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Serum ionized calcium, prognosis and the clinical course of pancreatitis in cats

Dias C, Carreira LM. Serum ionized calcium as a prognostic risk factor in the clinical course of pancreatitis in cats.  J Feline Med Surg. 2015 Dec;17(12):984-90.

Pancreatitis is a difficult disease to diagnose in a sick cat, especially in chronic cases or cat patients with non-specific signs. This is due to no simple, specific and sensitive diagnostic method is available. Often treatment of symptoms presumes the diagnosis of pancreatitis as the end result. Pancreatitis can be a significant illness leading to a systemic inflammatory response syndrome with failure of multiple organs and even death. The prevalence of pancreatitis is unknown, but clinical evidence indicates that it is around 0.6%.

The objectives of this study were to evaluate the potential effects of sex, age and breed on the development of pancreatitis. Also to better understand if low values of ionized calcium can be considered as a prognostic risk factor in the clinical course of the disease. There is verification from prior studies that hypocalcemia is present in 41-49% of patients with pancreatitis and therefore, it is one of the most common electrolyte abnormalities found in these cases. Of total calcium, the ionized calcium fraction is the metabolically active portion of total calcium which represents the real diagnostic value in laboratory tests.

Twenty-four cats with pancreatitis were included in the study and were grouped into two groups depending on disease progression: 1) non-fatal (NF) for those who recovered and 2) fatal (F) for those who died. Ionized calcium and feline pancreatic lipase (fPL) was quantified for each patient at two different times: T1 (day of diagnosis) and T2 (day of recovery or death). The cases were 50% male and 50% female, an age range of 4-11 years, and the domestic shorthair breed was the most represented (81.2%). A non-fatal course was noted in 66.6% of the cat patients (equal number of males and females, 8/8) and a fatal course in 33.4% (also equal number of males and females, 4/4). There was no statistical difference noted in age between both groups.

The results suggest that hypocalcemia is common in cats with pancreatitis. In regards to ionized calcium concentrations, the results indicated that at T2, time of recovery or death, an ionized calcium value of ≤ 1 mmol/l (mean for the F group was 0.88 mmol/l and NF group was 1.1 mmol/l) should be considered a prognostic risk factor associated with a poorer prognosis. In these situations, clinicians should consider a more intensive and aggressive medical treatment for the patient compared to other patients with pancreatitis in which the ionized calcium values are ≥ 1 mmol/l.  (VLT)

See also:
Stockhaus C, Teske E, Schellenberger K, et al. Serial serum feline pancreatic lipase immunoreactivity concentrations and prognostic variables in 33 cats with pancreatits. J Am Vet Med Assoc. 2013 Dec 15;243(12):1713-8.