Nutritional secondary hyperparathyroidism (NSHP), metabolic bone disease, rubber jaw, brittle bones The amphibian may be anorectic or may have obvious limb or mouth deformities. • An amphibian that is unable to maintain sufficient levels of circulating calcium may develop bloating, tetany, hydrocoelom, lethargy, and sudden death. • An amphibian that has normocalcemic NSHP may have a deformed lower jaw, a slightly protruding tongue, slight rounding of the profile of the snout, an inability to elevate itself from the substrate, a curved spine and a kinked tail, and deformed or obviously fractured limb bones. • A calcium-to-phosphorus ratio that is significantly different from 1.5 : 1 or 2 : 1. Most prey items fed to captive amphibians have an inverse ratio of calcium to phosphorus, typically less than 1 : 1. • An absolute lack of calcium despite an appropriate ratio of calcium to phosphorus • Calcium in the water may be a significant source of this mineral. Amphibians adapted for hard water may develop NSHP if the calcium hardness of their water is too low. • Lack of vitamin D3 in the diet may impair calcium absorption and distribution. A ratio of fat-soluble vitamins inappropriately high in vitamin A or vitamin E may impair vitamin D3 absorption and utilization. Typically, the ratio should be 100 IU D3 to 10 IU A to 1 IU E. Domestic rodents may have an inappropriate balance of fat-soluble vitamins. • An inappropriately acidic substrate may interfere with the proton pump systems needed to maintain normocalcemia and increase the demand for an external source of calcium. This frequently results in gastrointestinal bloating, tetany, seizures, and other signs of hypocalcemia. • Various other metal ions are present in common calcium supplements such as calcium carbonate and oyster shell flour. These may interfere with calcium uptake if above or below certain levels. • Oversupplementation with calcium may impair absorption and create NSHP.
Nutritional Secondary Hyperparathyroidism
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Synonyms
Clinical Presentation
History, Chief Complaint
Physical Exam Findings
Etiology and Pathophysiology
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