Nutritional management of acute pancreatitis in dogs and cats

Abstract

The nutritional management of veterinary patients with AP remains challenging. Based on clinical evidence in people, experimental animal studies, and preliminary studies in dogs and cats, the choice of EN over parenteral nutritional support during AP in dogs and cats appears to be beneficial and well tolerated. Optimization of nutritional therapies in dogs and cats including the use of immunonutrition during AP warrants further investigation.

Retrospective evaluation of ProcalAmine administration in a population of hospitalized ICU dogs: 36 cases (2010–2013)

“…The urban location of this hospital may, in part, account for this difference in patient cohorts. Additionally, the preferential use of EN over PN in most pancreatitic patients in recent years may help explain the change in patients selected for PN administration . Polytrauma can result in a marked stress response and significant protein catabolism.…”

Retrospective evaluation of the impact of early enteral nutrition on clinical outcomes in dogs with pancreatitis: 34 cases (2010–2013)

“…The ideal duration of fasting has not been identified in human or veterinary literature, and may likely be patient‐severity dependent if required at all. In fact, further imposed anorexia may be counterproductive to overall gastrointestinal health as avoidance of EN has been correlated to increased gut permeability, bacterial or endotoxin translocation, and immunosuppression . Additionally, the gut itself may either start or contribute to the systemic inflammatory response in AP …”

“…The traditional therapy for SAP is largely supportive with emphasis on analgesia, maintenance of fluid and electrolyte balance, and antiemetic therapy while the pancreas is “rested” by withholding food . However, this approach is complicated due to increased metabolic demands, substantial protein catabolism, gut‐derived inflammation, and potential bacterial translocation ultimately resulting in the development of systemic inflammatory response syndrome or sepsis .…”

“…The traditional therapy for SAP is largely supportive with emphasis on analgesia, maintenance of fluid and electrolyte balance, and antiemetic therapy while the pancreas is “rested” by withholding food . However, this approach is complicated due to increased metabolic demands, substantial protein catabolism, gut‐derived inflammation, and potential bacterial translocation ultimately resulting in the development of systemic inflammatory response syndrome or sepsis . In people, there have been numerous clinical trials performed demonstrating the benefit of decreased inflammatory complications associated with early enteral nutrition (EN) when compared with parenteral nutrition for treatment of acute pancreatitis (AP) .…”

“…A recent small pilot study of dogs with AP demonstrated no exacerbation in signs of pain or vomiting in the enterally fed group when compared to the parenterally fed group . However, there are no trials in veterinary medicine comparing early EN to the traditional therapy of nothing per os (NPO) in AP . Therefore, optimal nutritional management of AP in dogs remains unclear and warrants further research.…”