The diagnostic utility of hypophosphatemia for differentiating generalized tonic-clonic seizures from syncope in dogs: A case control study.

Transient hypophosphatemia is often detected in humans following generalized tonic-clonic seizures (GTCS), and serum phosphorus concentration (sPi) serves as a marker to differentiate GTCS from syncope. The objective of this retrospective study was to assess the usefulness of hypophosphatemia as a diagnostic marker for GTCS in dogs. Eighty-seven and 26 client-owned dogs with GTCS or syncope, respectively, were enrolled. Dogs were included if the episode occurred ≤ 3 h from presentation, and if sPi and serum creatinine (sCr) were measured. Dogs were excluded if aged < 1 year or if sCr exceeded 176.8 µmol/L. There were no group differences in sCr. Hypophosphatemia (sPi ≤ 0.97 mmol/L) occurred in 28 dogs (32%) in the seizure group, and in no dogs in the syncope group. Median sPi was significantly (P < 0.001) lower in the seizure group (1 mmol/L, [range, 0.31-2.87 mmol/L]) compared to the syncope group (1.35 mmol/L [range, 0.97-2.71 mmol/L]). Furthermore, in dogs presented while seizing (n = 24/87; 28%) median sPi was significantly lower compared to those that were not (0.9 mmol/L [range, 0.3-1.74 mmol/L] vs. 1 mmol/L [range, 0.33-2.18 mmol/L], P = 0.050). ROC analysis of sPi as a marker of GTCS yielded an AUC of 0.757 (95% confidence interval 0.667-0.847), with an optimum cutoff point of 0.97 mmol/L, corresponding to specificity and sensitivity levels of 100% and 44%, respectively. In conclusion, sPi may, in certain cases, serve as an additional diagnostic tool to differentiate GTCS from syncope in dogs. Hypophosphatemia, especially with sPi < 0.97 mmol/L, may be useful in clinical practice to rule in GTCS.

Effects of restricted dietary phosphorus supply during the dry period on productivity and metabolism in dairy cows.

Phosphorus in bovine nutrition is under ongoing scrutiny because of concerns with excessive amounts of P excreted in manure contributing to environmental pollution. Feeding rations with excessive P content, however, still remains common practice, particularly during the transition period, as limited P supply in late gestation and early lactation is thought to present a risk for health and productivity of high-yielding dairy cows. The objectives of this study were to investigate the effect of restricted P supply during the last 4 wk of pregnancy on Ca and P homeostasis during the transition period in high-yielding dairy cows, and to identify possible effects on metabolism and productivity throughout the following lactation. Thirty late-pregnant multiparous dairy cows were randomly assigned to either a dry cow diet with low (LP) or adequate P (AP) content [0.16 and 0.30% P in dry matter (DM), respectively] to be fed in the 4 wk before calving. After calving all cows received the same ration with adequate P content (0.46% P in DM). Blood, milk, and liver tissue samples were obtained during the dry period and the following lactation, DM intake (DMI), body weight, milk production, and disease occurrence were monitored. Plasma was assayed for the concentrations of P, Ca, Na, and K, metabolic parameters, and liver enzyme activities. Liver tissue was analyzed for mineral, triglyceride, cholesterol, and water contents. Repeated-measures ANOVA was used to identify treatment, time, and treatment × time interaction effects. Cows fed LP had lower plasma P concentrations ([Pi]) than AP cows during restricted P feeding, reaching a nadir of 1.1 mmol/L immediately before calving. After calving, plasma [Pi] of LP cows was at or above the level of AP cows and within the reference range for cattle. Symptoms assumed to be associated with hypophosphatemia were not observed, but plasma Ca was higher from 1 wk before to 1 wk after calving in LP cows, which was associated with a numerically lower incidence of clinical and subclinical hypocalcemia in LP cows. Both treatments had a similar 305-d milk yield (12,112 ± 1,298 kg for LP and 12,229 ± 1,758 kg for AP cows) and similar DMI. Plasma and liver tissue biochemical analysis did not reveal treatment effects on energy, protein, or lipid metabolism. The results reported here indicate that restricted dietary P supply during the dry period positively affected the Ca homeostasis of periparturient dairy cows but did not reveal negative effects on DMI, milk production, or metabolic activity in the following lactation. Restriction of P during the dry period was associated with hypophosphatemia antepartum but neither exacerbated postparturient hypophosphatemia, which is commonly observed in fresh cows, nor was associated with any clinical or subclinical indication of P deficiency in early lactation.

Electrolyte Derangements, Hyperlactatemia, and Cardiac Abnormalities Secondary to Refeeding in Three Dogs: Case Report.

Three dogs that presented to the emergency service in severely emaciated body conditions were admitted to the hospital for monitoring and refeeding. During their hospitalization, all three dogs developed electrolyte derangements or required supplementation to prevent hypophosphatemia and hypomagnesemia. Additionally, all dogs developed hyperlactatemia, which was suspected to be secondary to thiamine deficiency. Two dogs were reported to have cardiac abnormalities, including cardiac arrhythmias, systolic dysfunction, and spontaneous echogenic contrast. These cases highlight the complexity of refeeding syndrome and its associated complications that extend beyond electrolyte deficiencies.

Refeeding syndrome in a miniature donkey.

OBJECTIVE: To describe refeeding syndrome in an equid without a history of recognized risk factors. CASE SUMMARY: Refeeding syndrome with marked hypophosphatemia developed in an aged miniature donkey gelding during treatment of suspected enterocolitis. Hypophosphatemia (manifested clinically as ileus and neuromuscular weakness) developed despite a short (3 day) history of hyporexia, increased body condition (7/9), and adherence to nutritional recommendations for critically ill equids. Nutritional support included nasogastric enteral feeding with a commercial equine nutrition product claiming to provide 100% of the National Research Council's daily recommended protein, vitamin, and mineral requirements for equids. Hypophosphatemia developed despite this enteral supplementation and was ultimately corrected by intravenous administration of sodium phosphate solution. NEW OR UNIQUE INFORMATION PROVIDED: This case report suggests that risk factors for refeeding syndrome in equids may be broader than previously recognized. Specifically, critically ill equids at risk for insulin dysregulation may have unique nutritional co-morbidities and requirements. This report highlights the need for both broader recognition of risk factors for refeeding syndrome, and revised best-practice nutritional guidelines and supplementation products to improve equine critical care.

Retrospective evaluation of refeeding syndrome in cats: 11 cases (2013-2019).

OBJECTIVES: The aim of this study was to describe the clinicopathological findings, management and outcome of cats with refeeding syndrome (RS) following prolonged starvation. METHODS: Records from four referral hospitals were searched between May 2013 and November 2019 and retrospectively evaluated. Inclusion criteria were the presence of a risk factor for RS, such as severe weight loss or emaciation following a period of presumed starvation, hypophosphataemia or a delta phosphorous exceeding 30% reduction following refeeding, being treated on the basis of a clinical diagnosis of RS and one or more derangement of hypokalaemia, hypoglycaemia or hyperglycaemia. RESULTS: Eleven cats were identified, which had been missing for a median of 6 weeks (range 3-104 weeks). Mean ± SD percentage weight loss was 46% ± 7% (n = 8). Eight of 11 cats developed hypophosphataemia with a mean delta phosphorous of -47% ± 9%. All cats were documented to be hypokalaemic. During hospitalisation, 10/11 cats developed hyperglycaemia and 7/11 cats developed hypoglycaemia. Cardiovascular, gastrointestinal and neurological signs were common. Eight of 11 cats displayed new or progressive neurological deficits after refeeding, including mentation changes and cerebellar dysfunction. All cats became anaemic and seven cats required a blood transfusion. Eight cats survived to discharge after a mean of 14 ± 4 days of hospitalisation. Six cats developed acute kidney injury (AKI; International Renal Interest Society stage 1). The presence of AKI (P = 0.024) was associated with non-survival and maximum bilirubin concentration was significantly higher in non-survivors (P = 0.018). CONCLUSIONS AND RELEVANCE: Cats with RS in this cohort had been missing, presumed starved, for more than 3 weeks. In addition to hypophosphataemia and hypokalaemia, altered glucose homeostasis and organ damage involving the liver and kidneys were common. Cats with RS appear to have a good prognosis, but prolonged intensive care is required.

Study on the morphological and metabolic changes of femur in laying hens with hypophosphatemia.

Layer fatigue syndrome caused by the lack of calcium and phosphorus can cause fracture in laying hens. The effect of phosphorus deficiency on the femur of laying hens with layer fatigue syndrome has not been studied. In this study, sixty 22-week-old Roman white layers were randomly divided into control group (group C) and low phosphorus group (group P), 30 individuals in each group. The available phosphorus content of group P was 0.18%. At the age of 26, 30 and 34 weeks, the production performance, biomechanical index, protein expression, histopathological change of femur and serological index were detected. The results showed that the laying rate, egg quality and body weight of laying hens, bone density, cortical bone thickness, rigidity, flexural modulus, flexural rigidity, the maximum load of femur and expression of osteocalcin (OCN), receptor activator of nuclear factor kappa-Β (RANK) and receptor activator of nuclear factor kappa-Β ligand (RANKL) decreased of group P. The number of osteocytes was decreased, and the voids was increased. However, cell lacunae were not obvious. The levels of phosphorus, calcium and OCN were increased, and the content of estradiol (E2), OPG and calcitonin (CT) were decreased in serum. In conclusion, the low phosphorus diet can induce layer fatigue syndrome and affect the content of OPG and E2 in serum and the expression of OCN, OPG, RANK and RANKL in femur protein, which leads to the imbalance of bone homeostasis, the thinning of femur cortex bone and the decrease of bone density.

Refeeding syndrome in small ruminants receiving parenteral nutrition.

BACKGROUND: Small ruminants presented to tertiary care facilities commonly suffer from severe protein-calorie malnutrition. Some of these patients require parenteral nutrition (PN; amino acids and dextrose with or without lipids) during hospitalization. Refeeding syndrome, a potentially fatal shift of electrolytes seen in malnourished patients during refeeding, may occur. OBJECTIVE: (a) To report the prevalence of refeeding syndrome in small ruminants receiving PN and (b) to determine risk factors for the development of refeeding syndrome. ANIMALS: Hospitalized small ruminants (n = 20) that received PN from 2010 to 2018 and that had serial (≥2) monitoring of serum electrolyte concentrations after initiation of PN. METHODS: Retrospective case series. Refeeding syndrome was defined as the presence of at least 2 of the following electrolyte abnormalities after initiation of PN: hypophosphatemia, hypokalemia, hypomagnesemia, or some combination of these. Data was analyzed using Fisher's exact test, followed by univariate logistic regression. RESULTS: Eleven of 20 (55%) animals met the definition of refeeding syndrome. Mean minimum serum phosphorus concentration in animals with refeeding syndrome was 1.96 ± 0.69 mg/dL (reference range, 4.2-7.6 mg/dL). Eleven of 20 animals survived to discharge. Survival rate did not differ significantly between refeeding cases (4/11, 36.3%) and nonrefeeding cases (7/9, 77.8%; P = .09). Mean serum phosphorus concentration was significantly lower in nonsurvivors than in survivors (1.88 ± 0.10 mg/dL vs 4.32 ± 0.70 mg/dL, P = .006). CONCLUSIONS AND CLINICAL IMPORTANCE: We report the prevalence of refeeding syndrome in small ruminants receiving PN. Clinicians should anticipate refeeding syndrome after initiation of PN and consider pre-emptive supplementation with phosphorus, potassium, magnesium, or some combination of these.

Changes in the metabolic profiles of dairy cows before and after calving that were mainly fed fodder beet (Beta vulgaris vulgaris L.) during the dry period.

Case history: Two commercial pasture-based farms within the North Canterbury district of New Zealand were feeding fodder beet (Beta vulgaris vulgaris L.) as a large proportion of the diet to cows during the dry period. On each farm 25 multiparous cows were blood sampled up to six times from 28 days before, to 21 days after calving (Day 0). Plasma samples were analysed for concentrations of ß-hydroxybutyrate (BHBA), non-esterified fatty acid (NEFA), Ca, Mg and P, and aspartate aminotransferase (AST) activity. The first sampling visit was performed when cows were being fed their maximum intake of fodder beet. Clinical findings: The mean body condition score (BCS) of cows on Farm 1 was 5.4 (95% CI = 5.3-5.6) and on Farm 2, 5.4 (95% CI = 5.3-5.6) at first sampling. Mean concentrations of BHBA increased between Days -15 and Day -8 then decreased postpartum on Day 2 before increasing again on Day 21. On Farm 2, concentrations remained low (<1.2 mmol/L) on all days of sampling. Mean concentrations of NEFA in plasma remained low during the periparturient period on Farm 1, then increased on Day 2. On Farm 2, concentrations were elevated above 0.3 mmol/L between Days -28 and -17 then decreased on Day -10, before increasing on Day 2. Mean concentrations of Ca, Mg and P were higher than threshold values on both farms prepartum. However on Day 2, there were 8/23 (35%) cows on Farm 1 and 6/23 (26%) cows on Farm 2 with concentrations of Ca in plasma <2.0 mmol/L, and 10/23 (44%) cows on Farm 1 and 8/23 (35%) cows on Farm 2 with concentrations of P in plasma <1.3 mmol/L. Mean AST activities remained relatively constant and below 130 IU/L on both farms at all sampling times. Clinical relevance: On both farms, post-partum hypocalcaemia and hypophosphataemia were common after calving despite differing fodder beet feeding and mineral supplementation regimes. There was more variation in energy status, especially prior to calving. More research is required on factors affecting mineral and energy status in dry cows fed fodder beet.

Phosphorus content of muscle tissue and muscle function in dairy cows fed a phosphorus-deficient diet during the transition period.

Phosphorus (P) deficiency and hypophosphatemia are believed to be associated with muscle function disturbances in dairy cows, particularly around parturition. The objective of this study was to determine the effect of dietary P deprivation during late gestation and early lactation on muscle P homeostasis and muscle function in periparturient dairy cows. Thirty-six multiparous dairy cows in late gestation were randomly assigned either to undergo dietary P depletion or to be offered a diet with adequate P content from 4 wk before to 4 wk after parturition. Phosphorus-deficient rations for dry and lactating cows contained 0.15 and 0.20% P on a dry matter basis, respectively. Blood and muscle tissue for biopsy were obtained and electromyographic examinations were conducted on biceps femoris and intercostal muscles in regular intervals throughout the study. Muscle tissue was analyzed for the total P, adenosine triphosphate, adenosine diphosphate, adenosine monophosphate, creatine phosphate, and tissue water content. Dietary P deprivation resulted in a pronounced and sustained decline of the plasma phosphate concentration, reaching a nadir at calving with mean values below 1.5 mg/dL and remaining below 2.0 mg/dL during the first 4 wk of lactation. Hypophosphatemia was not associated with signs of clinically apparent muscle weakness or disturbed muscle function and was not associated with a decline in the content of any of the studied P-containing compounds in muscle tissue. Accordingly, no association between plasma phosphate concentration and muscle tissue P content was found. Electromyographic examination identified subclinical effects on motor unit action potentials that are indicative of disturbed neuromuscular functionality. Increasing occurrence of pathologic spontaneous activity possibly resulting from membrane instability of nerve or muscle cells and suggestive of myopathy was also recorded as P deprivation progressed. These effects were predominantly observed in intercostal and to a lesser degree biceps femoris muscles. Electromyographic parameters affected by P deprivation were found to be associated primarily with the plasma phosphate and to a lesser extent with the amounts of energy storing P-containing compounds contained in muscle tissue. These results indicate that prolonged and pronounced dietary P deprivation in transition dairy cows leads to marked sustained hypophosphatemia without altering the muscle tissue P homeostasis or causing clinically apparent muscle function disturbances.

Suitability of oral administration of monosodium phosphate, disodium phosphate, and magnesium phosphate for the rapid correction of hypophosphatemia in cattle.

BACKGROUND: Hypophosphatemia is commonly associated with disease and decreased productivity in dairy cows particularly in early lactation. Oral supplementation with phosphate salts is recognized as suitable for the rapid correction of hypophosphatemia. Little information is available about the differences in efficacy between salts used for oral phosphorus supplementation. OBJECTIVES: Comparison of efficacy of oral administration of NaH2 PO4 , Na2 HPO4 , and MgHPO4 in treating hypophosphatemia in cattle. ANIMALS: 12 healthy dairy cows in the fourth week of lactation in their second to fifth lactation. METHODS: Randomized clinical study. Phosphorus deficient, hypophosphatemic cows underwent a sham treatment and were afterwards assigned to 1 of 3 treatments-NaH2 PO4 , Na2 HPO4 , or MgHPO4 (each provided the equivalent of 60 g of phosphorus). Blood samples were obtained immediately before and repeatedly after treatment. RESULTS: Treatment with NaH2 PO4 and Na2 HPO4 resulted in rapid and sustained increases of plasma phosphate concentrations ([Pi]). Significant effects were apparent within 1 hour (NaH2 PO4 : P = .0044; Na2 HPO4 : P = .0077). Peak increments of plasma [Pi] of 5.33 mg/dL [5.26-5.36] and 4.30 mg/dL [3.59-4.68] (median and interquartile range) were reached after 7 and 6 hours in animals treated with NaPH2 PO4 and Na2 HPO4 , respectively, whereas treatment with MgHPO4 led to peak increments 14 hours after treatment (3.19 mg/dL [2.11-4.04]). CONCLUSIONS AND CLINICAL IMPORTANCE: NaH2 PO4 and Na2 HPO4 are suitable to rapidly correct hypophosphatemia in cattle. Because of the protracted and weaker effect, MgHPO4 cannot be recommended for this purpose. Despite important differences in solubility of NaH2 PO4 and Na2 HPO4 only small plasma [Pi] differences were observed after treatment.

Corn-Soy-Blend Fortified with Phosphorus to Prevent Refeeding Hypophosphatemia in Undernourished Piglets.

BACKGROUND: Phosphorus (P) levels in refeeding diets are very important as undernourished children are at risk of hypophosphatemia during refeeding. For this reason, conventional corn-soy-blends (CSB) have been reformulated by the World Food Programme to obtain a mono-calcium-phosphate fortified product (CSB+) and a product further fortified with skim milk powder (CBS++). METHODS: Using a piglet model of undernourished children, we hypothesized that feeding of CSB+, CSB++ or CSB+ with added whey permeate (CSB+/wp) would help to prevent refeeding hypophosphatemia. Pigs were weaned at 4 weeks of age and undernutrition was induced with a nutritionally inadequate pure maize diet for 7 weeks, after which they were refed for 3 weeks with either CSB+ (n = 10), CSB++ (n = 10) or CSB+/wp (n = 10). For reference, a fourth group continued on the maize diet (REF, n = 10). RESULTS: Following induction of undernutrition, body weight and length were 29±5% and 67±4% (means±SD) of values in age-matched pigs fed a nutritionally adequate diet, and the mean serum P level was 1.77±0.34 mmol/l. During the first week of refeeding, P levels in the CSB+ pigs decreased to 55% of values before refeeding (P < 0.05) while values in the CSB++ and CSB+/wp pigs were able to maintain their plasma phosphate at a similar level as before refeeding. CONCLUSION: We conclude that fortification of CSB with only monocalcium-phosphate does not prevent hypophosphatemia. Dairy products like skim milk powder or whey permeate may represent relevant sources of phosphorus during refeeding. The content and form of phosphorus in such diets need to be carefully evaluated, and the undernourished piglet may be used to test the efficacy of such diets.

Neuromuscular signs associated with acute hypophosphatemia in a dog.

The purpose of this report was to describe the successful recognition and management of neuromuscular dysfunction secondary to severe, acute hypophosphatemia in an adult dog with a 2 day history of vomiting, anorexia, and abdominal pain. Radiographs were suggestive of a foreign body obstruction, and surgery was recommended. Resection and anastomosis of the distal duodenum and proximal jejunum was performed. The dog recovered uneventfully, but approximately 36 hr postoperatively, he was found to have significant weakness and muscle tremors that were accompanied by hyperthermia. The only significant abnormality on a serum biochemical profile was a phosphorous level of 0.26 mmol/L. Within 6 hr of initiating phosphorous supplementation, the patient fully recovered and had no residual signs of neuromuscular dysfunction. Signs of neurologic dysfunction secondary to hypophosphatemia are commonly recognized in human patients. Reports of patients with severe muscle weakness, some of which necessitate ventilation due to weakening of muscles of respiration, are common throughout the literature. Less commonly, tremors are noted. This is the first known report of neuromuscular signs recognized and rapidly corrected in a dog. Although it is likely to be uncommon, hypophosphatemia should be recognized as a differential diagnosis in patients with tremors and/or muscle weakness.

Enteral administration of monosodium phosphate, monopotassium phosphate and monocalcium phosphate for the treatment of hypophosphataemia in lactating dairy cattle.

Hypohosphataemia is a frequent finding in early lactating and anorectic dairy cows. Sodium phosphate is commonly used for oral phosphorus (P) supplementation, although other phosphate salts may present useful treatment alternatives. Objectives of this study were to compare the efficacy of monopotassium phosphate (KH2PO4) and monocalcium phosphate (Ca(H2PO4)2) to monosodium phosphate (NaH2PO4) in P-depleted cows. Furthermore, the effect of concentrated NaH2PO4 on the reticular groove reflex was studied. Six healthy but P-depleted dairy cows underwent four treatments in randomised order. Treatments consisted of intraruminal administration of NaH2PO4, KH2PO4 and Ca(H2PO4)2 providing the equivalent of 60 g P. A fourth treatment consisting of concentrated NaH2PO4 combined with acetaminophen as a marker substance was administered orally to determine whether the reticular groove reflex could be induced. Intraruminal administration of NaH2PO4 and KH2PO4 resulted in similar increases in plasma Pi concentrations ([Pi]) while intraruminal Ca(H2PO4)2 resulted in lower increases in plasma [Pi]. Oral and intraruminal administration of NaH2PO4 resulted in similar times to peak plasma [Pi] and acetaminophen concentration, indicating that concentrated NaH2PO4 administered orally did not trigger the reticular groove reflex. These results suggest that oral administration of KH2PO4 is equally effective as NaH2PO4. Oral administration of Ca(H2PO4)2 in contrast has a less pronounced effect on the plasma [Pi].

Influence of feeding a low-phosphorus diet on leucocyte function in dairy cows.

Phosphorus depletion and hypophosphatemia have been described to interfere with immune function in rats and humans. In dairy cows, hypophosphatemia has been associated with muscle weakness and recumbency as well as with intravascular hemolysis resulting from increased osmotic fragility of erythrocytes, but so far, the influence of P depletion and hypophosphatemia on immune function has not been studied. Therefore, the aim of this study was to investigate whether P depletion and ensuing hypophosphatemia are associated with impaired granulocyte and lymphocyte function. Eight mid-lactation dairy cows were fed a P-deficient ration (0.2% P/kg of DM) for a period of 4wk. The depletion phase was preceded by a 2-wk acclimatization period and followed by a 2-wk repletion phase, during which the same ration was supplemented with P to meet or exceed daily requirements. Blood samples were collected at the end of the acclimatization period, after 2 and 4wk of P depletion, and at the end of the repletion phase. Plasma phosphate concentrations ([Pi]) were determined and white blood cells were counted and isolated. General immune function was investigated by performing a phagocytosis assay with Staphylococcus aureus and a lymphocyte stimulation test (LST) with concanavalin A and pokeweed mitogen. The plasma [Pi] decreased significantly, with the lowest values (mean 0.7±0.2mmol/L) occurring after 2wk of depletion, although depletion was continued for another 2wk. During repletion, plasma [Pi] increased above baseline concentrations. Granulocyte counts changed in parallel with plasma [Pi] over time, decreasing significantly at 2wk after P depletion and increasing again thereafter. Granulocyte survival after phagocytosis was lowest after 4wk of P depletion. Phagocytosis activity of surviving granulocytes determined by mean fluorescence intensity was higher, indicating that phagocytosis was not negatively influenced by P depletion. Lymphocyte stimulation showed a similar trend, with a decreasing stimulation index at the end of P depletion, but differences were not statistically significant. Data presented in this study indicate that hypophosphatemia leads to a decrease in granulocyte counts. Chronic P depletion impairs granulocyte survival during phagocytosis but not phagocytosis activity. Lymphocyte function is not influenced by P depletion.

Acquired proximal renal tubulopathy in dogs exposed to a common dried chicken treat: retrospective study of 108 cases (2007-2009).

BACKGROUND: Proximal renal tubulopathy was reported in Australian dogs with markedly increased frequency from September 2007. METHODS: Two veterinarian-completed surveys were launched in response to an increased incidence of acquired proximal renal tubulopathy in dogs. The selection criterion for inclusion was glucosuria with blood glucose < 10 mmol/L. Data collected included signalment, presenting signs, history of feeding treats, results of urinalysis and blood tests, treatment and time to resolution of clinical signs. RESULTS: A total of 108 affected dogs were studied. All had been fed the same brand of dried chicken treats, made in China, for a median of 12 weeks (range, 0.3-78 weeks). Small breeds (< 10 kg) accounted for 88% of cases. Common presenting signs included polyuria/polydipsia (76%), lethargy (73%), inappetence (65%) and vomiting (54%). Common biochemical findings included euglycaemia (74%; 71/96), hypoglycaemia (23%; 22/96), acidosis (77%; 20/26), hypokalaemia (45%; 38/84), hypophosphataemia (37%; 28/75) and azotaemia (27%; 23/85). In addition to discontinuation of treats, 64 dogs received medical treatment, including intravenous fluids (52%) and oral electrolyte, amino acid or vitamin supplements. Six dogs died or were euthanased. Two dogs were necropsied. Histopathological findings consisted of proximal tubular necrosis accompanied by regeneration. Time to resolution of clinical signs in 35 survivors available for follow-up was < 2 weeks (n = 8), 2-4 weeks (n = 2), 5-7 weeks (n = 5) and 2-6 months (n = 10). CONCLUSION: Of the 108 dogs with acquired proximal renal tubulopathy contemporaneous with chicken treat consumption, most survived but many required aggressive supportive care. The treats likely contained a toxin targeting the proximal renal tubules. Diet history and urinalysis were vital for diagnosis.

The effect of MgSO4 addition and the increasing doses of calcium and phosphorus during ending drying period on the occurrence of hypocalcaemia and hypophosphataemia in dairy cows.

The aim of the presented study was the estimation of optimal Ca and P levels applied before calving together with anionic salt addition, as an element of hypocalcaemia and hypophosphataemia prevention. The experiment was carried out during the dry period on 48 cows with similar milk yield in the previous lactation. Cows were divided into four groups. In group I (control) the amount of minerals was in accordance to NRC standards. In experimental groups (groups II-IV), two weeks before calving, cows received 140 g/day/head of hydrated magnesium sulphate to achieve dietary cation-anion difference at the level of about 50 mEq/kg DM. In groups II and III cows received calcium carbonate (100 g/day) 10 days a.p. (antepartum) (group II), or 5 days a.p. (group III), while cows in IV group received dicalcium phosphate (100 g/day) for 5 days a.p. Application of MgSO4 x 7H20 significantly affected the urine pH of cows from group III and IV 4-5 d. before calving - 6.45 and 6.81, respectively. The acidification of urine was observed after calving in group IV (7.13). In cows from group II (100 CaCO3 10 days a.p.) urine pH decline was not found (7.97-7.75). In that group the incidences of hypophosphatemia were noted (blood serum inorganic P level 1.41-1.46 mmol/1). Addition of magnesium sulphate prevented hypocalcaemia occurrence -- 4-5 d. before calving the concentration of ionized Ca in blood serum was 1.11, 1.13 and 1.16 mmol/1 (respectively for group II, III and IV). Reproductive functions were significantly improved after the application of CaCO3 and CaHPO4 for 5 days a.p. in comparison with control and group II -- progesterone concentration in the blood serum on the 45th day of lactation was 1.396 - 1.409 versus 0.799 - 0.401. The correlation between progesterone and inorganic P level in serum was almost significant. Based on the obtained results a treatment optimal in prevention of hypocalcaemia and hypophosphataemia is the application of 50 g CaCO3 and 50 g of CaHPO4 for the last 5 days of the dry period together with MgSO4 x 7H20 given for 14 days a.p.

Efeitos do polietilenoglicol 3350 e de soluções acidificantes e alcalinizantes sobre o perfil bioquímico de éguas hígidas / Effects of polyethylene glycol 3350 and alkalizing and acidifying solutions on the biochemical profile of healthy mares

Avaliou-se o perfil bioquímico de cinco éguas hígidas tratadas com polietilenoglicol 3350 (PEG); ou com polietilenoglicol 3350+Ringer lactato (PEG+RL); ou com solução isotônica poliônica enteral (SIPE); ou com solução isotônica poliônica enteral associada ao Ringer lactato intravenoso (SIPE+RL); ou com solução de cloreto de sódio a 0,9% (NaCl 0,9%). Os parâmetros avaliados foram: sódio, cloreto, potássio, cálcio ionizado, fósforo, magnésio total, proteínas totais, albumina, creatinina, ureia e osmolaridade calculada no soro de sangue venoso. O tratamento PEG não alterou os parâmetros bioquímicos. O PEG+RL diminuiu o fósforo. O SIPE diminuiu o fósforo e aumentou o cloreto. O SIPE+RL aumentou o sódio, e o NaCl 0,9% ocasionou o aumento do cloreto e a redução da osmolaridade sérica. Concluiu-se que o tratamento PEG associado ao Ringer lactato pode provocar o aparecimento de hipofosfatemia, o SIPE ocasiona hipercloremia, o NaCl 0,9% diminui a osmolaridade sérica e o SIPE+RL provoca hipernatremia.

The biochemical profile of five healthy mares treated with polyethylene glycol 3350 (PEG); or polyethylene glycol 3350+Ringer lactate intravenous (PEG+RL); or enteral polionic isotonic solution (EPIS); or enteral polionic isotonic solution associated with Ringer lactate intravenous (EPIS+RL); or chloride sodium solution 0.9% (NaCl 0.9%) was evaluated. The parameters evaluated were: sodium, chloride, potassium, ionized calcium, phosphorus, total magnesium, total protein, albumin, creatinine, urea, and calculated serum osmolality of venous blood. PEG treatment did not alter biochemical parameters. PEG+RL decreased phosphorus. SIPE decreased phosphorus and increased chloride. The EPIS+RL caused an increase of sodium and NaCl 0.9% caused an increase of chloride and a reduction of serum osmolarity. It is concluded that PEG treatment associated with Ringer lactate solution can cause the appearance of hypophosphatemia, EPIS causes hyperchloremia, NaCl 0.9% decreases the serum osmolality and EPIS+RL causes hypernatremia.

Hypophosphatemia in cats after renal transplantation.

OBJECTIVE: To report the prevalence of hypophosphatemia after renal transplantation in a historical cohort of cats. DESIGN: Case series. ANIMALS: Cats (n=86) that received a renal allograft. METHODS: Medical records (January 200-June 2006) were reviewed. Signalment, clinical signs, pre- and postoperative diet, pre- and postoperative clinicopathologic variables, renal histopathology, and outcome were retrieved. Prevalence, onset, duration, treatment and associated clinical signs of hypophosphatemia were recorded. A chi(2) test was used to compare hemolysis frequency between cats with normal serum phosphorus concentration or a single spurious low serum phosphorus concentration for <24 hours duration (group 1) and confirmed hypophosphatemia for >24 hours (group 2). A Cox proportional hazards model was used to evaluate the effects of hypophosphatemia on survival while controlling for other potentially confounding variables (age, sex, weight, body condition score, and pre- and 24 hours postoperative clinicopathologic variables). RESULTS: Eighty-six cats (mean age, 7.7 years) were identified. Hypophosphatemia occurred in 32 cats (37%), with a median onset of 2 days and median duration of 4 days. Treatment was initiated in 48 (56%) of hypophosphatemic cats. Survival and hemolysis frequency was not significantly different between groups, and no risk factors were identified. CONCLUSION: Hypophosphatemia occurs in cats after renal transplantation and does not affect survival. CLINICAL RELEVANCE: The clinical importance of hypophosphatemia in renal transplant recipients remains unknown.

Effect of intravenous calcium borogluconate and sodium phosphate in cows with parturient paresis.

Thirty cows with parturient paresis were divided into three groups of 10. All the cows were given 500 ml of a 40 per cent calcium borogluconate solution intravenously over a period of 10 minutes, and 20 were also given 500 ml of a 10 per cent solution of sodium phosphate intravenously; in 10 of the cows this solution was administered over a period of 10 minutes immediately after the calcium borogluconate solution, and in the other 10 cows 200 ml of the solution was administered rapidly and the remaining 300 ml was added to 10 litres of sodium chloride and glucose solution and infused slowly over six hours. There were no significant differences between the groups with respect to the outcome of the treatments; six or seven of the cows in each group stood within eight hours of the treatment. There were no significant differences between the changes in serum calcium concentrations among the groups. The mean concentrations of inorganic phosphorus in the groups given sodium phosphate were increased above the normal range initially, but after eight hours there were no significant differences between the groups in terms of the numbers of cows that were hypophosphataemic. There were no significant differences between the three groups with respect to changes after treatment in the serum concentrations of magnesium or parathyroid hormone.