Sunday, January 24, 2016

2926. When there is life, there is hope - Eclampsia & Theracalcium in a pregnant Pomeranian


1.  HOOK

On Jan 24, 2016 at 8 a.m, a dog breeder phoned me as I was driving to work.
"No hope, no hope at all!" the experienced breeder told me. My 54th day pregnant Pom collapsed. Stiff. Cannot stand up. No hope. No hope. She will not survive!"



VIDEO OF POM IN SIMILAR NECK TWISTED POSITION AS IN THE IMAGE BELOW

 2. THIS IS A BKTP


 


 




Jan 24, 2016

8.30 am   He wanted a  house-call. I got him to come to the surgery. He wanted to come after his breakfast. I advised him to come immediately as it was an emergency.

9.30 am
Pomeranian could not stand up. Her legs were stretched out rigid as if she had tetanus. Slightly fast heart and breathing rate. Rectal temperature of 39.5 deg C was considered on the high side. At 54th day pregnancy, it was too early to perform an emergency Caesarean section. My first diagnosis was eclampsia (hypocalcaemia) which is rare during pregnancy in dogs as compared to after birth.

No blood tests were performed to reduce medical cost for the breeder. Puppy prices are low nowadays owing to lack of demand for Pomeranians and alleged puppy smuggling into Singapore.

I injected Theracalcium  (France) 1 ml. slowly. The Pom vomited thrice, yellowish brown vomitus. i gave a bottle of 500 ml IV drip with amino acids and glucose till 12 noon. The dog stood up and wagged her tail. I took a video as proof

VIDEO
Since she appeared normal, I took off the IV set and asked the breeder to take the dog home. . 

3 pm
The breeder came. He said that the dog was not standing then. He phoned at 7 pm to say that I ought to have left the IV canula inside the vein so that the dog could be given another infusion. I told him that the dog had recovered and I showed him the video. He was not satisfied as the dog now was back to her original state of not being able to stand up, with the head twisted sideways rigidly.

VIDEO

7pm.    This was a relapse. The lateral right head tilt was prominently seen now. The rigid limp. But the rectal temperature was normal at 38.4 deg C. 

The calcium levels from the 1 ml of Theracalcium in the blood had not lasted for more than 6 hours. Hence the Pom collapsed again.

Dr Daniel came back from his engagment to help me out. He gave Theracalcium  1 ml slowly after setting up the IV drip of Hartmann's solution.. The dog vomited thrice, yellowish brown vomitus.
I pumped 6 ml Theracalcium inside the bottle of Hartmann's solution for slow drip at home from 8.30 pm to 2 am.

Jan 25, 2016. 
2 am
The dam recovered and ate a can of Science Diet A/D. This was good news for the breeder who expected the Pom to pass away. A bottle of 5% dextrose saline was given.

4 pm
The Pom tore off the I/V set and was back to her normal self.

9.30 pm. I visited the breeder's farm. 3 pups had been born naturally and had been kept inside a basket covered by towels. The Pom had stopped uterine contractions. "Let the 3 pups suckle her," I said. "Suckling will stimulate uterine contraction."

The Pom contracted and the 4th pup came out around one hour after the 3rd pup.

CONCLUSION
This was a rare case of eclampsia in a pregnant Pom. The 80-year-old breeder has over 50 years of breeding experience but he had not encountered such a clinical presentation. Neither will most vets as eclampsia usually occurs in the 2nd - 4th week of dogs with large litters; 

"I expected my Pom to have died, but now she gave birth to 4 beautiful puppies," the breeder remarked. He was most happy.



It was a happy ending due to the sufficient amount of calcium being given IV. This case shows the vet that "when there is life, there is hope."  The diagnosis must be correct.

Theracalcium (France)

The volume of Theracalcium must be given sufficiently and not overdosed to avoid cardiac toxicity such as arrhythmias, leading to death.

In this 5-kg Pom, the first time of 1 ml of Theracalcium IV was insufficient to last 24 hours.

The second time of 7 ml (1 ml IV direct and 6 ml in Hartmann's solution) was just right and the Pom gave birth 24 hours after the second injection.  

The manufacturer gave a guideline for IV, SC and IM injection as follows:
For dogs: 0.25 - 0.5 ml/kg.    That means 1.25 ml - 2.5 ml.
For dogs: 2-10 ml.                  I gave 7 ml during the relapse. The Pom did not die but gave birth naturally to 4 good-sized pups. I suspected the breeder had the pregnancy dates incorrect but he said that Pomeranian puppies are well developed by the 56th day. He has over 50 years of dog breeding experience. I respect his solid years of breeding experience. I am glad his prophecy was not fulfilled and we all had a very happy ending. .   

 





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POST SCRIPT.

1.  THERACALCIUM (France) PER ML
1.  Calcium  32.6 mg (as Calcium gluconate)
2. Calcium 8.2mg      (as Calcium gulcohepatonate)

IV, IM, SC
Dogs 10-20mg/kg   2-10 ml    0.25-0.5 ml/kg.    
Therefore this dam, 5 kg = 50 - 100 mg or 1.25 ml - 2.5 ml


In this case, the dam was given 1 ml direct IV and 6 ml in the IV drip  after the relapse. This 7 ml appeared to be sufficient and not cardio-toxic.


2. BSAVA POCKETBOOK FOR VETS
Hypocalcaemia
Calcium 50-150 mg/kg calcium (as calcium boroguconate}. 0.5-1.5 ml/kg of a 10% solution IV over 20-30 min. For this 5-kg Pom, it will be 2.5 ml - 7.5 ml

According to the website of manufacturer, Theracalcium has an advantage over calcium borogluconate in being longer-lasting and having less cardio-toxicity (fast heart beat due to arrhythmia) or fast breathing rate leading to death.

Calcium gluconate increases serum levels within 5-20 min for 5-6 hours
Calcium glucoheptonate increases serum levels within 3-4 hours and up to 12 hours.
Less risk of cardiotoxicity compared to calcium borogluconate as it has lower total calcium than the usual dose administered.   Calcium equivalent in Theracalcium is 32.6g + 8.2 g = 40.8 mg of Calcium per ml



FOLLOW UP ON FEB 13, 2016
Eclampsia was in Jan 26, 2016 (see video).


The 4 pups have opened their eyes and are thriving. The breeder is most happy.








             

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