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282 Ectopic Ureter

• Blood glucose and magnesium should also Chronic Treatment auscultation as a marker of calcium-induced
be evaluated because they are frequently • Neonates should be prevented from nursing cardiac toxicity when administering IV calcium
VetBooks.ir TREATMENT if clinical signs of hypocalcemia recur when PROGNOSIS & OUTCOME
abnormal.
gluconate.
for 12-24 hours and permanently removed
nursing recommences.
Treatment Overview • Cabergoline 5 mcg/kg PO q 24h for 7 days Excellent short-term prognosis for recovery
may be used to stop lactation.
Initial treatment is aimed at reversing the • Dams should be maintained on a high-quality with immediate treatment, with a long-term
clinical signs of hypocalcemia by administering commercial food approved for use during risk of recurrence.
intravenous (IV) calcium while simultaneously lactation and supplemented with oral calcium.
monitoring for dysrhythmia or bradycardia. • An appropriate daily calcium supplement for PEARLS & CONSIDERATIONS
Response to treatment occurs within 10-15 the queen is 50-100 mg/kg/day, and for the
minutes. Secondary clinical signs (e.g., hyper- bitch, it is 25-50 mg/kg/day divided into 3 Comments
thermia, hypothermia) and comorbid abnor- or 4 daily doses for the duration of lactation. Magnesium supplementation may be beneficial
malities (e.g., hypoglycemia, hypomagnesemia) • Vitamin D 3 is not recommended due to the for dams with refractory clinical signs.
should be concurrently managed as needed. transient nature of lactation, the lag time
needed for a response, and the potential for Prevention
Acute General Treatment hypercalcemia. • Adequate nutrition can minimize the risk of
• Slow IV administration of 0.5-1.5 mL/kg eclampsia but is not necessarily preventative.
10% calcium gluconate over 10-30 minutes Nutrition/Diet • Do not administer calcium supplements
to effect while simultaneously auscultating • All pregnant females should be maintained on during pregnancy.
the heart for dysrhythmia or bradycardia; a growth diet and transitioned to ad libitum
calcium is cardiotoxic. feeding of a diet suitable for lactation in the Technician Tips
○ Calcium administration should be stopped postpartum period. Calcium gluconate is the only calcium prepara-
immediately if any cardiac abnormalities • Supplemental feeding of neonates with a milk tion that should be administered intravenously
are noted on auscultation. Calcium replacer early in lactation may help reduce or diluted and administered subcutaneously.
administration may be restarted, although lactation demands on the dam, especially if
at a slower rate and only after normal the litter size is large. Client Education
cardiac rhythm is established. • Calcium supplementation is not recom- • Eclampsia may recur during subsequent
○ Electrocardiographic (ECG) monitoring mended during pregnancy because it alters pregnancies.
may be used (see Recommended Monitor- parathyroid function and may increase the • Calcium supplementation during pregnancy
ing below) in place of auscultation. risk of hypocalcemia. should be avoided because it may increase
• Refractory cases should be evaluated/treated the risk of eclampsia.
for hypomagnesemia and hypoglycemia. Drug Interactions • Optimal perinatal and lactation nutrition is
Repeated IV doses of calcium gluconate Oral calcium supplements may interfere with important for minimizing eclampsia risk.
given as required. absorption of other medications.
• After clinical signs are resolved, the equivalent SUGGESTED READING
amount of calcium gluconate given as an Possible Complications Drobatz KJ, et al: Eclampsia in dogs: 31 cases (1991-
initial IV dose may be administered over the Intravenous calcium administration can induce 1998). J Am Vet Med Assoc 217(2):216-219, 2000.
subsequent 24-48 hours diluted 1 : 1 with fatal bradycardia or dysrhythmia.
saline and administered subcutaneously. AUTHOR: Sophie A. Grundy, BVSc, MANZCVS,
• Body temperature should be monitored and Recommended Monitoring DACVIM
EDITOR: Michelle A. Kutzler, DVM, PhD, DACT
hyperthermia (bitch) or hypothermia (queen) ECG monitoring for bradycardia and shorten-
treated appropriately. ing of the QT interval may be used instead of

Ectopic Ureter Client Education
Sheet

BASIC INFORMATION • Prevalence among male dogs is likely underesti- bladder, ureterocele, hydroureter, hydrone-
mated due to lack of incontinence presumably phrosis, and renal agenesis or dysplasia
Definition because of urethral length and external urethral • Concurrent urinary tract infections are
A congenital abnormality in which the ureteral sphincter (median age of diagnosis, 24 months). common.
orifice is located anywhere distal to the normal Clinical Presentation
trigone location, typically causing urinary GENETICS, BREED PREDISPOSITION
incontinence in young dogs Labrador retriever, Siberian husky, golden DISEASE FORMS/SUBTYPES
retriever, Newfoundland, English bulldog, West • Unilateral or bilateral
Synonym Highland white terrier, fox terrier, Skye terrier, • Extramural or intramural
Ureteral ectopia Entlebucher mountain dog, and miniature and ○ Extramural ureter: bypasses the urinary
toy poodles are overrepresented. bladder and inserts at a distal location
Epidemiology (urethra, vagina, or vestibule in females
SPECIES, AGE, SEX ASSOCIATED DISORDERS and ductus deferens in males)
• Young female dogs (median age at diagnosis, • Other urinary tract anomalies: urethral ○ Intramural ureter (more common):
10 months) sphincter mechanism incompetence, pelvic enters the bladder in the normal

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