Eclampsia

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Eclampsia

 

Eclampsia does not occur during pregnancy (before giving birth). Eclampsia is a well-known disorder in dogs, but it occurs very rarely in cats. Timing (postpartum) and symptoms are the telltale features that lead a veterinarian to suspect eclampsia.

  • Post-parturient hypocalcemia.
  • Usually develops 1–4 weeks postpartum; may occur at term, prepartum, or during late lactation.
  • Alters cell membrane potentials, causing spontaneous discharge of nerve fibers and tonic-clonic contraction of skeletal muscles.
  • Life-threatening tetany and convulsions, leading to hyperthermia.
  • Cerebral edema is possible.

 

SIGNALMENT

Dog—postpartum bitch; most common in toy breeds; higher incidence with first litter.

  • Most common prior to day 40 postpartum; occasionally occurs prepartum.
  • Breeds at increased risk: Chihuahua, miniature pinscher, Shih Tzu, miniature poodle, Mexican hairless, Pomeranian.

Cat—rare.

 

SIGNS

Historical Findings

  • Poor mothering
  • Restlessness, nervousness
  • Panting, whining
  • Vomiting, diarrhea
  • Ataxia, stiff gait, limb pain
  • Facial pruritis
  • Muscle tremors, tetany, convulsions
  • Recumbency, extensor rigidity—usually seen 8–12 hours after onset of signs.

Physical Examination Findings

  • Hyperthermia
  • Rapid respiratory rate
  • Dilated pupils, sluggish pupillary light responses
  • Muscle tremors, muscular rigidity, convulsions

 

CAUSES & RISK FACTORS

  • Calcium supplementation during gestation, including dairy products
  • Inappropriate Ca:P ratio in the gestational diet
  • Low body weight: litter size ratio
  • Poor prenatal nutrition
  • First litter
  • Large litter size

 

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

  • Hypoglycemia—may be concurrent; hypoglycemia alone does not cause muscular rigidity.
  • Toxicosis—distinguished by signalment and history.
  • Epilepsy or other neurologic disorder—differentiated by signalment; calcium concentration diagnostic.

 

CBC/BIOCHEMISTRY/URINALYSIS

  • Total serum calcium < 9 mg/dL in bitches; < 8 mg/dL in queens.
  • Although ionized calcium (< 2.4–3.2 mg/dL) is the form important for normal neuromuscular function, measurement of total serum calcium is usually sufficient for diagnosis.
  • Hypoglycemia—may be concurrent.
  • Hypomagnesemia has been reported in 44% of affected bitches; may promote tetany.
  • Serum potassium is elevated in 56% of cases, due to metabolic acidosis or respiratory alkalosis.

 

IMAGING

N/A

 

OTHER LABORATORY TESTS

N/A

 

DIAGNOSTIC PROCEDURES

ECG shows prolonged QT interval, bradycardia, tachycardia, or ventricular premature complexes.

 

TREATMENT

  • Emergency inpatient.
  • Hyperthermia—cool with cool water soak and fans; use caution with cool water enemas.
  • Puppies—remove from dam onto a foster dam or hand-raise; if not possible or undesirable due to behavioral need for contact with the dam, remove pups from the dam for 24 hours, or until serum calcium is stabilized, and provide supplementation for the remainder of lactation; continue to monitor serum calcium level.

MEDICATIONS

DRUG(S)

  • Calcium gluconate—10% solution 0.22–0.44 mL/kg IV given slowly to effect over 5 minutes; monitor heart rate or ECG during administration.
  • Correct hypoglycemia.
  • Diazepam 5 mg IV; for unresponsive seizures.
  • Cerebral edema—treat, if indicated.
  • Send home on calcium carbonate, or gluconate 10–30 mg/kg PO q8h until lactation ends (calcium carbonate (TUMS) 500 mg tablets supply 200 mg calcium).
  • Magnesium supplementation may be helpful in hypomagnesemia bitches.
  • Start puppies/kittens on solid food at 3–4 weeks of age.

 

CONTRAINDICATIONS/POSSIBLE INTERACTIONS

Corticosteroids—avoid; cause decreased intestinal absorption and increased renal excretion of calcium.

 

FOLLOW-UP

PATIENT MONITORING

  • Serum calcium concentration—monitor until it is stabilized in the normal range.
  • Avoid calcium supplementation during gestation.
  • Diet—maternal: ensure calcium: phosphorus ratio of 1:1 or 1.2:1; avoid high-phytate foods (e.g., soybeans); puppies: supplement feeding for large litters.

 

POSSIBLE COMPLICATIONS

  • Cerebral edema
  • Death
  • Hand-raising of puppies

 

EXPECTED COURSE AND PROGNOSIS

  • Probably will recur with subsequent litters; calcium supplementation can be started after parturition for bitches with a history of eclampsia in prior litters.
  • Prognosis—good with immediate treatment; poor with delayed treatment.

 

MISCELLANEOUS

ABBREVIATION

ECG = electrocardiogram

 

Word Count: 550

Word Frequency:

16 (5%)calcium 

7 (2%)mg 

6 (2%)serum 

5 (1%)may 

5 (1%)supplementation 

4 (1%)during 

4 (1%)possible 

 

Visit your veterinarian as early recognition, diagnosis, and treatment are essential.

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