Written by Athulya Prakash
College Of Veterinary And Animal Sciences , Mannuthy, Kerala, India
IVSA India
1st Place Winner of SCOVE X Purina Institute Essay Competition: Addressing Hot Topics in Nutrition
Introduction
In the current era, many pet owners opt for homemade diets due to perceived benefits and a desire for more control over their pets' nutrition. However, misconceptions often lead to improper feeding practices, such as feeding pets the same foods consumed by the owner, providing unlimited portions, or excessively relying on meat-based diets. It's crucial to recognize that each animal has unique nutritional requirements influenced by factors like breed, age, size, activity level, and health status. Formulating a complete and balanced diet for pets requires careful consideration of these factors and should only be done under the guidance of a qualified veterinarian. This case of metabolic fracture in an animal fed a meat-based diet highlights the importance of balanced nutrition and the risks associated with dietary inadequacies in pet care.
Case Presentation
A 4-month-old female golden retriever puppy was presented to Teaching Veterinary Clinical Complex , Mannuthy with a chief complaint of an inability to bear weight on her right hind limb. The puppy's history revealed a diet exclusively comprising raw beef over the past 3 months. Clinical examination uncovered signs of pain and crepitation upon palpation of the femur of the right hind limb, hinting at a musculoskeletal issue.
Diagnosis and Nutritional Assessment
Radiographic evaluation demonstrated osteopenic changes and compression fractures in the femur of right hind limb (Figure1), supporting the suspicion of a metabolic bone disorder. Due to the high phosphorus content in raw beef, ranging from 15-20mg/100g, and the recommended safe intake range for puppies, approximately 0.8% to 1.8% of the total diet on a dry matter basis, translating to approximately 1.6 to 3.6 grams of phosphorus per 1,000 kcal of metabolizableenergy, the puppy's beef-heavy diet may have contributed to the development of hyperphosphatemia. Based on clinical findings and diagnostic imaging, a tentative diagnosis of metabolic fracture due to hyperphosphatemia was made. Serum calcium and phosphorus values confirmed the imbalance, with a disrupted Ca:P ratio of 0.68.
Figure 1: radiograph of right hind limb showing osteopenic changes and compression fracture in femur
Diet Modification
Transitioning to a ragi-based diet with egg white as the primary protein source, along with increased water intake and regular monitoring, benefits dogs with hyperphosphatemia. Ragi's low phosphorus content reduces intake, while egg whites offer quality protein without excess phosphorus. Adequate hydration supports kidney function and eliminates surplus phosphorus. Monitoring ensures the diet effectively manages phosphorus levels for the dog's health.
Treatment
External fixation of the fracture with plaster of paris cast was done. Pharmacological intervention for the 9 kg puppy included administering Meloxicam at a dose rate of 0.2mg/kg for pain relief and Cholecalciferol at a dose of 1ml (3 lakh IU) deep intramuscularly to correct the metabolic imbalance. Additionally, the puppy was prescribed sevelamer, a phosphate binder at a dose rate of 30mg/kg for 3 weeks, and calcium supplements (Shellcal) at a dose of 5ml daily to restore normal calcium-phosphorus homeostasis.
Outcome
Following the comprehensive treatment regimen, the puppy exhibited significant improvement upon follow-up every 2 weeks. The normalization of the Ca:P ratio and evidence of fracture healing within 3 months post-treatment underscored the efficacy of the multifaceted approach employed.
Discussion
Adequate intake of proteins, carbohydrates, vitamins, and minerals during post weaning lays the foundation for future health of puppies. An imbalance in energy intake can lead to skeletal abnormalities from excessive growth, while deficiencies can stunt their development. Essential minerals like calcium and phosphorus are indispensable for proper bone formation, with calcium being absorbed passively until intestinal maturation at around 6 months of age. Vitamin D plays a pivotal role in enhancing this process and facilitating active reabsorption from the intestine and kidney. Parathyroid hormone (PTH) orchestrates the regulation of blood calcium levels by promoting resorption from the kidney and bone, as well as activating vitamin D, while aiding in phosphorus excretion..
In this case of a puppy being fed a raw meat-based diet, hyperphosphatemia and hypocalcemia ensue, triggering increased PTH secretion. Compounded by vitamin D deficiency, exacerbated by the inadequate presence of this vitamin in beef, osteoclastic bone resorption occurs, resulting in osteopenia in affected puppies. Intrinsic factors such as muscular tension and heightened physical activity, common in breeds like golden retrievers, may predispose them to fractures. This is seen particularly in the femur, due to increased forces during locomotion. Studies indicate a notable prevalence of oblique and incomplete fractures. This case serves as a testament to the importance of timely intervention and appropriate dietary modifications in managing metabolic bone disorders in young animals.
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