Small Animal Emergency and Critical Care Medicine Q&A 09

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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.

Question	Answer		Article
What is your tentative diagnosis?	Eclampsia.		Link to Article
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.		Link to Article
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.		Link to Article
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.		Link to Article