Treatment of acute pancreatitis in dogs

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Pancreatitis is a complex disease with metabolic complications and often requires clinical findings, laboratory tests and imaging studies for correct diagnosis.¹ The main treatment window for acute pancreatitis is within 36 to 48 hours. Unfortunately, most patients only reach the clinic after a few days of consistent vomiting and abdominal pain. David C. Twedt, DVM, DAVCVIM, went through different treatment options for severe acute pancreatitis, how they affect the patient, and which ones to avoid.

What causes acute pancreatitis?

High-fat diets are a trigger for pancreatitis, as are high triglycerides, as they are activated by pancreatic lipase and subsequently produce pancreatitis.¹ A study conducted primarily with Yorkshire terriers, toy poodles and miniature schnauzers delved into the main causes of acute pancreatitis. What these researchers determined were seven important risk factors: dog breed and breed size, lack of weight management, a previous history of gastrointestinal disease, diabetes, hyperadrenocorticism, and hypothyroidism.² With a disease that can easily lead to a poor prognosis, the right treatments are essential.

Which therapies to stay away from

During his session, Twedt covered a number of therapies to avoid and his reasoning behind this decision:

1. Anticholinergics

These drugs reduce GI motility—which is the movement and exit of food throughout the body—and do not benefit patients with ileus in their GI tract.

2. NSAIDs

Twedt said, “If an animal is hypovolemic and has reduced kidney function, (NSAIDs) can cause kidney failure.” They will also have a negative impact on any GI ulceration in the patient.

3. Corticosteroids

Years ago, veterinarians believed that corticosteroids were the cause of pancreatitis, which was ultimately disproved, Twedt explained. The outlook has shifted to questioning whether they should be used as treatment. Twedt informed the audience, “There was a nice study done that was published in 2021. Vets reviewed the literature that looked at 5 dog studies – 4 or 5 that were experimental – 5 human studies and 21 rodent studies and found , that steroids can affect a positive result.” For dogs with chronic pancreatitis, steroids seem to help, especially with an autoimmune component. However, studies to confirm this effect are ongoing, and Twedt hopes to have clarity within the next few years on whether corticosteroids will really help patients.

Conclusion

Concluding the lecture, Twedt insisted: “Early nutrition is very important for the patient. We try to get them interested in it as soon as we can.”

References

1. Tweeted DC. Treatment of acute pancreatitis in dogs: Are we ready for a paradigm shift? Presented at: American Veterinary Medical Association; Denver, Colorado. 14.-18. July 2023.
2. Hess RS, Kass PH, Shofer FS, Van Winkle TJ, Washabau RJ. Evaluation of risk factors for fatal acute pancreatitis in dogs. J Am Vet Med Assoc. 1999;214(1):46-51.