PATIENT - Abaxis

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marrow, a replacement needlecan be placed directly intothe insertion site. Surveyradiographs can be usedto ensure the catheter isplaced correctly (Figure 2).Normosol-R fluids (AbbottLaboratories, North Chicago,IL USA) were used to correctthe animal’s fluid deficit andprovide maintenance fluids.The deficit was estimated tobe 10% (pending bloodwork),which meant that the animalrequired 230 ml of lost fluid.Maintenance was determinedto be 15 ml/kg/day. Thedeficit was to be correctedover 72 hours, while themaintenance level would beprovided daily. The fluids weredelivered continuously viaa syringe pump. The animalwas returned to the incubatorpending the diagnostictest results.The results of the CBCsuggested that the iguanahad a chronic inflammatoryresponse (14.6 x 10 3 cells/µL),characterized by a monocytosis(2.6 x 10 3 cells/µL), and wasdehydrated (PCV: 40%)(Mitchell, unpublished data).The results of the plasmabiochemistry panel can be foundin Table 1. The iguana was foundto be severely hypocalcemic,severely hyperphosphatemic,hypernatremic, hyperuricemic,and had elevated AST andCK levels. The inverse calcium:phosphorus ratio is a strongindicator of renal disease.Under normal conditions, thekidneys should conserve calciumand excrete phosphorus. Theelevated sodium and uricacid were considered to beassociated with dehydration.Elevated CK and AST areconsistent with muscledegradation, likely associatedwith the catabolic state ofthe patient. The total proteinvalues suggest an elevationin the globulins, as there isan inverse albumin: globulinratio. It is possible that albuminwas not being retained atthe level of the kidneys, butthe dehydration could alsofalsely elevate the value. It isimportant to consider thatsome patient values may fallwithin a minimum-maximum,but still be abnormal. Manyparameter ranges are quitelarge, and depending on wherethe patient’s value started canhave a large impact on whereit is at the time of testing.The radiographs revealedthat the two coelomic massesoriginated from the pelvis(Figure 3). The primarystructures found in the caudalcoelomic cavity in a green iguanainclude the two fat pads, therectum, urinary bladder andkidneys. The kidneys are actuallylobulated structures locatedwithin the pelvic canal. Thefindings on the radiographsand the bloodwork suggestedthat the animal had chronicrenal disease.Based on these findings, theowners were given a graveprognosis. Renal biopsies wererecommended to confirm adiagnosis, but were declined.A decision was made toinstitute additional therapiesto manage the chronic renalfailure and continue the fluidtherapy over 72 hours. At thattime, the blood work and theanimal would be re-assessed.Over the next 72 hours theiguana was started on calciumgluconate (400 mg/kg/day)IO to correct deficits andensure rapid availability tocells, aluminum hydroxide(25 mg/kg twice daily) toserve as a phosphate binder,and enrofloxacin (10 mg/kg once daily) as a broadspectrum antibiotic with goodpenetration to the kidneys.After 24 hours of treatmentand rehydration, the iguanawas more alert and active.Nutritional support wasinitiated at that time usingRepta-Aid Herbivore (FlukerFarms, Port Allen, LA USA).After 72 hours of treatment,the plasma biochemistrieswere re-tested using an <strong>Abaxis</strong>VetScan Avian/ReptilianProfile Plus. Because thechanges to the calcium (3.9mg/dL) and phosphorus (25.6mg/dL) were minimal, and theiguana had a grave prognosis,the owner elected euthanasia.Renal failure is a commonproblem identified in adultcaptive green iguanas. Thereare several theories as to whythis occurs, including chronicdehydration, high protein diets,and toxic exposure. In thiscase, and with many others,14 April 2010
enal failure in a green lguanathe author finds that iguanaswith free roam in a house andexposure to carnivore diets(e.g., cat diet) tend to developthis disease. Green iguanasare herbivores, and theirgastrointestinal system is notbuilt for the high protein andfat-soluble vitamins found incarnivore diets.A biopsy in this case wouldhave been helpful forconfirming the diagnosis anddetermining if there weremore specific treatments thatcould be used to manage thepatient, but it was declined bythe owner. A necropsy wasalso declined, but the authorhas seen similar cases wherethe post-mortem diagnosisis glomerulonephrosis. Aprognostic indicator that canbe used to predict the potentialsuccess with these cases is thecalcium and phosphorus levels.Under normal conditions theratio of calcium: phosphorusshould be 1.5–2.0:1. When theinverse ratio is slight (1:1–1.5),it is often possible to managethe patient by correctinghusbandry deficiencies (e.g.,no carnivore diets, access towater in an appropriatelysized container), providingfluids and oral calcium, andbinding phosphate. When theratio gets as large as was seen inthis case (1:7.9), it is not possibleto stabilize these patients shortof renal transplant.Table 1. Green iguana plasma biochemistry test results (pre-treatment).Parameter Green Iguana patient Reference 2MeanMinimum–MaximumAlbumin (g/dL) 1.6 2.02 0.91–3.01AST (IU/L) 248 19.80* 11.2–41.08Bile Acids (µmol/L)
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