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Low calcium level in the blood (hypocalcemia), rapid fall leads to death in German Shepherds
Question: Dear Sir – Last Monday our 6 1/2 year old German Shepherd Dog Omar started to feel very lethargic. She lost her appetite and was constantly thirsty, but was not interested in doing anything else. Several visits to the vet revealed that her blood was normal i.e. white blood cells etc, but she had low levels of calcium in her blood. Her urine was colored green. She was given a calcium shot on Wednesday and recovered, but after a day her blood calcium levels decreased. On Thursday, her condition worsened, and her heart rate and blood pressure fell. She died Thursday evening and we miss her very much. We think she had a growth on her parathyroid. Until last Monday she was apparently very healthy and happy. What do you think?
Sincerely, Steve
Answer: Steve-
Low levels of calcium in the blood (hypocalcemia) can indicate a number of conditions, so there are other possibilities as well. In addition, calcium is one of the laboratory values that appears to have a high margin of error in laboratory tests. After all, calcium in the blood is bound to albumin (a form of protein), and when albumin levels are low, total calcium levels are low, but ionized calcium (the active form) is normal. In this case, the hypocalcemia is a false finding, even if the laboratory correctly reports the measured calcium values.
Correcting calcium levels to compensate for albumin levels using a formula. An example of this is: Adjusted calcium = (measured calcium – albumin) + 4.
To give you an 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 = 9.1
The most common causes of protein levels so low that total calcium levels drop are bowel disease, in which proteins are not absorbed or flow back from the intestine, glomerulonephritis, in which proteins leak out of the kidneys, and liver failure, in which proteins do not leak out of the liver Amino acids are produced. In German Shepherds, protein loss enteropathies must be considered as a possible cause of the symptoms seen in Omar.
Assuming that calcium levels were indeed low, these are some of the possible diagnoses:
Hypoparathyroidism, acute pancreatitis, kidney failure in which urine is not produced, diet-related secondary hyperparathyroidism and secondary hyperparathyroidism of the kidneys, fast-growing bone tumors (can also lead to an increase in calcium levels), a vitamin D deficiency and sometimes thyroid tumors (produce hormones) causing a drop in calcium levels).
In Omar’s case, I would classify acute pancreatitis as a differential diagnosis because it can lead to sudden loss of appetite and then increased drinking and urination when there is an obstruction of the intestines or the absorption of toxins from the gastrointestinal tract.
Hypoparathyroidism is also possible. In hypoparathyroidism, albumin levels are usually normal, blood urea nitrogen and creatinine are usually normal, lipase and amylase are usually normal (helps rule out pancreatitis), phosphorus is usually elevated, parathyroid hormone ( requires special tests) is usually low and usually not a tumor of the parathyroid gland, but a degenerative process, lymphocytic / plasmatic atrophy, which is believed to be an immune-mediated disorder. Clinical signs of hypoparathyroidism include seizures, muscle tremors, difficulty walking, panting excessively, sometimes drinking and urinating more, and sometimes restlessness.
Primary hyperparathyroidism is often caused by cancer of the parathyroid glands, but this condition usually involves an increase in calcium levels rather than a decrease. However, the symptoms are roughly the same as in hypoparathyroidism. These include seizures, loss of appetite, muscle weakness, apathy, a stiff gait, tremors or shakiness, and increased drinking and urination, which is likely due, at least in part, to high levels of calcium in the blood.
It’s not really possible to tell you which of these conditions was most likely. I’m not sure what to think of urine color as a clinical sign. Maybe it means something that I’m missing out on at the moment. The only causes of green urine that I know of are an increased bilirubin level, which should also have shown up in the blood count, and the administration of methylene blue, which does not seem very likely to me.
The most likely problems seem to be low albumin levels from kidney or bowel disease leading to low total calcium levels, acute pancreatitis (with this disease the patient usually seems very ill), and hypoparathyroidism, but that’s still a fairly long time List, especially since some of the other problems are quite possible too.
I hope this helps understand the things that might have happened.
– 8/20/2001
Last edited on 01/30/05
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