Queen Eclampsia: The Postpartum Calcium Crash

Eclampsia, the postpartum calcium crash, appears 1 to 3 weeks after birth, most often in a queen raising 4 or more kittens. It moves from restlessness to tremors to seizures in 30 to 120 minutes and often pushes rectal temperature above 40 C. Treatment is 10 percent calcium gluconate given slowly into a vein by a vet; the work at home is warmth, quiet, and a phone call placed before the first seizure.

Why the calcium falls

Milk carries 30 to 40 mg of calcium per 100 mL, and a queen with 5 kittens can lose 1.5 to 2 g a day, roughly triple the demand of late pregnancy. Total calcium drops under 7 mg/dL against a normal 8 to 10.5, and ionized calcium under 1.0 mmol/L against a normal 1.1 to 1.3. Risk climbs with 4 or more kittens, a first litter, a queen under 3 kg, an all-meat diet with no calcium source, and a previous episode, which repeats in 30 to 50 percent of next litters.

The ladder from twitch to seizure

Stage	What you see	Typical duration	Rectal C
0	Restless, licks kittens, paces, drinks little	6 to 24 hours	39.0 to 39.5
1	Ear twitch, tremors, unsteady walk, fast breathing	2 to 12 hours	39.5 to 40.2
2	Stiff legs, face rubbing, drooling, unable to nurse	30 to 60 minutes	40.0 to 41.0
3	Tetany, seizures of 1 to 3 minutes, coma	Minutes to 1 hour	40.5 to 41.5

Stage 2 is the last easy moment: a queen that is drooling and wobbly but still standing can be carried to the car. Stage 3 is a seizure in a box, and the kittens are at risk of being crushed before the calcium is drawn. A queen with 4 to 6 kittens and a temperature of 40.2 C at day 10 is eclampsia until proven otherwise.

The first 10 minutes at home

Take the kittens out of the box and put them in a warm carrier at 28 to 30 C, because a seizuring queen crushes them. Dim the light, cut noise, keep the room at 25 to 27 C, and do not wrap her tight or hold her legs. Do not put fingers, water or calcium tablets in her mouth, since a seizing cat cannot swallow and will aspirate. Call the clinic while you are moving her and say 3 things: eclampsia, kittens born 10 days ago, 5 kittens. Carry the whole box if she is too wobbly to walk, and bring the kittens along so they can be fed.

Transport without a second crash

Two people make the 20-minute drive easier: 1 drives, 1 sits with the carrier and watches her breathing. Keep the car at 24 to 26 C, not 30, because a panting queen loses more fluid in a hot car, and put a towel over the carrier so she is not staring at headlights. Call ahead so the team has calcium drawn up when you arrive, which turns a 15-minute wait into 0. If the drive is over 45 minutes, ask whether a closer clinic can start the drip and transfer later.

The 21-day watch after any episode

Check rectal temperature twice a day at the same 2 hours for 21 days, and write it next to the kittens' weights. Weigh the queen on day 1, 7, 14 and 21; a loss above 5 percent of body weight in a week means she is not eating enough for the litter. Count nursings for 1 hour a day: 6 to 8 sessions is normal in the first 2 weeks, 3 to 5 by week 4. Any return of twitching, a temperature over 40 C, or a queen that stops grooming the kittens is a same-day call, not a wait-and-see.

What the vet does with 10 percent calcium gluconate

The usual move is 0.5 to 1.5 mL per kg of 10 percent calcium gluconate, diluted 1 to 1 with saline, into a vein over 10 to 20 minutes. The heart is listened to or on ECG the whole time, and the drip slows or stops if the rate falls under 140 a minute or an arrhythmia appears, because calcium given fast stops the heart. Tremors usually ease within 5 to 15 minutes. The vet then checks ionized calcium at 30 and 120 minutes, treats glucose under 60 mg/dL, warms her to 38 C, and may add oxygen. Expect 12 to 24 hours in hospital.

After the crisis: 4 weeks of management

Wean the kittens for 12 to 24 hours, hand-feeding any litter under 3 weeks at 8 to 12 mL per feed, 6 feeds a day, and give the queen free-choice kitten food. Oral calcium continues at 1 to 2 g of elemental calcium a day in 2 or 3 doses through week 4, then tapers over 7 days. Recheck at day 7 and again at day 21. For the next litter, ask about starting oral calcium 1 to 2 weeks before the due date; supplementing a pregnant queen without direction can suppress her own parathyroid response.

What eclampsia is not

Metritis gives a fever of 39.5 to 40.5 C with foul-smelling discharge and no tremors, usually day 1 to 7. Mastitis shows 1 or 2 hot, painful glands and kittens that refuse that side. Hypoglycemia gives weakness and a glucose under 60 mg/dL without tetany. A queen that trembles but has a normal temperature and normal calcium needs a different workup, and this metritis in the queen note covers the discharge side of that split. False pregnancy is the other look-alike: nesting, milk and swollen teats at 6 to 8 weeks with no fever and no tremors, explained in false pregnancy in the queen.

Call the vet now if

• Any tremor, twitch or stiff gait in the first 21 days after birth, at any temperature.
• A rectal temperature above 40 C with panting or drooling.
• A seizure, even 1 that lasts 30 seconds and resolves on its own.
• Kittens that suddenly scatter or cry while the queen is restless, which means she is not nursing.
• A queen that cannot stand, or that goes cold and quiet after a tremor episode.

Owners who have seen 1 episode should keep a thermometer and the clinic number by the box for the next 3 weeks, because a second crash in the same lactation happens in 30 to 50 percent of cases.

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