CALCIUM

PART 1: Core Principles and Causes

of Abnormalities
with Dr Jenna Harper

CORE PRINCIPLES
CALCIUM'S ROLE
Neural conduction
Stability of cellular membranes: action potentials
(AP) - messengers systems
All cells have resting membrane potential
Very important in neuro-hormonal cells and
cardiac cells (latter regulates rhythm)
Molecule transport inside and outside of cells
Bone formation

Most important role in terms of clinical manifestations: nervous and cardiac

NOTE systems

HYPOCALCEMIA
Most commonly seen in an emergency service
Clinical signs: Due to neuronal excitability - patient
becomes more excitable as cellular depolarisation is
reduced due to reduction of threshold/AP
nervousness
maybe behavioral changes - aggression
facial rubbing
muscle twitching
tetany - rigidity of muscle
Seizure activity: rare, only if severe
tachyarrhythmias/missing ventricular beats: rare,
only if severe
HYPERCALCEMIA
More commonly seen in specialist service
More subtle - may be chronic
Clinical signs:
lethargy/weakness
Anorexia (88% Dogs)
PUPD (68% Dogs - rare in cats)
Vomiting, diarrhea, poor appetite, weight loss: less common

Patient with concomitant diseases likely to be sicker if hypercalcaemic

also

Renal disease can be a consequence or cause of hypercalcaemia

MEASURING CALCIUM LEVEL

1 TOTAL BODY CALCIUM (CAT)
PRO-TIP If CaT is low, check albumin levels as
Available in most clinics hypoalbuminaemia may be the cause of
the hypocalcaemia
Ionized + bound (albumin)

2 IONIZED CALCIUM (CA2+) - bioactive components

More commonly available due to point of care equipment: Epoc Ⓡ or i-STAT
Clinical signs associated with the bioactive component: most important
measurement
Severity of the increase (mild, moderate and severe) can indicate chronicity
of disease and age of patient

PRO-TIP If you cannot measure Ca2+ in clinic and find CaT is high then assess severity
of the increase
If borderline high - repeat or correlate back to the case (are the clinical
signs indicative - isosthenuria, anorexia, evident causes of hypercalcaemia)
If elevated then need to investigate further
Need to measure ionized calcium in the clinic not send to the lab
Does not stabilize well and is hugely impacted by pH and temperature
CaT is less reliable in hypocalcaemia - can have a hypocalcaemic dog in
tetany with a normal total calcium
CAUSES OF HYPOCALCAEMIA
Eclampsia
Systemic inflammatory response syndrome
(SIRS)
Sepsis
Pancreatitis
Chronic protein losing diseases: loss
albumin
Acute and chronic renal failure - Vit D
deficiency so decreased Ca absorption in
the git

CAUSES OF HYPOCALCAEMIA
Paraneoplastic hyperparathyroidism: release
parathyroid hormone related peptide from a
tumour - common
True primary hyperparathyroidism: increase
in parathyroid hormone - uncommon
Vitamin D3 creams/supplements toxicity
from ingestion- uncommon
Squamous cell carcinomas - cats only
Idiopathic - cats. Often incidental findings
Age - normal in a young puppy

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