Case 50: Jennie Jankovsky. 1 st year Anatomic Pathology Resident University of Tennessee

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1 Case 50: Jennie Jankovsky 1 st year Anatomic Pathology Resident University of Tennessee

2 Signalment and History 2 week old male alpaca

3 Signalment and History 2 week old male alpaca Slow growth since birth

4 Signalment and History 2 week old male alpaca Slow growth since birth Lost 7.2% body weight in last 2 days of life

5 Signalment and History 2 week old male alpaca Slow growth since birth Lost 7.2% body weight in last 2 days of life 1 day history of ataxia, seizures, and collapse

6 Signalment and History 2 week old male alpaca Slow growth since birth Lost 7.2% body weight in last 2 days of life 1 day history of ataxia, seizures, and collapse Last known urination 24 hours prior

7 Presentation Laterally recumbent Obtunded Bradycardia

8 Diagnostics Clinical pathology: Metabolic acidosis, hyperkalemia, profound azotemia

9 Diagnostics Clinical pathology: Metabolic acidosis, hyperkalemia, profound azotemia Ultrasound: Bilaterally enlarged kidneys with perirenal fluid; small bladder

10 Gross Necropsy Findings

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13 Microscopic Findings

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24 Morphologic Diagnoses Severe diffuse glomerular and tubular basement membrane mineralization with intratubular protein casts

25 Morphologic Diagnoses Severe diffuse glomerular and tubular basement membrane mineralization with intratubular protein casts Moderate multifocal gastric (C3) mucosal and muscularis mineralization

26 Morphologic Diagnoses Severe diffuse glomerular and tubular basement membrane mineralization with intratubular protein casts Moderate multifocal gastric (C3) mucosal and muscularis mineralization Moderate multifocal choroid plexus mineralization

27 Morphologic Diagnoses Severe diffuse glomerular and tubular basement membrane mineralization with intratubular protein casts Moderate multifocal gastric (C3) mucosal and muscularis mineralization Moderate multifocal choroid plexus mineralization Moderate multifocal bronchial mineralization

28 Additional Information Received 10 ml vitamin supplement Minimum of 100,000 IU Vitamin D

29 Additional Information Received 10 ml vitamin supplement Minimum of 100,000 IU Vitamin D Recommended dose: IU/kg

30 Additional Information Received 10 ml vitamin supplement Minimum of 100,000 IU Vitamin D Recommended dose: IU/kg Usually ,000 IU per cria

31 Toxicology Renal 25-OH-Vitamin D 3 level:

32 Toxicology Renal 25-OH-Vitamin D 3 level: 740 nmol/l

33 Toxicology Renal 25-OH-Vitamin D 3 level: 740 nmol/l Levels >85 nmol/l are suggestive of intoxication Testing performed by Diagnostic Center for Population and Animal Health

34 Final Diagnosis

35 Final Diagnosis Vitamin D 3 Toxicity

36 Vitamin D Supplementation Crias prone to rickets Fall birth Dark haircoat

37 Vitamin D Toxicity Reported in many species Calcinogenic plants Cholecalciferol rodenticides Food manufacturing errors Medications Supplements

38 Pathogenesis

39 Cholecalciferol (D 3 )

40 Cholecalciferol (D 3 ) Liver: 25-hydroxylase Calcidiol [25(OH) D 3 ]

41 Cholecalciferol (D 3 ) Liver: 25-hydroxylase Calcidiol [25(OH) D 3 ] Kidneys: 1- -hydroxylase Calcitriol [1,25(OH) 2 D 3 ]

42 Increased calcium absorption/ resorption

43 Increased calcium absorption/ resorption Increased serum ionized calcium

44 Increased calcium absorption/ resorption Increased serum ionized calcium Soft tissue mineralization

45 Thank you! Dr. Shelley Newman Dr. Ricardo Videla Resident mates UT Histology Lab