See

discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/234004786

Emergent Diseases in Reptiles

Article in Seminars in Avian and Exotic Pet Medicine · July 2004

DOI: 10.1053/j.saep.2004.03.006

CITATIONS READS

12 574

2 authors, including:

James Wellehan
University of Florida
157 PUBLICATIONS 1,557 CITATIONS

SEE PROFILE

All content following this page was uploaded by James Wellehan on 19 January 2017.

The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the original document
and are linked to publications on ResearchGate, letting you access and read them immediately.
Emergent Diseases in Reptiles
James F.X. Wellehan, DVM, MS, and
Cornelia I. Gunkel, DVM
This article reviews basic clinical techniques necessary
for emergency treatment of reptile patients. Ap-
proaches to common emergency presentations of rep-
tile patients, including trauma, burns, dystocia, renal
failure, sepsis, dyspnea, gastrointestinal foreign bodies,
cloacal prolapse, and toxicosis are covered. © 2004
Elsevier Inc. All rights reserved.
Key words: Reptiles; emergency medicine; emergencies
T
he reptile patient presents a novel chal-
lenge to the emergency clinician. Reptiles
are good at masking illness, and clients
often fail to recognize disease in their pet and
seek veterinary assistance only in advanced stages
of disease. Many emergencies are secondary to
inappropriate husbandry for a given species. It is
important when taking a history to discuss hous-
ing and diet, and to determine how the owner is
measuring parameters such as temperature and
humidity. Reptiles may tolerate inappropriate
husbandry for very long periods of time before
disease manifests, so just because an animal has
been kept under the same conditions for years
does not mean that the conditions are appropri-
ate. The diversity of species also presents a chal-
lenge, and the clinician must be familiar with
what is normal for each species to recognize the
abnormal. It is important to maintain hospitalized
reptiles under optimal environmental conditions,
including temperature, humidity, light, noise, ac-
tivity, and exposure. An appropriate temperature
gradient should be provided to allow the patient
to thermoregulate. This article will discuss basic
clinical techniques and common emergency pre-
sentations in reptiles.
Hospital Caging
As ectotherms, reptiles thermoregulate by moving
to warmer or cooler areas. Reptiles have been
shown to select higher temperatures in response
to bacterial infection,1 and an ambulatory patient
160 Seminars in Avian and Exotic Pet Medicine, Vol 13, No 3 ( July), 2004: pp 160-174
is better able to select an appropriate temperature
than the clinician. To thermoregulate properly,
the patient needs to have a range of temperatures
to choose from. This is most easily accomplished
by use of a radiant heat source such as incandes-
cent heat lamps or ceramic heat bulbs or panels to
create an even gradient. Contact heat sources,
such as heat rocks, offer only two options for
temperature, on and off the source, which is un-
acceptable for the critical patient.2 For animals
that are stressed by the presence of people, hiding
areas should be added. Appropriate hiding areas
must be provided throughout the temperature
gradient so that the animal chooses where to be
based on choice of temperature rather than
choosing the only hide area.
In nonambulatory animals, the clinician must
choose the temperature for the animal, making it
even more critical for the clinician to be familiar
with the species. It has been shown that desert
iguanas (Dipsosaurus dorsalis) undergo respiratory
recovery more rapidly and incur lower energetic
costs when they recover from exercise at 20°C
instead of 40°C.3 In splenic macrophages of the
wall lizard (Hemidactylus flaviviridis), phagocytosis
was found to be maximal at 25°C and was de-
creased at either higher (37°C) or lower (15°C)
temperatures.4 It has been recommended by oth-
ers that chelonians not be warmed beyond ambi-
ent indoor temperature until hemostasis is
achieved, vital signs are stable, and antibiotics
have been administered.5 The practice of not pro-
viding supplemental heat until stabilization likely
varies according to species, and the authors advise
this in species from temperate but not tropical
climates. The hydration status of the animal must
From the College of Veterinary Medicine, University of Flor-
ida, Gainesville, FL 32610.
Address correspondence to Jim Wellehan, Zoological Medi-
cine Service, College of Veterinary Medicine, University of
Florida, Gainesville, FL 32610.
© 2004 Elsevier Inc. All rights reserved.
1055-937X/04/1303-0007$30.00
doi:10.1053/j.saep.2004.03.006
Emergent Diseases in Reptiles
also be taken into account. The critical thermal
maximum was shown to be decreased in dehy-
drated ornate box turtles.6
Other factors, such as space and humidity,
need to be appropriate for the species. It is essen-
tial for caging to be easily disinfected, and this
influences substrate and cage furniture choice.
Venipuncture
It is important to determine the maximum
amount of blood that may be sampled safely. Ten
percent of the blood volume may be safely with-
drawn from a healthy animal, and the blood vol-
ume of reptiles is approximately 5% to 8% of
body weight,7 so 0.5% to 0.8% of body weight may
be collected. Arterial blood pressures have been
shown to fall precipitously in green iguanas
(Iguana iguana) after loss of 35 ⫾ 19% of blood
volume.8 Blood smears are best made fresh, since
anticoagulants, especially EDTA, may alter cell
morphology and staining.9 Clotting times in rep-
tiles are significantly longer than in mammals.10
As serum chemistry changes occur rapidly on rep-
tile cells,11 it is the preference of the authors to
spin and separate heparinized samples immedi-
ately after blood collection for plasma chemistry
rather than serum chemistry.
In turtles and tortoises, the jugular is often a
preferred site for sample collection and catheter
placement, as lymph contamination is less com-
mon at this site.7 The jugular is also the only site
where the vein is palpable. In debilitated turtles
and tortoises, the head can often be coaxed out
with steady, gentle traction on the rhinotheca
(upper beak) with a blunt tipped probe. Pressure
may then be applied at the base of the neck to
raise the vein, located laterally.9 However, this
may not be feasible in large resistant unsedated
chelonans, and caution must be used to avoid
trauma to the patient. In common snapping tur-
tles (Chelydra serpentina), the ventral coccygeal
vein is very accessible for sample collection and
catheter placement, and less risky to personnel.
The brachial vein is accessible from the caudoven-
tral surface of the elbow. The tortoise is placed in
dorsal recumbency, the arm is extended, and the
skin fold on the caudoventral aspect is used as a
marker to advance the needle in a proximal di-
rection. The dorsal coccygeal vein is also a good
site for venous access in many species, although
there is a higher incidence of lymph contamina-
tion in samples from this site.7 In many tortoise
species, a venous sinus lies above the tail, beneath
161
the carapace. This is also a good site for venous
access for injection. The anastomosis of the inter-
costal arteries and the external jugular veins is
accessible for blood collection by directing a nee-
dle under the carapace mid-sagitally above the
head,12 although lymph contamination is also
common at this site. Intraosseous catheter place-
ment in the cancellous bone of the bridge be-
tween the carapace and plastron is a good site for
fluid administration,9 although technically diffi-
cult and not present in all species. Prior identifi-
cation of this site in a cadaver of the same species
is strongly recommended.
In iguanas and other lizards, the ventral coccy-
geal vein is the site of choice for sample collec-
tion7,9 and catheter placement.13 This may be ac-
cessed either by advancing the needle from a
ventral midline approach or laterally from a level
just below the vertebral body. Blood flow may be
improved if the animal is held vertically so that
the tail is dependent. The jugular vein has also
been used for catheter placement in green igua-
nas (M. Johnston, personal communication). Spi-
nal needles normograded into the medial aspect
of the tibial plateau as intraosseous catheters are
also useful for fluid administration14 (Fig 1). Fem-
oral and humeral intraosseous catheter place-
ment is also possible.9 The cephalic vein is also a
possible site for venous access, although cutdown
and dissection to the vein is typically required for
catheter placement.9 The ventral abdominal vein
is accessible,7,9 and lies just beneath the skin on
ventral midline.
In snakes, the ventral coccygeal vein is useful
for venous access.7 Cardiocentesis is also a com-
mon site for blood collection, although it is rec-
ommended only in snakes weighing greater than
100 to 300 g, depending on the reference.7,9 The
beating of the heart may be externally visualized
in the ventral surface approximately one quarter
of the body length from the head, just cranial to
the movement of the expansion of the lung(s).
The heart generally tends to be more caudal in
terrestrial snakes and more cranial in arboreal
snakes. Although the jugular vein is the best site
for catheter placement, access usually requires
cutdown and dissection to the vein.7,9 The right
jugular vein is larger and therefore preferred.14
The palatine vein is also a possible site for sample
collection.7,9
In crocodilians, the ventral coccygeal vein is
useful for blood collection9 and catheter place-
ment.13 The supravertebral vessel located just cau-
162
Figure 1. Radiograph of tibial intraosseous catheter placement
in a green iguana (Iguana iguana).
dal to the occiput is a useful sample collection site
in larger crocodilians.9
Fluid Therapy
Assessment of hydration in reptiles may be accom-
plished by skin turgor, mucous membranes, oral
secretions, dryness/sinking of eyes, and packed
cell volume.15 Slightly over 50% of body fluid is
maintained in the intracellular compartment in
reptiles and the circulating fluid volume percent-
age is lower than in mammals.16
Wellehan and Gunkel
Maintenance fluid requirements in reptiles
range from 15 to 25 mL/kg/d,14 which are lower
than those reported for mammals (40 to 60 mL/
kg/d), due to the lower metabolic rates and re-
quirements of reptiles. The definitive rate should
be based on the habitat to which the reptile is
adapted and the effect of the altered health status
of the animal on electrolytes and fluid require-
ments. Small-volume infusion pumps are essential
for accurate fluid infusion in small anesthetized
patients to prevent overloading.17
An interpretation of the acid-base balance of the
animal as well as determining PCV, TP and uric acid
is helpful for choosing the appropriate fluid solu-
tion and route of administration. The choice of
fluids is dependent on the reason for fluid loss.
Acute fluid therapy replaces absolute or rela-
tive plasma volume deficits within a period of
minutes to a few hours. Hypovolemia, shock, and
hypotension are indications for acute fluid re-
placement therapy using solutions such as Lac-
tated Ringer’s, Normosol-R or Plasmalyte 148. In
addition, 0.9% NaCl with added KCl to achieve a
K⫹ concentration of 4 to 10 mEq/L can also be
used as an alternative; however, the latter is an
acidifying solution in contrast to the alkalinizing
properties of the former standard fluid replace-
ment solutions that contain one or several bicar-
bonate precursors such as acetate, gluconate or
bicarbonate. Originally it was believed that lac-
tated Ringer’s solution was contraindicated in
reptiles due to the perception that adding lactate
could lead to increased production of lactic acid
in stress situations.16 This concept is erroneous, as
bicarbonate precursors including lactate in fluid
solutions cause an alkaline milieu, due to the use
of hydrogen ions and the regeneration of bicar-
bonate, which counteracts the lactic acidosis of
the animal.18 Isotonic dextrose solution (5%) or
combinations are indicated, when hypoglycemia
is present.17
In situations of moderate to severe blood loss
(more than 10% of blood volume) volume should
be replaced with colloid fluids like Hetastarch,
Dextran 70, or Oxyglobin (Fig 2). They provide
more efficient volume restoration than crystalloid
solutions, through volume expansion due to the
oncotic properties of the large size molecules
present in colloids. Volume expansion is also ac-
companied with less alteration of the packed cell
volume and total solids when compared with crys-
talloids. With an approximate total plasma vol-
ume of 40 mL/kg in reptiles,19 the authors set the
maximum colloid volume at 20 mL/kg. Colloid
Emergent Diseases in Reptiles
Figure 2. Oxyglobin administration via a coccygeal vein
catheter in a bearded dragon (Pogona vitticeps).
fluids should only be administered by intravascu-
lar or intraosseous routes.
Of the different routes of administration (en-
teric, intracoelomic, subcutaneous, intravenous
and intraosseous), in the critical patient, intrave-
nous or intraosseous fluid administration is pre-
ferred. Disadvantages of the intraosseous route
are the rate limitation as well as the painful stim-
ulus or impracticality in larger reptiles especially
when maintained over a longer period of time.
The main disadvantage of the intravenous route is
the difficulty of access in the hypovolemic patient.
Anesthesia and Analgesia
A combination of analgesia and appropriate physi-
cal restraint is often all that is needed for most
diagnostic procedures, especially when the animal is
a critically ill patient. Lizards and crocodilians can
be calmed down with slight pressure on the eyes,
which causes a vagal reflex. For all procedures
which include any surgical incision or other painful
stimulus, an analgesic should be administered and
sufficient time should be given for the onset of the
drug, which may be delayed in reptiles.
If general anesthesia is required, the choice of
premedication, induction and maintenance is de-
pendent on the disease status of the animal, espe-
cially from the cardiovascular and respiratory as-
pects. In an animal with respiratory distress or
other acutely life-threatening concerns, a mask
induction is contraindicated and rapid intubation
is necessary. Many reptiles can be gently intubated
with physical restraint and a bite-block like a
tongue depressor, but extra caution needs to be
taken in venomous animals.
163
The glottis in most reptiles is easily visualized
for intubation. Crocodilians have a well-devel-
oped basihyal valve that must be pushed down to
gain access to the glottis.20 Gentle intubation is
necessary to prevent damage and swelling. In rep-
tiles that are too small for standard endotracheal
tubes, intravenous catheters may be used as endo-
tracheal tubes (Fig 3), but careful monitoring for
obstruction is necessary when using smaller tubes.
Chelonians and crocodilians have complete tra-
cheal rings,20 like birds, which makes the use of
cuffed tubes usually contraindicated. Addition-
ally, some snakes, such as Indian and Burmese
pythons (Python molurus) and western rattlesnakes
(Crotalus viridis) have complete tracheal rings in
the proximal trachea,21 and use of cuffed tubes is
again usually contraindicated.
Inhalant anesthesia is most commonly used for
maintenance and occasionally induction in rep-
tiles.17 Despite the fact that reptiles may wake up
faster after use of inhalant anesthesia as a sole anes-
thetic, it is important to remember that the inhalant
agents are all cardiovascular and respiratory depres-
sants and don’t provide good analgesia. A balanced
anesthetic regime is often beneficial.
In general, premedication reduces stress and
makes intubation easier for handler and animal.
Midazolam (0.3 ⫺2 mg/kg) can be given intra-
muscularly and is the safest drug from a cardio-
vascular standpoint for a decent sedation. Ket-
amine can be added if the animal is healthy and
fights the physical restraint, but respiratory de-
pression has been reported and care should be
taken in renally compromised animals due to re-
nal excretion of Ketamine.16 Intravenous propo-
fol is commonly used for induction, with a dose
range of 2 to 10 mg/kg dependent on disease
status and temperament of the animal.22,23 Apnea
is common with the use of propofol and should
be anticipated.
Figure 3. A 20-gauge catheter used as an endotracheal tube
in a garter snake (Thamnophis sirtalis).
164
Figure 4. Mandibular nerve block in a green iguana (Iguana
iguana).
Analgesia is frequently an underutilized part of
critical care management in reptiles. The phar-
macokinetics, safety, and efficacy of analgesic
drugs in reptiles are still poorly studied, and the
presence and severity of pain in is underrecog-
nized in these species.24 Best studied is the highly
developed skin sensitivity, which is sufficient rea-
son to provide analgesia every time an incision has
to be made.16 The most commonly used analge-
sics in reptiles are the nonsteroidal antiinflamma-
tories, local anesthetics and opioids. All analgesic
drugs need some further research to evaluate an-
tinociception as well as pharmacokinetics/phar-
macodynamics, but from personal opinion and
observation, the following agents seem to provide
good analgesia and reduce the amount of anes-
thetics needed.
The nonsteroidal antiinflammatory drugs
meloxicam (0.1-0.3mg/kg), carprofen (2-4 mg/
kg), or ketoprofen (1-3mg/kg) show good effect,
especially for long term and postoperative analge-
sia, but careful observation of the renal status
needs to be undertaken and fluid therapy is often
beneficial to prevent potential complications. For
any extremity procedures a local blockade pro-
vides the best analgesia. Infiltration with 2% lido-
caine or 1% procaine has been used with success
for minor procedures,20 and the authors also fre-
quently use 2% mepivacaine with apparent effi-
cacy (Fig 4). Total amounts of local anesthetic
should be calculated to avoid systemic toxicity,
and until further data are available, mammalian
toxicity levels can be used.
As opioids have effects on mentation and be-
havior, it is difficult to assess analgesia in a reptile
that has received opioids. Butorphanol was found
not to show any MAC sparing effect in green
Wellehan and Gunkel
iguanas,25 suggesting that it is a poor analgesic.
However, butorphanol has also been shown to be
a relatively poor analgesic in mammalian species
when compared with other opioids and NSAIDs.
Morphine and meperidine were studied in Nile
crocodiles (Crocodylus niloticus).26 Morphine was
found to reduce thermal withdrawal response at
0.05mg/kg, with a maximal response at 0.3mg/
kg. At 0.1mg/kg, effects were found to last ap-
proximately 2 hours. Meperidine was found to
reduce thermal withdrawal response at 2mg/kg.
This suggests that crocodiles are relatively sensi-
tive to mu-agonists. Lacking further data, the au-
thors use opioids in conjunction with NSAIDs and
local anesthetics for painful procedures. Bu-
prenorphine (0.03 mg /kg) has a very long onset,
but is the longest acting opioid with relatively few
side effects.
Careful anesthetic monitoring is even more
important in the critical patient. It is difficult to
monitor heart rate with a stethoscope in most
reptiles. A Doppler ultrasound probe can be
placed over the heart in lizards and snakes, which
gives an audible signal for heart rate. In cheloni-
ans, probe placement over the carotid may be
useful. This can also be done in depressed or
compromised conscious animals to monitor vital
parameters. ECG clips can also be attached on
needles between the scales and give a visual ob-
servation of rate and rhythm.
Blood pressure is seldom monitored in rep-
tiles, due to difficulties with access and lack of
normal values. In some lizards and crocodilians
an arterial catheter can be placed,13 but some
experience is necessary for placement. Animals in
respiratory distress need detailed monitoring of
respiratory values like respiratory rate, end-tidal
CO2, and blood gases. Mucous membrane color
and capillary refill time should be monitored for
perfusion, requiring familiarity with normal mem-
brane color for a given species.
Recovery from anesthesia needs special care
and monitoring in a critically ill reptile. Initiation
of spontaneous breathing often takes a long time
and continued ventilation is needed. The endo-
tracheal tube should not be removed until the
control of the glottis musculature has returned.
Trauma
Etiology
Trauma is a common presentation in reptiles. In
the authors’ experience, bite wounds from live
Emergent Diseases in Reptiles 165

prey, cagemates, or other pets, and being

dropped or stepped on are the most common
histories in captive reptiles. Vehicular trauma and
dog attacks are most common in wild reptiles.
Bite wounds from live rodents are a very common
cause of trauma in pet snakes, and feeding
prekilled whole prey should be encouraged. Live
crickets left unattended as prey with a debilitated
lizard are also a common cause of bite wounds,
and feeding of live crickets should be supervised.
Wild aquatic turtles that are hit by cars are fre-
quently gravid females looking for nesting sites;
damage to eggs and resultant dystocia/ yolk peri- Figure 5. Shell fracture repair in a Blanding’s turtle
tonitis may occur. (Emydoidea blandingii) using surgical wire.

Diagnosis
port the use of glucocorticoids for head trauma.
Diagnosis of trauma is typically evident from phys-
Wounds should be lavaged copiously with sterile
ical examination. During physical examination,
fluids. In chelonians with shell fractures, it is im-
careful neurologic and ophthalmic examination
portant to determine that one is not flushing
should be emphasized, and wounds should be
lavage fluids directly into the lungs. Foreign ma-
thoroughly examined for myiasis. Radiographic
terial should be removed. Fresh clean skin lacer-
evaluation of bone density is important for ruling
ations may be closed using an everting suture
out pathologic fractures, which are frequently
pattern with nonabsorbable monofilament su-
seen with osteomyelitis and nutritional or renal
ture. Drains are not very efficacious in reptiles.14
secondary hyperparathyroidism. In chelonians,
As virtually all traumatic wounds are contami-
pulmonary hemorrhage is a common sequela to
nated, antibiotic therapy should be initiated. As
shell fracture, since the lungs of turtles are lo-
discussed above, it has been recommended by
cated dorsally in the coelomic cavity. Each bron-
others that chelonians not be warmed beyond
chus gives rise to between three and eleven
ambient indoor temperature until hemostasis is
groups of chambers,27 in which blood may pool.
achieved, vital signs are stable, and antibiotics
Radiographic evaluation of lung fields using an-
have been administered.5 Shell repair in turtles
terioposterior and lateral horizontal beam radio-
may be accomplished by wiring fragments to-
graphs is helpful in identifying fluid in the lungs,
gether (Fig 5). Wires may be placed through
although more advanced imaging techniques
holes drilled in the shell or looped around surgi-
such as CT or MRI are more sensitive. Plasma
cal screws. It is easier to monitor healing in shells
chemistry and hematology are useful for identify-
repaired in this manner than shells repaired with
ing electrolyte imbalances and sepsis.
fiberglass/epoxy patches or dental acrylic. Espe-
cially in aquatic turtles, the incidence of infection
Therapy seems to be lower in wire shell repairs.5 Gaps left
Bleeding may be controlled with pressure, elec- by missing fragments may initially be covered with
trocautery, or ligation of vessels.14 Fluid therapy wet-to dry bandages and managed as open
should be commenced as appropriate. Oxygen wounds; eventually, granulation tissue will form.
therapy may be useful in patients with respiratory The use of vacuum-assisted closure also appears to
compromise. Glucocorticoids may be given to pa- be highly efficacious in chelonians with shell de-
tients with spinal trauma that is known to be less fects.
than 6 hours old. However, this should be done
with caution, as very low concentrations (10⫺13 M,
roughly equivalent to .00005mg/kg in an animal) Burns
of hydrocortisone sodium succinate have been
shown to significantly impair phagocytosis and Etiology
nitric oxide production in cultured wall lizard Burns in reptiles are typically due to inappropri-
splenic macrophages.28 Further study of the use ate or malfunctioning heat sources. Heat rocks
of glucocorticoids in reptilian spinal trauma is frequently short and overheat. If the ambient tem-
needed. There is no convincing evidence to sup- perature is too cool, the reptile will be forced
166 Wellehan and Gunkel

onto the heat rock and will burn itself. Inappro-

priate access to heat lamps may result in similar
burns. Many burns may extend through the full
thickness of the body wall.

Diagnosis
By the time a case is presented, diagnosis of ther-
mal burns is typically evident from physical exam-
ination and history. Reptiles may have erythema-
tous skin and blistering; it is important to distin-
guish burns from sepsis. Plasma chemistry and
hematology are useful for identifying electrolyte
imbalances and sepsis.

Therapy
Fluid support and electrolyte homeostasis is im-
portant in burn patients.14 Systemic antibiotic
therapy should be initiated, and topical silver sul-
fadiazine cream is useful as an adjunct. Based on
studies in mammals, pentoxifylline may be indi-
cated.29 Wet to dry bandages or semipermeable
bandaging are useful in covering wounds while
granulation occurs. The line of demarcation of
devitalized tissue may take weeks to form; once
this is clear, then surgical debridement should be Figure 6. Radiograph of dystocia in a Texas tortoise
pursued. (Gopherus berlandieri). Note the presence of the fractured egg.

Dystocia when gravid,32 and it is reasonable to expect that

Etiology
Reptiles without egg deposition sites of appropri-
ate temperature, humidity, depth, consistency,
and shelter will frequently retain eggs. Poor phys-
ical condition may also result in egg retention. Of
more urgent concern is physical obstruction of
oviposition, which may be due to abnormal or
broken eggs, cystoliths, and reproductive tract
malformation or scarring.
Diagnosis
Physical examination will usually reveal palpable
eggs in the coelomic cavity. Eggs in turtles and
tortoises may be palpated in the prefemoral fossa.
Radiographs are useful for diagnosis of abnormal-
ities such as broken or abnormal eggs (Fig 6) or
cystoliths. Preovulatory follicles will not show shell
deposition and appear as soft-tissue density. Ultra-
sound is useful in diagnosis of these patients.30,31
Bone density should be evaluated as an indication
of calcium stores. Evaluation of plasma chemistry
and hematology is useful for identifying underly-
ing abnormalities. Female green iguanas have sig-
nificantly higher plasma calcium and phosphorus
this is the case in other reptiles. Gravid females
may be functionally hypocalcemic despite high
total plasma calcium, and resultant atony of the
reproductive tract may result. Evaluation of ion-
ized calcium33 is needed in these patients.
Therapy
Reptiles with dystocia should first be stabilized.
Fluid therapy should be commenced as appropri-
ate. Oxygen therapy may be useful in patients with
respiratory compromise. Once patients are stabi-
lized, they should be reevaluated. When no phys-
ical obstruction is present and patients are pro-
vided with a suitable location for egg deposition,
the situation will often resolve. Chelonians re-
spond well to injection of oxytocin at 1 to 10
mg/kg.14 Chelonians and snakes tolerate ex-
tended dystocia better than lizards; dystocia in
lizards may lead to death within days,34 and dys-
tocia has often been prolonged by the time of
presentation. If patients have a physical obstruc-
tion, surgical removal is necessary and should be
initiated once the patient is stabilized. Occasion-
ally, very caudal malformed eggs may be deflated
by ovocentesis per cloaca and removed. Details of
Emergent Diseases in Reptiles 167

and protein resorption may occur in the distal

gastrointestinal tract.36 Many species also have na-
sal salt glands that are involved in osmoregula-
tion.36 Causes of renal disease in reptiles include
dehydration, improper diet, infectious nephritis,
trauma, fibrosis, dystrophic calcification, amyloid-
osis, neoplasia, toxins, and inclusion body dis-
ease.37 Green iguanas seem particularly predis-
posed toward renal disease.

Diagnosis
On initial physical examination, reptiles with re-
nal failure are typically depressed. In green igua-
Figure 7. Celiotomy in a Texas tortoise (Gopherus berlandieri).
nas and other large species with intrapelvic kid-
Note the large venous sinuses.
neys, enlarged and irregular kidneys may be pal-
pated digitally via the vent. Iguana kidneys should
not protrude from the pelvis on radiographs;
surgery are given elsewhere.35 Important points
grossly enlarged iguana kidneys can be seen as
are avoidance of the abdominal vein lying be-
rounded soft-tissue opacities in the caudal coe-
neath the skin on the ventral midline in lizards
lom40 (Fig 8). Ultrasonography can be useful in
and avoidance of the two large venous sinuses that
the evaluation of reptilian renal disease.40 Hema-
lie beneath the plastron in chelonians (Fig 7).

Renal Failure
Etiology
Reptilian renal physiology differs from mamma-
lian physiology in several clinically important
ways. The major route of nitrogen excretion in
most reptiles is as uric acid.36 Uric acid has a very
low aqueous solubility, and therefore does not
contribute to urine osmolality.36 This obviates the
need for urine concentration for efficient elimi-
nation of nitrogenous waste. The trade-off is that
large amounts of protein are needed to maintain
the uric acid in colloidal suspension.36 Protein-
uria is therefore normal in reptiles. The reptile
kidney does not have a loop of Henle,37 and
therefore cannot concentrate urine. The blood
supply to the reptile kidney has multiple arteries
as well as venous blood supply returning from the
hind end via the renal portal system.36 The arte-
rial blood flow perfuses glomeruli and tubules in
a manner similar to the blood supply of the mam-
malian nephron. The renal portal blood supply
perfuses only the tubules and not the glomeruli.38
Because the kidney cannot produce concentrated
urine, one method of conserving water is by de-
creasing glomerular filtration rate (GFR). The
GFR of reptiles is quite labile.39 Arterial blood
flow to the nephron can be markedly reduced,
and the tubules will continue to have blood flow
from the renal portal system. The ureters empty Figure 8. Radiographic appearance of renomegaly and ascites
directly into the cloaca. Concentration of urine in a green iguana (Iguana iguana).
168
tology may be of use in diagnosing infectious
causes of renal disease. Urinalysis is not typically
useful in evaluation of renal function; since not all
species have a bladder, and in those that do, the
ureters empty at the opening into the cloaca,
urine samples are typically contaminated with fe-
cal material. However, the presence of tubular
casts is of clinical concern.41 Creatinine and blood
urea nitrogen are poor diagnostic tests for renal
failure in iguanas.42 Uric acid is of greater clinical
use; however, uric acid elevations are seen only
when greater than 70% of the kidney is nonfunc-
tional.41 At the lower body temperatures found in
reptiles, urates are less soluble. Another biochem-
ical indicator of renal disease is the calcium: phos-
phorus ratio. A ratio of less than 1 is suggestive of
renal disease.41 The most definitive method of
diagnosis is renal biopsy. In green iguanas, a min-
imally invasive approach for renal biopsy has been
described.43
Therapy
Treatment of renal disease is generally based
around hydration and restoration of electrolytes.
In cases of infectious nephritis, appropriate anti-
microbial therapy should be provided.
Sepsis
Etiology
Sepsis in reptiles is a common sequela to poor
husbandry and stress. Aerobic bacteria commonly
isolated from blood cultures of septic reptiles in-
clude Salmonella spp., Pseudomonas spp., Citrobacter
spp., Aeromonas spp., and Micrococcus spp.44,45 In a
study of anaerobic blood cultures from apparently
healthy lizards, Clostridium spp. were isolated from
51 of 58 (88%).46 This raises the possibility that
many reptiles may have subclinical bacteremia.
Septic snakes may present with proliferative ver-
tebral osteoarthritis. One retrospective study
found that blood cultures of eight of these snakes
revealed Salmonella spp, Citrobacter spp, and Strep-
tococcus spp.47
Diagnosis
Signs of septicemia in reptiles include depression,
anorexia, weakness, erythema, and petechiation.5
Septic reptiles will often be hypotensive due to
septic shock. Evaluation of a blood smear is help-
ful in diagnosis of sepsis. Septic reptiles will have
toxic heterophils, which show cytoplasmic baso-
philia, abnormal granulation, and vacuolation.42
Wellehan and Gunkel
Bacteria may often be seen on the blood smear.
Blood cultures are useful for identification of bac-
teria and sensitivity profiles, but therapy should
be initiated while cultures are pending. Radio-
graphs may be useful in identifying osteomyelitis,
which may be multifocal. Chemistry panels will
often reveal low glucose and elevated anion gap,
AST, and CK. Patients with osteomyelitis may have
elevated calcium and phosphorus.
Therapy
It has been recommended by one author that
septic chelonians not be warmed beyond ambient
indoor temperature, until antibiotics and fluid
therapy have had time to start to work.5 This is
also probably advisable in squamates from more
temperate habitats. However, this may be stressful
for species from tropical climates. Appropriate
intravenous or intraosseous fluid and antibiotic
therapy should be commenced. Ceftazidime, a
third-generation cephalosporin, is commonly
used as a first choice in septic reptiles because of
enhanced antipseudomonal activity, minimal
nephrotoxic effects, and ability to deliver a large
dose in a small volume.48 Pharmacokinetic studies
in several species of snakes maintained at 30°C
suggested that a dosage of 20 mg/kg intramuscu-
larly every 72 hours should be efficacious.49 In
juvenile loggerhead sea turtles (Caretta caretta)
kept at 24°C, pharmacokinetic studies suggested
that a dosage of 22 mg/kg intravenously or intra-
muscularly every 72 hours was appropriate.50
Dyspnea
Etiology
Dyspnea in reptiles may be due to primary respi-
ratory disease or extrapulmonary interference
with pulmonary function. Common causes of pri-
mary upper respiratory tract disease include
trauma, Mycoplasma agassizzi in North American
tortoises,51,52 tracheal chondromas in ball pythons
(Python regius)53-55 herpesviruses in tortoises,56
and iridoviruses in tortoises.57 Tortoises with my-
coplasmosis, herpesvirus, or iridovirus will present
with similar signs; dyspnea, serous to mucopuru-
lent nasal discharge, rhinitis, and conjunctivitis.58
Stomatitis and glossitis are signs present in her-
pesvirus infections but not mycoplasmal disease.58
Obstructive periglottal lesions with eosinophilic
intranuclear inclusions has been seen in a Sudan
plated lizard (Gerrrhosaurus major) with dyspnea; a
herpesvirus was identified.59 Some species of liz-
Emergent Diseases in Reptiles
ards, notably the green iguana, have salt glands in
their nares; salty discharge is normal and should
not be confused with respiratory disease.
Reptilian lungs do not have alveoli; terminal
air spaces are described as faveola or edicula,
depending on whether the spaces are deeper than
they are wide or wider than they are deep, respec-
tively.27 The edicular lungs of turtles are located
dorsally in the coelomic cavity. Each bronchus
gives rise to between three and eleven groups of
chambers,27 in which fluid may pool. The lungs of
lizards differ between species. The edicular lungs
of chameleons are notable in that they have hol-
low tentacular diverticula that have been com-
pared with avian air sacs.27 Snake lungs are asym-
metric. In most snakes, the left lung is vestigial. In
pythons and boas, the left lung is reduced in
size.27 The caudal aspect of snake lungs and some
lizard lungs is avascular and not involved in gas
exchange. The lungs of crocodilians are mul-
tichambered, with perforated septa separating the
tubular chambers.27
Lower respiratory tract disease may be bacte-
rial, viral, traumatic, parasitic, or fungal. Most
bacteria isolated from reptiles with pneumonia
are aerobic Gram-negative rods.58,60,61 Patients
with bacterial pneumonia should be screened for
underlying predisposing conditions such as im-
proper husbandry, infection with more fastidious
bacteria such as Mycoplasma spp and Chlamydia/
Chlamydophila spp, fungal disease, or viral disease.
Chlamydial pneumonia has been reported in puff
adders (Bitis arietans),62 and Chlamydophila (Chla-
mydia) psittaci has been reported in Greek tor-
toises (Testudo graeca) with pneumonia.63 Myco-
plasmal respiratory disease has been demon-
strated in crocodilians64 as well as North
American Tortoises, and a Mycoplasma spp. has
been found in a Burmese python (Python molurus
bivittatus) with proliferative tracheitis and pneu-
monia.65 Viral causes of lower respiratory disease
include paramyxoviruses66 and reoviruses.67 Para-
sites associated with lower respiratory tract disease
in reptiles include pentastomids, Rhabdias spp.
roundworms, flukes,68 and an intranuclear coc-
cidia in tortoises.58 Pentastomids are potentially
zoonotic.68
Extrapulmonary causes of dyspnea include gas-
trointestinal bloat, dystocia, abscesses, tumors,
and ascites (Fig 8). Causes of gastrointestinal
bloat include inappropriate diet and husbandry,
renomegaly, obstruction, intestinal displacement
and torsion, volvulus, intestinal intussusception,
abscesses, and neoplasia. Causes of ascites include
169
hypoproteinemia, liver failure, renal failure, car-
diac disease, septicemia, neoplasia, and iatrogenic
fluid overload.69
Diagnosis
Radiographic evaluation of lung fields using hor-
izontal beam radiographs is helpful in identifying
fluid in the lungs. Radiographs are also useful for
identification of extrapulmonary causes of dys-
pnea. Aortic mineralization may commonly be
seen on radiographs in lizards and may indicate a
cardiovascular component to ascites. Endoscopic
evaluation of chelonian lungs may be done via
either a trans-carapace approach70 or by ap-
proaching caudally via the prefemoral fossa.
There is a sharp bend in the bronchi before en-
tering the lungs, making endotracheal approach
to chelonian lung impossible with a rigid endo-
scope. Sample collection by tracheal/pulmonary
wash followed by cytological evaluation, culture,
and sensitivity is indicated in cases of pneumonia.
Testing for mycoplasmal and viral pathogens of
reptiles is done at the University of Florida; the
laboratory of Dr. Elliott Jacobson should be con-
tacted for specifics of sample submission for vi-
ruses and the laboratory of Dr. Mary Brown
should be contacted for specifics of sample sub-
mission for mycoplasma. Fecal examination is use-
ful for identifying parasitic pneumonias. Evalua-
tion of serum chemistry and hematology is useful
for identifying underlying abnormalities.
Therapy
Appropriate antibiotic therapy is indicated in
cases of bacterial pneumonia. Since Mycoplasma
spp. do not have a call wall, the use of cell wall
inhibitors such as penicillins and cephalosporins
is not appropriate in suspected mycoplasmal in-
fections. Enrofloxacin doses appear to vary signif-
icantly between species. Pharmacokinetic studies
suggest optimal doses ranging from 5 mg/kg in-
tramuscularly every 24 to 48 hours in gopher tor-
toises (Gopherus polyphemus)71 to 10 mg/kg every
12 hours in Indian star tortoises (Geochelone el-
egans).72 One possible complication of intramus-
cular enrofloxacin injection is tissue necrosis;
care should be taken when injecting enrofloxacin
to avoid nerves. Iatrogenic radial nerve paralysis
in chelonians is not uncommon with repeated
injections into the antebrachium. While treat-
ment of mycoplasmosis may result in cessation of
clinical signs, eradication of the organism has not
been shown and treated animals should be con-
sidered potential carriers. For fungal pneumo-
170
nias, itraconazole has been used. Pharmacokinet-
ics in fence lizards (Sceloporus sp.) suggest that
treatment with 23.5mg/kg every 24 hours for 3
days resulted in plasma levels for 6 days.73 In-
trapulmonary application of amphotericin B has
been used to successfully treat fungal pneumo-
nia.70 In herpesvirus infections, acyclovir has been
used empirically at 80 mg/kg daily.74 Appropriate
antiparasitic therapy may be used for Rhabdias
and flukes. Ivermectin is toxic in chelonians. Sur-
gical treatment of pentastomids is required. Sur-
gical treatment may be required for many causes
of gastrointestinal bloat and mass removal. Ascites
has been empirically treated with furosemide
at 5mg/kg orally, intramuscularly, or intrave-
nously.75 The authors are not aware of experi-
mental evidence for the efficacy of furosemide in
reptiles. While reptiles do not have a loop of
Henle, it is possible that furosemide acts at the
analogous intermediate segment of the nephron
or at another site.
Gastrointestinal Foreign Bodies
Etiology
Foreign bodies are more common in pet reptiles
given free reign of the house. Ingestion of bed-
ding material, especially corn cob, gravel, and
shavings, may cause gastrointestinal obstruction.
Among tortoises, African spur-thighed tortoises
(Geochelone sulcata) seem particularly disposed to-
ward ingestion of foreign objects. Obstructed an-
imals may present with depression, anorexia,
and/or vomiting.
Diagnosis
Radiographs are useful for diagnosis of gastroin-
testinal foreign bodies. Evidence of obstruction is
typically seen as gas-distended gastrointestinal
tract just proximal to the obstruction. Upper GI
contrast studies and ultrasound may be useful in
equivocal cases. CBC and analysis of abdomino-
centesis are useful for indication of compromised
or perforated bowel. Plasma chemistry is useful
for indication of electrolyte imbalances. Ob-
structed reptiles are usually depressed and an-
orexic. Vomiting is a poor prognostic indicator in
tortoises.14
Therapy
It is important not to get overaggressive in non-
obstructed foreign body cases. The authors have
seen fishhooks pass in western painted turtles
Wellehan and Gunkel
Figure 9. Colonic prolapse in a veiled chameleon (Chamaeleo
calyptratus).
(Chrysemys picta) weighing as little as 70g, and a
22-gauge needle pass in an African spur-thighed
tortoise uneventfully. Animals were closely moni-
tored with serial radiographs, which showed nor-
mal progression of the objects through the GI
tract.
Nonobstructed/nonperforated reptiles are
best treated with optimal environmental condi-
tions and fluid therapy. Psyllium may be useful.
Obstructed reptiles with compromised gastroin-
testinal tract need to go to surgery. Enterotomy is
descibed elsewhere.76 Important points are avoid-
ance of the abdominal vein lying beneath the skin
on the ventral midline in lizards and avoidance of
the two large venous sinuses that lie beneath the
plastron in chelonians (Fig 7).
Cloacal Prolapse
Etiology
Prolapse of the cloaca may be of reproductive,
urinary, or gastrointestinal origin. In females, ovi-
duct and shell gland prolapse typically occur sec-
ondary to dystocia.77 Paraphimosis typically oc-
curs when there is trauma to the everted penis. It
is most often seen in aquatic turtles secondary to
bite wounds when multiple turtles are housed
together. The most common cause of urinary
bladder prolapse is cystoliths.77 Colonic prolapse
may be secondary to constipation, bacterial enter-
itis, and parasitic enteritis77 (Fig 9).
Diagnosis
Identification of the prolapsed material is helpful
for identification of the underlying cause of the
prolapse. Hematology and fecal examination are
useful for diagnosis of an infectious component.
Emergent Diseases in Reptiles
Treatment
If the tissue is vital, reduction and placement of
transverse cloacal sutures is indicated.77 Colopexy
may also be performed. If tissue is not vital, resec-
tion and anastomosis is indicated.77
Toxicoses
Etiology
Toxicoses in reptiles are typically iatrogenic. Di-
chlorvos, an organophosphate found in no-pest
strips, is commonly used by hobbyists to treat
snake mites. Dichlorvos intoxication may result in
rhythmic contractions and loss of righting re-
flex.78
Ivermectin is toxic in chelonians. Tortoises ad-
ministered ivermectin will show flaccid paralysis
and a fatty change in the liver.79 Toxicosis with
ivermectin has been seen in leopard tortoises
(Geochelone pardalis) at a dose as low as 0.025
mg/kg, which is 12.5% of the normal mammal
dose and is not efficacious at treating parasitism.79
Fenbendazole administered to three Fea’s vi-
pers (Azemiops feae) orally at 560 to 1390 mg/kg
was associated with severe necrosis of intestinal
epithelium and necrosis of myeloid precursors in
the bone marrow.80 All three snakes died.
Aminoglycoside use in dehydrated reptilian pa-
tients may result in nephrotoxicity.15
Feeding of inappropriate prey may result in
toxicosis. Ingestion of a single firefly of the genus
Photinus can be fatal in bearded dragons (Pogona
vitticeps),81 and may be expected to be fatal in
other reptiles. Photinus spp. contain lucibufagins,
steroidal pyrones chemically related to bufotox-
ins. Bufo spp. toads may also be toxic in some
reptiles, although there are some species, such as
hognose snakes (Heterodon spp.), that are special-
ized toad predators. Bearded dragons seem par-
ticularly willing to ingest small moving prey be-
fore tasting.
Cholecalciferol poisoning in a leopard tortoise
that ingested rodent baits has been reported.82
Lead poisoning in a common snapping turtle
that had swallowed a fishing sinker has been re-
ported.83 The turtle presented with generalized
weakness and limited ability to walk. Lead-based
paint chips have also resulted in toxicosis with
CNS signs in a tortoise.84
Diagnosis
Diagnosis of toxicosis is usually made based on
history. Once a candidate toxin is identified, tis-
171
sue or serum samples may be submitted to a tox-
icology laboratory. Radiography may be useful in
identifying metallic densities in cases of heavy
metal toxicosis.
Therapy
Basic treatment of toxicosis consists of fluids and
cooling.78 In cases of oral toxicosis, activated char-
coal may be administered. For organophosphate
toxicity, atropine administered at 0.1 to 0.2
mg/kg has been used.75 The use of 2-PAM is not
reported in reptiles. Diazepam at a rate of 0.5
mg/kg has been used to control convulsions.78
Calcium EDTA at 10 to 40 mg/kg intramuscularly
q12 hour has been used for treatment of lead
toxicity.85
References
1. Muchlinski AE, Gramajo R, Garcia C: Pre-existing
bacterial infections, not stress fever, influenced
previous studies which labeled Gerrhosaurus major
an afebrile lizard species. Comp Biochem Physiol
A 124:353-357, 1999
2. Fleming GJ, Isaza R, Spire MF, et al: The use of
digital thermography for environmental evalua-
tion of reptile enclosures. J Herpetol Med Surg
13(1):38-42, 2003
3. Wagner EL, Gleeson TT: Postexercise thermoreg-
ulatory behavior and recovery from exercise in
desert iguana. Physiol Behav 61:175-180, 1997
4. Mondal S, Rai U: In vitro effect of temperature on
phagocytic and cytotoxic activities of spenic
phagocytes of the wall lizard, Hemidactylus turcicus.
Comp Biochem Physiol A 129:391-398, 2001
5. Bonner BB: Chelonian Therapeutics. Vet Clin
North Am Exotic Animal Practice 3:257-332, 2000
6. Plummer MV, Williams BK, Skiver MM, et al: Ef-
fects of dehyration on the critical thermal maxi-
mum of the desert box turtle (Terrapene ornate
luteola). J Herpetol 37:747-750, 2003
7. Redrobe S, MacDonald J: Sample collection and
clinical pathology of reptiles. Vet Clin North Am
(Exotic An Pract) 2:709-730, 1999
8. Hohnke LA: Regulation of arterial blood pressure
in the common green iguana. Am J Physiol 228:
386-391, 1975
9. Jenkins JR: Diagnostic and Clinical Techniques,
in Mader DR (ed): Reptile Medicine and Surgery.
Philadelphia, PA, WB Saunders, 1996, pp. 264-276
10. Lewis JH: Comparative Hemostasis in Vertebrates.
New York, NY, Plenum Press, 1996, pp. 86-96
11. Abou-Madi N, Jacobson ER: Effects of blood pro-
cessing techniques on sodium and potassium val-
ues: a comparison between Aldabra tortoises
(Geochelone gigantea) and Burmese mountain tor-
toises (Manouria emys). Vet Clin Pathol 32:61-66,
2003
12. Hernandez-Divers SM, Hernandez-Divers SJ,
Wyneken J: Angiographic, anatomic, and clinical
technique descriptions of a subcarapacial veni-
172
puncture site for chelonians. J Herpetol Med Surg
12(2):32-37, 2002
13. Wellehan FX, Lafortune M, Gunkel C, et al: Coc-
cygeal vascular catheterization in lizards and croc-
odilians. J Herpetol Med Surg 14(2) In press,
2004
14. Boyer TH: Emergency Care of Reptiles. Vet Clin
North Am (Exotic An Pract) 1:191-206, 1998
15. Klingenberg RJ: Therapeutics, in Mader DR (ed):
Reptile Medicine and Surgery. Philadelphia, PA,
WB Saunders, 1996, pp. 299-321
16. Malley D: Reptiles, in Seymour C, Gleed R (eds):
BSAVA Manual of Small Animal Anaesthesia and
Analgesia. UK, Glamorgan, 1999, p 271
17. Heard DJ: Reptile Anesthesia. Vet Clin North Am
(Exotic An Pract) 4:83-117, 2001
18. Hartsfield SM, Thurmon JC, Corbin JE, et al:
Effects of sodium acetate, bicarbonate and lactate
on acid-base status in anesthetized dogs. J Vet
Pharmacol Ther 4,51,1981
19. Jarchow JL: Hospital care of the reptile patient, in
Jacobson ER, Kollias GV (eds): Exotic Animals.
New York, Churchill Livingstone, 1988, p. 28
20. Bennett RA: Anesthesia, in Mader DR (ed): Rep-
tile Medicine and Surgery. Philadelphia, PA, WB
Saunders, 1996, pp. 241-247
21. Wallach V: The lungs of snakes, in Gans C, Gaunt
AS (eds): Biology of the Reptilia 19: Visceral Or-
gans. Chicago, IL, Society for the Study of Am-
phibians and Reptiles, 1998, pp 94-295
22. Bennett RA, Schumacher J, Hedjazi Haring K, et
al: Cardiopulmonary and anesthetic effects of
propofol administered intraosseously to green
iguanas. J Am Vet Med Assoc 212:93-98, 1998
23. Anderson NL, Wack RF, Calloway L: Cardiopul-
monary effects and efficacy of propofol as an
anesthetic agent in brown tree snakes, Boiga ir-
regularis. Bull Assoc Rept Amph Vet 9:9-15, 1999
24. Machin KL: Fish, amphibian, and reptile analge-
sia. Vet Clin North Am (Exotic An Pract) 4:19-33,
2001
25. Mosley CA, Dyson D, Smith DA: Minimum alveo-
lar concentration of isoflurane in green iguanas
and the effect of butorphanol on minimum alve-
olar concentration. J Am Vet Med Assoc 222:1559-
1564, 2003
26. Kanui TI, Hole K: Morphine and pethidine an-
tinociception in the crocodile. J Vet Pharmacol
Ther 15:101-103, 1992
27. Perry SF: Lungs: comparative anatomy, functional
morphology, and evolution, in Gans C, Gaunt AS
(eds): Biology of the Reptilia 19: Visceral Organs.
hicago, IL, Society for the Study of Amphibians
and Reptiles, 1998, pp 1-92
28. Mondal S, Rai U: Dose and time-related in vitro
effects of glucocorticoid on phagocytosis and ni-
trate release by splenic macrophages of wall lizard
Hemidactylus flaviviridis. Comp Biochem Physiol C
132:461-470, 2002
29. Kotadia BK, Ravindrath TM, Choudry MA, et al:
Effects of pentoxifylline on mesenteric lymph
node T-cells in a rat model of thermal injury.
Shock 20:517-520, 2003
30. Love NE, Douglass JP, Lewbart G, et al: Radio-
graphic and ultrasonographic evaluation of egg
Wellehan and Gunkel
retention and peritonitis in two green iguanas
(Iguana Iguana). Vet Radiol 37:68-73, 1996
31. Kuchling G, Randall DJ, Heller HC: Reproductive
Biology of the Chelonia. New York, NY, Springer-
Verlag New York, Inc., 1999
32. Harr KE, Alleman AR, Dennis PM, et al: Morpho-
logic and cytochemical characteristics of blood
cells and hematologic and plasma biochemical
reference ranges in green iguanas. J Am Vet Med
Assoc 218:915-921, 2001
33. Dennis PM, Bennett RA, Harr KE, et al: Plasma
concentration of ionized calcium in healthy igua-
nas. J Am Vet Med Assoc 219:326-328, 2001
34. DeNardo D: Dystocias, in Mader DR (ed): Reptile
Medicine and Surgery. Philadelphia, PA, WB
Saunders, 1996, pp. 370-374
35. Lock BA: Reproductive surgery in reptiles. Vet
Clin North Am (Exotic An Pract) 3:733-752, 2000
36. Braun EJ: Comparative renal function in reptiles,
birds, and mammals. Semin Avian Exotic Pet Med
7:62-71, 1998
37. Miller HA: Urinary diseases of reptiles: pathophys-
iology and diagnosis. Semin Avian Exotic Pet Med
7:93-103, 1998
38. Holz PH: The reptilian renal portal system: influ-
ence on therapy, in Fowler ME (ed): Zoo and
Wild Animal Medicine 4th ed. Philadelphia, PA,
WB Saunders, 1999, pp. 249-252
39. Brown JA, Rankin JC, Yokota SD: Glomerular he-
modynamics and filtration in single nephrons of
non-mammalian vertebrates, in Brown JA, Bal-
ment RJ, Rankin JC (eds): New insights in verte-
brate kidney function. Cambridge, England, Cam-
bridge University Press, 1993, pp 1-44
40. Canny C: Gross anatomy and imaging of the avian
and reptilian urinary system. Semin Avian Exotic
Pet Med 7:72-80, 1998
41. Divers SJ: Reptilian renal and reproductive dis-
ease diagnosis, in Fudge AM (ed): Laboratory
Medicine Avian and Exotic Pets. Philadelphia, PA,
WB Saunders, 2000, pp. 217-222
42. Campbell TA: Clinical Pathology, in Mader DR
(ed): Reptile Medicine and Surgery. Philadelphia,
PA, WB Saunders, 1996, pp. 248-257
43. Hernandez-Divers SJ: Green iguana nephrology: a
review of diagnostic techniques. Vet Clin N Am
(Exotic An Pract) 6:233-250, 2003
44. Griner LA: Pathology of Zoo Animals. San Diego,
CA, Zoological Society of San Diego, 1983, pp.
26-79
45. Zwart P: Infectious Diseases of Reptiles, in Fowler
ME (ed): Zoo and Wild Animal Medicine 2nd.
Philadelphia, PA, WB Saunders, 1986, pp. 155-162
46. Hanel R, Heard DJ, Ellis GA, et al: Isolation of
Clostridium spp. from the blood of captive lizards:
real or pseudobacteremia? Bull Assoc Rept Amph
Vet 9:4-8, 1999
47. Isaza R, Garner M, Jacobson E: Proliferative osteo-
arthritis and osteoarthrosis in 15 snakes. J Zoo
Wildl Med 31:20-27, 2000
48. Jacobson ER: Use of antimicrobial drugs in rep-
tiles, in Fowler ME (ed): Zoo and Wild Animal
Medicine 4th ed. Philadelphia, PA, WB Saunders,
1999, pp. 190-200
49. Lawrence K, Muggleton PW, Needham JR: Pre-
Emergent Diseases in Reptiles
liminary study on the use of ceftazidime, a broad
spectrum cephalosporin antibiotic, in snakes. Res
Vet Sci 40:413-415, 1984
50. Stamper MA, Papich MG, Lewbart GA, et al: Phar-
macokinetics of ceftazidime in loggerhead turtles
(Caretta caretta) after single intravenous and intra-
muscular injections. J Zoo Wildl Med 30:32-35,
1999
51. Brown MB, Schumacher IM, Klein PA, et al: My-
coplasma agassizii causes upper respiratory tract
disease in the desert tortoise. Inf Immun 62:4580-
4586, 1994
52. McLaughlin GS, Jacobson ER, Brown DR, et al:
Pathology of upper respiratory tract disease of
gopher tortoises in Florida. J Wildl Dis 36:272-283,
2000
53. Diethelm G, Stauber E, Tillson M, et al: Tracheal
resection and anastomosis for an intratracheal
chondroma in a ball python. J Am Vet Med Assoc
209:786-788, 1996
54. Drew ML, Phalen DN, Berridge BR, et al: Partial
tracheal obstruction due to chondromas in ball
pythons (Python regius). J Zoo Wildl Med 30:151-
157, 1999
55. Greenacre CB, Ritchie BW, Latimer KS: Treat-
ment of cartilaginous hyperplasia in ball pythons.
Compend Contin Educ Pract Vet 21:633-637,
1999
56. Harper PAW, Hammond DC, Heuschele WP: A
herpesvirus-like agent associated with a pharyn-
geal abscess in a desert tortoise. J Wildl Dis 18:
491-494, 1982
57. Westhouse RA, Jacobson ER, Harris RK, et al:
Respiratory and pharyngo-esophageal iridovirus
infection in a gopher tortoise (Gopherus
polyphemus). J Wildl Dis 32:682-686, 1996
58. Origgi FC, Jacobson ER: Diseases of the respira-
tory tract in chelonians. Vet Clin North Am (Ex-
otic An Pract) 3:537-549, 2000
59. Wellehan JFX, Nichols DK, Li LL, et al: Three
novel herpesviruses associated with stomatitis in
Sudan plated lizards (Gerrhosaurus major) and a
black-lined plated lizard (Gerrhosaurus nigrolinea-
tus). J Zoo Wildl Med 35(1) In press, 2004
60. Driggers T: Respiratory diseases, diagnostics, and
therapy in snakes. Vet Clin North Am (Exotic An
Pract) 3:519-530, 2000
61. Coke RL: Respiratory biology and diseases of cap-
tive lizards (sauria). Vet Clin North Am (Exotic
An Pract) 3:531-536, 2000
62. Jacobson ER, Gaskin JM, Mansell J: Chlamydial
infection in puff adders (Bitis arietans). J Zoo
Wildl Med 20:364-369, 1989
63. Vanrompay D, De Meurichy W, Ducatelle R, et al:
Pneumonia in Moorish tortoises (Testudo graeca)
associated with avian serovar A Chlamydia psittaci.
Vet Rec 135:284-285, 1994
64. Brown DR, Schumacher IM, Nogueira MF, et al:
Detection of antibodies to a pathogenic myco-
plasma in American alligators (Alligator mississip-
piensis), broad-nosed Caimans (Caiman latirostris),
and Siamese crocodiles (Crocodylus siamensis).
J Clin Microbiol 39:285-292, 2001
65. Penner JD, Jacobson ER, Brown DR, et al: A novel
Mycoplasma sp associated with proliferative tra-
173
cheitis and pneumonia in a Burmese python (Py-
thon molurus bivittatus). J Comp Pathol 117:283-
288, 1997
66. Jacobson ER, Adams HP, Geisbert TW, et al: Pul-
monary lesions in experimental ophidian
paramyxovirus pneumonia of Aruba Island rattle-
snakes, Crotalus unicolor. Vet Pathol 34:450-459,
1997
67. Lamirande EW, Nichols DK, Owens JW, et al:
Isolation and experimental transmission of a reo-
virus pathogenic in ratsnakes (Elaphe species). Vi-
rus Res 63:135-141, 1999
68. Murray MJ: Pneumonia and normal respiratory
function, in Mader DR (ed): Reptile Medicine
and Surgery. Philadelphia, PA, WB Saunders,
1996, pp. 396-405
69. Barten SL: Lizards, in Mader DR (ed): Reptile
Medicine and Surgery. Philadelphia, PA, WB
Saunders, 1996, pp. 324-332
70. Hernandez-Divers SJ: Pulmonary candidiasis
caused by Candida albicans in a Greek tortoise
(Testudo graeca) and treatment with intrapulmo-
nary amphotericin B. J Zoo Wildl Med 32:352-9,
2001
71. Prezant RM, Isaza R, Jacobson ER: Plasma con-
centrations and disposition kinetics of enrofloxa-
cin in gopher tortoises (Gopherus polyphemus). J
Zoo Wildl Med 25:82-87, 1994
72. Raphael BL, Papich M, Cook RA: Pharmacokinet-
ics of enrofloxacin after a single intramuscular
injection in Indian star tortoises. J Zoo Wildl Med
25:88-94, 1994
73. Gamble KC, Alvarado TP, Bennett CL: Itracon-
azole plasma and tissue concentrations in the
spiny lizard (Sceloporus) following once-daily dos-
ing. J Zoo Wildl Med 28:89-93, 1997
74. Schumacher J: Viral Diseases, in Mader DR (ed):
Reptile Medicine and Surgery. Philadelphia, PA,
WB Saunders, 1996, pp. 224-234
75. Jenkins JR: Medical management of reptile pa-
tients. Compend Cont Educ Pract Vet 13:980-988,
1991
76. Bennett RA: Non-reproductive surgery in reptiles.
Vet Clin North Am (Exotic An Pract) 3:715-732,
2000
77. Bennett RA: Cloacal prolapse, in Mader DR (ed):
Reptile Medicine and Surgery. Philadelphia, PA,
WB Saunders, 1996, pp. 355-359
78. Done LB: Postural Abnormalities, in Mader DR
(ed): Reptile Medicine and Surgery. Philadelphia,
PA, WB Saunders, 1996, pp. 406-411
79. Teare JA, Bush M: Toxicity and efficacy of iver-
mectin in chelonians. J Am Vet Med Assoc 183:
1195-1197, 1983
80. Garner MM, Gamble K, Alvarado T, et al: Pathol-
ogy of suspected fenbendazole intoxication in
three Fea’s vipers (Azemiops feae), in McKinnell
RG, Carlson DL (eds): Proceedings of the 6th
International Symposium on the Pathology of
Reptiles and Amphibians, Minneapolis, MN,
2001, pp 173-176
81. Knight M, Glor R, Smedley SR, et al: Firefly toxi-
cosis in lizards. J Chem Ecol 25:1981-1986, 1999
82. Duhr D: Poisoning due to an intake of mice bait
with cholecalciferol in combination with acute
 174 Wellehan and Gunkel

egg binding in a tortoise. Praktische Tierarzt 79:
210-212, 1998
83. Borkowski R: Lead poisoning and intestinal per-
forations in a snapping turtle (Chelydra serpentina)
due to fishing gear ingestion. J Zoo Wildl Med
28:109-113, 1997
84. Lawton MPC: Neurological disease, in Beynon PH
(ed): Manual of Reptiles. Ames, IA, Iowa State
University Press, 1992, pp. 128-137
85. Bennett RA: Neurology, in Mader DR (ed): Rep-
tile Medicine and Surgery. Philadelphia, PA, WB
Saunders, 1996, pp. 141-148

View publication stats