Small Animal Emergency and Critical Care Medicine Q&A 09
A two-year-old mixed-breed bitch had four puppies 16 days ago. The puppies seem healthy but the owners report that the dam is salivating, walking stiffly, panting and has muscle tremors.
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| What is your tentative diagnosis? | Eclampsia. |
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| What potential problems in the dam should be ruled out with your initial data base and physical examination? | Hypocalcemia is often accompanied by hyperthermia, dehydration, hypoglycemia and cardiac arrhythmias. |
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| What is your management plan for this case? | Ten percent calcium gluconate (0.5–1.5 ml/kg) should be administered slowly i/v until clinical signs regress. The drug must be discontinued if bradycardia or other arrhythmias are noted on ECG. Vomition or ‘licking the lips’ are indications that i/v administration should be discontinued. A second dose of calcium gluconate (1–2 ml/kg) can be given s/c if it is diluted 50:50 with saline. Fever, dehydration and hypoglycemia can be managed with i/v fluid therapy. Ideally, the pups should be removed and hand raised, but if they are allowed to remain with the dam, she should receive oral calcium supplementation (25–50 mg/kg/day divided every 8 hours) until lactation is completed. |
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| What problems have been associated with oral and parenteral calcium administration? | Calcium supplementation prior to whelping inhibits parathormone secretion and makes the dam more prone to hypocalcemia during lactation. If i/v calcium is administered too rapidly, cardiac arrhythmias may result. Oversupplementation with calcium may cause arrhythmias, neurologic impairment, GI dysfunction and renal failure. Calcium chloride must never be administered i/m or s/c, as tissue necrosis and skin sloughs can occur. |
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