Suspected Isolated Pancreatic Lipase Deficiency in a Dog

Abstract

A 4-month-old female Siberian Husky was referred for a 2-month history of intermittent diarrhea, poor body condition, polyuria, and polydipsia. Based on the history, the diarrhea was thought to be of small intestinal or mixed origin because the dog had a ravenous appetite, poor body condition and failure to thrive, frequent defecations, and feces that occasionally were covered by mucus. The dog had been diagnosed with and repeatedly treated for hookworms and coccidia by the referring veterinarian with a combination of praziquantel, pyrantel pamoate, and febantel, a and metronidazole.b The dog also had been treated with amoxicillin, c sulfadimethoxine, d and prednisone e for short periods of time. Two weeks before presentation, the referring veterinarian changed the dog's regular diet f to a prescription diet g formulated for dogs with gastrointestinal disease. The antiparasitic medications, antibiotics, glucocorticoids, and diet change led only to transient responses, and the diarrhea always recurred with discontinuation of therapy despite the fact that both direct fecal examination and fecal flotation were negative. The dog's appetite was increased for the entire period of 2 months.At the time of presentation, the dog weighed 12 kg and was in poor body condition (body condition score 3/ 9; optimal, 5/9).1 Slightly thickened, gas-filled intestinal loops were identified by abdominal palpation. CBC and serum electrolyte concentrations were within normal limits. A serum biochemical profile revealed mild increases in alkaline phosphatase activity (ALP, 187 U/L; reference range, 10-150 U/L), creatine kinase activity (CK, 421 U/L; reference range, 10-200 U/L), and serum phosphorus concentration (8.8 mg/dL; reference range, 2.1-6.3 mg/dL), and a mild decrease in blood urea nitrogen concentration (BUN, 4 mg/dL; reference range, 7-27 mg/dL). Liver disease was suspected, and fasting and 2-hour postprandial total serum bile acid concentrations were evaluated and found to be normal (fasting serum bile acid concentration, ,1.0 mM/L; reference range, 0-5 mM/L; postprandial serum bile acid concentration, 1.5 mM/L; reference range, 3.9-12.7 mM/L). A relatively low specific gravity (1.017) was noted on urinalysis, and bacterial culture of urine yielded no growth.Radiographs of the abdomen were normal, but the layers of the small intestinal wall could not be differentiated on abdominal ultrasonography, and a prominent pancreas of normal echogenicity was identified. Serum concentrations of cobalamin, folate, canine pancreatic lipase immunoreactivity (measured as Spec cPL h ), and canine trypsin-like immunoreactivity (cTLI) were determined and results of these tests were Spec cPL ,29 mg/L (below the detection limit; reference range, 29-200 mg/L), cTLI 7.1 mg/L (reference range, 5.0-35.0 mg/L), cobalamin 1,001 ng/L (reference range, 249-733 ng/L), folate 39.3 mg/L (reference range, 6.5-11.5 mg/L). These findings were interpreted as consistent with small intestinal bacterial overgrowth (SIBO), also referred to as antibiotic-responsi...

Effect of withholding food versus feeding on creatinine, symmetric dimethylarginine, cholesterol, triglycerides, and other biochemical analytes in 100 healthy dogs

“…Traditionally, diagnosis of hypertriglyceridemia is made based on measurement after withholding food for at least 12 hours. 21 However, in a report of Miniature Schnauzers with a history of visible lipemia, withholding food for >12 hours The percent change in SDMA exceeded the reference change value of 43% in 5 dogs, but none of the measurements in these 5 dogs exceeded the reference limit of 14 μg/dL reduced the sensitivity for detecting hypertriglyceridemia, suggesting that a triglyceride measurement after withholding food for 12 hours might fail to identify some dogs with delayed very low density lipoprotein clearance or other dyslipidemias. 26 Therefore, triglycerides measured both after withholding food as well as peak concentration after feeding might be useful in identifying dogs for which dietary fat restriction could be beneficial.…”

Evaluation of Fecal Elastase and Serum Cholecystokinin in Dogs with a False Positive Fecal Elastase Test

“…1 There have been isolated reports of dogs with EPI with a serum cTLI concentration 42.5 mg/L. 1,6,7 One dog reported in the literature was suspected of having an isolated pancreatic lipase deficiency. 7 However, this condition is suspected to be extremely rare in dogs.…”

“…1,6,7 One dog reported in the literature was suspected of having an isolated pancreatic lipase deficiency. 7 However, this condition is suspected to be extremely rare in dogs. Other dogs with EPI that did not have a serum cTLI concentration below the diagnostic cut-off value for EPI had serum cTLI concentrations in the questionable range, but rarely within the reference range or even above the reference range.…”

Canine and feline pancreatic lipase immunoreactivity

“…In that study, only one of the 74 healthy dogs had a cPLI result below the reference interval. More importantly, determination of serum cPLI concentration using the original cPLI ELISA has been shown to be useful for the diagnosis of isolated pancreatic lipase deficiency, a rare form of EPI in dogs that cannot be diagnosed by use of TLI . However, the original cPLI ELISA is no longer available.…”

“…More importantly, determination of serum cPLI concentration using the original cPLI ELISA has been shown to be useful for the diagnosis of isolated pancreatic lipase deficiency, a rare form of EPI in dogs that cannot be diagnosed by use of TLI. 67 However, the original cPLI ELISA is no longer available. Its replacement, the Spec cPL assay, has been optimized to detect normal and increased concentrations of serum pancreatic lipase; it is not suitable for accurate measurement of decreased concentrations 55 and cannot be used as a diagnostic test for EPI.…”