? B12 deficiency advice.

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Justin & Sebastian

Justin & Sebastian

Member Since 2019
Looking for anyone who has experience with B12 deficiency in their cat.

Sebastian has been having weight loss and lethargy for several months and chronic vomiting, diarrhea, and inappetance for a little over a month. We had a GI panel done at it showed he had a cobalamine deficiency. It's also possible he has IBD. The vet prescribed B12 shots at .25ml every 7 days, that I started on 5/19, so he's had 2 injections so far. We haven't seen any improvement. I've looked at treatments for IBD, such as S.Boulardi probiotics, slippery elm bark powder, and raw food diets, but everything I've seen says it's really not going to work if the B12 is low. Meanwhile, his weight continues to drop and, as he's a diabetic with a history of DKA who is having chronic diarrhea, he's not getting enough nutrients and I'm having to give him daily sub-q injections to stay ahead of the ketones.

So I'm wondering if anyone else has had experience with B12 injections. When should we start to see improvement? If it's not working, what is the alternative?

Here's the results of his GI panel done on 5/17:
Cobalamin 183, range 290-1500
Folate 10.6, range 9.7-21.6
PLI 9.2, range <= 3.5. He's already been diagnosed with pancreatitis
TLI 36.6, range 12-82. This is supposed to rule out the low cobalamin being cause by EPI.
 
I give my cyvie B12 methylcobalamin orally every day and it has worked very well, it did took about a week or a bit more till I noticed any difference
 
I have been in your shoes. The IBD, pancreatitis and FD trifecta is a roller coaster ride. It will take time for the B12 levels to rise - at least a month.


The cobalamin helps with food absorption. Which is 1 part of the puzzle. The other part is the IBD - it is an inflammation which will drive up the BG's and inhibits food absorption. So you need to get a firm diagnosis if that is the issue and address it with a change of food and possible medications.
Metronidazole can be used for the diarrhea and a steroid is used to bring the inflammation in the gut down. The third part is the diabetes, once you get the nutrients in...you need the BG's down in order for his body to capture that energy.

I found Jones did very well from his DX till about 16 months in - gained weight, had normal poops, had a good appy and was generally feeling better.

On the IBD side - to be truly diagnosed you need a biopsy to determine if it is IBD or Small Cell Lymphoma. If you feel you want to go that route and get the biopsy - you can not start any steroid therapy before the biopsy otherwise it will skew the results. The treatment is different for the two however some SCL patients start with the same steroid as IBD patients. Seems to depend on the vet. It is ok if you decide not to, I didn't as he was so sick at dx.

For the pancreatitis - that is painful. Pain relief is important to keep your kitty comfy. Here is some information for you. http://www.felinediabetes.com/FDMB/threads/a-primer-on-pancreatitis.83108/ I wish I had a pain relief for Jones from the very beginning. It was extremely helpful during flares.
 
Thanks for the input, it helped give me a clearer idea of what we need to do.

We had originally done a 7 day cycle of Metronidazole. After starting that I saw his ketone levels start to drop and after 2-3 days his stools started to solidify. 3-4 days after he went off it the diarrhea came back, however I didn't immediately make the connection since we were also trying other things like transitioning to a raw food diet and S.Boulardi probiotics. I now know that the diet and probiotics aren't going to work until the B12 is normal and if the diarrhea responds to the Metronidazole they need to stay on it to keep it in check. So I started him back on it last night. I've read that studies have shown long term use of Metro in humans can have cancer causing incidents so it's not something we want to do long term, however my thinking is if we can use it for a month or so to stop the diarrhea, get his B-12 in check, and then transition to raw food, do the AnimalBiome fecal transplant course, and start a regular probiotic regiment as if it's IBD, we'll see where we get. So I'm trying to do a natural remedy first and use steroids as a last resort. I would really prefer to avoid a biopsy so we're going to treat it as if it's IBD but if that doesn't work we'll revisit it.

I hadn't been doing anything for the pain, didn't know I need to since he hasn't been showing any visible signs, however we've definitely been having issues with the flare ups where he gets nauseous and doesn't want to eat. None of the anti-nausea medications or appetite stimulants have worked, so I've just taken to having a stock of syringes loaded with slurry to I give him a bit at a time and if he throws a couple up I just reload him. I have a vet apt tomorrow though and I will ask about the bupe, maybe that will help.
 
Justin & Sebastian said:
term use of Metro in humans can have cancer causing incidents
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Jones was on it from the day he was dx till a couple of days before we let him go. That was about 20 or so months. The dose went up and down over that time. I discussed issues with long-term use and my vet was of the opinion that the risk of long term use was limited and using it was better than not using it. Just a note that it is an antibiotic so you need to give it and any probiotics apart. Along with the SEB - need to give that at least 2 hours before or after a meal and meds.

Jones used cyproheptadine for an appy stimulate. To me it was gentler and it provided better coverage than mirtazapine. He used cerenia for anti-nausea and it worked great for him. Ondansetron is the other one you can use. They target different receptors. You can use both as well if needed.

If he is having a flare and nauseous you need to get that under control before trying the appy stims. Otherwise you can create food avoidance because you are making them eat while feeling bad.

I didn't think Jones was in pain either....after I got the buprenorphine and gave him some doses....noticed a big difference! Wish I had it to start with.

Have you checked out ibdkitty.net? There is a lot of information on there for IBD kitties.
 
Tracey&Jones (GA) said:
He used cerenia for anti-nausea and it worked great for him. Ondansetron is the other one you can use. They target different receptors. You can use both as well if needed.
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I have both and neither seem to have any effect. In fact, with this recent flare up and bouts of nausea, giving him the pills would make him vomit so I had to take to grinding them up and mixing them in his food, but they had no effect. So nausea is still an issue we haven't resolved and I basically just brute-force through it, syringe feeding him a little at a time, giving extra when he throws some up, and he eventually has gotten over it and back to eating the solid food. It seems to help with the food avoidance with it being a different texture. We've had periods where he won't eat the food in solid form but would happily lick the same food in in slurry form off a plate.
 
Hi, I'm sorry to hear Sebastian is still doing poorly. It's so hard when they won't eat :(
FWIW, Willow was on metronidazole since she was a kitten (literally) until she was around 10 years old, for "IBD" (quotes because no formal diagnosis, just never able to get a solid poop out of her, and the only thing that helped was metronidazole). Miraculously cured (and I mean that seriously) with a cerenia injection given for nausea and inappetence at that age... And that one cerenia injection somehow worked for everything. Great from then until diagnosed with DM last November, at 17 years.
So I personally would go with metronidazole if it's helpful. Vines for Sebastian :) with love, Nikki
PS also recently started Willow on B12 injections at home, she's already started on zobaline, and just got a prescription for b complex injections as well, as she's anemic (though vet doesn't think so, sigh). Hopefully it will perk her up too.
 
nslade001 said:
Hi, I'm sorry to hear Sebastian is still doing poorly. It's so hard when they won't eat :(
FWIW, Willow was on metronidazole since she was a kitten (literally) until she was around 10 years old, for "IBD" (quotes because no formal diagnosis, just never able to get a solid poop out of her, and the only thing that helped was metronidazole). Miraculously cured (and I mean that seriously) with a cerenia injection given for nausea and inappetence at that age... And that one cerenia injection somehow worked for everything. Great from then until diagnosed with DM last November, at 17 years.
So I personally would go with metronidazole if it's helpful. Vines for Sebastian :) with love, Nikki
PS also recently started Willow on B12 injections at home, she's already started on zobaline, and just got a prescription for b complex injections as well, as she's anemic (though vet doesn't think so, sigh). Hopefully it will perk her up too.
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Wow, that's good to know that there are some kitties out there on long term metro and it helps. He's definitely improved in the past day since I put him on it, so I'll be asking the vet to get a few refills on the books so I can stay stocked up. He's had a cerenia injection before from the vet and it definitely didn't cure everything but I seem to remember it being more effective at stopping the vomit than the pills have been. I've got my fingers crossed that we'll only need to do the metro and B12 short term to get things under control and then can use that period to switch to raw food and a probiotic supplement and that will handle things long term, but it's good to hear we've got effective long term treatments available.
 
I wonder if maybe some antacid will help??? I forget the name of the one Jones was on...started with an A - amizole??.

That helped Jones in the end and it definitely helps my KD kitty. She gets acidic tummy which make her vomit and not want to eat. A couple days of that and all better!
 
Tracey&Jones (GA) said:
I wonder if maybe some antacid will help??? I forget the name of the one Jones was on...started with an A - amizole??.
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Use of antacids (neutralize acid already in stomach) in cats is very rare. However, acid reducers (reduce the production of acid in the stomach are commonly used. Omeprazole (one trade name PRILOSEC) is sometimes used. Another is are famotidine (one trade name Pepcid AC).
 
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