2Clinical ImportanceMore than 3.9 million US households with 1+ reptile petsCa and P derangements are common in pet reptilesPreventable with proper husbandry and nutritionTreatable with early intervention
4Vitamin A deficiencyVitamin A is important in maintaining all epithelial cells, but the respiratory tree appears to be particularly sensitive. This turtles clear, bubbly nose is reflective of a vitamin A deficiency. This can easily lead to pneumonia from opportunistic bacteria
5Turtles-hypovitaminosis Hypovitaminosis A, red-eared slider turtle. Note the characteristic ocular swellingThis box turtle is exhibiting classic hypovitaminosis A, manifested by palpebral swelling, redness, pain, and accumulation of thick secretions. In some turtles, the eyes become glued shut
6Vitamin A deficiencyAural abscesses represent middle ear infections in turtles. In box turtles, these abscesses are commonly associated with vitamin A deficiencies.Rx.- Vit. A 2000 IU/kg PO, SC, IM q7-14d x 2-4 TreatmentsEnroflaxcinDiet Correction
7Hypocalcemia (<8.0 mg/dL) Dietary deficiencyExcessive dietary phosphorusSecondary nutritional hyperparathyroidismVitamin D3 deficiency (dietary or lack of UV light)HypobluminemiaHypoparathyroidism
8Hypocalcemia cont..The fold of skin on the side of this iguana is evidence of dehydrationLumpy jaw occurs when the body brings fibrous tissue to the area to stabilize the weak bones.
9This is the femur (thigh) bone of a healthy iguana This is the femur (thigh) bone of a healthy iguana. Compare it to the diseased one belowThis is the thinning (arrow) that occurs in this disease
10This disease also occurs in tortoises This disease also occurs in tortoises. The shell is soft due to inadequate nutrition -Rx. Ca gluconate 10-50mg/kg IM -Correct the diet
11Hypercalcemia (>20mg/dL) Excessive dietary calcium and vitamin D3Primary hyperparathyroidismPseudohyperparathyroidismOsteolytic bone disease
12Phosphorus Clinical Pathology Normal serum phosphorus: 1-5mg/dL
15Nutritional Secondary Hyperparathyroidism (Metabolic Bone Disease) Cause: diet low in calcium or vitamin D3, diet high in phosphorus, lack of exposure to UV-B lightPathogenesis: Low serum Ca PTH secretion increased bone resorption
16Nutrition and Nutritional Disease Nutritional secondary hyperparathyroidism, iguana. The mandible often becomes decalcified in this condition, and bowing or shortening then occurs.The mandible and maxilla of this green iguana are soft, spongy, and swollen due to nutritional secondary hyperparathyroidism
17Abnormal beak growth,it is often associated with nutritional secondary hyperparathyroidism leading to hypocalcemia, which may cause distortion of the skull as it develops and thus interfere with normal occlusion and wear
18Septicemic Diseases “Shell rot” Septicemic cutaneous ulcerative disease, slider turtle. Lesions are most obvious on the plastron (ventral surface).
19DermatitisUlcerative dermatitis (scale rot, necrotic dermatitis),. Contrary to popular belief, this is a disease that moves from the inside out, rather than outside in. The inciting cause is compromised immunity with subsequent invasion of bacteriaSecondary infection with Aeromonas spp , Pseudomonas spp , and a number of other bacteria may result in septicemia and death if untreated
20DysecdysisRefers to an incomplete or inadequate shed. Low humidity and other stresses, including decreased thyroid function, ectoparasitism, nutritional deficiencies, infectious diseases, and lack of suitable abrasive surfaces, have been incriminated as contributing factors
21DysecdesisWhen snakes have difficulty shedding , cutaneous damage can occur. In extreme cases, secondary bacterial infections can resultBlue color for one week then shed process, soak in water using an aquariums for severe case or use soaked paper towels in the aquarium, make sure to use a big bowl of water for big snakes for drinking and use it for soaking
22Difficulty shedding (dysecdesis) Subspectacle abscessation is a common ocular problem in snakes. Retained eye caps and subsequent damage is often the initiating cause.Subspectacle abscessation, African ball python. This snake was treated with enrofloxacin (5-10 mg/kg q24hr PO,SC,IM) and returned to normal after 2 subsequent shedding cycles
23Ulcerative Stomatitis (mouth rot) Early symptoms may be subtle and often overlooked: slight petechia; inappetence, a reluctance to feed or change in food selection; and increased, thickened, ropey or sheeting saliva.In cases of sudden and severe onset, there may be acute inflammation of the buccal and pharyngeal membranes or gingival necrosis. Pockets of caseous yellow, yellowish-gray or white-gray pus may occur in the soft tissues.Left untreated, the condition may progress to osteomyelitis of the mandibular and cranial structures
24Stomatitis cont…A variety of organisms have been associated with stomatitis, such as Aeromonas aerogenes, A. aerophila, A. hydrophila, Citrobacter freundii, Proteus sp., Pseudomonas aeruginosa P. fluorescens, Staphylococcus sp., and Streptococcus
25TreatmentDilute solutions of povidone-iodine (Betadine®) or chlorhexidine diacetate (Nolvasan®) are two products with low cytotoxicity.Flush the mouth with the dilute solution of 1% povidone-iodine or a 0.25%-0.5% solution of chlorhexidine diacetate. Debride using the curettes or tweezer. The resultant cavity must be checked to ensure removal of all the material. Any loose detritus should be swabbed away with a swab dipped in the dilute solution. Once the plaques are removed, the mouth should be flushed againSystemic Antibiotics (Enroflaxcin)
26Drug Dosage/Route/Frequency Amikacin (Amiglyde) 5 mg/kg SQ, IM then 2.5 mg/kg q 72 hrs (snakes);2.25 mg/kg IM q 96 hrs (alligators)Carbenicillin 200 mg/kg IM q 48 hrs (tortoises)Ceftazidime (Fortaz) 20 mg/kg IM q 72 hrs (snakes)Enrofloxacin (Baytril)* 5 mg/kg PO, SQ, IM q hrs; 10 mg/kg PO, SQ, IM q 24 hrs for resistant infectionGentamicin (Gentocin) 2.5 mg/kg IM q 72 hrs (snakes) 6 mg/kg IM q hrs (red-eared slider)Piperacillin* 100 mg/kg IM q 48 hrs (pythons)
28CloacaA passage used for eliminating fecal, urinary and reproductive discharges. From the Latin word meaning "sewer". Reptiles, like birds, have a chamber into which the contents of the bladder and anus flow prior to being eliminated from the body. This chamber lies inside the vent (venter).
30hemipeneThe male reproductive organ in snakes and lizards, kept inverted in the tail until needed. Chelonians have a single penis.
31A prolapse is the eversion of tissue into an area where it should not be. In iguanas (and reptiles in general), three types of prolapse may be occur that can be seen by the owner.Reptiles are like birds in that they have a single chamber into which feces and urates are deposited before being voided. Through this same chamber passes sperm, and eggs (or live babies, in viviparous species, hatchlings in ovoviviparous species) in the female. This chamber, the cloaca, is found just inside the vent
32In the normal course of defecation, the male hemipenes may be everted, that is, will be forced out of the vent. They will revert back (be pulled back in by the muscles) into their normal position within a few moments.During breeding season, males will frequently evert their hemipenes in conjunction with depositing some seminal material
33If the iguana is constipated, either due to dehydration, impaction due to a foreign object, or from being heavily parasitized, the strain of trying to defecate may result in either a section of the colon or cloacal tissue, or one or both hemipenes, being everted through the vent. Severe parasite infestation and dystocia may also result in prolapsed tissue.
35TreatmentYou can try soaking the iguana in a cool bath to which sugar has been added. Heavy concentrations of sugar in the water will act to draw out the fluids engorging the swollen everted tissue; this may reduce it enough to be inverted by the lizard. The tissue may be rinsed with fresh water and Betadine, and carefully pushed back in with a gloved finger lubricated with KY Jelly
36Injuries caused by live prey Don not feed sick animals with live prey
37Rodent bitesInflicted by uneaten prey, frequently cause traumatic injuries; secondary infection and abscessation are common sequelae.Untreated wounds frequently abscess and are seen as a soft or hard swelling. The abscess, including the fibrous capsule, should be removed surgically, and the defect sutured
38Bites….Fresh bite wounds may be treated by cleansing and saturating with povidone-iodine (diluted 1:10). Parenteral antibiotics, based on results of culture and sensitivity tests, should be usedAntibiotic ointments with proteolytic enzymes may be helpfu