Veterinary Medicine - July 2008 - (Page 398) Feline hypercalcemia PEER-REVIEWED Figure 1— Evaluating Hypercalcemic Cats Verify an elevated total calcium (tCa) concentration by repeating the measurement with a nonlipemic, nonhemolyzed sample. If the hypercalcemia is mild (tCa 15 mg/dl), evaluate renal function and consider supportive therapy. Re-evaluate the physical examination, serum chemistry profile, and urinalysis results. If the physical examination, serum chemistry, and urinalysis results are unremarkable, evaluate the serum phosphorus concentration. If the physical examination, serum chemistry, and urinalysis results are abnormal, perform radiography, ultrasonography, and biopsy as needed. If the serum phosphorus concentration is increased, verify the hypercalcemia by measuring the iCa concentration and measure the serum vitamin D concentration. If the serum phosphorus concentration is normal or decreased, verify hypercalcemia by measuring the iCa concentration and measure the parathyroid hormone (PTH) and parathyroid hormone-related protein (PTH-rP) concentrations. If the vitamin D concentration is increased, the patient has vitamin D toxicosis. If the vitamin D concentration is normal, measure the parathyroid hormone (PTH) and parathyroid hormonerelated protein (PTH-rP) concentrations. If the PTH-rP concentration is low or undetectable, evaluate the PTH concentration. If the PTH-rP concentration is increased, perform thoracic radiography or ultrasonography to search for neoplasia. If the PTH concentration is increased, the results are consistent with primary hyperparathyroidism. Perform ultrasonography and exploratory surgery of the cervical region. If the PTH concentration is high normal, the results are consistent with primary hyperparathyroidism. Recheck in two weeks, and perform ultrasonography of the cervical region. If the PTH concentration is low normal, perform thoracic radiography or ultrasonography to search for neoplasia. If no abnormalities are identified, recheck in four weeks, and evaluate risks for urolithiasis. If lesions are identified, pursue therapy as appropriate. 398 July 2008 VETERINARY MEDICINE
Table of Contents Feed for the Digital Edition of Veterinary Medicine - July 2008 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 Veterinary Medicine - July 2008 - Veterinary Medicine - July 2008 (Page Cover1) Veterinary Medicine - July 2008 - Veterinary Medicine - July 2008 (Page Cover2) Veterinary Medicine - July 2008 - Veterinary Medicine - July 2008 (Page 347) Veterinary Medicine - July 2008 - Veterinary Medicine - July 2008 (Page 348) Veterinary Medicine - July 2008 - Contents (Page 349) Veterinary Medicine - July 2008 - Contents (Page 350) Veterinary Medicine - July 2008 - Contents (Page 351) Veterinary Medicine - July 2008 - Contents (Page 352) Veterinary Medicine - July 2008 - Contents (Page 353) Veterinary Medicine - July 2008 - Contents (Page 354) Veterinary Medicine - July 2008 - Contents (Page 355) Veterinary Medicine - July 2008 - Leading Off (Page 356) Veterinary Medicine - July 2008 - Leading Off (Page 357) Veterinary Medicine - July 2008 - Practical Matters (Page 358) Veterinary Medicine - July 2008 - Practical Matters (Page 359) Veterinary Medicine - July 2008 - Practical Matters (Page 360) Veterinary Medicine - July 2008 - Practical Matters (Page 361) Veterinary Medicine - July 2008 - Clarification (Page 362) Veterinary Medicine - July 2008 - Clarification (Page I1) Veterinary Medicine - July 2008 - Clarification (Page I2) Veterinary Medicine - July 2008 - Clarification (Page I3) Veterinary Medicine - July 2008 - Clarification (Page I4) Veterinary Medicine - July 2008 - Dental Corner (Page 363) Veterinary Medicine - July 2008 - Dental Corner (Page 364) Veterinary Medicine - July 2008 - Dental Corner (Page 365) Veterinary Medicine - July 2008 - Dental Corner (Page 366) Veterinary Medicine - July 2008 - Dental Corner (Page 367) Veterinary Medicine - July 2008 - Dental Corner (Page 368) Veterinary Medicine - July 2008 - Dental Corner (Page 369) Veterinary Medicine - July 2008 - Dental Corner (Page 370) Veterinary Medicine - July 2008 - Dental Corner (Page 371) Veterinary Medicine - July 2008 - Dental Corner (Page 372) Veterinary Medicine - July 2008 - Dental Corner (Page 373) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 374) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 375) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 376) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 377) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 378) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page V1) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page V2) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page V3) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page V4) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page V5) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page V6) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page V7) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page V8) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 379) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 380) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 381) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 382) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 383) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 384) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 385) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 386) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 387) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 388) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 389) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 390) Veterinary Medicine - July 2008 - The Diagnostic Approach to Hematuria (Page 391) Veterinary Medicine - July 2008 - Guidelines for Evaluating Hypercalcemic Cats (Page 392) Veterinary Medicine - July 2008 - Guidelines for Evaluating Hypercalcemic Cats (Page 393) Veterinary Medicine - July 2008 - Guidelines for Evaluating Hypercalcemic Cats (Page 394) Veterinary Medicine - July 2008 - Guidelines for Evaluating Hypercalcemic Cats (Page 395) Veterinary Medicine - July 2008 - Guidelines for Evaluating Hypercalcemic Cats (Page 396) Veterinary Medicine - July 2008 - Guidelines for Evaluating Hypercalcemic Cats (Page 397) Veterinary Medicine - July 2008 - Guidelines for Evaluating Hypercalcemic Cats (Page 398) Veterinary Medicine - July 2008 - Guidelines for Evaluating Hypercalcemic Cats (Page 399) Veterinary Medicine - July 2008 - Guidelines for Evaluating Hypercalcemic Cats (Page 400) Veterinary Medicine - July 2008 - Guidelines for Evaluating Hypercalcemic Cats (Page 401) Veterinary Medicine - July 2008 - Guidelines for Evaluating Hypercalcemic Cats (Page 402) Veterinary Medicine - July 2008 - Guidelines for Evaluating Hypercalcemic Cats (Page 403) Veterinary Medicine - July 2008 - Advertiser Index (Page 404) Veterinary Medicine - July 2008 - Marketplace/Classifieds (Page 405) Veterinary Medicine - July 2008 - Marketplace/Classifieds (Page 406) Veterinary Medicine - July 2008 - Marketplace/Classifieds (Page 407) Veterinary Medicine - July 2008 - Marketplace/Classifieds (Page 408) Veterinary Medicine - July 2008 - Marketplace/Classifieds (Page 409) Veterinary Medicine - July 2008 - Mind Over Miller (Page 410) Veterinary Medicine - July 2008 - Mind Over Miller (Page Cover3) Veterinary Medicine - July 2008 - Mind Over Miller (Page Cover4)
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