Some pet owners can over-supplement their pets with vitamin D preparations intended as dietary supplements, and there are plants, notably the day blooming Jessamine (Cestrum diurnum) that contain vitamin D and can be associated with toxicity when ingested. The authors concluded that calcium chloride was more toxic to rats than calcium gluconate. Calcium: 50-150 mg/kg calcium (boro)gluconate = 0.5-1.5 ml/kg of a 10% solution i.v. . As palatable to dogs as they are to people, our pets can ingest a large number of these chews, wrappers and all which can result in a case of toxicity. Hyperkalemia is the most common electrolyte imbalance encountered in animals with acute uremia and can cause severe cardiovascular instability and death. Dehydrocholic acid . Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. In contrast to medical treatments for hyperkalemia which merely shift extracellular potassium to intracellular pools or antagonize its neuromuscular toxicity, long-term control is directed to elimination of the existing and ongoing potassium load. The ALI dose calcium gluconate group (LPS CG(M)) was induced ALI by severity scored for each lung tissue by a board-certied pathologist LPS and injected with 25 mg/kg calcium gluconate; and the LPS- using previously published criteria [11]. Also see pet health content regarding disorders of calcium metabolism in dogs Disorders of Calcium Metabolism in Dogs Calcium is an essential component of the skeleton, and it has important functions in muscle contraction, blood clotting, enzyme activity, the nervous system, and hormone release, among others read more and cats Disorders of Calcium Metabolism in Cats Calcium is an essential component of the skeleton, and it has important functions in muscle contraction, blood clotting, enzyme activity, the nervous system, and hormone release, among others read more . Infants and Children: 200 to 500 mg/kg/day as a continuous infusion or in 4 divided doses Vitamin D3 is usually included in supplements because it aids in the absorption of the calcium, allowing for the body to increase stores. This is a complicated system, and the pathogenesis of renal secondary hyperparathyroidism is incompletely understood. 500 to 2000 mg orally 2 to 4 times a day. Azotemia can be present because of the deleterious effects of hypercalcemia on the kidney (renal mineralization). Dystocia refers to abnormal or difficult birth. The dose is 0.02 to 0.03 mg/kg/day divided BID, and it can take a week to become effective. Use OR to account for alternate terms Calcium is necessary for many normal functions of the body, especially bone formation and maintenance. This product contains no preservative. Recent studies have shown equal efficacy for hypertonic sodium chloride and sodium bicarbonate to reduce serum potassium and to counteract its cardiac toxicity in experimental dogs with induced hyperkalemia and may be useful in dogs with concurrent hyperkalemia and metabolic alkalosis. Congenital and Inherited Cerebral Disorders in Animals, Meningitis, Encephalitis, and Encephalomyelitis in Animals, https://doi.org/10.1016/j.cvsm.2018.02.010. It occurs most commonly in small-breed dogs that are nursing large litters, especially at peak lactation, 23 weeks after whelping. Calcium can make it harder for your body to absorb certain medicines. Calcium chloride contains three . Calcium containing solutions and tetracyclines should not therefore be used together. Consult your veterinarian for re-evaluation of diagnosis and therapeutic plan if there is no improvement in 24 hours. The recommended dosage of calcium phosphate for dogs is 0.5 grams per 10 pounds (4.5 kg) of body weight daily.
4 to 8 years: 800 mg/day Urinary excretion is the major route for the elimination of dietary and endogenous potassium which can be disrupted with renal impairment. Administer by intravenous, subcutaneous or intraperitoneal injection using proper aseptic techniques. Typically, 1 dose is all that is needed; occasionally, however, a second dose may be given after 2-4 hours . CALCIUM GLUCONATE 10% Indication Treatment of hypocalcaemia 1 Cardiac arrhythmia when hypocalcaemia or hyperkalaemia present 1 . In dairy cows with a similar condition, parturient paresis Parturient Paresis in Cows Parturient paresis (milk fever, hypocalcemia, paresis puerperalis, parturient apoplexy) is a disease of adult dairy cows in which acute hypocalcemia causes acute to peracute, afebrile, flaccid read more , production of PTH is adequate; however, the pool of osteoclasts for PTH to stimulate is not. Powder for oral suspension is available as a 346.7 mg elemental calcium/15mL. Hypocalcemia is the medical term meaning low levels of calcium. Alternatively, regular insulin can be given at 0.25-1.0 units/kg IV in combination with intravenous glucose at 1-2 g/unit of administered insulin. Calcium plays a vital role in dogs that have just delivered a litter of healthy puppies. Calcium is involved in both smooth muscle and myocardial muscle contraction. Calcium gluconate may act as an irritant to the skin, eye or respiratory systems. Daily maintenance calcium: Vitamin D becomes toxic at doses of 0.1mg/kg or more, so he would have had to eat 1mg of Vit D (rather than the 0.0125mg he ate). high levels of calcium in your blood-- nausea, vomiting, constipation, increased thirst or urination, muscle weakness, bone pain, confusion, lack of energy, or feeling tired. It occurs in postpartum bitches and less commonly in postpartum queens. Molecular formula. 1 to 10 years: 800 mg/day Calcium gluconate is an ingredient found in a variety of supplements and vitamins, and is used to lower potassium in the blood or treat magnesium poisoning.. Generic Name Calcium gluconate DrugBank Accession Number DB11126 Background. Prolongation of the QT interval and ventricular premature contractions may be evident on an ECG. Common calcium gluconate side effects may include: warmth, tingling, or a heavy feeling; a chalky taste in your mouth; upset stomach, gas; or. Five conditioned dogs under halothane anesthesia received calcium chloride (4, 8, 12 mg/kg) and calcium gluconate (14, 28, 42 mg/kg) intravenously. The serum chemistry profile, besides hypercalcemia, shows a normal or low serum phosphorus concentration. A Ca++-dependant messenger system regulates important cell function and Ca++ activates some cellular enzyme cascades. It is important to base the dosage of calcium on a calculation of elemental (available) calcium because different products vary in the amount of calcium available. Currently formulated commercial renal diets likely provide excessive dietary loads of potassium (when consumed to meet daily nutrient requirements) that cannot be excreted effectively in animals with moderate/severe renal dysfunction. All rights reserved. For cardioprotective effect, calcium gluconate (10%) was administered slowly at 1 mL/kg IV while the electrocardiogram was monitored. About Us. The development and severity of hyperkalemia can be aggravated further by inappropriate administration of potassium in enteral or parenteral fluids, metabolic acidosis, and the use of angiotensin converting enzyme inhibitors (ACEi). Objectives: Intravenous (IV) calcium salts are routinely recommended as a cardio-protective therapy in the emergency treatment of severe hyperkalemia. Administer by intravenous, subcutaneous or intraperitoneal injection using proper aseptic techniques. Calcium gluconate 2,000 mg per 100 mL (20 mg/mL) single-dose bag. Fluid therapy is used to cause calciuresis and to increase glomerular filtration rate. For this reason, calcium must be monitored frequently, and owners should be made aware of the clinical signs of hypocalcemia. Hypocalcemia (dose depends on clinical condition and serum calcium level): For example, a 5 kg dog needs 250 mg of calcium per day. If given in a larger dose or too rapidly, the calcium may cause severe drop in the heart rate followed by a hard-to-control arrhythmia. Care must be taken to not overdose a pet in this way as well. During these temporary reprieves from the hyperkalemia, additional measures must be initiated to provide long-term regulation of serum potassium. IV administration of 10% calcium gluconate to control neurologic signs is usually required for treatment. Hypocalcemia secondary to citrated blood infusion: Oral calcium supplementation during gestation is not indicated and may cause rather than prevent postpartum hypocalcemia. The Veterinary Manual was first published in 1955 as a service to the community. Treatment of hyperkalaemia is based on its severity. Vitamin D is commonly available in two forms (dihydrotachysterol (DHT) and calcitriol). Available for Android and iOS devices. 1000 to 1500 mg/day orally in divided doses. Thank you for your question. Sodium bicarbonate can be administered empirically at 1-2 mmol/kg intravenously over 20 minutes in the absence of serum bicarbonate measurements. Most owners lack medical knowledge regarding the birthing process, and as such, they frequently look to the veterinarian to answer questions and to identify potential problems. More importantly, we now recognize hyperkalemia as a serious complication in dogs with I.R.I.S Stage II, III, and IV chronic kidney disease when they are fed commercial renal diets to supply daily energy and nutrient requirements (Figure 1). Your dose needs may be different during pregnancy or while you are nursing. Carbon . Generally, 5-10 ml of 10% calcium gluconate will provide sufficient calcium for a bitch weighing between five and ten Kg. The use of calcium does not reduce the serum potassium level, but counteracts the effects of hyperkalemia on cardiac excitability. Capsicum, fluid extract of . Please confirm that you are a health care professional. These inflammatory processes read more . The small osteoclast pool results from feeding a high concentration of dietary calcium during the nonlactating period, which suppresses secretion of PTH by the parathyroid gland and stimulates secretion of calcitonin by parafollicular C cells. Directions For Use. Post-operative care following a parathyroidectomy is critical because of the very high likelihood of post-operative hypocalcemia (iatrogenic hypoparathyroidism) even when normal parathyroid glands are left in place during surgery. Such tumors include multiple myeloma and osteosarcoma. The dosage of 1,25-dihydroxyvitamin D3 (calcitriol) is 0.030.06 mcg/kg per day. Hyperkalemia is a more prevalent and serious feature of acute uremia in cats with the increasing prevalence of acute ureteral obstruction over the past 10 years. An enlarged parathyroid gland is usually not palpable in dogs, but can be palpated about half of the time in cats with the disease. Vitamin D deficiency leads to poor intestinal calcium absorption and further lack of PTH inhibition, helping to add to the syndrome of renal secondary hyperparathyroidism. 10-50 mL. Slow intravenous administration of 10% calcium gluconate0.51.5 mL/kg over 1030 minutes (520 mL is a typical dose)is an effective treatment for eclampsia, usually resulting in clinical improvement within 15 minutes. Treatment options are: IV crystalloids, which correct volume and dehydration deficits. Children greater than 45 kg: 0.2 to 0.3 mEq/kg/day or 10 to 20 mEq/day. Hyperkalemia has become recognized in animals undergoing extended hemodialysis. Corticosteroids lower serum calcium and, therefore, are contraindicated. Recommended daily allowance (RDA): (Dosage is in terms of elemental calcium): ii) Dextrose-insulin infusion Children: 45 to 65 mg/kg/day in 4 divided doses Calcium Chloride Injection is indicated for use in Cardio-pulmonary Resuscitation where there is also hyperkalaemia or hypocalcaemia or calcium channel block toxicity. Dihydroxyaluminum sodium carbonate . Calcium supplements are various forms of calcium used to treat or prevent low calcium blood levels ( hypocalcemia) in many species. Calcium can be given as either calcium gluconate or calcium chloride. The dose is 0.03 to 0.06 mcg/kg/day (30 to 60 ng/kg/day) divided BID. Many drugs can interact with calcium gluconate, especially: This list is not complete and many other drugs may interact with calcium gluconate. Membrane potentials and action potentials. Amlodipine for dogs and cats: Uses, Dosage & Side Effects. Doses may be repeated every 1 to 3 days as needed and tolerated to normalize the serum calcium level. CBC is usually normal, but is necessary to rule out other causes of hypercalcemia. Fennel acid . These tumors are thought to secrete cytokines that activate osteoclasts, thereby resorbing bone and elevating serum calcium concentrations. In these cases, ionized calcium concentrations are normal. Assuming it was ONE chew that was eaten, there should be no risk. Calcium gluconate. IV: (Dose expressed in mg of calcium gluconate): Common calcium supplements may be labeled as: Calcium carbonate (40% elemental calcium) Calcium citrate (21% elemental calcium) Calcium gluconate (9% elemental calcium) Calcium lactate (13% elemental calcium) The two main forms of calcium supplements are carbonate and citrate. It does not require renal activation, has a quicker onset of activity, and the short half-life makes it much easier to manage iatrogenic vitamin D toxicity. Furosemide can also be used to promote urinary calcium loss. While this disorder is uncommon, some breeds are predisposed. It contains less elemental calcium than other kinds of calcium supplements and may be less bioavailable. Infants and Children: 500 to 725 mg/kg/day in 3 to 4 divided doses Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Capsicum . Granular dosage forms containing . Therapeutic effects begin within 10 minutes and may persist for 1 to 2 hours. (Calcium chloride cannot be given subcutaneously.) 11 to 24 years: 1200 mg/day It must be noted that every animal is different, and the return of normal parathyroid gland function is impossible to predict. Plus puppies and young dogs need larger amounts for growth. Stage III and Stage IV chronic kidney disease. Primary hyperparathyroidism occurs usually in older dogs, and the Keeshond is over-represented, so there may be a genetic basis for the disease in this breed. Duodenal substance . During this period, they should be fed a milk substitute or other appropriate diet; if mature enough, they should be weaned. While it does occur, primary hyperparathyroidism is rare in cats. Predisposing causes include prolonged delivery, dystocia, and retained fetuses or placentas. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. The effects of bicarbonate and glucose/insulin are more sustained then calcium gluconate but must be repeated as clinical circumstances dictate until the potassium load is alleviated. Blood markers, electrolyte levels, and kidney and liver function will be monitored because all must be normal before your pet can be released from the hospital. In primary hypoparathyroidism, the parathyroid glands are destroyed by immune-mediated mechanisms, rendering the response to hypocalcemia impossible. 2023 MJH Life Sciences and dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care. Mild hyperkalemia generally resolves with initial (potassium free) replacement fluids and administration of furosemide and/or sodium bicarbonate. Route of administration is IM or ICe. Calcium gluconate, also known as D-Gluconic acid calcium salt, glucobiogen, or calciofon, is the water-soluble calcium salt of gluconic acid. Sacramento, CA, Hyperkalemia in Animals with Renal Disease. IV: Sheep and Swine. Small-breed bitches with large litters are most often affected. Signalment is key to the diagnosis of eclampsia; typically a small-breed dog nursing a large litter at peak lactation. . It may be administered on an emergency basis at a dosage of 0.5 to 1.5 mL/kg, diluted and given over several minutes, or it is added to . a light-headed feeling, like you might pass out; high levels of calcium in your blood--nausea, vomiting, constipation, increased thirst or urination, muscle weakness, bone pain, confusion, lack of energy, or feeling tired. Pros. All rights reserved. The dose may be increased as needed. In my experience, the first clinical sign of post-thyroidectomy hypocalcemia is anorexia. All information is peer reviewed. Doses of calcium gluconate vary widely depending on the reason for prescribing and response top initial doses. For continuous infusions, adjust rate as needed based on serum calcium levels. No changes were observed in general appearance or in the urine of either . Deficiency of PTH results in an inability to adequately read more . In more severe cases of poisoning, such as in the case of hypercalcemia or kidney trouble, the veterinarian may need to commence more intensive treatment. Divide subcutaneous injections over several sites. Individualize the dose of Calcium Gluconate Injection within the recommended range depending on the severity of symptoms of hypocalcemia, the serum calcium level, and the acuity of onset of The toxic effects resolve in 114 days. IV: 3 to 4 mEq/kg/day Therefore, the nerve fiber becomes highly excitable, sometimes discharging repetitively without provocation rather than remaining in the resting state. IV: 100 to 200 mg/kg/dose over 5 to 10 minutes; may repeat after 6 hours or follow with an infusion with a maximum dose of 500 mg/kg/day o [ canine influenza] Exchange resins may be effective to control mild hyperkalemia, but have little efficacy or indications in the management of potassium associated cardiotoxicity. Dose expressed in mg of calcium gluconate: Here are some final tips for choosing and taking calcium supplements as found in the Harvard Special Health Report Osteoporosis: A guide to prevention and treatment: Avoid products made from unrefined oyster shell, bone meal, dolomite, or coral, as they may contain lead or other toxic metals. The intravenous calcium should be administered slowly, carefully and in the right amount (usually dogs need 1 milliliter of 10% calcium gluconate per kilo). IV: Give 0.45 mEq elemental calcium for each 100 mL citrated blood infused Calcium D-gluconate Calcium hexagluconate Calglucol Calglucon D-Gluconic acid, calcium salt (2:1) (9CI) Dragocal Ebucin . Vitamin B is not a fat soluble vitamin, and she should urinate any excess out. The treatment steps will be contingent on the severity of the toxicosis. The factors which decide the required calcium are: Size. Diagnosis is often based on signalment, history, clinical signs, and response to treatment. In dogs with hypocalcemia, unlike cows, excitation-secretion coupling is maintained at the neuromuscular junction. The body of ratio of 1.2 to 1. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. The end result, however, is that calcium is usually normal in dogs and cats with renal failure, and it does not require treatment. Half the dextrose should be given as a bolus and the remainder administered i.v. To make sure calcium gluconate is safe for you, tell your doctor if you have ever had: Tell your doctor if you are pregnant or breastfeeding. Thus, the severity of clinical signs may not correlate with total calcium concentration. A total serum calcium concentration < 7 mg/dL is confirmatory. Calcium Gluconate Injection is a clear, colorless to slightly yellow, solution available in the following: Single dose vial: 1,000 mg per 10 mL (100 mg per mL) Single dose vial: 5,000 mg per 50 . Because calcium carbonate contains 40% elemental calcium, one 750 tablet contains 300 mg of calcium, so a cat would need approximately 3 tablets daily for calcium supplementation. My preference is to use calcitriol (trade name is Rocaltrol), which is active vitamin D3. As chronic kidney disease progresses to an advanced state (less than 5% to 10% of normal renal function) compensatory adjustments for potassium homeostasis become ineffective and potassium retention and hyperkalemia may develop. Follow all directions on the product . 1 to 6 months: 210 mg/day Giant breed dogs: 6 to 10 grams orally per day. When expressed at the sinus node and on myocardial cells these perturbations cause classic electrocardiographic abnormalities associated with the severity of hyperkalemia. Mild to moderate elevations Mild to moderate elevations exist when the serum potassium concentration is between 5.5mmol/L and 6.5mmol/L. BID calcitriol is reduced to once a day treatment, then to every other day treatment, then to every 4 day treatment. You may report side effects to FDA at 1-800-FDA-1088. Calcium supplements poisoning can result in effects as serious as kidney failure. Calcium gluconate works best if you take it with food. Calcium gluconate will treat or prevent the deleterious effects of hypocalcemia. Use intravenously in horses. 3. Medium dogs that weigh between 20 to 45 pounds should get 500 mg a day. There are several causes of hypocalcemia worth noting: Normally, the parathyroid gland responds rapidly to hypocalcemia by secreting PTH. Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Tell your caregivers if you feel any burning, pain, or swelling around the IV needle when this medicine is injected. Presumptive diagnosis based on signalment and clinical signs, Confirmatory diagnosis based on results of measurement of serum calcium concentration. However, this recommendation is supported by a low level of evidence and is anecdotal. The condition occurs more commonly in certain breeds. It is employed to treat hypocalcemia and conditions in which the physiological effects of increasing the plasma calcium level are likely to be beneficial to the animal. Calcium Gluconate Injection 10ml is a super-saturated solution containing calcium gluconate 95.3 mg/mL in water for injections. Calcium can be toxic at excess levels, however. Generic name: calcium gluconate (oral/injection) [KAL-see-um-GLUE-koe-nate]. 500 to 3000 mg (5 to 30 mL) IV one time at a rate not to exceed 0.5 to 2 mL/min. Calcium gluconate is a prescription drug and can only be obtained from a veterinarian or by prescription from a veterinarian. Dogs up to 20 lb, 2 mL initial dose; 1 mL per dose thereafter. The usual daily dosage ranges from 1000 to 15,000 mg (10 to 150 mL) in divided doses or as a continuous infusion. calcium-lactate gluconate are more easily absorbed than calcium carbonate, but all of these forms of calcium can be used to increase dietary . Even if your pet feels better, the entire treatment plan should be completed to prevent relapse. In an acute hypocalcemic crisis following treatment of hyperparathyroidism, IV calcium gluconate is given at a dose of 1 ml/kg of 10% solution slowly IV. The toxicity associated with hyperkalemia is intensified by acidosis, hypocalcemia, and hyponatremia that can coexist with either acute or chronic uremia. If your product contains calcium citrate, then it may be taken with or without food. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use calcium gluconate only for the indication prescribed. Other causes of hypercalcemia of malignancy include apocrine gland adenocarcinoma of the anal sac, and any tumor that has osteolytic activity. Calcium borogluconate is preferred to calcium gluconate because it is more soluble (Budavari, 1996). Neocalglucon, an oral calcium supplement (10% solution) can be given at a rate of 1.0 ml per kg of animal once daily as needed. It is best not to let puppies or kittens nurse for 1224 hours after the bitch or queen is treated for hypocalcemia. Calcium carbonate . First pregnancy or subsequent ones. Dosage may be repeated after several hours if required, or as recommended by your veterinarian. For dogs with dystocia, 1 mL of 10% solution per 10 pounds (4.5 kg) body weight may be given subcutaneously. . In anticipation of this problem, vitamin D should be administered beginning two days prior to surgery and for a variable period afterwards. Giant breeds will need 2000 mg. Calcium should only be offered after labor has begun. The mechanism of these effects is not known, but they occur before there is any measurable improvement in serum potassium concentration. L. Ari Jutkowitz, VMD, DACVECC. intravenous/Dog : Age. Calcium can make it harder for your body to absorb certain medicines.
In more acute situations, the injectable variety is preferable. Use cautiously in patients receiving digitalis glycosides, or with cardiac or renal disease. In fact, this is such a common cause that lymphoma must be pursued rigorously in any dog with hypercalcemia before another diagnosis is considered. 200 to 800 mg/kg/day as a continuous infusion or in 4 divided doses Oral: Once the cardiotoxicity has been controlled, transient lowering of serum potassium can be achieved by promoting its translocation from the extracellular to the intracellular fluid compartment with sodium bicarbonate or insulin and glucose administration. Diagnosing and managing canine dystocia (Proceedings) July 31, 2008. Take this medication by mouth with food. Natural calcified seaweed sourced from Iceland. Treatment depends on the severity of neurologic signs but usually requires IV administration of calcium gluconate. However, in many cases IV treatment with calcium is started before serum calcium concentration is known. i) Calcium gluconate or calcium chloride - 10% solution (1) Calcium Gluconate - 0.5 to 1.0 ml/kg slowly IV (2) Calcium Chloride - 0.5 ml/kg slowly IV (3) Duration of effect ~ 20 to 30 minutes (4) Does not lower serum potassium but helps normalize cell membrane potentials. 2023 Wag Labs, Inc. All rights reserved. 500 to 1500 mg/kg/day in 4 to 6 divided doses Behavioral changes such as aggression, whining, salivation, pacing, hypersensitivity to stimuli, and disorientation are common. Still, hypervitaminosis D is a rare cause of hypercalcemia. Usual Adult Dose for Exchange Transfusion: 300 mg (3 mL) IV one time with each 100 mL of citrated blood at a rate not to exceed 0.5 to 2 mL/min. Administering calcium before delivery occurs can result in eclampsia and death. Development of hyperkalemia in a hemodialysis dependent dog with chronic kidney disease in response to feeding a commercial renal diet via an esophageal feeding tube (dashed insert) and its resolution with a potassium restricted formulated diet. Calcium gluconate . Tachycardia, hyperthermia, polyuria, polydipsia, and vomiting sometimes occur. Dosage and Administration Dosing: Adult. Recommended daily allowance (RDA): (Dosage is in terms of elemental calcium): Approval was partially successful, following selected items could not be processed due to error, http://instance.metastore.ingenta.com/content/formulary/backmatter/canine-and-felineemergencydosesfordogsandcats, Asystole or pulseless electrical activity, Raised intracranial pressure (impending herniation), BSAVA Small Animal Formulary Part A: Canine and Feline. Daily maintenance calcium: Get emergency medical help if you have signs of an allergic reaction to calcium gluconate: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Contains 72 teaspoons of product. Mild hypocalcemia may contribute to ineffective myometrial contractions and slow the progression of labor without causing other clinical signs. In some cases, when the litter is large, or if the new mom belongs to a toy breed, calcium may become scarce, causing a serious condition called eclampsia, also known as Canine Hypocalcemia or .
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