Exocrine pancreatic insufficiency (EPI) impairs an animal’s ability to digest and absorb the nutrients available in food. Because there are insufficient digestive enzymes created by the pancreas, food passes through the body basically undigested. The affected animal will begin to lose weight and have loose, foul-smelling diarrhea. Animals with EPI eat voraciously because they are not able to gain nourishment from the food they do ingest.

 

Treatment for this condition focuses on the use of enzyme replacements in the food. Replacements are typically required for the remainder of the animal’s life.

​

Vitamin B12 (Cobalamin) Deficiency

 

Both dogs and cats with exocrine pancreatic insufficiency (EPI) are at risk of developing a vitamin deficiency at some point. Vitamin B12 (cobalamin) deficiency is extremely common in cats with EPI, and is seen in more than half of dogs with the condition. Because the body can store up the vitamin under normal conditions, it may take some time before it reaches a critically low point. The reason an animal becomes deficient is that vitamin B12 is not absorbed from the food eaten by animals suffering from EPI due to the absence of the glycoprotein Intrinsic Factor.

 

Intrinsic Factor helps the body to absorb the vitamin into the bloodstream. Without sufficient IF, the animal will have even greater difficulty in getting enough vitamin B12. In the cat, the pancreas is the only site of intrinsic factor production. and when the pancreas is compromised, IF deficiency (and thus B12 deficiency) results.

 

Once a deficiency of B12 does occur, the animal will have difficulty gaining (or maintaining) weight, even when he or she may have been doing well on enzyme replacement therapy. The dog or cat will also become lethargic and confused. This is because vitamin B12 plays an important role in intestinal health, as well as brain function.

 

Any animal that is not improving on enzyme replacement therapy should be checked for B12 deficiency to determine if supplementation is necessary.

 

Treating Vitamin B12 Deficiency

​

Animals that are not properly treated for B12 deficiency will have a very poor prognosis and will not show improvement when only treated for EPI. Because animals with EPI are unable to absorb certain nutrients and have a diminished capacity to produce intrinsic factor, giving them oral supplementation of B12 without intrinsic factor doesn’t help.