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Eclampsia (Puerperal Tetany) In The Dog

Reprinted with permission from T. J. Dunn, DVM and ThePetCenter.com

Canine Eclampsia, more correctly called Puerperal Tetany, and sometimes erroneously called "milk fever", is a startling and dangerous condition brought on by extremely low levels of calcium in the blood stream.  Also called hypocalcemia, veterinarians consider these epileptic-like episodes emergencies and the patient is admitted as soon as possible.  Most canine patients (the disorder is rare in cats) are presented suffering from severe muscle spasms, panting, eye twitching, and incoordination.  High body temperatures often complicate management.  In the video of a dog with eclampsia (puerperal tetany) displayed on this page the muscle contractions mimic what is often seen in epileptic dogs (see the video of a dog having an epileptic seizure) and dogs suffering from hypoglycemia.  Most commonly seen in small to mid-sized bitches a few weeks after whelping, puerperal tetany demands quick intervention by a veterinarian.

A typical call to a veterinarian goes like this:

Dan Paretsky, DVM and assistant Becky treat dogs with eclampsia."Doctor, my four year-old Schnauzer whelped five puppies two weeks ago.  She was fine until today when she started pacing and didn't want to nurse.  Now she's worse and panting, shaking all over, and can't even stand up." The veterinarian will sure take this situation very seriously and hasten to evaluate the patient as soon as possible in the clinic.  Specific treatments may be required to terminate the muscle spasms that occur with this disorder.  And if the muscle spasms reoccur in spite of correctional measures the pups may have to be hand reared so the lactating bitch will no longer be stimulated to produce milk. 

Definitions

ECLAMPSIA
A term applied to toxic complications that can occur late in pregnancy. Toxemia of pregnancy occurs in 10% to 20% of pregnant women; symptoms include headache, vertigo, visual disturbances, vomiting, hypertension, and edema. The four categories of hypertension during pregnancy are pre-eclampsia, eclampsia, chronic hypertension, and transient hypertension. Pre-eclampsia, which occurs late in pregnancy, is characterized by decreased cardiac output and increased blood vessel resistance. It may be prevented with calcium supplements and low-dose aspirin, and a cesarian section is often safer than natural childbirth. Only 5% of of women with pre-eclampsia progress to eclampsia, which is accompanied by convulsions and coma. To avoid renal and cardiovascular damage of the mother and to prevent fetal damage, the condition is treated by termination of pregnancy.


EPILEPSY
A transient seizure or fit usually associated with a short-lived disturbance of consciousness. It stems from a synchronous high-voltage electrical discharge from groups of neurones in the brain. The disorder takes several forms, which include loss of consciousness with generalized convulsions (
grand mal), short periods of loss of consciousness in which patients simply stop what they are doing and look blank (‘absence’ or ‘drop attacks’, or petit mal), seizures with involuntary movements of only part of the body, such as a limb (Jacksonian epilepsy), and short-lived sensations of smell and smacking of the lips (temporal lobe epilepsy). The majority of cases do not have an obvious cause, but in some individuals seizures follow organic damage to the brain (eg from trauma or tumour), or metabolic disturbances (eg diabetes and kidney failure). Electroencephalography is used in the diagnosis.

HYPOCALCEMIA
Abnormally low levels of calcium in blood

MILK FEVER
A disease of newly lactating cows, sheep, or goats that is caused by excessive drain on the body mineral reserves during the establishment of the milk flow called also
parturient apoplexy, parturient paresis;

PUPERAL
Of or pertaining to a woman (or animal) in childbirth.

TETANY
A state marked by severe, intermittent tonic contractions and muscular pain, due to abnormal calcium metabolism.

The following is a brief outline of what a case of Canine Eclampsia looks like:


Signs:


Muscle tremors, restlessness, panting, incoordination, grand mal seizures and fever as high as 106 degrees.

Causes:
Hypocalcemia (low blood calcium) brought on by the following:

1. Poor Nutrition - "Home brewed" diets usually are at fault.  The owner innocently may be adding too much unbalanced meat to the bitch's diet, thinking the extra protein is beneficial.  What's really happening is the calcium to phosphorus ratio is out of balance because the amount of useful calcium in the food is actually reduced!  The ideal diet for dogs should contain a ratio containing, approximately, a ratio of calcium to phosphorus of 1.2 to 1.   (Many organ meats such as liver have a ratio of calcium to phosphorus of 1 to 15!!   Liver is great for dogs but if it comprises a large part of the diet, the calcium/phosphorus ratio of the diet will be improper.)

2. Low Blood Levels of Albumen - Dietary protein deficiency or excessive loss from the body of albumen, which happens in some
kidney diseases, will cause low levels of calcium.

3. Disease of the Parathyroid Glands - This condition is quite rare.

4. Excessive Milk Production - When pups require large amounts of milk  (10 to 30 days post whelping) the bitch's ability to maintain proper amounts of calcium in her blood stream becomes stressed.  As pups grow their total daily intake of milk increases which puts a greater and greater demand on their milk production.  Interestingly, though, even with small litters, some bitches produce so much milk so rapidly that their blood calcium levels simply cannot be maintained... her body is preferentially puting large amounts of calcium ions into milk production.  Milk production has priority over the blood stream for calcium!  Since calcium ions in the blood have a dynamic impact on nerve transmission and muscle contractility, all sorts of physiologic dysfunction will arise if blood calcium levels are too low.  In some disorders, blood calcium ion concentrations are too high which has another set of dysfunctional outcomes.

Quick iv medication is important in treating eclampsia.Treatment:
1. I. V. Catheter for a slow, careful injection of a calcium solution under the close supervision of the veterinarian.  Give too much and severe cardiac arrhythmia may occur.  Often a patient will be monitored via an ECG or other device to record heart rate and blood pressure.

2. I.V. dextrose for quick energy.  After only a few minutes of seizure activity, and even by continuous tremors or spasms, the patient's temperature will rise to dangerously high values.  It isn't uncommon for a dog, whose normal body temperature is generally near 101 and 102 degrees, to have a body temperature of 107 degrees.  Any higher values will surely lead to irreversible brain damage. After only a few minutes of muscle spasms the bitch will be thoroughly exhausted and rapidly available glycogen (glucose) stored in the liver and muscles can be depleted.  Low blood sugar can trigger seizure activity, too.  You soon will be able to see here in ThePetCenter.com a case of chronic low blood glucose due to a tumor in the pancreas that created severe seizure activity for an apparently healthy retriever.  iv glucose for eclampsia patients can be beneficial.

3. Mild sedation may be beneficial to assist in relaxing the muscles.

4. Cool bath to lower body temperatures to normal.

NOTE: If there is time, your vet may take a blood sample prior to treatment for a thorough analysis of the bitch's blood chemistry.  Quick action is very important and careful administration of medications is required.  Generally, the patient stabilizes within ten or fifteen minutes and the temperature is reduced to normal via the cool bath.

Prevention:

1. High quality meat-based quality food but don't over supplement with all sorts of calcium, vitamins or meat products.

2. If you think you must add some sort of supplement use only small amounts of a
balanced source of calcium, phosphorus, and Vitamin D to the bitch's diet beginning about mid-term. Milk makes a good "supplement" as long as the lactose does not create loose stool. DO NOT add calcium alone!! It MUST be used with phosphorus and Vitamin D.  Remember that optimum ratio of calcium to phosphorus of 1.2 to 1.

3. Sometimes cortisone is very helpful in preventing Canine Eclampsia - ask your veterinarian about having some on hand prior to the next whelping.

4. Supplement the puppies' intake with a milk replacer as soon as possible to decrease the milk demands on the bitch.

5. Wean the pups as soon as possible.

Canine Eclampsia... Hypocalcemia... Puerperal tetany... Milk Fever...
fancy names for a not-so-fancy disorder.  Be on the alert and call your veterinarian if you become suspicious your bitch is having trouble.  Never underestimate the importance of a high quality, meat-based diet for your dog.  Do NOT over supplement with calcium powders, excess vitamins or too much meat in the dog's diet.  A high quality meat-based diet with increasing quantities available to the pregnant and nursing bitch plus readily available water is ideal. 


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