Hypercalcemia and acute renal insufficiency following use of a veterinary supplement / Hipercalcemia e insuficiência renal aguda após uso de suplemento veterinário

Abstract A previously healthy 24 yo male presented with a two-month history of epigastric pain, nausea, vomiting, fatigue and malaise. He reported abuse of different substances, including an injectable veterinary vitamin compound, which contains high doses of vitamin A, D and E, and an oily vehicle that induces local edema and enhances muscle volume. Serum creatinine was 3.1 mg/dL, alanine transaminase 160 mg/dL, aspartate transaminase 11 mg/dL, total testosterone 23 ng/dL, 25-OH-vitamin D >150 ng/mL (toxicity >100), 1,25-OH-vitamin D 80 pg/mL, vitamin A 0.7 mg/dL, parathormone <3 pg/mL, total calcium 13.6 mg/dL, 24-hour urinary calcium 635 mg/24h (RV 42-353). A urinary tract ultrasound demonstrated signs of parenchymal nephropathy. The diagnosis was hypercalcemia and acute renal failure secondary to vitamin D intoxication. He was initially treated with intravenous hydration, furosemide and prednisone. On the fifth day of hospitalization a dose of pamidronate disodium was added. The patient evolved with serum calcium and renal function normalization. Thirty days later he presented normal clinical and laboratory tests, except 25-OH-vitamin D that was persistently increased (107 ng/mL), as it may take several months to normalize. This case report is a warning of the risks related to the use of veterinary substances for aesthetics purposes.

Resumo Um paciente de 24 anos do sexo masculino, previamente hígido, apresentou-se com uma história de dois meses de dor epigástrica, náuseas, vômitos, fadiga e mal-estar. Ele relatava abuso de diferentes substâncias, incluindo um composto vitamínico veterinário injetável contendo altas doses de vitamina A, D e E, e um veículo oleoso que induz edema local com aumento de volume muscular. A creatinina sérica estava 3,1 mg/dL, alanina transaminase 160 mg/dL, aspartato transaminase 11 mg/dL, testosterona total 23 ng/dL, 25-OH-vitamina D > 150 ng/mL (toxicidade > 100), 1,25-OH-vitamina D 80 pg/mL, vitamina A 0,7 mg/dL, paratormônio < 3 pg/mL, cálcio total 13,6 mg/dL, cálcio urinário de 24h 635 mg/24h (VR 42-353). Uma ultrassonografia do trato urinário demonstrou sinais de nefropatia parenquimatosa. O diagnóstico foi hipercalcemia e insuficiência renal aguda secundária a intoxicação por vitamina D. Ele foi tratado inicialmente com hidratação intravenosa, furosemida e prednisona. No quinto dia de hospitalização uma dose de pamidronato dissódico foi adicionada. O paciente evoluiu com normalização do cálcio sérico e da função renal. Trinta dias depois ele apresentou testes clínicos e laboratoriais normais, exceto a 25-OH-vitamina D que estava persistentemente elevada (107 ng/mL), já que ela pode demorar vários meses para normalizar. Este relato de caso é um alerta aos riscos relacionados ao uso de substâncias veterinárias para fins estéticos.

Evidence for beneficial effects of vitamin E

Oxidative stress and lipid peroxidation have been implicated in the pathogenesis of various diseases, including atherosclerosis and fatty liver diseases, and consequently the role of antioxidants in the prevention and treatment of such diseases has received much attention. In particular, the effects of vitamin E, the most important lipophilic radical-scavenging antioxidant, have been investigated extensively. Many in vitro, animal, and epidemiological studies have reported positive results, but large-scale randomized controlled intervention studies and meta-analyses have produced inconsistent and often disappointing results. In the present review article, the role and action of vitamin E are discussed, with consideration of the factors that determine the outcome of vitamin E treatment. Vitamin E should benefit subjects experiencing oxidative stress due to free radicals when administered at the correct time and for an appropriate duration.

Hipercalcemia e lesão renal aguda causadas por abuso de um composto veterinário parenteral contendo vitaminas A, D e E / Hypercalcemia and acute kidney injury caused by abuse of a parenteral veterinary compound containing vitamins A, D, and E

Um rapaz de 19 anos, previamente hígido, procurou o hospital com queixas de anorexia, náuseas e vômitos. Exames laboratoriais revelaram hipercalcemia (valor máximo do cálcio de 14,8 mg/dL) e lesão renal aguda (valor máximo da creatinina de 2,88 mg/dL). O paciente admitiu utilizar uma formulação parenteral de vitaminas A, D e E de uso exclusivo veterinário, contendo 20.000.000 UI de vitamina A; 5.000.000 UI de vitamina D3 e 6.800 UI de vitamina E, por ampola de 100 mL. Ele refere ter usado cerca de 300 mL do produto no último ano. O jovem não estava interessado na quantidade maciça de vitaminas contida no produto, mas apenas no efeito local do veículo oleoso; o edema provocado pela injeção simulava um aumento de massa muscular. O produto, no entanto, foi absorvido e causou hipervitaminose. O nível sérico de 25(OH) vitamina D estava claramente elevado em 150 ng/mL (referência de 30 a 60 ng/mL), mas não tanto quanto em outros casos publicados de intoxicação por vitamina D. A maioria dos casos de hipercalcemia por hipervitaminose D se associa a níveis de 25 (OH)D bem maiores do que 200 ng/mL. O PTH estava indetectável, e outras causas de hipercalcemia foram excluídas. Deste modo, conclui-se que a gravidade da hipercalcemia encontrada neste caso foi resultado do efeito sinérgico da intoxicação pelas vitaminas A e D. O paciente foi tratado com soro fisiológico, furosemida e ácido zolendrônico e evoluiu com normalização rápida dos níveis séricos de cálcio e da função renal.

A previously healthy 19 year-old male presented to the hospital with anorexia, nausea, and vomiting. Laboratory studies were significant for hypercalcemia (peak calcium value of 14.8 mg/dL) and acute kidney injury (peak serum creatinine of 2.88 mg/dL). He admitted to using a parenteral formulation of vitamins A, D and E restricted for veterinary use containing 20,000,000 IU of vitamin A; 5,000,000 IU of vitamin D3; and 6,800 IU of vitamin E per 100 mL vial. The patient stated to have used close to 300 mL of the product over the preceding year. Interestingly, the young man was not interested in the massive amounts of vitamins that the product contained; he was only after the local effects of the oily vehicle. The swelling produced by the injection resulted in a silicone-like effect, which gave the impression of bigger muscles. Nevertheless, the product was absorbed and caused hypervitaminosis. The serum level of 25(OH) vitamin D was clearly elevated at 150 ng/mL (reference range from 30 to 60 ng/mL), but in most published cases of vitamin D toxicity, serum levels have been well above 200 ng/mL. His PTH level was undetectable and other potential causes of hypercalcemia were excluded. Therefore, we posit that the severity of the hypercalcemia observed in this case was the result of a synergistic effect of vitamins A and D. The patient was treated with normal saline, furosemide and zolendronic acid, with rapid normalization of calcium levels and renal function.

Efeito do consumo de óleo de linhaça e de vitamina E no desempenho e nas características de carcaças de frangos de corte / Effect of linseed oil and vitamin E consumption on poultry performance and carcass traits

Foi avaliado o efeito da utilização de óleo de linhaça na ração, em substituição ao óleo de soja em diferentes proporções, e de vitamina E, até o nível de 400mg/kg de ração, sobre o desempenho e a composição de carcaça de frangos de corte. O desempenho produtivo foi avaliado com base em pesagens das aves e da ração aos 21 e 49 dias de idade. No 49º dia, as aves foram abatidas, e os rendimentos de carcaça e dos principais cortes comerciais e a porcentagem de vísceras e de gordura abdominal foram avaliados. A composição da fração oleosa da ração, de forma geral, não interferiu nos parâmetros de desempenho avaliados (P>0,05). Os machos consumiram mais ração e ganharam mais peso que as fêmeas (P<0,01). As fêmeas apresentaram, em geral, pior conversão alimentar, associada à maior deposição de gordura abdominal. Os machos apresentaram maior porcentagem de coxa com sobrecoxa em relação ao peso da carcaça eviscerada, e as fêmeas apresentaram maior porcentagem de peito. A porcentagem de asas e vísceras não diferiu entre os sexos.

The effect of the utilization of linseed oil at different concentrations in poultry feed instead of soy oil and the effect of vitamin E administration up to 400mg/kg feed on performance and carcass traits of broilers was investigated. Productive parameters were determined by weighting birds and rations at 21 and 49 days of experiment. Broilers were slaughtered on the 49th day of the experiment for the evaluation of yields of carcass and main cuts, percentages of viscera and abdominal fat. The oil composition of rations did not influence the performance of the broilers (P>0.05). Male broilers had higher feed consumption and weight gain (P<0.05). Female broilers showed worse feed conversion and higher deposition of abdominal fat (P<0.05). Male broilers also had higher percentages of legs and forelegs in relation the weight of the eviscerated carcass while females showed higher breast percentage (P<0.05). Percentages of wings and viscera did not differ between genders (P>0.05).

Suplementación con vitamina E, benéfica o dañina? / Is vitamin-E supplementation beneficial or harmful?

Aunque en estudios de laboratorio se han observado efectos potencialmente benéficos de la vitamina E, los resultados de la evaluación clínica son inconsistentes. Una situación que ha limitado el conocimiento en esta área, es la dificultad para establecer comparaciones entre los diferentes estudios. Existen diferencias entre sujetos, tipos de formulaciones, etapas de la enfermedad, y otros aspectos. El consumo de megadosis de esta vitamina se ha incrementado en muchos países. En estudios recientes se ha informado que además de su capacidad antioxidante, esta vitamina tiene acciones moleculares precisas que influyen sobre la actividad de varias enzimas modulando la expresión de genes y la inducción de apoptosis. Sin embargo, algunos estudios clínicos y metaanálisis han informado que dosis de 400 UI/día o mayores de α-tocoferol, se asocian con aumento del índice de mortalidad. Resulta claro que hasta la fecha no se tiene un conocimiento completo de los efectos de estas sustancias a nivel celular y que existe controversia en los resultados de ensayos clínicos. En el presente trabajo se revisa el conocimiento actual sobre las características de esta vitamina, sus principales efectos benéficos, su toxicidad potencial y se discuten los resultados de algunos metaanálisis recientes en relación al aumento del riesgo de mortalidad.

Even though the beneficial effects of vitamin E have been experimentally observed, some clinical trials failed to verify a consistent benefit. One reason for this situation has been the difficulty to make comparisons among different studies. There are differences due to subjects, chemical forms of vitamin E, stages of the disease and others. The intake of high doses of vitamin E as a supplement has increased in many countries. Novel studies, have informed that vitamin E not only has antioxidant properties but can acts through precise molecular actions interacting with proteins and enzymes and modulating cellular signaling, transcriptional regulation and apoptosis induction. However, some recent clinical and meta analysis studies have found that daily supplementation with vitamin E 400 IU or higher is associated to increased mortality. In conclusion, a complete understanding of vitamin E actions at the cell does not exist yet and the controversy about its clinical effects is still present. This paper offers current knowledge on the characteristics, metabolism, properties, beneficial effect as well as the potential toxicity of vitamin E.

Efecto de la vitamina E en el proceso de hemostasia de individuos sanos / Effect of vitamin E in haemostasis of healthy individuals

La vitamina E (VE) es una vitamina liposoluble que actúa como antioxidante y ha sido asociada a tiempos prolongados de sangramiento en individuos sanos. El objetivo del siguiente trabajo fue evaluar el efecto de la VE en el proceso de coagulación de personas sanas. Fueron incluidos en el estudio 211 individuos sanos sin historia de enfermedades que comprometieran la hemostasia y separados en dos grupos dependiendo de la ingesta o no de VE. Los datos epidemiológicos de cada paciente así como el tiempo de protrombina (PT) y el tiempo parcial de tromboplastina (PTT) fueron recolectados. Todos los datos fueron analizados mediante el programa estadístico SPSS versión 13.0 y las medias comparadas usando la prueba estadística t de student. 114 individuos consumian al menos 400mgrs diarios de VE por un lapso no menor de 3 meses (75 mujeres y 39 hombres, edad promedio de 53.82+1.7 años) y 97 individuos que no consumian VE (55 mujeres y 42 hombres, edad media de 54.29+1.9 años) fueron incluidos como grupo control. El grupo que consumía VE mostró valores de PT estadísticamente mayores que los controles (p=0.001) (14.3+0.23seg y 13.2+0.23seg respectivamente). Así mismo, los valores de PTT del grupo VE estuvieron estadísticamente por encima de los pacientes control (p<0.0001) (31.19+0.33seg y 28.69+0.18seg respectivamente). El presente estudio sugiere que el consumo contínuo de VE podría alterar los valores de PT y PTT en individuos sanos y por tal razón modificar el proceso de coagulación normal

Vitamin E (VE) is a fat-soluble vitamin that acts as an antioxidant and it has been associated to prolonged bleeding in healthy individuals. The aim of this study was to evaluate the effect of VE in haemostasis. 211 healthy individuals were included and separated into groups depending on the VE ingest. Epidemiological data, prothrombin time (PT) and activated partial thromboplastin time (PTT) were collected. Data was analysed using SPSS 13.0 and means compared by t student test. 114 individuals consuming VE regularly (75 women and 39 men, mean age 53.82+1.7 years) and 97 controls (55 women and 42 men, mean age 54.29+1.9 years) were evaluated. VE group showed PT values significantly higher (p=0.001) than controls (14.3+0.23sec and 13.2+0.23sec respectively), as well as statically augmented PTT times (p<0.0001) (31.19+0.33sec 28.69+0.18sec respectively). VE may alter PT and PTT values in healthy people and therefore modifies haemostasis

Efeito da suplementação de linhaça, óleo de canola e vitamina e na dieta sobre a oxidação dos ácidos graxos na gema dos ovos de galinhas poedeiras / Effect of supplementation of flaxseed, canola oil and vitamin e on diet in fatty acids oxidation of egg yolk laying hens

A presente pesquisa teve como objetivo estudar o efeito de fontes deácidos graxos poliinsaturados- óleo de canola e/ou semente de linhaça com diferentes concentrações de vitamina E suplementar sobre o teor de produtos de oxidação de ácidos graxos na gema de ovos de galinhas. Utilizou-se 288 galinhas da linhagem Babcock que receberam dietas com 6% de óleo de canola, 20% de semente de linhaça moída ou 3% de óleo de canola e 10% de semente de linhaça moída com teores de 0, 100 e 200 UI/kg de a-tocoferol, para análise estatística dos resultados empregou-se arranjo fatorial 3X3 em blocos casualizados.Os grupos que receberam óleo de canola tiveram menores concentrações de malonaldeído (menor oxidação) na gema dos ovos que aqueles alimentados com linhaça, em ovos crus sem armazenamento e nos cozidos após armazenamento. Os ovos crustiveram as menores concentrações de produtos de oxidação dos ácidos graxos. Os grupos de ovos cozidos, que receberam 100 e 200UI/kgde vitamina E na dieta, tiveram menores teores de malonaldeído na gema dos ovos que os grupos não suplementados.

To investigate the effect of dietary sources of polyunsaturated fattyacids - canola oil and flaxseed – with different vitamin E supplementation upon the fatty acids oxidation produtcts deposition into the eggs. 288 Babcock laying hens were used. Birds were fed diets containing 6% of canola oil, 20% of flaxseed or a combination of 3% of canola oil and 10% of flaxseed, enriched with 0,100 or 200 Ul of dl-a-tocopheril acetate, hens were randomly allocated and the experimental design was a 3X3 factorial arrangement. The inclusion of flaxseed into the diet increased the yolk polyun saturated fatty acids oxidation products, in crude and cooked stored eggs. The concentration of fatty acids oxidation products de crease in crude eggs in all sources of polyunsaturated fatty acids. The cooked eggs without a-tocopherol supplementation in the diet increase the concentration of oxidation products when compared with cooked eggs from diets with 100 or 200UI a-tocopherol in the diet.

Efeito da suplementação de linhaça, óleo de canola e vitamina E na dieta sobre as concentrações de ácidos graxos poliinsaturados em ovos de galinha / Effect of dietary supplementation of flaxseed, canola oil and vitamin E upon polyunsaturated fatty acids in chicken eggs

Estudou-se o efeito de diferentes fontes de ácidos graxos insaturados (óleo de canola e semente de linhaça), acrescidas de diferentes teores de alfa-tocoferol nas dietas de poedeiras, sobre a composição de ácidos graxos da gema do ovo foi estudado. Foram utilizadas 288 galinhas da linhagem Babcock que receberam dietas com 6 por cento de óleo de canola, 20 por cento de semente de linhaça moída ou 3 por cento de óleo de canola e 10 por cento de linhaça moída com teores de 0, 100 e 200UI/kg de alfa-tocoferol. As dietas com 20 por cento de semente de linhaça proporcionaram teores mais elevados de ácidos graxos poliinsaturados no ovo com aumento, em particular, dos teores de ácido alfa-linolênico e EPA (ácido eicosapentaenóico) e diminuição de ácido araquidônico na gema. Os teores de vitamina E contidos nas rações experimentais não determinaram alteração significativa na deposição dos diferentes ácidos graxos na gema dos ovos, exceto com relação aos ácidos graxos saturados.

The effect of dietary sources of polyunsaturated fatty acids - canola oil and flaxseed - with different vitamin E supplementation on the fatty acid deposition into the eggs of 288 Babcock laying hens was investigated. Birds were fed diets containing 6 percent of canola oil, 20 percent of flaxseed or a combination of 3 percent of canola oil and 10 percent of flaxseed, enriched with 0, 100 or 200Ul of dl-alpha-tocopheril acetate. The inclusion of flaxseed in the diets increased the yolk polyunsaturated fatty acids, mainly alpha-linolenic acid and EPA (eicosapentaenoic acid). The concentration of alpha-tocopherol in the diet did not change the egg yolk, fatty acids deposition but changed the saturated fatty acids deposition.

Comparison of two-month and four-month effect of vitamin E on cyclic Mastalgia

Cyclic mastalgia is a common cause of anxiety among women who visit health care centers. Due to some characters, the administration of proper drugs in treating of cyclic mastalgia is of prime importance. To compare the two-month and four-month effect of vitamin E on cyclic mastalgia in 20 years-old to premenopausal women. This was a double-blind randomized clinical trial performed on 150 women who visited three different clinics in Qazvin. The cases were divided into two study and control groups, each consisting of 75 women. Duration and intensity of pain was evaluated by visual analog scale [VAS] and breast pain chart. Daily vitamin E and placebo as chewing pills [200 IU] and for duration of 4 months were given to study and control groups, respectively. The cases were followed up for two and four months. Duration and intensity of pain and drug side-effect was evaluated afterward. The two-month and four-month administration of vitamin E and placebo caused a reduction in intensity of breast pain. But the four-month consumption of vitamin E in study group was more effective than in control group. The two-month and four-month intake of vitamin E and placebo caused a decrease in duration of breast pain. Again the four-month administration of vitamin E showed a greater effect in study group than in control group. It can be concluded that the administration of vitamin E for four months is an effective therapeutic protocol for cyclic mastalgia with no obvious side effects and could be considered as a suitable substitution for other types of treatment in case of cyclic mastalgia

Comparison of the effects of vitamin E and mefenamic acid on the severity of primary dysmenorrhea

Primary dysmenorrhea has relatively high incidence which can influence the well being and activities of the sufferers. An experimental cross-over study was designed to compare the effectiveness of vitamin E and mefenamic acid on reducing the severity of dysmenorrheal symptoms. Eighty six female medical students, aged between 18-26 who were suffering from primary dysmenorrhea were recruited. After having written consent they were divided into two groups of 43 individuals who received 500 units of vitamin E [2 tablets of 400 and 100 units] and 750mg mefenamic acid [250mg IDS] per day respectively. Treatment with vitamin E was started 2 days before the beginning of menstruation and continued until the first day of bleeding [3 days in total] and mefenamic acid was administered only during the first 48 hours of menstruation [only two days] Severity of pain, duration of bleeding, duration of menstruation and other symptoms such as diarrhea, secondary nausea, vomiting, vertigo, headache, legache, epigastric pain, pelvic pain before and after the treatment were recorded. Severity of pain was monitored by visual analogue scale [VAS] method on a visual scale. Monitoring was carried out for 2 consecutive cycles in both groups. Crossover was carried out and observation was continued for another 2 cycles. The result of this study indictate that both vitamin E and mefenamic acid could reduce the severity of pain similarly nevertheless but vitamin E consumption, complications such as digestive disorders such aspyrosis, stomach-ache, nausea and fatigue were significantly less compared to mefenamic acid. It appears that mefenamic acid could be replaced by vitamin E in reducing complications of dysmenorrhea

O paradoxo do papel da vitamina e na iniciação e progressão da aterosclerose e sua correlação com os radicais livres: [revisão] / The paradox of the role of vitamin e in the beginning and progression of atherosclerosis and its correlation with free radicals: [review]

O estresse oxidativo tem sido implicado na etiologia de diversas doenças crônicas, e se deve ao desequilíbrio entre as reações produtoras de radicais livres (particularmente espécies reativas de oxigênio - ROS) e a capacidade dos antioxidantes atuarem em mecanismos como scavenger. A vitamina E, na forma de alfa tocoferol, é um componente essencial do corpo, sendo o melhor antioxidante lipofílico biológico na defesa contra efeitos nocivos dos radicais livres. Diversos estudos epidemiológicos e ensaios clínicos indicam que uma elevada ingestão ou níveis plasmáticos elevados de vitamina E associam-se à redução dos riscos de doença cardiovascular (DCV). Porém, recentes investigações têm demonstrado que ela pode atuar também como pró-oxidante, contribuindo para o desenvolvimento da DCV através da geração de radicais lipídicos reativos. Os co-antioxidantes desempenham importante papel como parceiros do α-tocoferol na defesa contra os efeitos deletérios dos radicais livres.

The oxidative stress has been implicated in the etiology of several chronic diseases, and is related to the unbalance between the production of free radicals (particularly reactive oxygen species) and the scavenger capacity of the antioxidant mechanisms. Vitamin E, in a-tocopherol form, is an essential nutrient, being the best lipofilic biological antioxidant in the defense mechanism against the harmful effects of free radicals. Several epidemiological studies and clinic assays indicate that a high ingestion or elevated plasmatic levels of vitamin E are associated with the reduction of the cardiovascular risk. However, recent investigations have shown that it can aiso act as a pro-oxidant, contributing to the development of cardiovascular diseases through the formation of lipid reactive radicals. The co-antioxidants play an important role as partners of alfa-tocopherol in the defense against the hatmful effects of free radicais.

Effect of alpha-tocopherol on the ischemia/reperfusion lesions induced in the hindlimb of rats

Recentes estudos demonstraram que os radicais livres de oxigênio parecem desempenhar papel importante nas lesões de isquemia-reperfusão. O alfa-tocoferol(AT) age in vivo como um anti-oxidante. Nosso objetivo foi o de verificar se o AT atenuava as lesões de isquemia-reperfusão em pata direita de ratos. Os animais, randomizados, foram divididos nos seguintes grupos(G): G1-controle sem isquemia; G2 e G3 - quatro horas isquemia e duas reperfusão. Os animais do G2 foram tratados com salina e os do G3 com AT, 50mg/kg. Como parâmetros examinamos as alterações de volume e circunferência do pé direito ao longo do experimento, assim como a captação de 99mTc-pirofosfato e a microscopia eletrônica de transmissão do músculo soleus direito. Os aumentos de volume e circunferência do pé dos animais do G2 foram estatisticamente maiores quando comparados com o G1. As medidas do G3 não diferiram do G1. A captação de 99mTc-pirofosfato foi bem aumentada nos G2 e G3, quando comparados ao G1, porém sem diferenças entre os grupos isquêmicos. As lesões ao MET foram menos intensas em três animais do G3, quando comparados ao G2. Conclusão: O tratamento com AT diminuiu a formação do edema mas só protegeu parcialmente as células musculares contra as lesões de isquemia-reperfusão.

Spectrum of benign breast disorders in a university hospital.

In a period of 2 years, 234 cases of benign breast disorder were studied. Breast pain and modularity was the commonest group (70.1%) followed by fibroadenoma (17.5%). Cyclical mastalgia (61.5%) is more common than non-cyclical mastalgia (38.5%). The age of the patients with cyclical mastalgia was significantly lesser than patients with non-cyclical mastalgia. Cyclical mastalgia was seen only in premenopausal females while non-cyclical mastalgia was also seen in postmenopausal females. Treatment with vitamin E showed 41% response rate with minimal side-effects while treatment with danazol showed 72.1% response rate but was associated with side-effects in one third of the patients.

Parafinoma: a propósito de um caso / Paraffinoma: apropos of a case

Os autores apresentam caso de parafinoma em paciente masculino devido `a aplicaçäo hipodérmica de vitamina A e E em veículo oleoso vegetal a 20%, de uso veterinário em diferentes áreas do corpo