Hypercalcemia... Dermatology...

Re: Hypercalcemia... Dermatology...

John Flynn — Fri, 14 Jun 2013 08:24:37 GMT

Thanks for all the help and advice so far!

I'll do a thorough physical exam before I go any further and try to remember a photo to share here.

Assuming no further findings of relevance on exam, I'd thought further blds (PTH, repeat ionised calcium +/- PTHrp) was probably the way to go, but survey xrays would be a lot cheaper and might make more sense to do first.

I normally GA for chest radiographs if looking for signs of mets/masses so can manually inflate lungs - are there any contraindications re hypercalcaemia and a GA in particular? (I'd probably take suitable blood samples and freeze them, then drip with saline to get calcium down a bit before GA, but is there actually an increased GA risk associated with hypercalcaemia other than perhaps poorer renal perfusion?)

Should have added that lab testing was requested after 3 x in-house hypercalcaemia results on 2 x separately taken samples (all the same day though). Also >16hrs fasting prior to blood results above.

Re: Hypercalcemia... Dermatology...

Stephen Courtney — Thu, 13 Jun 2013 23:32:57 GMT

But confirm the hypercalcaemia again before spending loadsa cash looking for the rare and wierd

Re: Hypercalcemia... Dermatology...

Mark Holmes — Thu, 13 Jun 2013 21:33:54 GMT

Can I suggest chest x-rays as soon as you get the chance. Mediastinal lymphoma has cropped up loads in hypercalaemic dogs.

Re: Hypercalcemia... Dermatology...

Busybee — Thu, 13 Jun 2013 19:26:12 GMT

Don't forget.........!

GOSH DARN IT

G—Granulomatous disease, Grapes
O—Osteolytic
S—Spurious
H—Hyperparathyroidism, Humoral hypercalcemia of malignancy, House plants
D—Vitamin D toxicity, Dehydration
A—Addison’s, Vitamin A, or Aluminum toxicity
R—Renal disease
N—Neoplasia (humoral hypercalcemia of malignancy)
I—Idiopathic
T—Temperature (hypothermia)

Would strongly suggest resampling - the high triglycerides could be causing a pseudohypercalcaemia.

Re: Hypercalcemia... Dermatology...

Stephen Courtney — Thu, 13 Jun 2013 18:20:11 GMT

Definitely get a finger up the rear, and maybe consider a PTH assay if things point that way. also repeat the calcium - lab error happens. the calcium may be spurious or not, and it may have nothing to do with the lumps on the paws.

It might be better to fine needle the lumps - if they are bad news then surgery is not likely to benefit the dog.

Re: Hypercalcemia... Dermatology...

John Flynn — Thu, 13 Jun 2013 17:57:03 GMT

[quote user="Martin Atkinson"]X-rays to look for any evidence of soft tissue calcium deposition[/quote]

Thanks - I hadn't thought to do xrays - good idea, certainly prior to any biopsy if does come to that.

Re: Hypercalcemia... Dermatology...

Martin Atkinson — Thu, 13 Jun 2013 17:54:06 GMT

X-rays to look for any evidence of soft tissue calcium deposition, if there is calcification in the pad lesions biopsies may be revealing. That Na:K ratio looks suspiciously Addisonian but nothing else does. Low T4 may just be sick thyroid syndrome.