Hypercalcaemia

RE: Hypercalcaemia

Rob Loxley — Sat, 27 Feb 2016 12:23:54 GMT

I'll look up what I was suggested by an internal medic for the couple of dogs on it next week. Think it was 10mg/dog SID starting dose

RE: Hypercalcaemia

Rob Davis — Sat, 27 Feb 2016 10:49:14 GMT

Still can't find it.... do you have a protocol?

RE: Hypercalcaemia

Rob Loxley — Sat, 27 Feb 2016 09:44:16 GMT

[quote user="Rob Davis"]can't find alendronic acid in the BSAVA formulary - does it have another name, or can you point me in the right direction to find some more information?[/quote]

US trade name is Fosamax so may be better search term

RE: Hypercalcaemia

Rob Davis — Fri, 26 Feb 2016 19:51:51 GMT

[quote user="robloxley"]I've used alendronic acid a fair bit and it is cheap. Whether a cox-2 selective NSAID and bisphosphonate for the hyperCa is better than pred I'm not sure[/quote]

I've only used pamidronate (aredia) before by very slow IV infusion, and it does work out very expensive. I can't find alendronic acid in the BSAVA formulary - does it have another name, or can you point me in the right direction to find some more information?

RE: Hypercalcaemia

Rob Loxley — Thu, 25 Feb 2016 15:50:20 GMT

[quote user="Ashlea"]I've never used bisphosphonates, would they be worth at least discussing though? If very expensive I don't think it'll be an option[/quote]

I've used alendronic acid a fair bit and it is cheap. Whether a cox-2 selective NSAID and bisphosphonate for the hyperCa is better than pred I'm not sure

RE: Hypercalcaemia

Lindsay Sissons — Wed, 24 Feb 2016 19:37:31 GMT

Just had a case very similar - turned out to be mediastinal lymphoma - all palpable lns normal. 5 yr old Ridgeback.

RE: Hypercalcaemia

Gillian Mostyn — Wed, 24 Feb 2016 17:57:08 GMT

We've got a similar case at the moment...presented with the symptoms from hypercalcaemia but had a mahoosive anal sac adenocarcinoma. Is doing brilliantly on piroxicam though....

RE: Hypercalcaemia

Ashlea — Wed, 24 Feb 2016 16:36:30 GMT

Thanks for your reply - the reasoning for doing PTH over PTHrP in particular made a lot of sense. It turns out I was worrying for nothing about diagnostic plan in the end - the dog came back this afternoon continuing to lose weight and I found an anal sac mass which has spread to the sublumbar and prescapular lymph nodes. for now I've put the dog on palliative preds - I've never used bisphosphonates, would they be worth at least discussing though? If very expensive I don't think it'll be an option, I'm concerned about the calcium though and am not too keen on adding frusemide in given the level of PUPD already plus using pred.

RE: Hypercalcaemia

Rob Davis — Wed, 24 Feb 2016 15:26:03 GMT

PS - recheck Ca++ first just in case the sample was contaminated with EDTA!

RE: Hypercalcaemia

Rob Davis — Wed, 24 Feb 2016 15:25:04 GMT

I'm not expert, but I'll give you my thoughts until somebody more clever than me appears!

I'm not sure ionic Ca++ on it's own is going to gain you much - I would be very surprised if it's not elevated with total Ca++ that high unless you have a very high albumen level. If anal sacs haven't been checked, I suspect you may find your answer there, but if anal sacs, LNs and scan are unremarkable, then PTH would be my next step. This should tell you whether it's primary hyperparathyroidism, and if that's normal then a tumour seems likely (PTHrP would help but adds significantly to cost).

If they don't want further diagnosics then prednisolone is probaly the cheapest and simplest option, though the prognosis will remain guarded. Bisphosponates can be useful but are expensive and have the potential for severe adverse effects.

These can be frustrating when funds are limited...