Concurrent pancreatitis and diabetes in 10yo Westie

Re: Concurrent pancreatitis and diabetes in 10yo Westie

Andrew Kent — Mon, 24 Feb 2014 08:31:48 GMT

Can you get some neutral insulin from a local pharmacy? I would be treating the hyperglycaemia quite aggressively in this dog with either CRI or intermittent IM neutral insulin. And keep an eye on the potassium - these dogs have a whole body deficit of potassium and so tend to require quite significant supplementation (more than just Hartmann's).

Andy

Re: Concurrent pancreatitis and diabetes in 10yo Westie

Jenny Smith — Sun, 23 Feb 2014 23:30:47 GMT

I taken a PCV tube of blood when I'm checking bg in my DKAs from the needle hub/syringe (depends how hard they are to bleed!) spin it down and then use the serum on a urine dipstick so I can semi-quantitatively track ketones.... Much easier than waiting for wee!! Jenny

Re: Concurrent pancreatitis and diabetes in 10yo Westie

Charlie Lyon — Sun, 23 Feb 2014 23:02:45 GMT

Her kennel pad was v wet when did inpatients managed to do a dipstick, pro++, ph 8, blood+++ ket++ glu++++ obviously couldn't do a proper usg but does confirm the dka, on a better note glucose 26 instead of 30s

Re: Concurrent pancreatitis and diabetes in 10yo Westie

John Flynn — Sun, 23 Feb 2014 22:21:10 GMT

[quote user="Glenn Hodgson"]FYI blood ketone.[/quote]

or serum on a urine dipstick?

Re: Concurrent pancreatitis and diabetes in 10yo Westie

Glenn Hodgson — Sun, 23 Feb 2014 21:46:12 GMT

FYI blood ketone. Meters aren't too 'spensive.

I use ours surprisingly often and helps guide me when to stop fluids.

Survived fine for 10 years without one though.

Re: Concurrent pancreatitis and diabetes in 10yo Westie

Rob Loxley — Sun, 23 Feb 2014 20:47:56 GMT

Ketamine or M/L/K can be helpful in painful pancreatitis cases I've found

Re: Concurrent pancreatitis and diabetes in 10yo Westie

Charlie Lyon — Sun, 23 Feb 2014 20:29:03 GMT

Is a methadone/lidocaine/ketamine CRI more for surgical pain or could it be used as she does seem unhappy before her next dose is due? Remember going on a surgery cpd where that was discussed. Have been working on the data sheet with methadone IM lasting 4 hours (according to comfortan) rather than 6-8. Sorry if obvious questions but we usually just use methadone for surgical pain

Re: Concurrent pancreatitis and diabetes in 10yo Westie

John Flynn — Sun, 23 Feb 2014 20:08:19 GMT

[quote user="Charlotte Lusted"]Didn't even think about a methadone CRI, was giving buprenorphine for longer action esp overnight as we are not a 24 hour centre but can get that set up at my next check. Thanks[/quote]

I use methadone 0.1mg/kg/hr (I think - double check that if it doesn't sound right!) for up to 24hrs CRI and haven't had problems, though I know some folk say it accumulates easier than morphine (I've not seen any evidence to justify this concern though) and ideally as with any CRI should be titrated to effect. I do also wonder whether a SC injection of methadone might not last just as long as buprenorphine, but that's just my speculation! You'd probably be best to start with a decent loading dose (e.g. 0.3mg/kg if not very obviously unconformable) and then CRI at no more than 0.05-0.1mg/kg/hr overnight if not monitored. I think some caution is sensible if you're not used to using methadone CRI before, but not so much that you shouldn't start.

Re: Concurrent pancreatitis and diabetes in 10yo Westie

Charlie Lyon — Sun, 23 Feb 2014 20:00:17 GMT

Didn't even think about a methadone CRI, was giving buprenorphine for longer action esp overnight as we are not a 24 hour centre but can get that set up at my next check. Thanks

Re: Concurrent pancreatitis and diabetes in 10yo Westie

John Flynn — Sun, 23 Feb 2014 19:23:24 GMT

I should caution that I HATE diabetics, which probably says something about my ability to treat them

I think you'll struggle to get the hyp0erglcaemia under control while there is active pancreatic inflammation to the degree suspected. WOuldn't stop me bring pretty liberal with the insulin though, so yes I would happily increase the dose and if all have is caninsulin I might do this by giving more often based on whether getting any response to BG at 4-hourly checks or whatever.

[quote user="Charlotte Lusted"]She had been on vivitonin for chronic bronchitis but otherwise well, was on pred 5mg eod, but this was stopped before Xmas as going so well with vivitonin.[/quote]

"Going well" does sound like chronic bronchitis rather than idiopathic pulmonary fibrosis, but jsut a thought to mention would be that if suspected the latter ocndition I'd be considering PTS now rather than treating the current issues.

[quote user="Charlotte Lusted"]buprenorphine[/quote]

Might be fine, but I'd go something stronger and assume pain is part of not eating until proven otherwise. Prefarably methadone for me (can do a CRI if not about enough for regular doses) and I'd maybe add paracetamol also wihtout knowing whether it really helps that much or not.

[quote user="Charlotte Lusted"]ranitidine ,cerenia[/quote]

SOund helpful, I'd keep these going.

[quote user="Charlotte Lusted"]We started her on IVFT (#1 saline added K)[/quote]

[quote user="Charlotte Lusted"]changed to maintenance hartmanns,[/quote]

I'm a Hartmann's man at heart (lack of imagination!), but would be going with 3 x maintenance in a patient like this. Rechecking K+ as required, but I suspect might correct itself quite well once metabolic derangements resolve a bit?

[quote user="Charlotte Lusted"]any advice to try and get her glucose down[/quote]

Treat the pain, keep the fluids liberal and crack on with insulin as reuqired.

[quote user="Charlotte Lusted"]How do people find the general outlook for managing these cases?[/quote]

Mixed. Some do better than expected, others a constant struggle with repeated hospitalisations etc.

Re: Concurrent pancreatitis and diabetes in 10yo Westie

Charlie Lyon — Sun, 23 Feb 2014 18:03:43 GMT

Thanks for the advice - annoyingly she keeps urinating on her kennel pads rather than when I take her out so still trying to get a sample - to be fair I fully expect to see ketones - would do a cysto but sole charge over the weekends. Is it ok to keep increasing the insulin units quite quickly until I get a response?

Re: Concurrent pancreatitis and diabetes in 10yo Westie

Robin Grimmer — Sun, 23 Feb 2014 17:27:55 GMT

Might have DKA. Check a urine sample. Carry on as you are. Try and get glucose down but avoid hypoglycaemia. You need to keep supplementing potassium as already low and insulin will drive lower. Don't worry too much about pancreatitis. Need to get eating. Use metoclopramide or Cerenia if needed.