Javier G. Nevarez - Blackwell's Five-Minute Veterinary Consult - Reptile and Amphibian

Presumptive diagnosis based upon history and clinical presentation.

Hepatic fibrosis

Osteoporosis

Decreased or abnormal bony growth in juvenile animals.

Epidermal ulceration

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Often need assisted feeding

Esophageal feeding tube is often recommended, especially in chelonians with skin sloughing, which makes it difficult to manipulate the head and neck.

Proper education about the correct diet and formulation of vitamin A for the species.

Education about differences between water soluble and fat‐soluble vitamins.

Discontinuing supplementation of non‐ beta carotene vitamin A.

Other treatment focuses on supportive therapy and managing secondary infections.

Systemic fluid therapy may be needed but with the goal of transitioning to oral fluids or passive soaking.

Pain management can be important.

Judicious topical use of silver sulfadiazine cream for epidermal ulcers can help.

Vitamins E and K and taurine administration have all been shown to help mitigate hypervitaminosis A in rat studies, but no studies are available in reptiles.

Oversupplementation of vitamin A can have negative interactions with other fat‐soluble vitamins (D, E, K) leading to either decreased absorption or excess accumulation.

Reassessment of clinical manifestation

Review of current diet plan

Repeat liver biopsy if feasible

In the acute form, hypervitaminosis A generally resolves quickly and clinical manifestation is uncommon (except in very high overdosing).

The chronic form is most common. Clinical resolution can take many months, with most dermatological manifestations resolving, although skeletal and hepatic damage may be permanent.

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OTC = over the counter

UVB = ultraviolet B

1 Chen LP, Huang CH. Effects of dietary β‐carotene levels on growth and liver vitamin A concentrations of the soft‐shelled turtle, Pelodiscus sinensis (Wiegmann). Aquacult Res 2011;42:1848–1854.

2 Chen LP, Huang CH. Estimation of dietary vitamin A requirement of juvenile soft‐ shelled turtle, Pelodiscus sinensis. Aquacult Nutr 2015;21:457–463.

3 Mans C, Braun J. Update on common nutritional disorders of captive reptiles. Vet Clin North Am Exot Anim Pract 2014;17(3):369–395.

AuthorEric Klaphake, DVM, DACZM

Abnormally low blood glucose concentration. In most species, glucose concentrations fluctuate; normal concentrations range from 60 mg/dl to 200 mg/dl (3.3–11 mmol/l), but lower values could be normal.

Exhaustion, starvation, malnutrition

Septicemia

Hepatobiliary disease

Pancreatic disease

Animals with severe systemic disease may be predisposed.

Long‐lasting anorexia

Weakness

Tremors

Loss of righting reflex

Torpor

Unresponsiveness

Poor nutritional status

Systemic disease

Blood glucose levels below 20 mg/dl (1.1 mmol/l) indicate hypoglycemia.

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Detection of hypoglycemia in a clinically healthy animal should not cause concern.

In animals with clinical signs and hypoglycemia, attempts should be made to rule out septicemia, hepatobiliary disease, and pancreatic neoplasia.

Glucose may be artificially low in blood samples stored for a prolonged period prior to separation of plasma/serum.

Depends on underlying etiology

• The pancreas should be thoroughly evaluated.

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Consider energy‐rich nutritional support by stomach tube in cases of anorexia.

If related to poor nutrition and management, educate clients on appropriate feeding practices.

Treat underlying disease

Supportive administration of glucose or dextrose parenterally (e.g., 2.5% in 0.45% saline, 20–40 mL/kg SC) or orally (3 g/kg PO) may be indicated.

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Monitor glucose levels and clinical signs.

If related to nutritional status prognosis is good.

If secondary to severe systemic disease prognosis is poor.

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