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Hypervitaminosis A in an Indotestudo elongata - Chris Tabaka DVM
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Copyright © 2003 World Chelonian Trust. All rights reserved
One of the most common misperceptions when it comes to medications is that while a little bit is good, a little bit more (or occasionally a whole lot more) is better. This is unfortunately not true. Each medication has it's own individual safety range as well as toxicity level and whereas a properly dosed level of a drug such as fenbendazole (Panacur) or metronidazole (Flagyl) can kill parasites, an improper level can literally kill the patient. This is also true with nutritional supplements such as vitamin A.
One of the most common diagnoses that is made when it comes to sick chelonia is hypovitaminosis A. When turtles or tortoises develop swollen eyelids and excessive tearing, the most common assumption is that the cause is low vitamin A levels. While this may be true in situations with obviously deficient diets or possibly in the case of American box turtles exposed to environmental agents that disrupt the metabolism of vitamin A1, with modern husbandry knowledge and commercial diets, true hypovitaminosis A is relatively uncommon. Also unfortunately, HYPERvitaminosis A physically manifests almost exactly the same as HYPOvitaminosis A leading to even further aggressive treatments thus exacerbating the situation.
Treatments for hypovitaminosis A vary from giving eyedrops to oral medications to injectable drugs. While the animal is able to process most vitamin A given in the eyes or orally, when the drug is injected, the potential for harm (aka. hypervitaminosis A) increases exponentially. The following is one such example.
In January of 2002, I received a call from someone wanting to donate a pair of elongated tortoises to a good home. As I am interested in many Asian chelonia as well as almost all tortoise species, I told him I would be thrilled to add the animals to my collection. He was in the midst of moving from the East coast to the western portion of the country and decided to drop the pair off on his way through Memphis. Unfortunately the female became ill not long before he left so he took it to his vet for treatment.
When I received the animals a week or so later, the male was in excellent condition whereas the female was depressed with swollen eyelids. By the next day, the animal started sloughing skin over much of her body. Within a few days after arriving, she looked like the following pictures.
The skin was quite literally falling off her body everywhere!!! While I had seen bad cases of hypo- as well as hypervitaminosis A, this was one of the most disturbing cases I had ever seen. The sloughing was so bad that even after she had lost every bit of skin covering her body, she proceeded to lose the two keratinous scales just above her nostrils (not pictured-a few days after this picture, she lost the scales over her nose as well as all of the scales on her front limbs, tail, and rear limbs still pictured below).
Fortunately with time, tube feeding, fluid treatments (much like human burn patients, when animals lose their protective layer of skin, they dehydrate very rapidly), systemic antibiotics, and copious copious amounts of silver sulfadiazine spread over her entire body to prevent infection while her skin healed underneath, she was able to pull through and can be seen pictured below today.
So, the moral of the story is that if you see swollen eyes and tearing in your animal and you have been feeding a decent diet, please do not assume that a lack of vitamin A is the problem. There are a wide range of other causes of such symptoms in turtles and tortoises (systemic infection, humidity problems, severe dehydration, pneumonia, mycoplasma, etc. etc.) so be sure to work with your vet to try to figure the problem out.
References:
1 - Aural abscesses in wild-caught box turtles (Terrapene carolina): possible role of organochlorine-induced hypovitaminosis A.Holladay SD, Wolf JC, Smith SA, Jones DE, Robertson JL., Department of Biomedical Sciences and Pathobiology, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Phase II, Southgate Drive, Blacksburg, Virginia 24061-0442, USA. holladay@vt.edu
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