Veterinary Medicine - July 2008 - (Page 396)

Feline hypercalcemia PEER-REVIEWED TABLE 5 Suggested Diagnostic Work-up for Hypercalcemic Cats Diagnostic Work-up Verify hypercalcemia Physical examination FeLV or FIV test Complete blood count Serum chemistry proﬁle Comments • Repeat tCa measurement on a nonlipemic, nonhemolyzed sample. • Determine iCa concentration (in-house or through a reference laboratory). • Evaluate mammary glands, skin, lymph nodes, and abdominal organs. • Appropriate in any patient with uncertain retroviral status • Anemia suggests renal failure, neoplasia, or chronic disease. • Leukogram changes may suggest neoplasia or inﬂammatory disease. • Increased BUN or creatinine concentrations suggest renal failure. • Increased phosphorus concentrations suggest renal compromise, vitamin D toxicosis, or osteolytic disease. • Decreased phosphorus concentrations indicate hyperparathyroidism. • Increased hepatic enzyme activities or hyperbilirubinemia may indicate liver disease. • Decreased albumin or cholesterol concentrations may indicate gastrointestinal tract dysfunction. • PTH concentrations are commonly increased in cats with hyperthyroidism. • Speciﬁc gravity may be decreased by hypercalcemia. • Look for calcium oxalate crystalluria. • Evaluate for primary or metastatic disease. • Evaluate for primary or metastatic disease. • Look for bony lesions. • Look for nephroliths, ureteroliths, and cystoliths. • Evaluate all organs, including the lymph nodes, bladder, and pancreas. • Look for ureteroliths and cystoliths. • Essential for diagnosing hyperparathyroidism. • Decreased in cats with neoplasia, vitamin D-related toxicosis, or osteolytic disease. • May be elevated with chronic renal failure. • Marker for neoplasia • Undetectable PTH-rP does not rule out neoplasia. • Concentrations may be increased with nonneoplastic diseases. • Standard test measures 25-hydroxycholecalciferol concentration only. • Increased concentrations conﬁrm vitamin D toxicosis. Thyroid function Urinalysis Thoracic radiography Abdominal radiography Abdominal ultrasonography PTH concentration PTH-rP concentration Vitamin D assay disease. Examine the cervical region carefully, as parathyroid adenomas are sometimes palpable.7 2. Retroviral testing ELISA tests for feline leukemia virus (FeLV) and feline immunode ciency virus (FIV) infections are appropriate in any cat whose retroviral status is uncertain. Always verify a positive ELISA test result with an alternative test, such as an immuno uorescent antibody (IFA) test. Vaccination against FIV infection will result in positive results with ELISA, IFA, and Western blot tests for as long as vaccine antibodies persist. If a hypercalcemic cat is FeLV positive, the index of suspicion for lymphoma is higher. FIV infection does not necessarily increase the incidence of neoplasia, but it may predispose patients to osteolytic or granulomatous disease. 3. Complete blood count Anemia suggests chronic in ammatory disease, renal compromise, or myeloinltrative disorders. Cats with idiopathic hypercalcemia or hyperparathyroidism are not anemic, so nding a low hematocrit suggests occult cancer or 396 July 2008 VETERINARY MEDICINE

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Veterinary Medicine - July 2008 Contents Leading Off Practical Matters Idea Exchange Clarification Dental Corner The Diagnostic Approach to Hematuria Guidelines for Evaluating Hypercalcemic Cats CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - July 2008

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