Cobalamin Supplementation

Hypocobalaminemia is regularly seen in canine and feline small intestinal disease and exocrine pancreatic insufficiency (EPI).

Despite other therapy, gastrointestinal symptoms may fail to resolve if low cobalamin levels are not corrected. Historically supplementation has been recommended by SC injections, as oral supplementation was suspected to be ineffective. However, oral supplementation has recently been shown to be effective in both cats and dogs.

In cats, a small study looking at clinical enteropathy cases showed resolution of hypocobalaminemia in all cases with oral supplementation of 0.125-0.25mg once daily for 28-94d (Toresson et al, ECVIM 2015 poster abstract).

In dogs, a much larger study involving 51 dogs with hypocobalaminemia has been published (Toresson et al, JVIM 2016). 48/51 dogs had resolution of their hypocoblaminemia on oral supplementation (after 20-202 days). Doses used were 0.25mg once daily PO in dogs 1-10kg, 0.5mg once daily PO in dogs 10-20kg, 1mg once daily PO in dogs >20kg.

The duration of oral cobalamin therapy required prior to reassessment at this point is unclear, but 30-60 days might be appropriate. Oversupplementation of vitamin B12 is of no concern as it is water-soluble and excreted in urine. Patients can be supplemented with proprietary oral supplements from health food shops and chemists.

There is very little information regarding the use of oral cobalamin supplementation in EPI cases, so at this point, we cannot advocate it. For the time being, SC supplementation continues to be the advised method of supplementation in EPI.