DIFFERENTIAL DIAGNOSIS  h  INTERNAL MEDICINE  h  PEER REVIEWED

Hypocalcemia
Julie Allen, BVMS, MS, MRCVS, DACVIM (SAIM), DACVP

FOR MORE Most (≈99%) calcium in the body is stored Medullary thyroid carcinoma (increased
h 

Find more Differential in the bones. The remaining calcium calcitonin)

Diagnosis lists in Metabolic (eg, secondary to protracted vom-
is stored in extracellular fluid and is h 
upcoming issues of iting) or respiratory (eg, hyperventilation)
Clinician’s Brief and on composed of 3 parts: protein-bound,
alkalosis
cliniciansbrief.com complexed, and unbound/ionized
h Postsurgical correction of primary hyper-
(active form) calcium. As a result, protein
parathyroidism or hyperthyroidism
h Anemia concentrations can affect total calcium; h Primary hypoparathyroidism
h Basophilia
however, formulas to correct for albumin h Protein-losing enteropathy
h Decreased Total
concentration should not be used, as h Renal secondary hyperparathyroidism
Thyroxine
h Eosinophilia
they are often inaccurate. Any decrease in • C
 hronic or, less commonly, acute renal failure

h Epistaxis total calcium should be rechecked and an h  Secondary hyperparathyroidism due to

h Erythrocytosis ionized calcium test performed if calcium nutritional (eg, vitamin D) deficiencies
h Hypercalcemia is still decreased. h  Severe rhabdomyolysis or soft tissue trauma
h Hypercholesterolemia h Snake envenomation
h Hyperglobulinemia h Urethral obstruction
Following are differential diagnoses for
h Hyperkalemia h Vitamin D-resistant rickets (types I and II) n
h Hypoalbuminemia
patients presented with hypocalcemia.
h Hypocholesterolemia
h Acute pancreatitis References
h Hypoglycemia
Dias C, Carreira LM. Serum ionised calcium as a prognostic risk
h Acute tumor lysis syndrome
h Hypokalemia factor in the clinical course of pancreatitis in cats.
h Artifactual hypocalcemia J Feline Med Surg. 2015;17(12):984-990.
h Hypophosphatemia
Ferguson DC, Hoenig M. Endocrine system. In: Latimer KS, ed.
h Increased & Decreased • E  DTA or citrate contamination of serum
Duncan and Prasse’s Veterinary Laboratory Medicine: Clinical
Blood Urea Nitrogen sample Pathology. 5th ed. Ames, IA: Wiley-Blackwell; 2011:301-302.
Holowaychuk K. Hypocalcemia of critical illness in dogs and
h Increased & Decreased h  Critical illness (likely multifactorial), including cats. Vet Clin North Am Small Anim Pract. 2013;43(6):1299-
Creatinine sepsis 1317, vi-vii.
h Increased Total Luschini MA, Fletcher DJ, Schoeffler GL. Incidence of ionized
h Drug-induced effect
hypocalcemia in septic dogs and its association with
Thyroxine • Bicarbonate infusion morbidity and mortality: 58 cases (2006-2007). J Vet Emerg
h Lymphocytosis Crit Care. 2010;20(4):406-412.
• Bisphosphonates Schenck PA, Chew DJ, Nagode LA, Rosol TJ. Disorders of
h Lymphopenia
• Enrofloxacin calcium: hypercalcemia and hypocalcemia. In: DiBartola
h Monocytosis SP, ed. Fluid, Electrolyte, and Acid-Base Disorders in Small
• Furosemide Animal Practice. 4th ed. St Louis, MO: Elsevier Saunders;
h Neutropenia
2012:163-174.
h Panting
• Phosphate enema
Stockham SL, Scott MA. Calcium, phosphorus, magnesium
• Tetracyclines and their regulatory hormones. In: Stockham SL, Scott
h Eclampsia
MA. Fundamentals of Veterinary Clinical Pathology. 2nd ed.
Ames, IA: Blackwell Publishing; 2008:602-610.
h Ethylene glycol toxicity Whitehead J, Quimby J, Bayliss D. Seizures associated with
h Hyperthyroidism
hypocalcemia in a Yorkshire terrier with protein-losing
enteropathy. J Am Anim Hosp Assoc. 2015;51(6):380-384.
h Hypoalbuminemia (most common cause) Williams TL, Elliott J, Berry J, Syme HM. Investigation of
h Hypomagnesemia
the pathophysiological mechanism for altered calcium
homeostasis in hyperthyroid cats. J Small Anim Pract.
h Massive blood transfusion (excessive citrate) 2013;54(7):367-373.

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