17/06/2024
and Feline Hypercalcemia
in Dogs and Cats.
Hypercalcemia is diagnosed when calcium levels are elevated beyond normal ranges, indicating an underlying disease affecting calcium homeostasis. Clinical signs may not always be evident.
Response to Hypercalcemia:
* Decreased parathyroid hormone (PTH) secretion
* Increased calcitonin secretion
* Decreased calcitriol synthesis
Causes in Dogs:
* Paraneoplastic hypercalcemia of malignancy
* Primary hyperparathyroidism (PHPT)
* Renal disease
* Addison disease
Signs:
Hypercalcemia affects the nervous, gastrointestinal, and urinary systems. Severe clinical signs can occur with calcium levels >14 mg/dL or acute rises. Total calcium concentrations >15-18 mg/dL can be life-threatening.
Treatment:
* Intravenous fluid treatment with normal saline
* Furosemide, steroids, bisphosphonates, calcitonin, bicarbonate, plicamycin
* Dialysis for lowering calcium
:
* Full physical exam, including peripheral lymph nodes and a**l sacs
* Complete blood count and biochemical profile with ionized calcium test
* Urinalysis and potential culture
:
* Abdominal radiographs or ultrasound for urolithiasis
* Thoracic radiographs for evaluating lungs, lymph nodes, and bones
Hyperparathyroidism (PHPT):
PHPT is common in older dogs and can be treated effectively with surgical excision of the hyperfunctional parathyroid gland(s). Postoperative hypocalcemia is common and requires ongoing treatment.
Points on PHPT:
* Bladder stones and UTIs are common
* Abnormal parathyroid tissue can be small, ectopic, or multiglandular
* Surgery is highly effective, though transient hypocalcemia post-surgery is common
Causes of Hypercalcemia:
* Paraneoplastic hypercalcemia of malignancy: Common in dogs (lymphoma, apocrine gland a**l sac adenocarcinoma) and cats (lymphoma, squamous cell carcinoma)
* Addison disease: Hypercalcemia occurs in ~30% of cases, usually mild and resolves with treatment
* Secondary and Tertiary Hyperparathyroidism: Resulting from conditions like renal failure and vitamin D deficiency
* Idiopathic Hypercalcemia in Cats: Most common form in cats, often with no clinical signs
:
Characterized by low PTH and low calcium, caused by surgical excision, trauma, or other factors. Clinical signs include nervousness, seizures, and muscle issues. Treatment includes calcium and vitamin D supplementation.
Calcium Administration:
For hypocalcemic tetany or convulsions, immediate IV administration of 10% calcium gluconate is required, with close monitoring.