Diagnostic performance of predicted ionized calcium in dogs with total hypercalcemia and total hypocalcemia.

BACKGROUND: Abnormal total calcium (tCa) values do not necessarily imply dysregulated ionized calcium. OBJECTIVES: We aimed to evaluate the diagnostic performance of predicted ionized calcium (piCa) regarding true calcium status in dogs with abnormal tCa. METHODS: This was a cross-sectional multicenter study. piCa and its prediction interval (PI) were calculated in 114 dogs, from three different hospitals, with either increased (62) or decreased tCa (52), All dogs also had ionized calcium and a biochemical profile available. The sensitivity, specificity, predictive values, and diagnostic discordance of piCa to confirm ionized hypercalcemia (iHyperCa) and ionized hypocalcemia (iHypoCa) were calculated using logistic regression analysis. RESULTS: iHyperCa was found in 28% and 66% of hyperphosphatemic and non-hyperphosphatemic dogs with tCa above the reference interval upper limit, respectively. The piCa correctly classified dogs with iHyperCa in 72.2% of those with hyperphosphatemia and 93.2% of those without hyperphosphatemia. Comparatively, elevating the tCa threshold to 12 mg/dL properly classified dogs 50% and 75% of the time in hyperphosphatemic and non-hyperphosphatemic dogs, respectively. iHypoCa was found in only 31/52 (60%) dogs with decreased tCa. The piCa correctly classified 55.2 to 100% of dogs with iHypoCa depending on the hospital. The PI demonstrated high sensitivity for iHyperCa (100%) and high specificity for both iHyperCa (100%) and iHypoCa (100%). CONCLUSIONS: Evaluating tCa alone does not reliably determine ionized calcium status. Even with hyperphosphatemia, piCa and its PI represent a reliable alternative to interpret abnormal tCa values when ionized calcium measurements are not available. However, if the tCa reference interval is notably different from 7.6 to 11.4 mg/dL, piCa values might be under/overestimated.

Pregnancy-associated immune-mediated hemolytic anemia in a dog.

OBJECTIVE: To describe the clinical presentation, diagnostic investigations, and outcome of a dog with pregnancy-associated immune-mediated hemolytic anemia. CASE SUMMARY: A 6-year-old, pregnant Bichon Frise was presented due to lethargy, inappetence, and progressive regenerative anemia with spherocytosis. The dog had been recently receiving ranitidine and amoxicillin/clavulanate. An in-house saline agglutination test identified marked agglutination and a urinalysis identified hemoglobinuria. Thoracic and abdominal imaging, as well as infectious diseases testing, was unremarkable. The bitch started whelping shortly following hospitalization, and the anemia progressively resolved without any other intervention. Ranitidine and amoxicillin/clavulanate were re-introduced within the following 2 months but the anemia did not reoccur. In light of these findings, a diagnosis of pregnancy-associated immune-mediated hemolytic anemia was made. NEW OR UNIQUE INFORMATION PROVIDED: Pregnancy-associated immune-mediated hemolytic anemia should be considered in female dogs that develop severe hemolytic anemia during pregnancy and may resolve spontaneously following parturition.

The multivariate predictive model to estimate ionized calcium concentration from serum biochemical results in dogs: External validation.

BACKGROUND: Predicted ionized calcium (piCa) can be calculated from routine biochemistry variables using a recently developed predictive model in dogs. However, it has not been evaluated with variables measured from multiple laboratories. OBJECTIVES: We aimed to (a) externally validate piCa in dogs where biochemistry results were obtained from different analyzers, and (b) compare the diagnostic performances of piCa and total calcium (tCa). METHODS: A cross-sectional multicentric study on 138 dogs from three different hospitals was performed. The sensitivity (Sen), specificity (Spe), positive (PPV) and negative predictive values (NPV), and diagnostic discordance of piCa and tCa were calculated using logistic regression for ionized hypercalcemia and hypocalcemia. Diagnostic performance fluctuations across hospitals were also assessed. RESULTS: For ionized hypercalcemia, the Sen (81.8%), Spe (96.1%), PPV (69.2%), NPV (97.7%), and diagnostic discordance (5.1%) of piCa were not significantly different among hospitals or from those of tCa. For ionized hypocalcemia, the Sen (range: 9.7%-53.8%) and Spe (range: 95.6%-99.6%) of piCa and tCa (Sen range: 16.2%-87.8%; Spe range: 58.3%-98.1%) varied across hospitals, although to a lesser extent for piCa. The diagnostic discordances of piCa (20.3%) and tCa (25.4%) were close. The prediction interval (PI) of piCa demonstrated high Sen to screen for ionized hypercalcemia (100%) and hypocalcemia (range: 75%-93.3%), and high Spe to diagnose ionized hypercalcemia and hypocalcemia (100% for both). CONCLUSIONS: These results support the external validation of piCa in dogs. Its PI represents a notable advantage over tCa to help clinicians explore calcium-related disorders when ionized calcium cannot be readily measured.

Clinical resolution of a nasal granuloma caused by Trichosporon loubieri.

The current report describes the diagnosis of a nasopharyngeal granuloma due to a fungal infection by Trichosporon loubieri. This is the first report of successful treatment of nasal granuloma formation caused by Trichosporon species infection in a cat.

Intra-abdominal actinomycetoma in a cat.

A 5-year-old, female Ragdoll cat was diagnosed with an intra-abdominal mycetoma involving the ileocaecal region. Diagnosis was obtained via histopathological examination following surgical resection of the mass and an ileocolic anastomosis. The initial surgery was complicated by lymphangiectasia, chylous abdominal effusion and mild bacterial leakage from the anastomosis site. A second, exploratory laparotomy was performed to augment the anastomosis with serosal patching and omentalisation and to investigate a cystic structure observed on follow-up abdominal ultrasound. Initial amoxycillin clavulanate (Clavulox; Pfizer Animal Health) therapy was ineffective, but clindamycin (Antirobe; Pfizer Animal Health) proved successful in resolving the infection. Abdominal actinomycetoma in the cat may be an under-diagnosed condition due to its close resemblance to neoplastic disease. Standard diagnostic and therapeutic regimens are commonly ineffective in Actinomyces species infections. Surgical resection along with adjunctive, long-term, selective antimicrobial therapy is effective and prognosis is good for localised lesions.