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Hypercalcemia- any experiences?

post #1 of 16
Thread Starter 
Has anyone had any experience with hypercalcemia in cats? My 11-year-old female kitty just had an extended visit at the emergency vet due to loss of appetite, and the only significantly abnormal lab result was elevated calcium. They're still waiting for the results of a hypercalcemia malignancy profile, but the vet suspects that it may be idiopathic hypercalcemia.

Has anyone had any experience with this? I've been doing some research, but I haven't been able to find much info.

Thanks in advance!
post #2 of 16
I haven't had experience of this with my own cats but from what I know, it can have something to do with impaired excretion of calcium by the kidneys, so perhaps kitty needs a urine test or a test for CRF.
post #3 of 16
Thread Starter 
She had extensive blood work done and a urinalysis done, and although her creatinine was slightly elevated, all of the results combined indicated normal kidney function. So confusing!
post #4 of 16
That's interesting. Perhaps it's an indication of very early CRF. The way it works is that in CRF, Phosphorus isn't eliminated by the kidneys like it should be, causing too much Phosphorus in the blood - hyperphosphatemia. This hyperphosphatemia causes the hyperparathyroid gland to become overactive - hyperparathyroidism. Hyperparathyroidism causes calcium levels in the blood to become elevated as it pulls too much calcium from the bones. Has your kitty ben tested for hyperphosphatemia? That might give you a clue as to what's going on.

As you said, it may be completely idiopathic and have no real reason to be worried about.
post #5 of 16
Thread Starter 
The e-vet is waiting for the results of an "MSU hypercalcemia malignancy profile," which I'm pretty sure is this:

She sent the sample out either last Thursday or Friday, and since it has somewhat of a long turnaround time, she wasn't expecting the results to be in until late this week.

I don't THINK she's been tested for hyperphosphatemia. Do you know how they test for that or what the test is called?
post #6 of 16
Yes, they're looking for malignant cancer, which can also be a cause of hypercalcaemia.

I think the test for hyperphosphatemia is very similar to the test for hypercalcaemia, in that they test how much Phosphate is in the serum.
post #7 of 16
Thread Starter 
Yeah, I know they've been looking for cancer. The good news is that she bounced back very well with IV fluid therapy and all the other poking and prodding they did at the e-vet. She's also on Pepcid now, and her appetite has been very impressive since I brought her home. So she seems to be a happy kitty for the moment.

They did x-rays and an ultrasound to look for any lymphomas, enlarged organs, abnormalities, etc. They didn't find anything abnormal but said that cancer can be difficult to locate. Hopefully the hypecalcemia malignancy profile comes back normal. Another thing that might be worth noting is that her ionized calcium level went down pretty significantly after about 36 hours of IV fluid therapy. Prior to IV fluids, it was 1.54 (normal range 1.2 - 1.32), and after IV fluids, it went down to 1.37.

Do you know what the abbreviation for phosphate would be when looking at lab results? I have all of them, but I'm not really sure what to look for.
post #8 of 16
phosphorous is listed on lab results as PHOS. Hope all turns out well for your kitty.
post #9 of 16
Thread Starter 
Her phosphorus was 4.0, with the normal range being 3.1 - 7.5.
post #10 of 16
Actually, 3 of my kitties had some issues with hypercalcemia about 6 months ago. My vet told me everything yours has about the possible causes of it. Also, she said inflammation can sometimes cause it and since one of my girls had pancreatitis at the time, the vet felt it could be attributed to that. The other 2 were tougher to figure out. They were elevated but not dangerously so--just high enough to investigate further. Our plan was to re-test after a 2 week period, with them being fasted prior to the bloodwork. If it was still elevated, we were going to send bloodwork off to MSU for the test you are referring to. When we re-tested the 2nd time around, both kitties fasted, the calcium levels came back normal.

Bottom line.......both were diagnosed as idiopathic hypercalcemia, with Gabby's probably due to her pancreatitis as it came down after her pancreas issues resolved. I did some research on it & it seems idiopathic hypercalcemia is not that uncommon--my vet said most of the cases of hypercalcemia they see have no known cause.

Do you know if your vet ran a TLI/PLI on your kitty? They're not 100% definitive, but if elevated, can mean some degree of pancreatic inflammation is going on.

Anyway......I hope all of my rambling made sense, it's been a long day ! I hope your kitty continues to do well & I hope you get good results back from MSU!
post #11 of 16
Thread Starter 
Angie8, they didn't do a TLI/PLI. The vet didn't think pancreatitis was the cause (she told me why, but I'm running out of room in my brain!). There's a good possibility that additional testing may be done depending on the results of her hypercalcemia malignancy profile. I really don't know what the course of action will be if that test has any levels that are out of range. If that test comes back normal, I'm thinking maybe we should repeat her blood work (calcium, BUN, creatinine, etc.) in a couple of weeks and see if things have leveled out. I'm not sure what the vet will recommend... I'm trying not to freak out and hoping that it's NOT cancer.
post #12 of 16
Thread Starter 
Also, Angie8, what were your kitty's symptoms of pancreatitis? How was it treated?
post #13 of 16
Cleo had slightly elevated calcium levels due to her CRF. My vet did a telephone consult with Dr. Nagode, from Ohio State University, who is a leading researcher using Calcitriol to control hypercalcemia in CRF cats. Cleo has been on Calcitriol for about 4 years now. Her renal numbers are stable in the high end of normal range, her phosphorus levels are WNL and best of all, her calcium levels are also within normal limits too!
We also used the MSU lab to test her ionized Calcium and intact parathormone levels. I think it took a little over a week to get results from MSU. I joined the Yahoo!group dedicated to Calcitriol use. This is where I got in contact with Dr. Nagode (he contributes to the list, answers questions and is willing to do phone consults with veterinarians.) Here's a link to the group. You have to be a member to read the archives and post, but membership is free. I highly recommend joining. There's a lot of very informed people who can give you lots of info about hypercalcemia.

Good luck!

Pookie & the girls
post #14 of 16
Thread Starter 
Pookie-poo, thank you so much! I'll have to check that out.
post #15 of 16
Originally Posted by JennyJen View Post
Pookie-poo, thank you so much! I'll have to check that out.
I second Pookie Poo's recommendation. I was a member of the calcitriol group, left since I felt I got enough from the related crf support list..but this is what I feel kept Patrick going for almost 4 years, and I have Tyler, Frankie and Tippy on it.

Dr. Nagode is a wonderful, wonderful man (and vet) from all I know of him. Invaluable resource.
post #16 of 16
Originally Posted by JennyJen View Post
Also, Angie8, what were your kitty's symptoms of pancreatitis? How was it treated?
Her symptoms were very non-specific (as is common with pancreatitis in cats).......she was lethargic and wouldn't eat, she just didn't seem like herself. She also had the elevated calcium that one time. She's had it on several occasions and those are the symptoms every time--only occasionally has she seemed painful when the vet palpated her abdomen--more often than not all we had to go on was the lethargy & not eating. There's really no way to treat it in cats, other than supportive therapy like fluids, sometimes antibiotics, and appetite stimulants.....and wait for it to resolve itself which could take anywhere from a few days to a couple of weeks. The fluids seemed to make a big difference with Gabby. Since hers is related to her IBD, we have used pancreatic enzyme supplements a few times which also helped--not sure how really, but it was a "might-help-can't-hurt" type of therapy.

The problem with the TLI/PLI is that they're not 100% conclusive--they can come back normal & the cat could still have pancreatic inflammation. Also, they might come back elevated, and the cat's pancreas is normal--although I believe the latter is less common--Gabby's PLI levels were off the charts when she had her last bout with it. The PLI is much more recent testing than the TLI and is supposed to be a bit more conclusive than the TLI. There are only a handful of universities in the country that run these tests so the results take around a week to come back, unfortunately. My vet usually does these in conjunction with an ultrasound to look at the pancreas--sometimes the pancreas will appear inflamed, but the blood work will be normal.

It's a very, very frustrating situation because you can spend a small fortune on diagnostics & come back with nothing conclusive.........just a kitty who "ain't doin' right".

Hope that helps some, and I didn't confuse the matter further .
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