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Nutritional Assessment in a
Dog with Chronic Enteropathy
Linda Toresson, DVM
Evidensia Specialist Animal Hospital
Helsingborg, Sweden
THE CASE
A 4.5-year-old intact female shar-pei was presented for
chronic recurrent diarrhea, which was either watery or
mucoid, of more than a year’s duration. Vomiting and hyp-
orexia developed the month before presentation and was asso-
ciated with mild weight loss. The dog was the only pet in the
household and was up-to-date on vaccinations and flea/tick
preventives; heartworm prevention was unnecessary, as there
is no heartworm disease in Sweden or northern Europe,
where this dog lives.
Physical Examination
The patient had to be sedated for physical examination due to
temperament. BCS was 4/9, with a muscle condition score
showing mild muscle atrophy and a dull hair coat. Despite
chronic diarrhea, no signs of dehydration were observed.
ASK YOURSELF …
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Administer the appropriate combination of chewables
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3. Castelli MC, Friedman K, Sherry J, et al. Comparing the efficacy and tolerability of a new daily To ensure adequate absorption, always administer SENTINEL SPECTRUM
oral vitamin B12 formulation and intermittent intramuscular vitamin B12 in normalizing low to dogs immediately after or in conjunction with a normal meal.
cobalamin levels: a randomized, open-label, parallel-group study. Clin Ther. 2011;33(3):358-371. SENTINEL SPECTRUM may be offered to the dog by hand or added to a small
amount of dog food. The chewables should be administered in a manner
4. Bolaman Z, Kadikoylu G, Yukselen V, Yavasoglu I, Barutca S, Senturk T. Oral versus intramuscular that encourages the dog to chew, rather than to swallow without chewing.
cobalamin treatment in megaloblastic anemia: a single-center, prospective, randomized, open- Chewables may be broken into pieces and fed to dogs that normally swallow
label study. Clin Ther. 2003;25(12):3124-3134. treats whole. Care should be taken that the dog consumes the complete dose,
and treated animals should be observed a few minutes after administration to
5. Kim HI, Hyung WJ, Song KJ, Choi SH, Kim CB, Noh SH. Oral vitamin B12 replacement: an effective ensure that no part of the dose is lost or rejected. If it is suspected that any of
treatment for vitamin B12 deficiency after total gastrectomy in gastric cancer patients. Ann Surg the dose has been lost, redosing is recommended.
Oncol. 2011;18(13):3711-3717. Contraindications
6. Toresson L, Steiner JM, Suchodolski JS, Spillmann T. Oral cobalamin supplementation in dogs There are no known contraindications to the use of SENTINEL SPECTRUM.
with chronic enteropathies and hypocobalaminemia. J Vet Intern Med. 2016;30(1):101-107. Warnings
7. Toresson L, Steiner JM, Olmedal G, Larsen M, Suchodolski JS, Spillmann T. Oral cobalamin Not for use in humans. Keep this and all drugs out of the reach of children.
supplementation in cats with hypocobalaminaemia: a retrospective study. J Feline Med Surg. Precautions
2017;19(12):1302-1306. Treatment with fewer than 6 monthly doses after the last exposure to
mosquitoes may not provide complete heartworm prevention.
8. Toresson L, Steiner JM, Razdan P, et al. Comparison of efficacy of oral and parenteral cobalamin
Prior to administration of SENTINEL SPECTRUM, dogs should be tested for
supplementation in normalizing low cobalamin concentrations in dogs: a randomized controlled existing heartworm infections. At the discretion of the veterinarian, infected
study. Vet J. 2018;232:27-32. dogs should be treated to remove adult heartworms. SENTINEL SPECTRUM
9. Toresson L, Steiner JM, Suchodolski JS, Spillmann T. Methylmalonic acid concentrations in dogs is not effective against adult D. immitis.
with hypocobalaminemia treated with oral versus parenteral cobalamin supplementation. J Vet Mild, transient hypersensitivity reactions, such as labored breathing, vomiting,
Intern Med. 2017;31:39. hypersalivation, and lethargy, have been noted in some dogs treated with
milbemycin oxime carrying a high number of circulating microfilariae.
10. Luckschander N, Allenspach K, Hall J, et al. Perinuclear antineutrophilic cytoplasmic antibody These reactions are presumably caused by release of protein from dead
and response to treatment in diarrheic dogs with food responsive disease or inflammatory bowel or dying microfilariae.
disease. J Vet Intern Med. 2006;20(2):221-227. Do not use in puppies less than six weeks of age.
11. Ruaux CG. Cobalamin in companion animals: diagnostic marker, deficiency states and Do not use in dogs or puppies less than two pounds of body weight.
therapeutic implications. Vet J. 2013;196(2):145-152. The safety of SENTINEL SPECTRUM has not been evaluated in dogs used for
12. Allenspach K, Wieland B, Grone A, Gaschen F. Chronic enteropathies in dogs: evaluation of risk breeding or in lactating females. Studies have been performed with milbemycin
factors for negative outcome. J Vet Intern Med. 2007;21(4):700-708. oxime and lufenuron alone.
13. Batchelor DJ, Noble PJ, Taylor RH, Cripps PJ, German AJ. Prognostic factors in canine exocrine Adverse Reactions
The following adverse reactions have been reported in dogs after administration
pancreatic insufficiency: prolonged survival is likely if clinical remission is achieved. J Vet Intern of milbemycin oxime, lufenuron, or praziquantel: vomiting, depression/lethargy,
Med. 2007;21(1):54-60. pruritus, urticaria, diarrhea, anorexia, skin congestion, ataxia, convulsions,
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a retrospective study in 136 cases. J Vet Intern Med. 2017;31(4):1043-1055. To report suspected adverse drug events, contact Virbac at 1-800-338-3659
or the FDA at 1-888-FDA-VETS.
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Information for Owner or Person Treating Animal
supplementation in cats with signs of gastrointestinal disease and severe hypocobalaminemia. Echinococcus multilocularis and Echinococcus granulosus are tapeworms
J Vet Intern Med. 2005;19(2)155-160. found in wild canids and domestic dogs. E. multilocularis and E. granulosus
16. Kempf J, Hersberger M, Melliger RH, Reusch CE, Kook PH. Effects of 6 weeks of parenteral can infect humans and cause serious disease (alveolar hydatid disease
and hydatid disease, respectively). Owners of dogs living in areas where
cobalamin supplementation on clinical and biochemical variables in cats with gastrointestinal E. multilocularis or E. granulosus are endemic should be instructed on how
disease. J Vet Intern Med. 2017;31(6):1664-1672. to minimize their risk of exposure to these parasites, as well as their dog’s risk
17. Grützner N, Bishop MA, Suchodolski JS, Steiner JM. Association study of cobalamin deficiency in of exposure. Although SENTINEL SPECTRUM was 100% effective in laboratory
studies in dogs against E. multilocularis and E. granulosus, no studies
the Chinese Shar Pei. J Hered. 2010;101(2):211-217. have been conducted to show that the use of this product will decrease the
incidence of alveolar hydatid disease or hydatid disease in humans. Because
the prepatent period for E. multilocularis may be as short as 26 days, dogs
treated at the labeled monthly intervals may become reinfected and shed eggs
References continue on page 35. between treatments.
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