2012
DOI: 10.1177/1098612x12458101
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Hyperammonaemia due to cobalamin malabsorption in a cat with exocrine pancreatic insufficiency

Abstract: A 10-year-old domestic shorthair cat showed anorexia, lethargy and ptyalism with hyperammonaemia. Portosystemic shunts were not identified by computed tomography angiography. Biopsy results revealed mild interstinal nephritis and no lesion in the liver. Analysis of urine revealed the presence of a high methylmalonic acid (MMA) concentration. Serum cobalamin (vitamin B(12)) and serum feline trypsin-like immunoreactivity levels were also markedly low. The cat was diagnosed as having exocrine pancreatic insuffici… Show more

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Cited by 14 publications
(17 citation statements)
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“…Exocrine pancreatic insufficiency (EPI) is characterized by inadequate production of pancreatic enzymes from pancreatic acinar cells and has been previously considered rare in the cat . The related literature consists mainly of case reports of confirmed or suspected EPI cases in cats, with only 10 reports published between 1975 and 2009 . In addition, there have been only 2 small case series of EPI in cats that have been reported in the English peer‐reviewed literature.…”
mentioning
confidence: 99%
“…Exocrine pancreatic insufficiency (EPI) is characterized by inadequate production of pancreatic enzymes from pancreatic acinar cells and has been previously considered rare in the cat . The related literature consists mainly of case reports of confirmed or suspected EPI cases in cats, with only 10 reports published between 1975 and 2009 . In addition, there have been only 2 small case series of EPI in cats that have been reported in the English peer‐reviewed literature.…”
mentioning
confidence: 99%
“…[7][8][9] Studies examining biochemical Cbl deficiency in cats have focused on serum MMA concentration, [7][8][9][10][11] and urine MMA concentration has been only sporadically reported. 6,[12][13][14] In humans, a linear relationship exists between serum and urine MMA concentrations. 15 In veterinary medicine, comparisons between serum and urine MMA concentrations are lacking.…”
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confidence: 99%
“…Although it is not known when depletion of cellular Cbl stores and increases in MMA levels begin in the course of subnormal serum Cbl concentrations, MMA is currently considered the best indicator of Cbl status in cats . Studies examining biochemical Cbl deficiency in cats have focused on serum MMA concentration, and urine MMA concentration has been only sporadically reported . In humans, a linear relationship exists between serum and urine MMA concentrations .…”
mentioning
confidence: 99%
“…Hyperammonaemia can develop secondarily to different mechanisms: (1) acquired urea cycle amino acid deficiency; (2) cobalamin deficiency leading to accumulation of methylmalonic acid (MMA) and subsequent impaired uptake of ammonia into the urea cycle; 16 , 17 and (3) congenital deficiency in urea cycle enzymes such as ornithine transcarbamylase (OTC) deficiency. 18 The plasma amino acid profile in this case revealed several urea cycle amino acids deficiencies (citrulline, ornithine and arginine), which could be responsible for the hyperammonaemia.…”
Section: Discussionmentioning
confidence: 99%
“…The MMA status could not be assessed in this cat; however, the few feline cases reported in the literature with hyperammonaemic encephalopathy and high MMA concentration had low serum cobalamin concentrations. 16 , 17 …”
Section: Discussionmentioning
confidence: 99%