A Most Unusual Case of Chronic Vomiting

An 18 month old, neutered male Boston Terrier presented with a long history of chronic vomiting. The dog was treated with the usual medications and would be better for a while. His diet had been changed several times. He would improve with each change, but after a couple weeks would begin vomiting again.

The history suggested chronic gastritis due to food allergies. A food allergy panel showed allergies to many foods. A Stool Microbial Profile showed major deficiencies in probiotic bacteria- but no pathogens. A hypoallergenic diet and probiotic were started. He was normal for a few weeks, but the vomiting began again.

A Snap CPL test was abnormal- suggesting pancreatitis. A CBC was within normal limits. A chemistry panel revealed a mild elevation in ALT ( liver enzyme) and very low serum chloride. He was treated for pancreatitis and responded well.

Two months later the vomiting began again. At this point, it was clear the dog was suffering from something unusual. A Urine Essential Elements panel was run since the serum chloride had been low. Low serum chloride can be associated with hypochlorhydria ( low stomach acid). Iodine is essential for the production of stomach acid so a Urine Halides Panel was run. 90% of the time the Urine Halides Panel shows elevated fluoride- which can block iodine. In this case, urine fluoride was normal, but urine iodine was so low that none could be detected. Iodine supplement and betaine HCl (stomach acid) were started. At recheck 3 months later, the dog continues to do well.