HYPERPARATHYROIDISM Nutritional Secondary
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VETERINARY NURSING EDUCATION
Nutritional Secondary
HYPERPARATHYROIDISM
In Reptiles Sarah Kolb, RVT, VTS
(Exotic Companion Animals)
Learning Objective: Upon completion of this article readers will be able to describe the pathophysiology of nutritional
secondary hyperparathyroidism in reptiles. Readers will also be able to identify clinical signs of nutritional secondary
hyperparathyroidism, describe and perform diagnostic modalities, and explain prevention and management of nutritional
secondary hyperparathyroidism in reptiles.
Nutritional secondary hyperparathyroidism variety of husbandry and nutritional fac-
(NSHP) is the most common nutritional tors can contribute to a reptile developing
disorder of captive reptiles, particularly NSHP, but the most common causes are
herbivorous and insectivorous lizards and insufficient dietary calcium, insufficient
This program was reviewed and approved by the AAVSB chelonians. NSHP is commonly referred dietary vitamin D3, inappropriate calcium/
RACE program for 1 hour of continuing education in
to as metabolic bone disease. However, phosphorus (Ca:P) ratio, insufficient ultra-
jurisdictions which recognize AAVSB RACE approval.
metabolic bone disease is an encompass- viole-B (UV-B) lighting, and suboptimal
Please contact the AAVSB RACE program if you have any
comments/concerns regarding this program’s validity or
ing term referring to a variety of condi- temperatures. Reptiles that feed on whole
relevancy to the veterinary profession. tions that affect bone form and function, prey, such as snakes, are less susceptible
of which NSHP is the most common. A to NSHP, because whole prey contains
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VETERINARY NURSING EDUCATION
adequate amounts of calcium and vitamin contrast, elevated levels of ionized calcium
D3. NSHP causes a wide variety of clinical in the bloodstream stimulates the ultimo-
signs and will vary in severity. Veterinary branchial gland to release calcitonin. The
technicians play a vital role in performing function of calcitonin in reptiles is not fully
diagnostic tests and providing nursing care understood, but is thought to cause a neg-
to hospitalized reptiles, as well as educat- ative feedback effect on parathyroid hor-
ing reptile owners about proper husbandry mone release, resulting in an increase of
and dietary requirements to prevent and calcium storage in bones and an increase
manage NSHP. in renal excretion of calcium (Figure 2).1,7
Calcium/Phosphorus Homeostasis Phosphorus
Reptiles rely on various nutritional Phosphorus is the second most
and environmental factors to maintain abundant mineral in the body. Like cal-
calcium homeostasis, including vitamin cium, phosphorus is involved with the
D, ultraviolet light, heat, and dietary cal- formation of bones and teeth, as well as
cium and phosphorus. Figure 1: Vitamin D Synthesis muscle contractions, nerve transmissions,
and metabolic processes. Phosphorus
Vitamin D, Ultraviolet light, & Heat dihydroxycholecalciferol), the active combines with calcium to form calcium
Vitamin D is a hormone necessary for form of vitamin D3.1-3 phosphate, which is the substance that
intestinal absorption of dietary calcium and forms teeth and bones.8 The use of phos-
phosphorus.1,2 Unlike mammals, lizards • Calcitriol promotes absorption of dietary phorus throughout the body is connected
and chelonia are unable to obtain vitamin calcium from the intestines. to calcium, vitamin D, and parathyroid
D solely from dietary sources.1 Many liz- hormone.8 There is a delicate balance
ards and chelonia are heliothermic, mean- Dietary vitamin D3 supplements contain that needs to occur between calcium
ing they display basking behavior to attain the inactive form of vitamin D3, cholecal- and phosphorus for proper function.
heat and ultraviolet (UV) radiation from ciferol. Dietary vitamin D3 supplements A calcium/phosphorus (Ca:P) ratio of 1:1
natural sunlight.1 Heliothermic reptiles rely need to be synthesized in the liver and kid- to 2:1 is ideal.3,4,8 Too much phosphorus
on basking in natural sunlight to synthesize neys to become the active form of vitamin in the diet causes a decline in calcium
their own vitamin D3 through elaborate D3, calcitriol.2 However, more research on in relation to phosphorus in the blood-
processes involving UV-B light and heat.1,2 how various species synthesize supple- stream, or an inverse Ca:P ratio. Phospho-
Reptiles kept in captivity rely on artificial mental oral vitamin D3 is necessary.3 rus affects the bioavailability of calcium,
UV-B lighting and supplementary heat because it binds with calcium in the
and dietary vitamin D to be provided for Calcium bloodstream to create an insoluble calcium
them. It is important to note that artificial Calcium is the most abundant mineral in phosphate that is excreted from the body
UV-B lighting is only a replacement for the the body. It plays a significant role in the in urine and feces.8,9
sunlight the reptile would otherwise be formation and integrity of bones and teeth,
exposed to in their natural habitat.3,4 nerve transmission, blood clotting, and Pathophysiology & Clinical Signs
muscle contractions.3 99% of the body’s The term nutritional secondary hyper-
The process of vitamin D synthesis and calcium is stored in bones and teeth and is parathyroidism refers to excessive activity
calcium absorption is as follows (Figure 1): in constant fluctuation, with the remaining of the parathyroid gland as a result of
1% in the bloodstream, muscles, and fluid hypocalcemia secondary to inadequate
• UV-B light in the spectrum of 290- between cells.3,5 nutrition or inappropriate husbandry.3,6-9
315nm changes the structure of A calcium deficiency can be caused by
provitamin precursors (7-dihydrocho- Parathyroid hormone is the primary hor- insufficient dietary calcium, a decrease in
lesterol) in the skin of reptiles to form mone responsible for maintaining blood the bioavailability of calcium, vitamin D3
previtamin D3.1-3 calcium concentration.1,3,6 Calcium in insufficiency, inadequate exposure to UV-B
circulation is either non-ionized and bound light, inadequate environmental tempera-
• Heat is required for previtamin D3 to be to proteins or it is ionized calcium, which is ture, an imbalance of the Ca:P ratio, or an
converted to an inactive form of Vitamin free calcium in its most active form.7 Low increase in calcium demand during rapid
D3 called cholecalciferol.1-3 levels of ionized calcium in the blood- growth or egg production.3,6-9 As previ-
stream stimulates the parathyroid gland to ously discussed, numerous organs and
• Cholecalciferol binds to plasma proteins release parathyroid hormone. Parathyroid mechanisms must function properly to
to be transported to the liver for conver- hormone causes calcium to be released maintain calcium homeostasis. Pathology
sion into calcediol.1-3 from bones; vitamin D synthesis is stim- of the kidneys, liver, gastrointestinal tract,
ulated to cause an increase in absorption parathyroid gland, or ultimobranchial body
• Calcediol is then transported to the kid- of dietary calcium in the intestines, and may also result in an imbalance of calcium
neys to be converted to calcitriol (1,25 renal excretion of calcium is reduced.1,7 In homeostasis resulting in NSHP.1
VETERINARY NURSING IN ACTION | OCT/NOV 2017 23
VETERINARY NURSING EDUCATION
Figure 2: Calcium Metabolism
Recall that low levels of ionized calcium reinforce the skeleton. Areas affected by Juvenile lizards and
in the blood stimulate the parathyroid fibrous osteodystrophy may appear swol-
gland to release parathyroid hormone. len and palpate as hard lumps.8,9
chelonians that are
The parathyroid hormone causes calcium rapidly growing and
to be released from bones into the blood Juvenile lizards and chelonians that are
stream to normalize calcium levels. Simul- rapidly growing and reproductively active reproductively active
taneously, renal tubular reabsorption of female reptiles are more prone to devel-
calcium is increased, phosphorus excre- oping NSHP because of a higher demand
female reptiles are
tion is increased, and active vitamin D3 for calcium.6 Spinal deformities and kinked more prone to devel-
is released from the kidneys to stimulate tails appear to be more common in young,
calcium absorption in the intestines.6 If rapidly growing lizards. Young chelo- oping NSHP because
the parathyroid hormone is unable to raise nians with NSHP may experience stunted
calcium levels in the blood to acceptable growth, secondary infections, and soft,
of a higher demand
levels, the parathyroid gland will continue deformed shells. Reproductively active for calcium.6
to produce parathyroid hormone, caus- females have a higher calcium demand
ing further calcium to be released from for formation of their eggs. Dystocia is
bone, eventually depleting the skeleton common in gravid reptiles that Patient History
of calcium and phosphorus.9 Without have NSHP. Obtaining a thorough patient
calcium and phosphorus, osteomalacia history is essential to identify incorrect
will develop. Osteomalacia is a soften- Once a reptile’s skeleton is completely husbandry and dietary practices that
ing of bones due to decreased miner- depleted of calcium, calcium blood levels may lead to NSHP.4
alization. Clinical signs of osteomalacia will continue to drop, resulting in hypo-
commonly noticed by owners include a calcemia. The reptile is no longer able to Physical Examination
swollen, pliable, or misshapen jaw (Figure maintain calcium homeostasis by drawing Performing a thorough physical examina-
3), anorexia, lethargy, stunted growth, calcium from the bones. Clinical signs of tion may reveal clinical signs that influence
and difficulty or inability to ambulate.10,11 hypocalcemia include tremors, seizures, the veterinarian to strongly suspect NSHP.
Pathological fractures of long bones and tetany, disorientation, muscle fascicula- Early clinical signs of NSHP can be subtle
the spine can occur.3,10 Fibrous osteodys- tions, and ataxia (Figure 4).3,9,10 Hypocalce- and may only recognized by an experi-
trophy is the body’s response to osteoma- mia also causes gastrointestinal bloating, enced owner or practitioner. Clinical signs
lacia. Fibrous osteodystrophy is a process which can lead to secondary conditions will depend on the severity of disease, as
of laying down fibrous connective tissue such as cloacal prolapse and gastrointesti- well as the species and age of the reptile.3
across the weakened areas to attempt to nal impaction.9,10
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Blood Analysis positioned in sternal recumbency in a nat- intramuscularly or intracelomically until
A complete blood count and chemistry ural position for all radiograph views. The cessation of tetany. The patient should
panel should be performed to screen for x-ray beam and cassette can be reposi- then be switched to an oral calcium glu-
underlying disease and pathology of body tioned to achieve the lateral and rostrocau- bionate for long-term therapy. Calcium
systems that may affect calcium homeo- dal views (Figure 6).12 Tape, foam blocks, injections are painful and can permanently
stasis. Plasma calcium and phosphorus boxes, bags, and other radiolucent items damage the kidneys, so they should not
levels are useful for evaluating the Ca:P can be used to assist with positioning. be utilized long-term. Vitamin D and calci-
ratio. A low plasma calcium level in con- tonin can also be used to restore calcium
junction with an elevated phosphorus level Treatment balance.3,8 Underlying diseases and sec-
is an inverse Ca:P ratio and indicative of Treatment of NSHP will vary depending of ondary conditions, such as dehydration
NSHP. Normal limits will vary by species the severity of disease. The focus of treat- or infection, should be treated accord-
and physiologic condition, but most rep- ment includes stabilizing the patient, treat- ingly.4,6 Most importantly, correction of the
tiles have a plasma calcium concentration ing secondary conditions, reversing bone patient’s nutrition and husbandry must
between 8 and 11 mg/dL and plasma loss, promoting new bone production, occur.3 Proper nutrition and husbandry will
phosphorus concentration between 1 and and correcting underlying nutritional and be discussed further in the next section.
5 mg/dL.3 However, a total blood calcium husbandry causes. Pathologic fractures Prognosis of NSHP will vary from excellent
level within the normal range for that spe- and life-threatening hypocalcemia condi- to grave depending on the severity
cies does not rule out NSHP. The parathy- tions should be addressed immediately of disease. If corrections to husbandry
roid hormone has stimulated mechanisms upon presentation.3 Reptiles experiencing and nutrition are made early, minor symp-
to keep calcium levels within normal range. acute hypocalcemic crisis characterized toms will subside or reverse completely.
Hypocalcemia will not be appreciated on by muscle fasciculations or tetany can be Skeletal deformities cannot be reversed,
a chemistry panel until end-stage NSHP.4,9 treated with injectable calcium gluconate but with prompt treatment, the reptile
Instead, an ionized calcium level may be
beneficial. Recall that ionized calcium is
not bound by proteins and is calcium in its
most active form. An ionized calcium value
will provide a more accurate assessment
of the reptile’s calcium status.3
Radiographs
Radiographic imaging is the most valu-
able diagnostic tool for NSHP. Whole body
radiographs will enable the veterinarian to
assess bone density, skeletal deformities,
and will reveal pathologic fractures.4,10
Most reptile species can be radiographed
without sedation with the use of tape and
foam positioners. Many lizards, iguanas in
particular, are easily positioned by placing Figure 3A: green iguana with facial deformity and Figure 3B: iguana with a misshaped mandible
an eye lubricant in the eyes, covering the stomatitis jaw misalignment.
closed eyelids with cotton balls, and wrap-
ping the head with bandage material. The
pressure over the eyeballs causes a vaso-
vagal reflex, decreasing their heart rate and
blood pressure and inducing a catatonic
state.12 Chelonians are comfortably posi-
tioned by placing a radiolucent apparatus
that is slightly smaller than the plastron
under the chelonian, preventing the feet
from touching the table (Figure 5).12
Standard radiograph projections for a
lizard include a dorsoventral view and a
lateral view. Standard radiograph projec-
tions for a chelonian include a dorsoven-
tral view, lateral view, and a rostrocaudal Figure 3C: veiled chameleon with severe jaw misalign- Figure 3D: green iguana with a swollen mandible
(craniocaudal) view.12 Reptiles can be ment, sunken eyes, dysecdysis, and poor body condition and jaw misalignment.
VETERINARY NURSING IN ACTION | OCT/NOV 2017 25
VETERINARY NURSING EDUCATION
may return to a normal lifestyle. Severe, Reptiles are ectothermic, meaning they rely on
chronic NSHP characterized by fibrous
osteodystrophy, fractures, or paralysis
outside sources of heat to control their body tem-
has a grave prognosis.3,8 perature. A thermal gradient that corresponds to
Prevention natural habitat temperatures should be provided
Proper nutrition and husbandry are essen- to every captive reptile.
tial for the prevention of NSHP. Veterinary
technicians play a vital role in educating artificial lighting 12-18 inches from the and most reptiles will choose heat over
reptile owners about proper husbandry reptile. The reptile will not receive the full UV radiation.1
and nutrition, as well as early detection. benefits of the UV-B radiation if the arti-
ficial lighting is placed a further distance A variety of heat sources are available
Ultraviolet light from the reptile than recommended. UV for purchase. Hot rocks are popular, but
A source of UV-B lighting in the spectrum radiation from all artificial light bulbs should be used with extreme caution. Hot
290-315 nm should be provided to all diur- decreases over time and should be rocks provide a focal heat that generally
nal lizards and chelonia. Ultraviolet light replaced according to the manufactur- becomes hotter over time, increasing the
can be provided to captive reptiles in two er’s recommendations, usually every six risk of burns. Recommended heat sources
ways: unfiltered, direct sunlight or a store- months. Lastly, the artificial light needs include adjustable heating pads placed
bought UV-B light bulb. Owners should to be provided for the length of time that under the enclosure, incandescent bulbs,
be encouraged to provide natural sunlight corresponds to the daylength and time of ceramic heaters, and heat tape.3 Enclosure
for their pet reptile whenever possible. For year in the natural habitat for that species. temperature should be monitored regu-
many owners, it is not possible to have 14 hours of light per day in the summer larly using a temperature gun, rather than
their reptile outside for several hours a day. and 12 hours of light per day in the winter a hanging thermometer. Temperature guns
When natural sunlight is not possible, light corresponds to the average day length at allow the temperature to be measured
bulbs that emit artificial UV-B lighting are the equator and is the photoperiod recom- throughout the entire enclosure. Hanging
available for purchase online and in most mended for most reptiles.3 thermometers measure the temperature in
pet stores.2 Common bulbs purchased are the exact spot it is located only, providing
incandescent bulbs and florescent bulbs. Temperature no insight about the temperature variance
Incandescent bulbs provide heat and UV As previously discussed, heat is required throughout the entire enclosure.
light. Florescent bulbs are generally tubular for the conversion of previtamin D3 to
and provide a wider spectrum of UV light cholecalciferol.1 Reptiles are ectothermic, Dietary Calcium
than the incandescent bulbs, but omit very meaning they rely on outside sources of Supplementary dietary calcium should
little heat.3 heat to control their body temperature. be provided to all captive reptiles. A wide
A thermal gradient that corresponds to range of supplements containing addi-
Failing to provide UV-B lighting and not natural habitat temperatures should be tional varied vitamins and minerals are
using artificial lighting correctly are com- provided to every captive reptile. Fluctua- available for purchase.1 Dietary require-
mon mistakes made by owners that will tions in temperature according to the time ments for each reptile patient can be chal-
cause NSHP. It is important to know that of day and season should also be consid- lenging to meet and necessitate research
not all light bulbs available for purchase ered. A thermal gradient allows the reptile according to species. Most diurnal species
for reptiles omit UV-B radiation and care to seek warmer temperatures for basking will benefit from a supplement that does
should be taken to read product pack- or choose cooler temperatures if desired, not contain phosphorus, but provides
aging. It is often assumed that placing a replicating normal behavior of reptiles calcium only or calcium with vitamin D3.5
reptile’s enclosure near a sunny window in their natural habitat.3 Every reptilian There are a number of supplements on
will allow the reptile natural UV-B light from species will have an individual preferred the market that claim to contain vitamin D.
the sun. However, glass and plastic filter temperature range. However, a general Attention to the ingredient list is necessary
out UV radiation. Artificial lighting needs guideline for most diurnal species is a to ensure the supplement contains vitamin
to be placed in a location where the reptile temperature range between 80ºF to 95ºF D3 (cholecalciferol), not vitamin D2. Vita-
can benefit from it. Enclosures constructed during the daytime with a basking area min D2 is not usable by reptiles.3
from plastic or glass will also filter UV slightly higher than the upper end of the
radiation, making it necessary to place preferring temperature range. Nighttime Herbivorous reptiles, such as green
the artificial lighting inside the enclosure temperatures should never fall below 70ºF iguanas, uromastyx lizards, chuckwal-
for the reptile to receive full benefits of the for most reptile species.3 Ideally, the bask- las, and prehensile-tailed skinks tend to
UV-B radiation. Manufacturers of UV light- ing site and the UV-B lighting should be in be the most challenging reptiles to feed.
ing will provide information on the range the same location. Placing the UV lighting Herbivorous reptiles obtain calcium from
of UV-B radiation emitted from the bulb and the primary heat source at different leafy green vegetables, such as kale,
and the distance the radiation is emitted. sites forces the reptile to choose between okra, dandelion greens, bok choy, collard
Most manufacturers recommend placing basking in warmth or under UV radiation, greens, mustard greens, turnip greens
26 THE NAVTA JOURNAL | NAVTA.NET
VETERINARY NURSING EDUCATION
Figure 4: Bearded dragon displaying
neurological signs, characteristic of
hypocalcemia.
Figure 5: Chelonians are comfortably positioned for Figure 6: Lateral and dorsoventral projections of a blue-tongued skink with severely decreased opacity of the skeleton.
radiographs by placing a radiolucent apparatus that is Note the concavity of the ventral spine and the appearance the teeth are floating due to loss of mineralization of the
slightly smaller than the plastron under the chelonian, perialveolar bone in the lateral projection. Also note the spinal deformities, kinked tail, and decreased aeration of the lung
preventing the feet from touching the table. lobes secondary to a weakened musculature in the dorsoventral projection.
VETERINARY NURSING IN ACTION | OCT/NOV 2017 27
VETERINARY NURSING EDUCATION
and watercress. Oxalate-rich vegetables,
such as spinach and carrots, should be
fed sparingly to avoid oxalates binding to
calcium, preventing calcium absorption in
the intestines. The rest of the diet should
be composed of other nutrient-rich vege-
tables and less than 10% fruit.
Crickets and worms are the most com-
mon food item provided to insectivorous
reptiles, such as chameleons and bearded
dragons. Crickets and worms are high in
fat and protein and deficient in calcium.5
Gut-loading crickets, or feeding a nutri-
tious diet to the crickets for 48 hours, is
recommended prior to feeding them to a
captive reptile. The diet fed to the crickets
Figure 7: The x-ray beam and cassette can be repositioned for ease of obtaining lateral radiographic views of lizards.
will remain in the gastrointestinal tract of
Note the use of foam blocks to assist with positioning of the patient.
the cricket and be ingested by the reptile.
Dusting the external surface of insects
with a calcium supplement powder is
also recommended.3 Owners should be
encouraged to also provide calcium-rich
leafy green vegetables and a wide variety
of other insects.5
Carnivores, such as snakes, that are
fed a whole prey diet will consume
an adequate amount of calcium and
vitamin D3. However, carnivores fed only
neonate prey, such as pinky mice, are
susceptible to developing NSHP. Neonate
prey have skeletons that are not suffi-
ciently calcified, decreasing their calcium
content and causing an inverse Ca:P ratio.
Muscle and organ meat also contain an
inverse Ca:P ratio. Frozen fish, mice, and
rats are recommended food items for car-
nivorous reptiles.5
Conclusion
Nutritional secondary hyperparathyroidism
is a complex metabolic disorder common
in captive reptiles. A considerable number
of body systems and physiologic func-
tions are involved in maintaining calcium
homeostasis in reptiles. Veterinary tech-
nicians can advocate for captive reptiles
by striving to understand the complicated
nature of NSHP, recognizing early clinical
signs of disease, and providing owners
with information about proper husbandry
and nutrition.
Figure 8: Dorsoventral projection of gravid female veiled chameleon. Note the multiple oval shaped soft tissue structures
in the coelomic cavity, the overall decreased bone density, and the thin, indistinct bone cortices, characteristic of
nutritional secondary hyperparathyroidism.
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References Term Definition
1. Hedley, J. (2012, July 3). Metabolic bone disease
in reptiles: Part 1. Companion Animal, 17(6), 52-54.
doi:10.1111/j.2044-3862.2012.00210.x BASKING To lie in or be exposed to warmth
2. Lamb, S. (n.d.). Vitamin D and Why It’s So Import-
ant. Retrieved August 21, 2017, from Exotic Animal HELIOTHERMIC To gain heat from the sun
Care Center: http://exoticanimalcarecenter.com/cli-
ents/18988/documents/VITAMIN%20D%20AND%20 CHOLECALCIFEROL Inactive form of vitamin D3
WHY%20IT.pdf
CALCITRIOL Active form of vitamin D3
3. Mader, D. R. (2006). Metabolic Bone Diseases. In D.
R. Mader, Reptile Medicine and Surgery (2nd ed., pp. Most abundant mineral in the body; important for
841-851). St. Louis, MO: Saunders Elsevier. CALCIUM formation and integrity of bones and teeth, nerve
transmission, blood clotting, and muscle contractions
4. Mans, C., & Braun, J. (2014). Update on Common
Nutritional Disorders of Captive Reptiles. Veterinary Hormone necessary for intestinal absorption of dietary
Clinics of North America: Exotic Animal Practice, 17, VITAMIN D calcium and phosphorus
369-395. doi:10.1016/j.cvex.2014.05.002
PARATHYROID
5. Avila-Guevara, R. A. (2012, November). Nutri- Hormone responsible for maintaining blood calcium levels
HORMONE
tional Secondary Hyperparathyroidism in Rep-
tiles. Veterinary Technician, E1-E5. Retrieved from Most active form of calcium; calcium not bound
IONIZED
file:///C:/Users/Sarah/Desktop/NAVTA%20Journal/ to proteins in the bloodstream
CALCIUM
VT1112_Avila-Guevara_CE.pdf
6. Eatwell, K. (2013). Nutritional Secondary Hyperpara- ULTIMOBRANCHIAL A small organ located in the neck region of reptiles
thyroidism in Reptiles. In J. Rand (Ed.), Clinical Endocri- GLAND that is responsible for producing calcitonin
nology of Companion Animals (1st ed.). John Wiley &
Sons, Inc. Retrieved from file:///C:/Users/Sarah/Desk- OSTEOMALACIA Softening of the bones
top/NAVTA%20Journal/Clinical%20Endocrinology%20
of%20Companion%20Animals%20_%20R2%20Digi- The body’s response to osteomalacia;
tal%20Library.pdf FIBROUS the laying down of fibrous connective tissue
7. Rivera, S., & Lock, B. (2008). The Reptilian Thyroid OSTEODYSTROPHY across weakened areas to reinforce the skeleton
and Parathyroid Glands. Veterinary Clinics of North
America: Exotic Animal Practice, 11, 163-175. 2nd most abundant mineral in the body;
doi:10.1016/j.cvex.2007.10.002 important for formation and integrity of bones
PHOSPHORUS and teeth, muscle contractions, nerve transmissions,
8. Kaplan, M. (2014, January 1). Calcium metabolism and metabolic processes
and metabolic bone disease. Retrieved from Melissa
Kaplan’s Herp Care Collection: http://www.anapsid.org/
HYPOCALCEMIA Calcium deficiency in the bloodstream
mbd2.html
9. Miller, C. (2017). Metabolic Bone Diseases in Reptiles
Muscular spasms caused by hypocalcemia or malfunction
and Amphibians: Calcium Balance. Retrieved from TETANY of the parathyroid gland
ReptileApartment.com: http://reptileapartment.com/
metabolic-bone-diseases-reptiles-amphibians-calci-
um-balance/ ATAXIA Complete loss of control of bodily movements
10. Hedley, J. (2012, September 6). Metabolic bone
disease in reptiles: Part 2. Companion Animal, 17(7), DIURNAL Most active during the daytime
38-41. doi:10.1111/j.2044-3862.2012.00227.x 8.
11. Wissman, M. A. (2017). Nutritional Secondary
Hyperparathyroidism in Reptiles. Reptile Magazine.
Retrieved from http://www.reptilesmagazine.com/
Nutritional-Secondary-Hyperparathyroidism-In-Reptiles/
12. Brown, M., & Brown, L. (2014). Radiography for
Veterinary Technicians (5th ed.). St. Louis, MO: Saunders
Elsevier.
VETERINARY NURSING IN ACTION | OCT/NOV 2017 29
VETERINARY NURSING EDUCATION
Article Questions
1. The active form of Vitamin 4. What spectrum of UV-B
D3 is called lighting should be provided
to diurnal lizards?
a. Cholecalciferol
a. 215-250 nm
b. Calcediol
b. 280-315 nm
c. Calcitriol
c. 315-350 nm
d. 7-dihydrocholesterol
d. 380-415 nm
2. The primary hormone
responsible for 5. What is the coolest
maintaining blood temperature recommended
calcium concentration is for a diurnal reptile’s
enclosure during the
a. Parathyroid hormone
night time?
b. Thyroid stimulating
a. 70ºF
hormone
b. 80ºF
c. Thyroxine
c. 90ºF
d. Cortisol
d. 100ºF
3. The ideal Ca:P ratio
for reptiles is
a. 1:3
b. 3:1
CONTINUING EDUCATION
c. 2:1
QUIZ ONLINE
d. 1:2 visit VetMedTeam.com
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Vet Med Team Profile.
®
Sarah Kolb, RVT, VTS (Exotics)
Sarah graduated from Minnesota School of Health Science/Globe College in 2005, and is currently working towards her bachelor’s
degree in veterinary technology through St. Petersburg College in Florida. She has worked in the Primary Care/Exotic Companion
Animal department and Wildlife Care Clinic at ISU VMC located in Ames, Iowa since 2006. In 2015, Sarah achieved VTS status
with the AVTCP- exotic companion animals. Sarah is also a CE instructor for VSPN, a licensed wildlife rehabilitator, and parrot
foster home for her local Animal Rescue League.
30 THE NAVTA JOURNAL | NAVTA.NET
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