6m.o. cat with hypocalcaemia - HELP!!

Re: 6m.o. cat with hypocalcaemia - HELP!!

Sarah Keir — Thu, 29 Mar 2012 20:32:10 GMT

[quote user="Alex Allen"]

If you stil have a renal physiology text lurking somewhere that will detail Ca and Phos regulation - guaranteed to make your brain hurt after a while though!

[/quote]

Yes, I went home with a thumping headache!!!

Re: 6m.o. cat with hypocalcaemia - HELP!!

Sarah Keir — Thu, 29 Mar 2012 20:31:15 GMT

Thanks for that Alan - very helpful

I didn't manage to get a urine sample as bladder too small for a safe cysto and not peed in tray all day.

I've taken and frozen EDTA plasma for future PTH assay but the owner can't afford it. Hopefully I can persuade her to try treating the little cat rather than automatic euthanasia. It is on a calcium infusion now as the boluses were not doing a great deal to raise calcium levels and and also started on Rocalitrol as that is what we have on the shelf. Where do you get the AT10 - from usual veterinary distributors such as NVS or a private prescription and owner goes to pharmacist?

Many Thanks, Sarah.

Re: 6m.o. cat with hypocalcaemia - HELP!!

Alex Allen — Thu, 29 Mar 2012 18:07:36 GMT

review article by Penny Barber on parathy disorders in JFMS worth a read -

http://jfm.sagepub.com/content/6/4/259.full.pdf+html

If you stil have a renal physiology text lurking somewhere that will detail Ca and Phos regulation - guaranteed to make your brain hurt after a while though!

Re: 6m.o. cat with hypocalcaemia - HELP!!

Martin Atkinson — Thu, 29 Mar 2012 17:59:10 GMT

Some may recall the case I posted on another thread about a 4 year old cat with high PTH and low PTHrp, long standing calcified pinnas (since a kitten), bony exostoses in the joints, calcium deposits in the kidneys and ankylosing spondylitis. This had been mis-managed by previous vets but had been put on prednisolone to reduce calcium levels and the corticoids have also managed his pain from his back quite well. He now has normal calcium levels but a persistent hypo-phosphataemia, and renal function is normal albeit UP/C ratio is in IRIS borderline range. Cost does not allow us to follow this up further but our best guess now is that because the cat was fed on a calcium deficient diet as a kitten it developed compensatory hyper-parathyroidism which has remained persistent but we are hopeful that with consistently normal calcium levels it will slowly recover, still can't explain the low phosphate levels though. My aim is to get if off preds but it needs some pain relief, what are thoughts on giving meloxicam on days off preds as we wean him off?

Re: 6m.o. cat with hypocalcaemia - HELP!!

Sarah Keir — Thu, 29 Mar 2012 17:14:09 GMT

Looked back at the blood results and phosphorus was on the panel done - within normal at 1.97 (0.9-2.20 reference range). I'll do a cysto urine sample after my surgery has finished.

Sarah

Re: 6m.o. cat with hypocalcaemia - HELP!!

HMC — Thu, 29 Mar 2012 16:01:00 GMT

We had a hypercalcaemic pup in recently (I can't remember the values but absolutely sky high). Her kidney values were completely normal and she stumped specialists. Yet their tentative diagnosis in the end was renal disease as she had a very marked hyperproteinuria.

I have been meaning to look up/ask about renal disease without azotaemia ever since.

Have you got any urinalysis results?

Also, dog in the hospital now. Creatinine just above normal but urea off the scale.... marked hyperphosphataemia. So our diagnosis is renal failure.

Re: 6m.o. cat with hypocalcaemia - HELP!!

Kate Richardson — Thu, 29 Mar 2012 15:11:57 GMT

Have you got a Urine SG? i don't think you can say it is not renal until you have assessed this. Am doing some research for you, cos I love these intriguing cases!

Re: 6m.o. cat with hypocalcaemia - HELP!!

Alex Allen — Thu, 29 Mar 2012 14:34:42 GMT

[quote user="Sarah Keir"]Why would phosphorus be useful? Almost certainly not kidney related, has not had a phosphate enema.[/quote]

If this a primary hypoparathy case then in the absence of normal calcium homeostasis / PTH release the Phosphate levels will be either within normal range or only just elevated. If renal aetiology (ethylene tox etc) then would expect normal PTH function resulting in marked elevation in Phos to compensate.

Crude differentiation but quicker and cheaper to run phos than PTH assay

Re: 6m.o. cat with hypocalcaemia - HELP!!

Robin Grimmer — Thu, 29 Mar 2012 14:26:28 GMT

Primary or secondary hypoparathryoidism sound the most likely. A PTH would be useful but if they don't want to do that then will probably need long term Vitamin D. AT10 is best as liquid, not capsule. Once stabilised just keep on lowest effective dose to keep Ca in the lower end of the reference range. Will need regular monitoring though. Need to avoid hyercalcaemia or that will damage the kidneys.

Re: 6m.o. cat with hypocalcaemia - HELP!!

Sarah Keir — Thu, 29 Mar 2012 13:43:06 GMT

Worming up to date withMilbemax. Cat is lovely condition - glossy coat and well muscled, no pot belly.

Not PU/PD, mild raise in urea but creatinine normal, eating and drinking normally until neurological signs got severe on Sunday. No RBC abnormalities seen on comprehensive haematology report.

Why would phosphorus be useful? Almost certainly not kidney related, has not had a phosphate enema. Am I missing something?

Re: 6m.o. cat with hypocalcaemia - HELP!!

Alex Allen — Thu, 29 Mar 2012 13:18:53 GMT

just throwing some suggestions out there:

1. Endoparasites - would deplete Ca even if on decent diet. Last time wormed?

2. Toxicities - Anti freeze would be top of the list for acute Calcium consumption - possible had low dose so not enough to cause more serious signs other than Calcium drop??? Some "safer" antifreeze solutions combine with other compounds like Propylene glycol - any signs of heinz bodys in RBCs?

3. Phosphorus level would be useful - any chance of running this test?