Eclampsia (Puerperal Hypocalcemia in Small Animals)



What does Eclampsia mean?

Eclampsia refers to a state of convulsions during pregnancy or immediately after birth.




What does Puerperal mean?

Puerperal refers to the period immediately after birth or delivery in animals or humans.



What is Puerperal Hypocalcemia?

Puerperal Hypocalcemia thus refers to reduced calcium levels in the animals' bloodstream immediately after birth and occurs around 2 - 3 weeks postpartum (the period immediately after birth). Puerperal Hypocalcemia is also referred to as Postpartum hypocalcemia, Periparturient hypocalcemia, Puerperal tetany, or Eclampsia. It is also referred to wrongly as "milk fever". Puerperal Hypocalcemia is a dangerous condition and needs emergency veterinary medical attention. Puerperal hypocalcemia is an acute, life-threatening condition.

Which dogs breed are at risk of eclampsia?

Small-breed bitches or medium-sized bitches a few weeks after whelping with large litters are often the most affected with eclampsia as the demands on bitches to feed these puppies are greatest. Hypocalcemia can also occur during delivery and may lead to dystocia (difficult delivery). Clinical signs most commonly develop during the first 3 weeks of nursing. However, they can also be seen in the last few weeks of pregnancy and as long as 6 weeks after birth. Eclampsia can, however, occur in any breed of dog with any litter size, and at any time during lactation.


What causes eclampsia?

Eclampsia (hypocalcemia) is caused by low blood calcium through the loss of calcium into the milk and from inadequate dietary calcium intake - inappropriate nutrition due to "Homemade" diets that are usually at fault. A common mistake is the addition of extra meat to the bitch's diet which causes a mineral imbalance, upsetting the levels of calcium in the blood. The imbalance in calcium levels occurs because calcium mobilization from bone into the bloodstream is insufficient to maintain the efflux of calcium leaving through the mammary glands and the milk puppies are receiving. Bitches with heavy lactational demands from large puppies or a large litter are often at risk of eclampsia as milk contains quite high levels of calcium and when puppies start to take large amounts of milk (10 to 30 days after whelping) the bitch may find it hard to maintain sufficient calcium in her blood. Milk production has priority over the bloodstream for calcium! In queens, though uncommon, eclampsia (hypocalcemia) may occur during early lactation. In dogs, supplementation with oral calcium during pregnancy may predispose to eclampsia during peak lactation, because excessive calcium intake during pregnancy causes downregulation of the calcium regulatory system and subsequent clinical hypocalcemia when calcium demand is high. Hypoglycemia (low glucose levels) can occur concurrently.



What are the clinical signs of eclampsia?

Early signs of eclampsia can easily be missed. Historically, the bitch has been otherwise healthy and the newborn babies have been thriving. Clinical signs include the following:-

  1. Panting and restlessness are early clinical signs

  2. Tiredness and reduced appetite.

  3. Shivering, restlessness, panting, and incoordination.

  4. Some bitches show signs of pain, rubbing their face and bite at their feet.

  5. Some bitches often do not respond to the owner in their usual way.

  6. Bitches may have seizures and very high temperatures of up to 41°C with the condition worsening rapidly (1-2 hours) needing immediate help.

  7. Mild tremors, twitching, muscle spasms, and gait changes (stiffness and incoordination) resulting from increased neuromuscular excitability.

  8. Behavioural changes such as aggression, whining, salivation, pacing, hypersensitivity to stimuli, and disorientation.

  9. Severe tremors, tetany, generalized seizure activity, and finally coma and death.

  10. Increased urination, excessive drinking of water, and vomiting are sometimes seen.

  11. Ineffective uterus contractions and slow progression of labour without causing any other clinical signs.


How is eclampsia treated?

Eclampsia is a life-threatening condition and treatment needs to be done immediately. Slow intravenous administration of 10% calcium gluconate is given to effect (0.5–1.5 mL/kg over 10–30 min; 5–20 mL is the usual dose). Rapid clinical improvement occurs within 15 min with immediate muscle relaxation. Intravenous fluids are also given and the bitch is admitted and monitored closely during this time. In addition to correcting the calcium levels, other emergency treatments include lowering body temperature with cool baths.


How can eclampsia be prevented?


Preventive steps to consider in the bitch include:-

  1. Feeding a high-quality, nutritionally balanced, and appropriate diet during pregnancy and lactation

  2. Providing food and water ad lib (unlimited) during lactation

  3. Supplemental feeding of the puppies with milk replacer early in lactation and with solid food after 3–4 wk of age.

  4. Puppies should be weaned as soon as possible.

  5. Oral calcium supplementation during pregnancy is not indicated and may cause rather than prevent postpartum hypocalcemia.

  6. Calcium administration during peak milk production may be helpful in bitches with a history of puerperal hypocalcemia.

References

Drobatz K J & Casey K K (2000) Eclampsia in dogs - 31 cases (1995-1998). JAVMA 217 (2), 216-219 PubMed.

Aroch I, Srebro H & Shpigel N Y (1999) Serum electrolyte concentrations in bitches with eclampsia. Vet Rec 145 (11), 318-320 PubMed.

Frascetti A A & Hickman M A (1999) Preparturient hypocalcaemia in four cats. JAVMA 215 (8), 1127-1129 PubMed.

Wallace M S (1994) Management of parturition and problems of the periparturient period of dogs and cats. Semin Vet Med Surg (Small Anim) 9 (1), 28-37 PubMed.

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