the abdominal
area, discuss this possibility with
Pancreatitis may cause malabsorption of
particularly in cats who also have IBD.
Texas A&M University
provides a treatment protocol if required, which calls for Vitamin
B12 injections because oral supplementation is unlikely to be effective in
cats with pancreatitis.
Sometimes cats with pancreatitis are given antibiotics.
Metronidazole (Flagyl) is commonly prescribed because it has
anti-inflammatory properties.It tastes utterly foul, so if
your vet prescribes this, try to give it in a gelcap.
One commonly used anti nausea medication
which is very effective is ondansetron (Zofran).
You may also be
metoclopramide (Reglan), which
works by regulating stomach contractions, and therefore
is helpful for nausea
caused by a lack of motility in the stomach; but since
it can cross the blood/brain barrier, it also acts on the brain to
control feelings of nausea, which can be helpful to cats
There are several medications which can be most effective in
controlling stomach acid, thus reducing vomiting and nausea, and increasing
appetite, which can be helpful for cats with pancreatitis. There is more
information about these treatments
Humans with pancreatitis have reported that they
experience less pain when given digestive enzymes, though others have
apparently felt worse. It is not known if the same applies to cats, but some
vets do recommend trying them. Viokase is one commonly used brand.
Obviously, if you feel the digestive enzymes are making your cat worse, you
should speak to the vet about stopping them.
Since there is often inflammation present in cases of
pancreatitis, corticosteroids may be prescribed to help dampen down the
inflammation. A commonly used corticosteroid in cats is pred (prednisone or
prednisolone). Cats metabolise prednisolone better than prednisone (they
have to convert prednisone into prednisolone in their bodies anyway before
they can use it) so it is usually better to give prednisolone in the first
Bioavailability and activity of prednisone and
prednisolone in the feline patient (2004) Graham-Mize CA &
Rosser EJ Veterinary Dermatology15 (s1), pp 10 supports this view.
Your vet may want to start at a higher dose
to reduce the inflammation, then reduce to a maintenance dose. If your cat
can eventually come off the steroids, they
should not be stopped suddenly, but rather
the dose must be tapered.
This is because using corticosteroids may suppress the adrenal
glands' ability to produce cortisone naturally; so tapering
the dose minimises the risk of adrenal insufficiency occurring as a result.
has more information about steroids.
One study into humans with severe acute pancreatitis,
Probiotic prophylaxis in predicted severe acute
pancreatitis: a randomised double-blind placebo-controlled trial
(2008) Besselink MGH, van Santvoort HC, Buskens
E, Boermeester MA, van Goor H, Timmerman HM, Nieuwenhuijs VB, Bollen TL, van
Ramshorst B, Witteman BJM, Rosman C, Ploeg RJ, Brink MA, Schaapherder
AFM, Dejong CHC, Wahab PJ, van Laarhoven CJHM, van der Harst E, van Eijck
CHJ, Cuesta MA, Akkermans LMA, Gooszen HG The Lancet371(9613)
pp651 - 659, found that using
probiotics more than doubled the risk of death. The same may not apply to
cats but I would not take the risk. If you are using probiotics, therefore,
I would speak urgently to your vet about stopping them.