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Hypoalbuminemia Hypocalcemia 1239

Hypoalbuminemia
VetBooks.ir Mechanism Examples Key Feature

Decreased production Hepatic insufficiency Common cause of severe ↓; liver enzymes usually ↑; ± icterus; abnormal hepatic imaging common
Starvation Mild to moderate ↓; weight loss; ± GI signs; may be associated with maldigestion/malabsorption
Acute phase inflammation Mild to moderate ↓; inflammatory leukogram; hyperglobulinemia; infectious and/or inflammatory disease
(negative acute phase protein) often recognized
+
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Hypoadrenocorticism Mild to moderate ↓; absence of stress leukogram; Na ↓K ↑ (if typical); waxing and waning GI signs
sometimes recognized
Dilution Iatrogenic fluid use Mild to moderate ↓; in-hospital weight gain; history supportive
Fluid-retaining states Mild to moderate ↓; evidence of underlying disease (e.g., congestive heart failure, cirrhosis, kidney failure)
+
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SIADH Mild to moderate ↓; Na ↓ with hypo-osmolality; inappropriate urine Na retention; evidence of underlying
disease or drug (e.g., nervous system disorders, neoplasia, lung disease, and drug induced)
Loss Protein-losing nephropathy Very common cause of severe ↓; proteinuria with inactive urine sediment and UPC >0.4 (cat) or 0.5 (dog)
Protein-losing enteropathy Very common cause of severe ↓; globulin ↓; GI signs common
Protein-losing dermatopathy Can cause severe ↓; readily apparent on physical examination (e.g., burns, major skin sloughing)
Blood loss Chronic blood loss more relevant than acute; GI bleeding or Ancylostoma spp infestation important causes
Sequestration Effusion into body cavities Mild to marked ↓; abdominal and/or pleural effusion, especially high protein or chylous effusions
Differentials, Lists, and Mnemonics
Vasculitis Mild to moderate ↓; thrombocytopenia common
GI, Gastrointestinal; SIADH, syndrome of inappropriate antidiuretic hormone; UPC, urine protein creatinine ratio.

Hypocalcemia

Differential Diagnosis Key Feature(s)
Primary hypoparathyroidism (immune- Clinical signs of hypocalcemia usually are present. Normal to increased phosphorus. Normal to decreased parathyroid
mediated, idiopathic)* hormone (PTH). Normal renal function.
Primary hypoparathyroidism (post-op Clinical signs of hypocalcemia may be present. May occur 1-3 days post-op parathyroidectomy to treat
parathyroidectomy or bilateral thyroidectomy)* hyperparathyroidism or bilateral thyroidectomy to treat hyperthyroidism.
Eclampsia* Clinical signs of hypocalcemia usually are present. Normal to decreased phosphorus. Usually occurs in small-breed
dogs in the first few weeks of lactation.
Acute kidney injury/chronic kidney disease Ionized calcium is normal, except in advanced disease. Usually asymptomatic for hypocalcemia. Increased phosphorus.
Azotemia.
Ethylene glycol toxicity* Clinical signs of hypocalcemia may be present. Azotemia. Monohydrate calcium oxalate crystals may be seen on
urinalysis.
Acute pancreatitis* Usually asymptomatic for hypocalcemia. Occurs with severe, acute pancreatitis.
Intestinal malabsorption* Clinical signs of hypocalcemia may be present. May have concurrent hypomagnesemia and/or hypovitaminosis D.
Hypoalbuminemia Ionized calcium is normal. Does not cause clinical signs.
Hypomagnesemia* Clinical signs of hypocalcemia may be present. Occurs secondary to decreased absorption or increased gastrointestinal
or renal loss.
Rhabdomyolysis* Usually asymptomatic for hypocalcemia. Myoglobinuria and increased AST and CK may be observed.
Tumor lysis syndrome* Clinical signs of hypocalcemia may be present. Occurs during the period of maximum cytolysis (usually 5-7 days after
initiation of chemotherapy) in dogs with large tumor burden. Hyperkalemia and hyperphosphatemia may also be present.
Nutritional secondary hyperparathyroidism* Usually asymptomatic for hypocalcemia but exhibit pain and skeletal abnormalities. Hypophosphatemia. Increased PTH.
History of a homemade diet.
Hypovitaminosis D* Clinical signs of hypocalcemia may be present. Occurs from intestinal malabsorption or a homemade diet.
Phosphate-containing enemas* Clinical signs of hypocalcemia may be present. History is confirmatory.
Massive blood transfusion* Clinical signs of hypocalcemia may be present. Can occur after multiple transfusions with citrated blood.
Laboratory error Ionized calcium is normal. Does not cause clinical signs. Repeat measurement of total calcium is normal.
*Ionized serum calcium concentration is also low.
Clinical signs of hypocalcemia include muscle fasciculations, ear twitching, facial rubbing, anxiety, and seizures.
AUTHOR: Karen M. Tefft, DVM, MVSc, DACVIM
www.ExpertConsult.com