Vetinfoindex
Vetinfo4cats
Catindex
Subscriber Area (members only)
Zoonotic disease
Becoming A Veterinarian
Your Turn
Search vetinfo4dogs
Support Vetinfo and Subscribe toVetinfo Digest
Hypocalcemia - Low blood calcium levels in Dogs
Hypocalcemia, rapid decline, death in German Shepherd
also see Pancreatitis
also see Parathyroid problems
Low blood calcium levels (hypocalcemia), rapid decline lead to death in German ShepherdQuestion: Dear Dr. Richards
Last Monday our 6 1/2 year old German Shepherd Omar began feeling very
lethargic. She lost her appetite and was continuously thirsty but
wasn;t interested in doing anything else. Several trips to the vet indicated
that her blood was normal i.e. white counts, etc but she had a low
blood calcium level. Her urine was green in colour. A calcium injection was
given to her on the Wed and she perked up but then her blood calcium
dropped after a day. On Thursday her condition deteriorated and her
heart rate and blood pressure dropped. She died on Thursday evening
and we miss her terribly. We think that she had a growth on her
parathyroid gland. She was apparently very healthy and happy until last Monday.
What do you think?Regards, Steve
Answer: Steve-
Low blood calcium levels (hypocalcemia) can be indicative of a number
of conditions so there are other possibilities. In addition, calcium is
one of the lab values that seems to have a high error rate in lab testing.
Finally, calcium is bound to albumin (a form of protein) in the blood
stream and if albumin levels are low, total calcium levels will be low
but ionized calcium (the active form) are normal. In this case, the
hypocalcemia is a false finding even though the lab is correctly
reporting the measured calcium levels.To correct for calcium levels to compensate for albumin levels, using a
formula. One example of this is: Adjusted calcium = (Measured Calcium
- albumin) + 4.To give you some idea of how this works, if the calcium level is 6.5,
but the albumin level is 1.4, then the adjusted calcium level is: (6.5 -
1.4) + 4 = 5.1 + 4= 9.1The most common causes of protein levels falling low enough to cause
low total calcium levels are intestinal disease in which protein is not
absorbed or leaks back out of the intestines, glomerulonephritis in
which protein leaks out of the kidneys and liver failure in which proteins
aren't manufactured from amino acids by the liver. In German shepherds,
protein losing enteropathies have to be considered as a possible cause of the
symptoms seen in Omar.Assuming that the calcium level was actually low, though, these are
some of the possible diagnoses:Hypoparathyroidism, acute pancreatitis, kidney failure in which no
urine production is occurring, nutritional secondary hyperparathyroidism, and
renal (kidney origin) secondary hyperparathyroidism, rapidly growing
bone tumors (can also cause increases in calcium), deficiency of Vitamin D
and thyroid gland tumors (sometimes produce calcitonin, a hormone that
causes drops in calcium levels).I would consider acute pancreatitis among the differential diagnoses in
Omar's case, because it can lead to a sudden loss of appetite and then
increased drinking and urinating if an intestinal obstruction or
absorption of toxins from the GI tract occurs.Hypoparathyroidism is also possible. When hypoparathyroidism occurs,
the albumin level is usually normal, the blood urea nitrogen and creatinine
are usually normal, lipase and amylase are usually normal (helps to rule
out pancreatitis), phosphorous is usually increased, parathormone (requires
special testing) is usually decreased and there is usually not a tumor
of the parathyroid gland but a degenerative process,
lymphocytic/plasmacytic atrophy, that is thought to be an immune mediated disorder. The
clinical signs of hypoparathyroidism include seizures, muscle tremors,
difficulty walking, excessive panting, sometimes increases in drinking and
urinating and sometimes restlessness.Primary hyperparathyroidism is often caused by cancer of the
parathyroid glands but in this disorder there is usually an increase in calcium
levels rather than a decrease. The symptoms are about the same as for
hypoparathyroidism, though. These include seizures, loss of appetite,
muscular weakness, apathy, stiff gait, shivering or tremoring and
increased drinking and urinating that is probably at least partially due to the
high blood calcium levels.It is not really possible to tell you which of these conditions was
most likely. I am not sure what to make of the urine color as a clinical
sign. This may mean something that is escaping me at the present time, too.
The only causes I know of for green urine are increases in bilirubin, which
should have shown up in the blood work, too, and administration of
methylene blue dye, which doesn't seem likely at all.The most likely problems would seem to be low albumin levels from
kidney disease or intestinal disease leading to low total calcium level, acute
pancreatitis (usually the patient seems really sick with this illness)
and hypoparathyroidism, but that is still a pretty long list, especially
since some of the other problems are definitely possible, too.I hope that this helps some in understanding the things that might have
happened, though.Mike Richards, DVM
8/20/2001
Last edited 01/30/05
Vetinfo | vetinfo4cats | vetinfo4dogs | Canine Encyclopedia |
Feline Encyclopedia | VetInfo Digest | Links