is a common condition seen in waterfowl, some raptors and psittacines. Common sources include lead shot in raptor prey items, lead fishing weights, paint, putty, solder, and lead batteries. Old houses may have additional sources of lead. Lead can be absorbed from the GI tract and stored in bones and soft tissue. It is excreted slowly over months by the kidneys. Clinical signs include neurological signs, lethargy, weakness, vomiting, polydipsia, polyuria, haemoglobinuria and death. Diagnosis is by clinical signs, radiography (presence of extremely radiodense material in ventriculus) and whole blood lead analysis. Treatment with chelation therapy should start immediately, either with CaEDTA injectable or with oral penicillamine (injectable CaEDTA is more effective, although it can have more side effects). Supportive treatment is usually necessary until the animal recovers. If heavy metal particles do not pass the stomach and continue producing symptoms over weeks, then a gastric flush is indicated. When the particles are small, endoscopy is generally unsuccessful. Response to treatment should be followed by radiographs and measurement of lead levels in blood to decide when to stop treatment. Lead in muscle does not cause toxicity. The lack of radiodense material in the GI tract does not rule out heavy metal toxicity. 

is also commonly seen in captive birds. Many wire cages are coated with zinc powder; toys for birds may contain zinc; and there may also be some sources of zinc in the house. Clinical signs and treatment are similar as in lead poisoning. Parrots that roam free at home are predisposed to heavy metal toxicity. 

It is not an aetiologic agent, but the consequence of a kidney problem or an excess of dietary protein. There are two types of gout in birds

• -  Articular. Deposition of white material (uric acid crystals) within the joints, particularly in the legs.

• -  Visceral. Deposition of white material (uric acid crystals) in the serosal surfaces of organs: mainly liver, kidneys and pericardium, but also air sacs, etc.

  Diagnosis is made by a combination of FNA and cytology of the articular lesions, endoscopy to visualise visceral gout and measurement of uric acid in blood. Uric acid rises after a meal, particularly in carnivorous/piscivorous species, so care should be taken not to over-diagnose the condition.

  Initial cases can be controlled with aggressive fluid therapy, elimination of the initiating cause and the administration of allopurinol to reduce uric acid levels in blood. Advance cases will eventually end up in the death of the bird, and many cases of severe visceral gout are just found on necropsy without any previous specific clinical sign. 

0. Feather picking, feather destructive behaviour and self-mutilation 

0. These abnormal behaviours are commonly seen in parrots and can be the consequence of medical or behavioural problems. Medical causes are many and may include viral infections such as PBFD or polyomavirus, hypothyroidism, systemic disease, bacterial or fungal folliculitis, liver disease, air sacculitis, coelomic masses, ectoparasites, neurological disease or reproductive disease. Behavioural problems include boredom, sexual frustration, excitation, and many other conditions (known or unknown) derived from captivity, as the problem does not occur in free-ranging psittacines.

   An accurate history should be taken and should include date of initial presentation, any changes in husbandry at that time, seasonality of the problem, when and in what conditions the bird develops that behaviour, if there is any action/situation that trigger the problem, etc. A complete medical examination should be performed including physical exam, radiographs, bloodwork, endoscopy and tests for PBFD/polyomavirus. Other tests such as cultures, cytology and histopathology of the skin and tests for other diseases can be done. If no medical cause is found, a presumptive diagnose of behavioural origin is made, and a poor prognosis is usually given, particularly in chronic cases and where the initiating cause cannot be found. 

Treatment is complicated, and referral to a behaviour specialist should be considered. As a general rule, improve husbandry such as diet and photoperiod, and provide UV light and opportunities for the parrot to develop a more natural behaviour, including exercise, foraging for food, baths, etc. In some cases, the use of sedatives (haloperidol), antidepressants (fluoxetine) or drugs to control reproductive behaviour (deslorelin) should be considered. Severely traumatised feathers should be pulled out under anaesthesia; this is painful and analgesia should be provided. Re-growth may happen within eight weeks (particularly for tail feathers), but flight feathers will only regrow with the next moult, although this depends on the species. Elizabethan collars should only be used as a last resort or in cases where significant self-trauma is likely. The collar is removed when normal feathers have regrown (about 2 months). 

This condition is particularly common in pet cockatiels. It is caused by excessive stimulation of breeding behaviour by the presence of another bird, inanimate object (cage furniture, toy, mirror) or a person with whom the bird has bonded. Excessive feeding and artificial photoperiods can also have an influence. Laid eggs should not be removed from the nest, as the bird will continue laying to replace them. Consider medical treatment (deslorelin, cabergoline) together with husbandry modification (remove nest boxes and items that may stimulate laying, artificially reduce day length to eight hours by covering the cage and reduce caloric intake if the bird is in good body condition). If treatment is unsuccessful, hysterectomy is indicated. Birds that are chronic egg layers are predisposed to other conditions such as dystocia, egg yolk peritonitis and hypocalcaemia. 

Egg binding/dystocia 

It can be caused by calcium/vitamin D3 deficiencies, oversized or misshapen eggs, uterine inertia due to excessive laying, metritis and obesity. In many cases the cause cannot be found. Clinical signs include dyspnoea (the egg compresses the air sacs and lungs), hindlimb weakness (the egg compresses the nerves of the legs), lethargy, abnormal faeces (usually softer) and a wide non- perching stance. The lower coelom may be swollen and an egg may or may not be palpable. Egg retention is more common in smaller birds such as cockatiels, lovebirds and budgerigars but can present in any species. Radiographs and a serum calcium determination can be indicated for diagnosis and to better guide treatment. The patient should be stabilized (warmth, oxygen, fluids) and left in a quiet place. Injectable calcium is commonly given, and the use of hormones such as oxytocin or topical prostaglandins (the latter ones being more effective) should be tried. If medical treatment is unsuccessful, consider manual massage with lubrication, ovocentesis (the collapsed egg will be passed over the next day or so) or even surgery. All these procedures are best performed under anaesthesia. Egg binding is an emergency. 

Egg yolk peritonitis 

It is caused by ectopic ovulation but may also be seen with salpingitis, metritis, neoplasia, or a ruptured oviduct. These can be sterile or septic. Some birds respond to medical management while others will require removal of yolk material and extensive lavage, and other birds may die. Prognosis is guarded. Lethargy and respiratory problems may be seen. Egg yolk peritonitis is commonly seen in birds with chronic egg laying. The diagnosis can be made by aspiration and cytology of coelomic fluid (only in very recent cases) or by endoscopic examination. 

Critical care and emergency treatment of birds 

Birds have a high metabolic rate and tend to hide the symptoms of a disease; as a consequence, they usually present very debilitated in emergency situations. What the owner perceives as an emergency, it may be a disease that has been developing for days or even weeks, but the owner has not been able to notice any clinical sign. When we talk on the phone with an owner that may have a sick bird, it is usually indicated to advise seeing the patient as soon as possible.

At the time of presentation, even handling can be fatal and physical restraint of such a bird may be contraindicated. It is often necessary to stabilise ill birds before a full clinical assessment can be made of their condition (warmth, oxygen). Only experience will allow the veterinary surgeon to assess how far to go with an individual case. Before handling and stressing the bird a full diagnostic and therapeutic plan should be formulated as you may be able to complete a number of procedures whilst handling the bird. In some cases a complete physical examination may only be possible under anaesthesia. 

Hospitalisation 

Most sick birds will require hospitalisation and diagnostic procedures. Unless a bird is collapsed it will want to perch; this is also essential to keep tail feathers from dragging on the floor and becoming soiled or damaged. In raptors, a tail guard should be placed. Birds of prey will require either a block or bow perch, while parrots and other cage birds will require dowelling type perches. If possible, birds should be kept away from other birds, or at least not directly share the same air space, to reduce the risk of disease transmission. Predator and prey species should be separated. Ideally, it is useful to be able to observe them remotely in order to assess their actual demeanour, as by nature they will always attempt to appear well.

If the patients are voluntarily feeding then the usual diet should be fed. This may mean the practice has stocks of suitable food or, for more specialised feeders, the owner is requested to bring some of the more usual diet along for their pet. Avoid doing diet changes in sick birds. Measuring and recording a patients’ weight is a vital part of monitoring their health status and feeding requirements; this can be done one or two times a day. For fluid therapy, consider 100 mL/kg/day, either as IV/IO infusion/boluses or as subcutaneous boluses. Include fluids given by mouth in the calculation of the daily requirements. In anorexic birds, crop feeding should be regular (usually 3-6 times a day) to avoid weight loss. When crop feeding a bird, the neck should be palpated to make sure the feeding tube is not inside the trachea (therefore, both the feeding tube and the trachea should be palpated separately). If this is not done, accidental intubation is a real risk in birds over 100 grams. Make sure the tube is lubricated and give 1-5% of body weight at a feed (do not use higher percentages initially). 

- Give itraconazole to a grey parrot (or at least not with the same doses used in other parrots) - Inject enrofloxacin IM or SC (or at least not for more than 1-2 injections)
- Clip the wing of a bird
- Add mineral/vitamin supplements to a balanced diet
- Give avocado to parrots
- Give chocolate to parrots
- Give intracoelomic fluids to birds
- Misidentify the normal gizzard for an egg or a mass on palpation