Canine Hypoparathyroidism - Severe Hypocalcemia

Hello everybody. This is Diego from Chile. I am actually a human physician (pediatrician to be precise), and I understand my clinical knowledge and experience must be very different from yours. My 13 year old dog (intact male miniature Schnauzer), Napoleon, whom of course we love and care for; is sadly very ill with what our vets believe is hypocalcemia. Besides this, Napo has a diagnosis of Myxomatous mitral stenosis (mild, currently without treatment) , Hepatic steatosis (mildly to moderately elevated transaminases), bile sludge (no gallbladder stones). The symptoms started maybe 16 days ago more acutely, with loss of strength of his legs and paws, then 14 days ago he began having spasms and 13 days ago he started seizures (apparently... I didn't see these), alteration of his levels of consciousness and stiffness. He was brought to an emergency room were Total Calcium levels were measured showing severe hypocalcemia and hyperphosphemia. His PE was positive for signs of hypocalcemai and he also showed an EKG with PVC and QT enlargement. He was hospitalized and given iv calcium. He used a urinary catheter due to difficulty to urinate, afterwards he seems to have developed a UTI that began treatment (negative cultures so far). He has not developed renal failure so far and has adequate urinary output. He stayed hospitalized for 10 days, where our vets had to administer multiple IV Calcium boluses, at most daily. We saw him get better some days at a time, but get worse other days, so he wasn't allowed to be discharged. In fact, his last hospitalized day he was administered hourly IV calcium boluses plus IV magnessium as a last attempt (they recommended euthanasia in case this last resort didn't work). We saw him stand, wag his tail, drink water, walk, defecate and eat his last day hospitalized so we decided to bring him home without currently thinking of euthanasia. On his differential study: PTH was performed (although our doctor assures that Napo most probably has hypoparathyroidism due to low serum calcium and high phosphorus); an abdominal ultrasound was performed (negative for neoplasia), a neck ultrasound was NOT performed ( the endocrinologist tells us he doesn't palpate any neck masses nor an enlarged thyroid gland and therefore didn't ask for that echo; besides a normal thyroid function). He has not been evaluated by a neurologist because it seems like Napo is better after having been administered IV calcium. PLI was performed coming out negative for pancreatitis. At this moment, Napoleon is home, although showing signs of hypocalcemia (mostly weakness and night deambulation), and his first Calcium control 24 hrs after discharge and with currently a total 1800 mg oral calcium plus vitamin D and his oral antibiotics. Do you think there is any differential we have left off? Do you think there is any other alternative to what is happening? I'm trying to think out of the box. Maybe we need a different opinion. Have you seen hypocalcemia due to hypoparathyroidism cases THIS refractory? Thank you very much for your time and help.

Hello - in short, the answer to your question is that no, I haven't seen cases so refractory, or even very many cases; I suspect that hypocalcaemia has been historically underdiagnosed and not treated as attentively as it has been in humans.  Calcium, as you know, exists in three forms - ionised (biologically active), protein bound and chelated (bound to Phosphate, Sulfate and Citric acid) and for years, ionised Calcium often went untested.  If you can get access, the Veterinary Times recently ran a 3-parter on Calcium, starting 30th January 2024 and written by Gerardo Poli.   Poli lists the major causes thus:  acute kidney failure, acute pancreatitis, diabetic ketoacidosis, eclampsia, ethylene glycol intoxication, protein-losing enteropathy, sepsis, trauma, urethral obstruction, parathyroid disease and tumour lysis.  They observe that situations altering the fraction of extracellular Calcium include acid-base disturbances / an increase in fatty acids and they also mention that iatrogenic cases can occur following blood transfusion.  I hope that something there is interesting.

hi. I am not a vet, just a mom. I am not sure if I can respond or ask questions. I hope I am not breaking any rules.  My dog has had various acute onset phase symptoms. She is almost 3. She has had many, many tests. Just wondering if the vets have considered /ruled out immune disorders, genetic, infectious diseases and/or drug hypersensitivities. I am next door in Argentina, but my dog is a rescue from your northern neighbors. I have no medical knowledge. I am just a mom of a dog whose acute symptom phases have involved several diagnoses, 7 echos, 9 ultrasound, countless tests and so thought I would just add our medley of a mess (which has included more diagnoses than you can imagine- primarily in the endocrine / cardiac genres- but most now her lameness/neuro/respiratory/inflammation responses are current being seen from an immune/mutation/drug hypersensitivity lens. Strangely- i had never considered the second two. abrazos de mendoza!

sorry, i hope it's ok to add a couple things. keep in mind i know nothing. i would ask about which bacteria would not show up on a urine culture. i was unaware that was a question i only asked when my dog was diagnosed with two hemotropic mycoplasmas. and then i asked. it would not have appeared. Our bacteria was just a 1+.  that first ever ultrasound showed mild bilateral renomalogia but spelled right, as well as over 60 campo.did you have any notable cbc/biochem abnormalities other than those you mentioned?  and a full renal panel?   .A month or two later, a secretion sediment was done that was negative for bacteria. The vet wanted to do a special yeast/hongos type of test that would have taken three weeks. my dog has a uniquely bad pre-me past that involves hydrocarbon, and she has particularly bad luck.  are you able to get ED method for thyroids? we get electrochem/chem immunoassays, which my dog skews.  You are a doctor and I am sure you are able to get the goldest methods possible, none of which are available here. The only thing I can offer would be tests i wish i could get, from ANA, coombs, c-reactive protein, i won't go on and on. I was once fixated on infectious/parasitic/cualquier bicho, and never though about how so many new symptoms began after multi-drug administration. I won't write more- the question I think I wish I asked more when i received 'negative' for xyz parasite or tick disease was which things would not have appeared. our seven echos are quite different in terms of conclusions, which most recently include pseudohypertrophy. did your cardio feel that any symptoms were attributable to his heart? our current situation, at least to me (no medical records in either countries, so i have to google, which benefits no one is along the lines of mechanotransduction). Due to frequently changing results, often inexplicably abnormal, along with symptom patterns that defy traditional diagnoses- all i got is outside the box, but with no knowledge. i hope something could be helpful. the most important thing, to me, was time-lining everything that began before acute symptom phases, from where she played, what she could have licked, assuming you may also live somewhere leashless with many callejeros, i tried to think about all interactions with nature/animals within the two weeks prior to symptom onset. that was not helpful for my dog, but could be for yours :)