The recommendation for treatment of feline pancreatitis is largely supportive care. The ability of veterinary practitioners to diagnose pancreatitis in cats has improved dramatically during the last 10 years, but our ability to treat it has not changed much during this time.
Fluid therapy is recommended for treatment of pancreatitis in cats. Often they need to be hospitalized and administered intravenous fluids to correct dehydration and electrolyte abnormalities. Other routes of fluid administration are subcutaneously (under the skin) or through a feeding tube. Cats with pancreatitis often don’t feel well to drink enough water on their own.
Most cats with pancreatitis do not vomit, but if they do, treatment with anti-emetics is indicated. Dolasetron (Anzemet®) and ondansetron (Zofran®) act on the serotonin 5-HT3 receptors in the chemoreceptor trigger zone (CRTZ) in the brain. Metoclopramide (Reglan®) is probably not as good an anti-emetic in cats as it is in dogs and people. The reason is because it is a dopamine antagonist and cats are reported to have few central nervous system dopamine receptors in the CRTZ. Although maropitant citrate (Cerenia®) is only labeled for dogs, it has become increasingly popular as an anti-emetic for cats. It acts on the neurokinin receptors in the vomiting center in the brain.
Antacid therapy can be used to treat secondary gastritis that can occur with pancreatitis. H2-receptor antagonists, such as famotidine or ranitidine, can be given as an injection or orally. Another option is to use a proton pump inhibitor, which is a stronger antacid then an H2-receptor antagonist. The options for proton pump inhibitors are omeprazole (Prilosec®) orally or pantoprazole (Protonix®) as an injection.
Unlike dogs and people, cats with pancreatitis often do not appear to have abdominal pain on palpation. However, most cats with pancreatitis appear to benefit when treated with pain medication. Because of this, pain management is recommended in cats with pancreatitis. Opioids, such as fentanyl and buprenorphine, are probably the most widely used pain medications for cats. Other opioid options are butorphanol, morphine, and hydromorphone.
Cats with pancreatitis often do not have a bacterial infection. However, some veterinarians will treat them with antibiotics in case there is an infection. This is fine as long as the cat tolerates the antibiotics.
Cats with pancreatitis will have a decreased appetite. Mirtazapine (Remeron®) and cyproheptadine (Pericatin®) are appetite stimulants that can be given orally to a cat with pancreatitis. If they do not improve the cat’s appetite then it is imperative that a feeding tube is placed to assure adequate nutrition. An esophagostomy or gastrostomy tube can be placed in a cat under general anesthesia. This can be used temporarily by the owner to tube feed their cat until the pancreatitis resolves and the cat starts eating on its own.
There are no studies to support dietary choices for cats with pancreatitis. In dogs with pancreatitis there is strong evidence that high-fat foods cause pancreatitis. However, nutritional experts do not feel that high-fat foods cause pancreatitis in cats. Due to this difference the recommendation for cats with pancreatitis is to feed them caloric dense food that they can tolerate. If there is concurrent gastrointestinal disease then a prescription diet might be indicated.
Cobalamin (vitamin B12) can be decreased in cats with concurrent intestinal disease which is common for cats with pancreatitis. Therefore, measuring serum cobalamin levels in cats with pancreatitis is recommended. If the serum obalamin level is low then the cat should be supplemented with injectable cobalamin.
There are cats with pancreatitis that have “triaditis” which is a term used for cats that have concurrent cholangitis, inflammatory bowel disease, and pancreatitis. Although not all cats with pancreatitis will benefit from corticosteroids, this subset of cats with “triaditis” may benefit from corticosteroid treatment. Also, cats with chronic pancreatitis may benefit from corticosteroid treatment. The different types of corticosteroids used in cats are prednisone, prednisolone, and dexamethasone.