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140.e4 Calcinosis Cutis and Calcinosis Circumscripta

fish oil capsule (containing 180 mg EPA syrup, fruit-flavored yogurt, or applesauce nutritional properties appropriate for the
and 120 mg DHA) per 5 kg body weight • Cats typically prefer meat or fish flavors as patient’s underlying disease. This includes
to the dog’s food may improve food intake.
VetBooks.ir is made by a company with independent enhancers, but high-sodium foods should be appropriate treats and those to be avoided,
q 24h provides this dose. Ensure fish oil
the pet food (ideally offer choices),
discussion of other food items (rawhides,
testing of quality control.
avoided in animals with CKD or CHF, and
○ Fish oil should contain vitamin E as an
antioxidant but no other nutrients. meat and fish should be avoided as flavor bully sticks, dental products), and methods
enhancers in animals with CKD.
for administering medications.
○ Cod liver oil and flaxseed oil should not ○ Owners of patients with medical condi-
be used (vitamin A and D toxicity or Prevention tions are more likely to administer dietary
ineffective, respectively). • Muscle loss may be detected and addressed supplements. Specifically ask owners if
earlier by performing a nutritional assessment they are using supplements and be sure
Drug Interactions (body weight, BCS, MCS, and diet history) that any supplements are safe, unlikely
Medication side effects can contribute to on all animals at every visit. to interact with medications, and are
cachexia by causing reduced food intake • Minimize risk by ensuring adequate intake manufactured with good quality control.
(e.g., digoxin toxicosis, azotemia secondary of an appropriate diet and optimal therapy ○ Provide the owner with suggestions for
to angiotensin-converting enzyme inhibitor for underlying disease. improving the animal’s food intake (see
or overzealous diuretic use, antibiotics) or Nutrition/Diet above).
by directly contributing to muscle loss (e.g., Technician Tips
glucocorticoids). • A nutritional assessment should be performed SUGGESTED READING
on all animals at every visit. This includes Freeman LM: Cachexia and sarcopenia: emerging
Recommended Monitoring body weight, BCS, MCS, and diet history. syndromes of importance in dogs and cats. J Vet
• Body weight (be sure to adjust for ascites), • The diet history includes the specific brand, Intern Med 26:3-17, 2012.
BCS, and MCS product, flavor, and amount of pet food Johnson LN, Freeman LM. Recognizing, describing,
• Complete diet history (or recipe and amounts for home-prepared and addressed reduced food intake in dogs and
• Food intake diets), treats, table foods, rawhides and other cats. J Am Vet Med Assoc 251:1260-1266, 2017.
• Make specific recommendations for diet chew toys, dental products, dietary supple- ADDITIONAL SUGGESTED
(including treats and foods for administering ments, and foods used for administering
medications). medications. READINGS
• Animals with CHF, CKD, or cancer often Pet Nutrition Alliance: Nutritional calculator
PROGNOSIS & OUTCOME have hyporexia or dysrexia (i.e., variable and (website). http://petnutritionalliance.org/.
cyclical appetites). Reassure owners that this WSAVA Global Nutrition Committee. Nutri-
Prognosis depends on the underlying disease. is common, and provide multiple appropriate tion Toolkit (website). https://www.wsava.org/
Guidelines/Global-Nutrition-Guidelines.
However, reduced food intake (anorexia, hypo- diet options that they can offer. However, WSAVA Nutritional Assessment Guidelines Taskforce
rexia, and dysrexia) is a common contributing anorexia longer than 24-48 hours should et al: 2011 nutritional assessment guidelines. J Small
factor to an owner’s decision for euthanasia. trigger re-evaluation of the underlying disease Anim Pract 52:385-396, 2011.
and medications.
PEARLS & CONSIDERATIONS AUTHOR: Lisa M. Freeman, DVM, PhD, DACVN
Client Education EDITOR: Jennifer A. Larsen, DVM, PhD, DACVN
Comments • Optimizing diet
• Dogs with chronic diseases often prefer sweet ○ Provide owner with specific instructions
flavors. Adding enhancers such as maple regarding an overall plan that has the

Calcinosis Cutis and Calcinosis Circumscripta Client Education
Sheet

BASIC INFORMATION Epidemiology • Calcinosis circumscripta is typically found
in large-breed dogs, with German shepherds
Definition SPECIES, AGE, SEX overrepresented.
• Calcinosis cutis is characterized by inap- • Calcinosis cutis develops secondary to an
propriate deposition of inorganic, insoluble underlying disorder or through chronic RISK FACTORS
calcium and phosphate ions in the dermis percutaneous exposure to calcium-containing Calcinosis cutis:
and subcutaneous tissue. Calcinosis cutis products. No age or sex predisposition is • Diagnosed most commonly in dogs with
is commonly used to describe dystrophic reported, although HAC is most likely in iatrogenic or endogenous HAC
calcification associated with iatrogenic older dogs. • Diseases associated with calcium and phos-
hyperglucocortism or endogenous hyper- • Calcinosis circumscripta is a very uncommon phorous imbalances (e.g., chronic kidney
adrenocorticism (HAC). disorder diagnosed primarily in young (<2 disease)
• Calcinosis circumscripta is a clinical subgroup years of age), large-breed dogs. • Systemic infections: blastomycosis, leptospi-
of calcinosis cutis that is characterized by • Rare in cats rosis, and paecilomycosis
the deposition of calcium salts in tumor-like Calcinosis circumscripta:
nodules, typically in the deep dermis and GENETICS, BREED PREDISPOSITION • Repetitive trauma (e.g., bony prominences
subcutis. • Calcinosis cutis secondary to endogenous and pressure points)
HAC will have the breed predisposition • Severe chronic inflammation (e.g., foreign
associated with this endocrinopathy. body tissue reaction)

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