Common emergencies in reptiles (Proceedings)

Common Reptile Conditions Needing Veterinary CareReptiles take a very long time to get sick. By the time they show signs of disease, their condition is usually advanced. There are very few true "emergencies" in reptile medicine. There are a few exceptions, however, with acute traumas such as bleeding and broken bones as examples.

With that in mind, there ARE several conditions that may appear to an owner to be an emergency. It is not uncommon for a reptile owner to come home from work and check in on their pet when they suddenly realize that "the animal is really sick." I often hear "it was not like that yesterday!"

Again, with reptiles, most things happen slowly. Most of the perceived "emergencies" have some sort of chronic, insidious basis, and for whatever reason, suddenly become apparent to the owner.

In some cases, there may be a legitimate, dramatic change in the patient's condition. To use an old adage, it is like "the straw that broke the camel's back." For instance, a reptile may be suffering from disease and showing a gradual, barely perceptible decline, when all of a sudden, its health just seems to fall apart.

An example here is the very common Nutritional Secondary Hyperparathyroidism (NSHP), a condition incorrectly known as Metabolic Bone Disease (MBD). With NSHP the animal will have a gradual decline in body condition. Part of the disease is a weakening of the bones. Eventually there comes a point where the bones are so weak that they just "snap." This is called a pathological fracture, and it happens all at once, although, the CAUSE of the problem is chronic in nature. So, to the owner, the apparent problem with the pet is acute – meaning "it wasn't like that yesterday!"

Blood Loss and Trauma

Hemorrhage can result from many different causes. Trauma is perhaps the most common cause in reptiles.

Bites from prey, bites from dogs and cats, cuts from caging (glass, wire, screens, etc.) and combat with cagemates can all cause trauma that involves bleeding.

A second serious emergency is also related to trauma. Any bite wound, whether from a cagemate, a dog/cat or prey animal, regardless of whether or not it is bleeding, MUST be treated by a veterinarian to prevent infection and for evaluation of serious underlying damage. For instance, what appears to be a simple puncture wound to the skin over the ribs, may actually involve deeper structures within the body cavity. If a client calls the ER clinic with this scenario, it is imperative that the employee stress the emergent nature of this condition.

Fractures

"There is no such thing as an orthopedic emergency." What this means is simple – a reptile patient won't die from a broken bone. They may die from related problems – such as bleeding associated with the broken bones, especially if there is a compound fracture (where the bones are exposed through the skin).

If there is no hemorrhage, or once the bleeding has stopped, then carefully splint the entire broken limb with cotton or gauze. Use LOTS of padding. After you have wrapped the limb, cover the padding with some tape. White adhesive tape or waterproof tape will provide external support around the cotton or gauze. The most important thing to do here is to IMMOBILIZE the fracture, including the joints above and below, so that it does not become more damaged, or, cause more damage to any other tissues.

If you suspect that the patient has a broken back it is best not to try to wrap or splint it. Rather, your primary objective is to keep the animal immobile. This is best achieved by gently placing it in a very small box and sending it to a reptile veterinarian. Make sure you tell anyone that may be potentially handling the animal that you suspect a broken back prior to them trying to pick it up.

Burns

Thermal injury can be obvious, or as in many cases, occult. The obvious ones are, well, obvious. For instance, the snake that falls asleep on top of the exposed light bulb in the cage. When it wakes up, it finds itself stuck to the glass of the bulb. The skin may be charred, boiled or melted away. These types of burns are extremely serious and need immediate attention.

Occult burns are not so easy to determine. Reptile skin does not flush like mammal skin. Consider the tourist that falls asleep on the beach the first day of vacation. By the end of the day their skin is lobster red.

Reptiles, by contrast, do not show the "erythema"or reddening, that is seen with minor to semiserious burns as do mammals. Rather, the skin changes that are seen with reptile burns may not actually show up for up to a week after the burn has occurred. In many instances, the owner does not even know or realize that their pet has been burned.

You may note swelling, drying or blanching to the scales. Sometimes the skin and scales will turn yellow-brown and develop a moist film around the edges.

If a burn is suspected, provide analgesia (ketoprofen, flunixen, butorphenol) and apply wet to dry dressings. Antibiotics are not usually necessary unless the burn has already penetrated the epidermis.

Twitching/Seizures/Convulsions

Like vomiting and diarrhea, there are many causes of twitching/seizures/convulsions. To discuss all the possibilities is not realistic at this point. However, what is important to note is that these symptoms are usually just the tip of the iceberg.

Probably the most common cause is hypocalcemia, or some variation of an imbalance of calcium homeostasis (phosphorus, magnesium and other mineral imbalances, vitamin D deficiencies, kidney disease and more). These conditions are not acute – meaning that they did not "just happen."

Conditions that can account for twitching/seizures/convulsions that are acute include poisoning (eg. plant toxins, animal [e.g. toad] toxins and insecticides used for mite treatment).

Above all, avoid using injectable calcium unless proper diagnostics are performed. Many causes of these neurological conditions look the same, but require vastly different treatments. For instance, a patient presenting with hypocalcemia due to improper diet may benefit from supplemental calcium, where a patient in terminal renal failure may have the condition exacerbated with the same.

Prolapses

There are many types and causes of prolapses. A prolapse occurs when any internal structure (such as a uterus, intestinal tract, bladder) is forced out through a natural body orifice (usually the cloaca).

If at all possible, try to identify the source of the prolapse, although, in an emergency situation, this is not a critical step. The most important thing to do is 1) protect the prolapsed tissue, 2) control hemorrhage, 3) support the patient (shock) and 4) provide antibiosis.

Protect the prolapsed tissue by wrapping it with a clean cotton cloth. Try NOT to cover the prolapse with Vaseline if at all possible. Petroleum jelly coats the organ and interferes tissue handling and healing if surgery is necessary.

If the prolapsed tissue is allowed to dry out, or if it gets traumatized (stepped on, bitten by cage mates, etc.) it could be irreversibly damaged. This could lead to amputation of the body part (such as a hemipenis) or even death (as when an intestine is irreversibly damaged).

Vomiting/Regurgitation

Reptiles should not vomit or regurgitate. There are many causes for vomiting/regurgitation. To discuss all the causes is beyond the scope of this article.

Regardless of the cause, the important point is this: Vomiting/regurgitating blood should be considered a priority emergency, and needs to be addressed immediately.

Radiographs, PCV/TS and careful palpation may help determine the cause. If the source is not readily apparent, consider supportive care (IV, Ice, IO fluids, warmth and possibly, antibiotics) may be started.

Diarrhea

Similar principles apply here as with vomiting/regurgitation. This is generally not considered an emergency situation unless blood is being passed from the gastrointestinal tract. Treatment should follow the same guidelines.

Lumps and bumps

For the most part, any lump or bump needs to be administered by a qualified veterinarian. These are rarely considered an emergency with perhaps the exception of a trauma case. If an animal is stepped on, bitten, dropped, etc, and it suddenly develops a swelling, it should be seen immediately. Swellings in these situations can indicate internal bleeding, hernias, ruptures etc. A careful physical examination and radiographs are warranted.

Summary

Remember, reptiles do everything slowly. They get sick slowly, and they get better slowly. As an ER veterinarian, if you do nothing else, you will never be faulted for providing a warm cage. The administration of a balanced crystalloid will further the chances of a successful outcome for the majority of reptile cases.