Why are dogs with PLE often hypocalcemic, and how should this be addressed?

• A. They fat-soluble vitamins are not absorbed; treat with Vitamin D supplementation
• B. They have high calcium losses; give calcium chelation
• C. They overabsorb calcium; reduce calcium intake
• D. They do not have any electrolyte issues

Answer: (D)

Protein-losing enteropathy in dogs disrupts the absorption of fats and fat-soluble vitamins, including vitamin D. Vitamin D is essential for calcium uptake from the gut, so deficiency from malabsorption can contribute to lower calcium levels. In addition, hypoalbuminemia from protein loss lowers total serum calcium (calcium bound to albumin), while the ionized (free) calcium can remain normal. Therefore, the hypocalcemia often seen with PLE reflects decreased vitamin D–mediated absorption and the binding change from low albumin, not a primary calcium problem. The way to address this is to treat the underlying PLE and, if there is true vitamin D deficiency or low ionized calcium, supplement vitamin D and monitor calcium status. Avoid assuming calcium restriction or chelation, and check ionized calcium to guide any calcium supplementation, since total calcium can be misleading in hypoalbuminemia.