Cobalamin malabsorption, low Tli

RE: Cobalamin malabsorption, low Tli

Kate Richardson — Tue, 08 Sep 2015 22:13:03 GMT

I think you have your diagnosis then. I personally wouldn't be in a hurry to do imaging unless the owner is keen to rule out other causes, I would waut and see how he responds to your treatment first

RE: Cobalamin malabsorption, low Tli

Danny cazabon — Tue, 08 Sep 2015 22:03:26 GMT

Yes definitely polyphagic, owner has stated he had to double feed intake to try keep condition optimal. Had brought in fecal sample looked to be pale, sludge like, some particles.

RE: Cobalamin malabsorption, low Tli

Kate Richardson — Tue, 08 Sep 2015 21:41:59 GMT

[quote user="james herriot lied"]It sounds, to be honest, like you're on top of this case and your thoughts are reasonable. My gut (sorry) feeling is that the TLI will be equivocally low again and it'll be difficult to draw conclusions, but in the meantime your initial approach is decent and treatment[/quote]

+1. Dies he have a good to increased appetite in the face of this weight loss? and are faeces paler than normal? If so, extra plus points for EPI.

RE: Cobalamin malabsorption, low Tli

Danny cazabon — Tue, 08 Sep 2015 20:37:12 GMT

My patient is currently on Metronidazole a 10 day course, weekly anivit B 12 injections and pancreatic enzymes since last Thursday.

I have considered dietary intolerance, there has been no change in diet within the last year.

Yes I agree, my plan is to advise radiography and an ultrasound exam and redo bloods in 7 weeks, perhaps a hemogram... maybe granulocytic differential in the meantime.

Thank you for your input,

Danielle

RE: Cobalamin malabsorption, low Tli

Catriona MacIntyre — Sun, 06 Sep 2015 22:40:59 GMT

You've probably already considered this.... but dietary sensitivity?

B12 is my current grab medicine! I saw vets using it a lot when I was growing up, but then it seemed to go out of fashion and was rather sneered at. I use it frequently in chronic diarrhoea cases now and there is increasing evidence for its use as far as I know

RE: Cobalamin malabsorption, low Tli

james herriot lied — Sun, 06 Sep 2015 21:48:06 GMT

Danielle

It sounds, to be honest, like you're on top of this case and your thoughts are reasonable. My gut (sorry) feeling is that the TLI will be equivocally low again and it'll be difficult to draw conclusions, but in the meantime your initial approach is decent and treatment-based. I'd back the suggestion for a bit of imaging, as this will help in tracking pancreatic changes (or lack of).

How long have you been supplementing with pancreatic extract, and what antibiotics are you using?

RE: Cobalamin malabsorption, low Tli

Danny cazabon — Sat, 05 Sep 2015 18:04:32 GMT

For 4 months it has been ongoing, faeces were loose initially to more diarrhoea like, however not a watery diarrhoea. No blood, on/off mucous. Owner reports to have seen undigested food particles in faeces.

Eating up to 1KG a day .

RE: Cobalamin malabsorption, low Tli

Danny cazabon — Sat, 05 Sep 2015 17:58:13 GMT

Biochemistry included the following:

ALB 34 (25-44), ALP 42 (20-150), ALT 61 (10-118), AMY 229 (200-1200), TBil 7 (2-10), BUN 6 (2-9)

Ca2+ 2.56 (2.15-2.95), Phos 1.3 (.93-2.13), Crea 79 (27-124), Glu 5.4 (3.3-6.1), Na 143 (138-160)

K+ 4.5 (3.7-5.8), TP 64 (54-82), GLOB 29 (23-52)

Forgot to mention, the patient has been up to date with milbemax worming tablet every 3 months.

RE: Cobalamin malabsorption, low Tli

KathW — Sat, 05 Sep 2015 17:39:49 GMT

How long has the diarrhoea been present for and how does the owner describe it? What is the consistency? Increased frequency? Tenesmus? Any blood or mucus present?

What was the actual albumin level in this case?

I would agree with doing imaging if there isn't some response to the current therapy.

RE: Cobalamin malabsorption, low Tli

Rob Davis — Sat, 05 Sep 2015 15:14:11 GMT

Were electrolytes included in the biochemistry?

RE: Cobalamin malabsorption, low Tli

Danny cazabon — Sat, 05 Sep 2015 10:24:57 GMT

Thank you for your replies,

I thought Malabsorption contributes to small intestinal dysbacteriosis - low cobalamin is consistent with small intestinal disease and bacterial overgrowth/ SIBO.

http://www.battlab.com/tli.htm

I thought perhaps if it had been such a chronic bacterial overgrowth could lend to the fact of such low WBC.

But no other tests have been performed as of yet.

Folate normal.

We do have an endoscope, X ray, ultrasound.

I will suggest some imaging. I have started antibiotics, this may affect a fecal culture test?

I was reluctant to send for fecal proteolaytic activity due to amount of false positives.

RE: Cobalamin malabsorption, low Tli

Martin Atkinson — Sat, 05 Sep 2015 09:29:09 GMT

I don't like the low WBC count and would want a granulocyte differential. Presume folate was normal and you've done faecal culture/examination? Any abdominal imaging especially of pancreas and intestinal thickening?

RE: Cobalamin malabsorption, low Tli

Hannah Wynne Richards — Sat, 05 Sep 2015 09:10:49 GMT

Bacterial overgrowth would give high cobalamin. I'd say malabsorption. Do you have flexible endoscopy?

Wynne

RE: Cobalamin malabsorption, low Tli

Danny cazabon — Fri, 04 Sep 2015 20:30:04 GMT

Have started on pancreatic enzymes, weekly b12 injections and 10 days of Metronidazole.