Summer 2005 Issue

Time is critical with acute pancreatitis—your
in-house laboratory helps with quick diagnostic and treatment decisions
IDEXX VetLab® analyzers provide comprehensive information when you need it most

Managing acute canine pancreatitis can be a challenge because the dog is often critically ill and the owner is distraught. Time is of the essence in providing the necessary care and saving your patient.

A confident pancreatitis diagnosis usually includes the following:

• A detailed history of clinical signs and physical exam findings. Lethargy, vomiting, diarrhea, fever, abdominal pain, dehydration and sometimes shock are all indicative of pancreatitis.

• Information gained from the CBC, biochemical analyses, amylase and lipase tests, urinalysis, ultrasound and abdominal radiographs

Running both amylase and lipase is important because these enzymes can elevate independently in some cases of pancreatitis. Some studies have indicated that lipase is more beneficial than amylase.

With pancreatitis, the levels of amylase and lipase can be moderately to extremely elevated. IDEXX VetTest® Analyzer reference ranges account for this. Once diagnosed, treat patients immediately with appropriate fluid therapy.

The recommended patient monitoring protocol

• Once a clinical diagnosis is made and the patient is being treated, having an in-house laboratory helps with ongoing monitoring.

• Monitoring should include serial amylase and lipase determinations because a marked drop in these values would strongly support a clinical diagnosis of acute pancreatitis during the resolution phase of the disease.

• Monitor serially using the following tests: electrolytes, amylase, lipase, CBC, urinalysis, total protein, glucose, BUN and creatinine.

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Meet Gina Panagakos

Gina Panagakos is a research scientist who has been a member of the Clinical Chemistry Research and Development team at IDEXX for five years. Her primary focus is VetTest® Chemistry Analyzer scientific support for current and upcoming VetTest® chemistries. She interacts with various groups throughout the company who work together to ensure that the information contained in each VetTest® software release yields the most accurate chemistry results.

Gina says, "Adding UPC to the VetTest analyzer was a challenging and rewarding experience. We're now able to help veterinarians diagnose early renal disease and begin treatment sooner, giving their patients with renal disease a better chance to live longer, healthier lives.

Gina enjoys the beach and spending time with her family, and is a die-hard Red Sox fan. She is particularly fond of German shepherds and looks forward to having one join the family when her kids are older.

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did you know? by Michelle Kahn, MS, DVM

Bile Acids Basics
There are many reasons the bile acids test has become the liver-function test of choice in the veterinary community. It is relatively inexpensive and easy to perform (all that is required is a fasted serum sample and a two-hour postprandial sample), and best of all, it is a very sensitive indicator of liver function. To obtain the best results, there are some basics to consider when performing this assay:

• A 12-hour fast must be undertaken prior to the first (preprandial) sample.

• It is very important to perform a postprandial sample, as well as a fasting sample, or the diagnosis may be missed.

• The amount and type of food used with this assay are important. While the amount of food is not known for sure, general recommendations are to feed at least 2 teaspoons of food to animals that weigh less than 5 kg, and approximately 1/4 can of food for larger animals. You don't want to overfeed because lipemia can adversely affect the bile acids results, and you should avoid foods with low-fat and low-protein concentrations.

• Hemolysis can adversely affect your test results. Careful sample handling and a large-gauge needle are useful to avoid hemolysis, which can significantly impact bile acids assay results. If you note hemolysis, you should draw a new sample for testing.

• Sometimes, preprandial levels may be higher than postprandial levels. This may be due to many things, including delayed gastric emptying and interdigestive gall bladder contraction. It is suggeted that you retest if this type of result is noted. You should also consider that owner compliance might be a problem and the client may have tried to sneak some breakfast to the dog. It is important to emphasize that the patient must be fasted for the retest!

• The Maltese conundrum: abnormal bile acids test results are commonly seen in this breed when there is no liver function abnormality. This is obviously a concern since this breed is genetically predisposed to portosystemic shunts (PSS). Therefore, an abnormal bile acids test result is inconclusive, but a normal bile acids test can rule out PSS in Maltese puppies. Several other terrier breeds may also produce suspect results.

• Don't test icteric "yellow" dogs. Knowing when not to run can be just as important as knowing when to run the bile acids assay. If an animal is icteric (and not anemic), there is no reason to run a bile acids assay. You already know that liver function is compromised in this patient, and you should move on to finding the cause of the liver disease.

To get the most out of your bile acids testing, you should keep in mind that a complete diagnostic workup is essential to diagnosing liver disease in the cat and dog. You should always perform a complete CBC, a biochemical profile and a urinalysis (including a sediment exam) prior to evaluating liver function. I can think of several cases where I went back and tested for a portosystemic shunt after noting ammonium biurate crystals in the urine. Even though there were no clinical signs and nothing in the history suggested a shunt, it was present. If possible, you should assess the liver with diagnostic imaging as well. An ultrasound can be particularly beneficial, especially in the right hands. The more complete your diagnostic protocol, the better your chance of discovering the underlying pathology and successfully treating your patient.

To contact Dr. Kahn, e-mail
Didyouknow@idexx.com.

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Coming Soon—the new bile acids test for the IDEXX SNAP® Reader

Add bile acids to your in-house testing menu to expand your liver-function testing capabilities.

Only the IDEXX VetLab® system offers you the flexibility to test what you want when you want, and the ability to use the liver-function test best suited to your patients' needs. The IDEXX VetTest® Chemistry Analyzer already provides flexibility in evaluating liver enzymes and the ability to run ammonia to determine liver function. By adding the SNAP® Bile Acids Test to your in-house testing, you will expand your liver-function testing capabilities, giving you the most comprehensive in-house diagnostics for liver testing.

Bile Acids
Soon it will be possible to screen for decreased liver function with the easy-to-use, in-house SNAP Bile Acids Test for the IDEXX SNAP Reader. The IDEXX SNAP Reader is expanding its menu to include bile acids in addition to the T₄ and cortisol testing capabilities that your already have. With quick results, you can begin treatment or rule out impairment during the patient visit.

Ammonia
The VetTest analyzer is the only in-house analyzer that offers ammonia, which can be used for plasma ammonia concentration tests and an ammonia tolerance test. While ammonia concentrations are very unstable after blood collection, the VetTest analyzer allows you to run these test immediately using plasma, assuring quick and accurate results. Although less sensitive than the bile acids assay for determining liver function, the plasma ammonia concentration test and ammonia tolerance test may be the best choice for a liver-function test in some cases. Moreover, the plasma ammonia concentration test is an excellent assay to screen for early neurologic dysfunction in your patients with liver disease.

For more information on the IDEXX SNAP Bile Acids Test and other IDEXX products, call IDEXX at 1-800-355-2896.

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IDEXX SNAP® Reader rental program
satisfaction guaranteed
The SNAP Reader gives you the ability to screen for common endocrine disorders in-house, and it attaches to the top of your VetTest® analyzer—no extra bench space needed!

With the SNAP Reader, enjoy:

• SNAP® ELISA technology for the most accurate results (minimizes the effects of interfering substances) for total T₄, cortisol and bile acids levels (coming soon)
• Easy-access front display
• Automatic countdown for remaining incubation and assay times
• Real-time calibration status
• High-performance, reliable digital components
• Upgraded optics and illumination

Integrate this high-quality diagnostic analyzer into your in-house system for a low monthly payment. Call 1-800-355-2896 for more information.

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Become an ammonia-testing expert!

Enclosed in your VetTest® 8.04 software packet you'll find a technical bulletin regarding ammonia (NH₃) testing on your IDEXX VetTest® Chemistry Analyzer. For the best results when testing ammonia levels in your patients, it's important to follow the recommendations outlined in the bulletin. Read through it, and then test your knowledge by taking the quiz below. You'll be on your way to becoming an ammonia-testing expert!

Some questions may have more than one correct answer.

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