Today's Veterinary Practice

NOV-DEC 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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PEER REVIEWED 70 NOVEMBER/DECEMBER 2018 todaysveterinarypractice.com in iguanas when used at 10 Joules/cm 2 . 8 Morphine can be used in chelonians (1.5 mg/kg IM or SC) and lizards (10 mg/kg IM or SC) or meloxicam can be used at 0.2 to 0.3 mg/kg PO or IM q24h, but the patient must be carefully monitored for respiratory depression. 1 Nutritional support, with or without a feeding tube, may also be indicated. 1,2 Treatment should continue until wounds have healed, which can take 4 to 6 months. 1,2,4 Reptiles with chronic hypervitaminosis A require long-term support and wound management as well as routine check-ups. 1 If vitamin A supplementation is warranted, it is better to give a fat-soluble than a water-soluble formulation because water-soluble vitamin A can be absorbed more quickly and thus potentially be more toxic. 4 PROGNOSIS The prognosis for patients with hypervitaminosis A depends on the extent of skin lesions, amount and form of vitamin A given, clinical signs, prior health of the animal, chronicity of the disease, and aggressiveness of treatment. 1-4 The prognosis for lesions is fairly good, unless there are large areas of sloughing. 1 CONCLUSION It is easy to oversupplement reptiles with vitamin A. Before administering vitamin A, you should perform a physical examination, review the diet, and analyze blood test results. 1,4 If the patient is showing signs of hypovitaminosis, rather than directly administering an injectable formulation, consider providing oral medication and changing the diet to include more vegetables with vitamin A. 1,6 Typically, this regimen will help treat hypovitaminosis A and is unlikely to cause hypervitaminosis A, which, again, is often iatrogenically induced. 6 Vitamin A from natural foods rarely leads to an overdose. 1 The best ways to avoid and under- and oversupplementation of vitamin A are to provide oral supplementation such as gut-loading insects (feeding insects nutritious diets prior to feeding the reptile), dietary supplementation, and/or vitamin A-rich vegetables. CLIENT KEY POINTS ■ Hypervitaminosis A typically affects carnivorous or omnivorous reptiles; herbivorous reptiles are less affected because of their diet. ■ Treatment is mainly supportive, so resolution may several weeks to months. ■ Any skin lesions should be treated with antimicrobials and pain medications. FIGURE 4. Computed tomography image of the eustachian tubes of a reptile. The direct connection to the oral cavity is clearly visible and might be the cause of the aural abscessation found in turtles when the epithelial lining is compromised by a lack of vitamin A. FIGURE 3. Aural abscess in a box turtle. These abscesses have been linked to hypovitomenosis A, and treatment often leads to overdose. For these small patients, a single oral dose of vitamin A might be more suitable. In reptiles with severe hypervitaminosis, the dermis and muscle can become exposed and they can die of secondary dehydration. 1

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