Hi, we've done the folate test. The result is 50.30 nM/l.
Is it all right or not? I can't find the reference intervals anywhere..

The range in your units is 11 - 34. This is elevated. This is consistent with small intestinal bacterial overgrowth or exocrine pancreatic insufficiency. Full interpretation requires assessing the other results.

Hi, are you sure that it refers to 11-34?? The units are nM/l, as far as I know the normal range in ng/ml is 9,7-21,6 so we need to trasfer nM/l to ng/ml which is (50,3*441,4 (folate molar mass) )/1000 = 22,2 ng/ml. Then our results are all right. Correct me, am I wrong? If I am wrong and as you said it's elevated, which tests shall we do next? We were planning to do gut and heart ultrasound soon.

Not sure where you get the reference range from - is this the ref range for humans? The reference range for cats depends a bit on the laboratory but one lab quotes 3.5 - 8.5 ng/ml and another (which is the one I used before), quotes 4.8 - 13.0 ug/l which is 11 -34 nM/l or 4.85 - 15 ng/ml. So it is still elevated.


Sorry for the delay in replying but I have been on holiday.



Edited 1 time(s). Last edit at 09/15/2011 08:36AM by MarkRicher.

Ok, so we now got normal B12 level and high folates level. What do we do next? Soon we will make gut and heart ultrasound and we will be doing a blood test as well. Do we need to test for something in the blood at this stage?

High folate indicates bacterial overgrowth or pancreatic insufficiency so a feline TLI would rule out pancreatic insufficiency - the TLI test must be a specific feline test - the human/canine TLI tests do not apply to the cat. Let me know what the scan results are - the walls of the intestine and stomach need to be measured in several places, as well as looking at the pancreas and the normal heart measurements taken through the left ventricle at the level of the chordae on M-mode.

So we first do the ultrasound and depending on the result we will either need or not need pass the TLI test, is that correct?

Actually I''m quite interested in this thread since my own cat had a high folate (23.6 ), low cobalamin <100 test result. At the time he also had a high fPLI >50! His bloodwork showed very low albumin ( 17.00 later improved to 18.3 - scary I know! ) and low protein and calcium levels. The instigating symptoms prior to this test result were typical of IBD ( intestinal thickening showed on X-ray ) with loose, soft stools, bloated abdomen and intermittent diarrhea plus weight loss and vomiting. Slight anaemia on first bloods which later improved along with protein and calcium levels which were near normal levels. No steroids ever used in his treatment. Vet not too keen.

Very good appetite throughout-atypical for a cat with pancreatitis. Weight gain and more solid stoods while on Hills i/d plus B12 injections.Noticed vomiting on Hills i/d and switched to Hills d/d.After a while refused to eat prescription diet so switched to good, highmeat content grain-free food, single protein source food. Stools absolutely normal now though more volume than my other cats and no vomiting at all though he's begun to lose some weight again. Recent addition of Probiotics have helped with gas. Have begun to supplement B12 once again. Also other than he had always appeared to be a normal healthy cat even though he's 16! He's absolutely lovely and we adore him!

My main concern has always been to do with intestinal bacterial overgrowth and leaving this untreated. Suspect this has caused the intestinal inflammation in the first place as opposed to a food allergy. Will I ask vet to prescribe Metronizadole or some other antibiotic?

Many thanks for your help in advance. Not sure if my current vet is very experienced in dealing with this type of conditon.

Actually I''m quite interested in this thread since my own cat had a high folate (23.6 ), low cobalamin <100 test result. At the time he also had a high fPLI >50! His bloodwork showed very low albumin ( 17.00 later improved to 18.3 - scary I know! ) and low protein and calcium levels. The instigating symptoms prior to this test result were typical of IBD ( intestinal thickening showed on X-ray ) with loose, soft stools, bloated abdomen and intermittent diarrhea plus weight loss and vomiting. Slight anaemia on first bloods which later improved along with protein and calcium levels which were near normal levels. No steroids ever used in his treatment. Vet not too keen.

Very good appetite throughout-atypical for a cat with pancreatitis. Weight gain and more solid stoods while on Hills i/d plus B12 injections.Noticed vomiting on Hills i/d and switched to Hills d/d.After a while refused to eat prescription diet so switched to good, highmeat content grain-free food, single protein source food. Stools absolutely normal now though more volume than my other cats and no vomiting at all though he's begun to lose some weight again. Recent addition of Probiotics have helped with gas. Have begun to supplement B12 once again. Also other than he had always appeared to be a normal healthy cat even though he's 16! He's absolutely lovely and we adore him!

My main concern has always been to do with intestinal bacterial overgrowth and leaving this untreated. Suspect this has caused the intestinal inflammation in the first place as opposed to a food allergy. Will I ask vet to prescribe Metronizadole or some other antibiotic?

Many thanks for your help in advance. Not sure if my current vet is very experienced in dealing with this type of conditon.

Yes

Vampyra,

My approach to these cases of IBD is this:

1. start on steroids at a decent dose - at least 1mg/kg twice a day of prednisolone, cats often need higher doses than dogs and get the owner to make a list of all foods the cat has been fed

2. after 2 weeks change diet to something the cat has never eaten before (that means at least a source of protein the cat has never eaten - many pet foods use different protein sources depending on what is available at the time so do not rely on the packet saying 'chicken flavour' or 'with chicken' as most of the protein may be beef for instance - look at the ingredients). Make sure the cat does not eat anything else.

3. give B12 injections (not orally) as necessary (I do not find I have to do this much as it seems to sort itself out once the IBD is controlled in many cases)

4. Maintain the high dose of steroids for at least another 2 weeks, then reduce the dose of steroids by 20-25%.

5. after a further 2 weeks give the same dose of steroids but every other day and then reduce by 20-25% after 2 weeks and again every 2 weeks until down to zero or symptoms return.

6. Add chlorambucil if steroids do not work on their own.

7. If there is concurrent pancreatitis then at least 6 weeks of antibiotics starting as soon as steroids start. Good choices are metronidazole and a penicillin together or clindamycin and marbofloxacin together.

8. The SIBO may well resolve itself when the IBD is controlled especially if pancreatitis has been treated with antibiotics, but if not then long term use of metronidazole or tylosin may resolve the problem.

9. Probiotics are not effective.

By the way thickening of the intestinal wall does not show on xray (it will on ultrasound) - what your vet has interpreted as thickening is a compound shadow - a common misinterpretation.

Thank you Mark for your prompt reply. Actually our diagnosis was about ten months ago now and apart from a liver supplement and a course of weekly B12 injections we've had no other medications. However, I believe we've isolated the trigger foods as chicken and grains. Even though it's very difficult to find a single source protein food ( he did well on the Hills d/d but refused to eat it and the i/d after a while-did however gain weight ) I managed to find one beef only one which he does best on.-even gained weight in the beginning.However even though stools are much better ( solid but a little soft and slightly lighter in colour compared to my other cats, who always produce dark hard stools ) and no vomiting it is difficult to maintain his weight. Incidentally in the early stages he did have a ravenous appetite ( malabsorption? ) leading us to suspect EPI though appetite has normalised now. Resumed B12 recently so will see if this impacts on weight.

Compound shadows? Wonder what these are then? The vet reported it diffuse interstinal thickening at the time. Also wondered if the SIBO was responsible for the inflammation and not true IBD. Without biopsy difficult to pinpoint though I'm reluctant to put him through anything invasive.

Do you think we need to instigate some medication at this stage then and if so which one? Metronidazole? Since this is both antibiotic and anti-inflammatory. If there is inflammation present I really don't like leaving this unaddressed though I wonder in view of improvments it had dampened down now?

Compound shadows are optical illusions - this makes it look like the gut wall is thickened, but it is not necessarily the case.

Some patients respond to diet alone which settles the inflammation but slower than with steroids so if the patient is fine do not complicate things with more treatment.

Thank you Mark for your reply. Yes, I am pleased with his response so far in terms of no vomiting and firmer stools. However, I am still concerned about his failure to gain or maintain weight. He's got a very good appetite and eats as much as our other cats so feel there must be some malabsorption issues remaining here. Otherwise behviour is normal. Our course he may do better on one of the prescription foods like Hills, though it's been difficult maintaining his interest in them. Will I resume the Hills d/d? We can't have him on the i/d owing to the vomiting it caused.

Failure to gain weight suggests that there may be malabsorption assuming the cat is eating sufficient calories. Personally I am not a fan of chopping and changing the diets too frequently to get results as if there is still inflammation in the bowel then the new diet may become part of the ongoing problem because the proteins in the diet may stimulate the immune system. If you have already tried a few diets then it would be better to go onto steroids on a reducing dose over at least 6 weeks