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An Urban Experience
Cyclosporine has been shown to be successful in a proportion of dogs with steroid-refractory IBD (5 mg/
kg PO once daily). Transient adverse effects including include vomiting and loss of appetite, hair coat changes, and gingival hyperplasia may be seen during the first
2 weeks of treatment in approx. 1⁄4 of the dogs and. Most side effects respond to temporary discontinuation followed by dose-reduction.
Hypocobalaminemia: Low serum cobalamin concentrations are commonly found in dogs with PLE, especially in the presence of underlying IBD, and may delay proper healing of intestinal inflammation. Treatment consists of weekly SC injections of vitamin B12 (from 250 to 1500 μg/dog based on body weight) for 6 weeks. If the treatment is successful, the interval between injections may be increased to 2 weeks for another 6 weeks. The full dosing schedule can be viewed on the site of the Texas A&M University GI Laboratory website ( gilab). Interestingly, a study published in early 2016 reported that oral administration of vitamin B12 is likely to be effective in dogs with chronic intestinal diseases (0.25 mg q24h in dogs weighing 1-10 kg, 0.5 mg q24h in 10-20 kg dogs, and 1 mg q24h for dogs >20 kg).
Hypercoagulability: Studies have revealed a high prevalence of hypercoagulability in dogs with PLE, which increases the risk of potentially fatal thromboembolic events. However, hypercoagulability does not appear to resolve after successful treatment of PLE. Although there is no scientific evidence to support this, administration of clopidogrel (1-5 mg/kg/day) may be considered in order to prevent thrombosis.
Hypocalcemia: Because 50% of serum calcium is bound to albumin a decrease in serum total calcium is expected with severe hypoalbuminemia. Additionally, malabsorption of fat-soluble vitamins occurs along
with the dietary fat malabsorption associated with
PLE and low serum ionized calcium concentration,
low 25-hydroxyvitamin D, and increased levels of parathyroid hormone are found in dogs with PLE. In dogs with a moderate to severe decrease in ionized calcium, treatment with calcium (e.g. calcium carbonate between 1 g [toy breeds] and 10 g [giant breeds] PO per dog q24h) is recommended, possibly with addition of calcitriol (0.03-0.06 micrograms PO q24h) if calcium alone is not successful. Regular rechecks of serum ionized calcium are required for adequate monitoring, particularly to prevent hypercalcemia. Hypovitaminosis D was associated with a negative outcome in a recent retrospective study. Concurrent hypomagnesemia may compromise the success of treatment and should be corrected if present.
In two studies encompassing a total of 150 dogs with chronic enteropathies, hypoalbuminemia (serum albumin < 20 g/l) was associated with a less favorable outcome.
Idiopathic intestinal lymphangiectasia: Preliminary reports from a few studies show a high mortality among Yorkshire terriers with IL (50-60%). In one of the author’s practice (FG), some Yorkshire terriers with IL respond well to a strict diet alone or with anti-inflammatory doses of glucocorticoids. The proportion of refractory cases seems to vary according to geographical location. There are no known parameters that allow early segregation
of dogs likely to be refractory to dietary and steroid treatment. In the other author’s practice (LW), feeding of fat-restricted and novel protein (both plant and animal derived) home-prepared diets leads to improved outcomes for dogs with PLE.
Crypt disease: The presence of crypt abscesses in the small intestine was associated with significantly shorter survival in a study from one of the author’s (FG) group.
1. Allenspach K, Rizzo J, Jergens AE et al. Hypovitaminosis D with negative outcome in dogs with protein-losing enteropathy: a retrospective study of 43 cases. BMC Vet Res 2017; 13: 96 -101 (Open access).
2. Dandrieux JR, Noble PJ, Scase TJ et al. Comparison of a chlorambucil- prednisolone combination with an azathioprine-prednisolone combination for the treatment of canine chronic enteropathies with concurrent protein-losing enteropathy: 27 cases (2007-2010). J Am Vet Med Assoc 2013; 242 (12): 1705-1714
3. Dossin O, Lavoue R. Protein-losing enteropathies. Vet Clin N Amer Small Anim 2011;41(2):399-418.
4. Goodwin LV, Goggs R, Chan DL, et al. Hypercoagulability in dogs with protein-losing enteropathy. J Vet Intern Med 2011;25(2):273-277 (Open access)
5. Gow AG, Else R, Evans H, et al. Hypovitaminosis D in dogs with inflammatory bowel disease and hypoalbuminaemia. Journal of Small Animal Practice 2011;52(8):411-418.
6. Simmerson SM, Armstrong PJ, Wunschmann A et al: Clinical features, intestinal histopathology and outcome of protein-losing enteropathy on Yorkshire Terrier dogs. J Vet Intern Med 2014; 28: 331-337 (Open access)
7. Toresson L, Steiner JM, Suchodolski JS et al: Oral cobalamin supplementation in dogs with chronic enteropathies and hypocobalaminemia. J Vet Intern Med 2016; 30: 101-107 (Open access)
8. Willard MD, Helman G, Fradkin JM, et al. Intestinal crypt lesions associated with protein-losing enteropathy in the dog. J Vet Intern Med 2000;14:298-307 (Open access)

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