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Nutritional Secondary Hyperparathyroidism 697

Drug Interactions • Guarded to poor with GI tract perforation Prevention
• Concurrent use of glucocorticoids and • Renal effects of NSAIDs are usually Keep all NSAIDs, especially chewables, out of
VetBooks.ir • Increased serum drug levels: phenytoin, • Recovery from idiosyncratic hepatic toxicity Technician Tips Diseases and Disorders
the reach of pets.
NSAIDs increases the risk of adverse effects.
reversible if discovered early and treated
intensively.
valproic acid, oral anticoagulants, sulfon-
amides, sulfonylurea hypoglycemic agents,
ketoconazole, methotrexate, and fluconazole is good when NSAID is discontinued and Misoprostol is an abortifacient. Do not handle
if pregnant.
with supportive care.
• Increased risk of nephrotoxicosis: amino-
glycosides, angiotensin-converting enzyme PEARLS & CONSIDERATIONS Client Education
(ACE) inhibitors, and diuretics Owners should not give any medications to
Comments their pets at home without first consulting a
Possible Complications • For most NSAIDs, the minimal toxic/ veterinarian.
• Chronic kidney disease lethal dose is unknown. Generally, an acute
• Hepatopathy overdose of 5-10 times more than the recom- SUGGESTED READING
• GI perforation and peritonitis mended dose could cause potentially severe Khan SA, et al: Toxicology of frequently encountered
GI irritation/ulceration in dogs. nonsteroidal anti-inflammatory drugs in dogs
Recommended Monitoring • Some NSAIDs (naproxen and meclofenamic and cats. Vet Clin North Am Small Anim Pract
• Blood urea nitrogen, serum creatinine, acid) have a much longer half-life in dogs 42:289-306, 2012.
electrolytes, urinalysis (baseline, 24, 48, due to extensive enterohepatic recirculation AUTHOR: Camille DeClementi, VMD, DABT, DABVT
and 72 hours in acute cases) (naproxen: 74 hours). EDITOR: Tina Wismer, DVM, MS, DABVT, DABT
• Serum liver enzymes and bilirubin (for • Check baseline CBC and serum biochemistry
hepatopathy) profile in all patients before long-term use
of NSAIDs.
PROGNOSIS & OUTCOME • Before starting long-term therapy, discuss
common adverse effects associated with
• Excellent with mild to moderate GI irritation/ NSAIDs with clients.
ulceration

Nutritional Secondary Hyperparathyroidism Client Education
Sheet

BASIC INFORMATION • Exotic pets because dietary requirements for • History of malabsorption due to intestinal
calcium, phosphorus, and vitamin D are disease
Definition not always known and diets fed are often • Reluctance to walk, stiff gait, bone pain,
Chronic elevation of circulating parathyroid inappropriate lameness, or limb deformities (pathologic
hormone (PTH) resulting from low serum • Animals with severe gastrointestinal disease bone fractures); difficulty with prehension;
ionized calcium (iCa) concentrations due to that limits calcium or vitamin D absorption tooth loss, ± neurologic signs if the axial
deficiency of absorbed calcium or vitamin D skeleton is involved
or a calcium/phosphorus (Ca:P) imbalance GEOGRAPHY AND SEASONALITY • Signs of hypocalcemia: twitching, tremors,
The condition may be more common in stiffness, or seizures (rare)
Synonyms winter months in some indoor-housed exotic
• Nutritional secondary hyperparathyroidism pets because of decreased exposure to sunlight. PHYSICAL EXAM FINDINGS
(NSHP), nutritional osteodystrophy This does not apply to cats and dogs because • Bone palpation may elicit pain; fractures may
• The term rickets describes bony changes they cannot make vitamin D in skin. be noted.
consistent with vitamin D deficiency. • Swelling of costochondral junctions or
ASSOCIATED DISORDERS metaphyses may be evident.
Epidemiology Animals may have decreased bone density
SPECIES, AGE, SEX or fractures related to increased circulating Etiology and Pathophysiology
Young, rapidly growing animals of any sex PTH. • Inadequate calcium absorption decreases iCa,
or species that have been fed an improperly Clinical Presentation increasing PTH production.
formulated diet; occasionally affects older • Inadequate absorbed vitamin D decreases
animals, especially those with malabsorptive DISEASE FORMS/SUBTYPES calcitriol production, decreasing iCa and
disorders • Inadequate dietary calcium or vitamin D increasing PTH production.
concentration or altered dietary Ca:P ratio • PTH stimulates renal 1,25-dihydroxyvitamin
RISK FACTORS • Inadequate absorption of dietary calcium D (calcitriol, the active metabolite of
• Animals fed improperly formulated and vitamin D due to intestinal disease vitamin D) synthesis and bone resorption
homemade (especially all-meat) diets, par- and increases renal calcium resorption and
ticularly during growth. Such diets typically HISTORY, CHIEF COMPLAINT phosphorus excretion.
contain deficient calcium and/or excessive • History of a poorly formulated homemade • Calcitriol also stimulates bone resorption to
phosphorus, with a calcium-to-phosphorus diet or exclusive use of a commercial diet raise iCa into the normal range and decreases
ratio (Ca:P) ≤ 1 : 16 (1 : 1 to 2 : 1 for dogs intended for supplemental feeding only PTH production.
and 1 : 1 to 1.5 : 1 for cats is recommended) • Excessive use of supplements such as meats, • Excessive PTH production reduces bone
and inadequate vitamin D. vitamins, and minerals density, and pathologic fractures may occur.

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