Successful treatment with oral alfacalcidol supplementation for nutritional hypocalcaemia with protein-losing enteropathy in a dog

Protein-losing enteropathy is characterised by panhypoproteinaemia, mainly associated with small intestinal diseases. A homemade ultralow-fat diet is effective for the short-term treatment of protein-losing enteropathy, especially if it is caused by intestinal lymphangiectasia. However, ultralow-fat diet provides poor nutritional balance, including low calcium and vitamin D contents. A 7-year-old, neutered, female chihuahua showing repeated diarrhoea and panhypoproteinaemia was diagnosed with intestinal lymphangiectasia based on the dog's endoscopic histopathology. The dog was treated with immunosuppressants and ultralow-fat diet. After 1.5 years of ultralow-fat diet treatment, a transient seizure suspected with hypocalcaemia (albumin-corrected total calcium: 5.9 mg/dl) occurred, with suspected nutritional secondary hyperparathyroidism, despite calcium carbonate administration. Oral alfacalcidol (active vitamin D3) was initiated. The hypocalcaemia improved within 28 days. Therefore, an oral alfacalcidol supplement should be considered as a reasonable therapeutic strategy in canine intestinal lymphangiectasia with hypocalcaemia.