This is a rehabber and veterinary document
Metabolic bone disease is a medical emergency. If you are not a permitted rehabilitator, the right move is to get the squirrel to one. In West Tennessee, text 901-340-6534. This protocol is published so rehabbers and veterinarians can find it in a form a search engine can actually read, rather than buried in a PDF in a Facebook group.
What MBD is
Metabolic bone disease is what happens when a squirrel’s diet does not supply enough usable calcium relative to phosphorus. The body pulls calcium out of the skeleton to keep blood levels stable. Bones become brittle and the nervous system starts to fail.
It is overwhelmingly a diet disease, and it is almost always caused by well-meaning people feeding a squirrel nuts, seeds and corn. Those foods are high in phosphorus and low in calcium, and a squirrel raised on them looks perfectly healthy right up until it does not.
Symptoms
Weakness
Loss of appetite
Muscle pain
Lethargy
Paralysis, often starting in the hind limbs
Seizures
Without treatment and an immediate change of diet, MBD leads to death.
Emergency treatment: do this now
Get calcium into the squirrel immediately. Not later, not tomorrow. Delay causes death or permanent paralysis.
You need a calcium supplement, and Tums, Rolaids or any calcium pill will do for the first dose, plus a syringe or spoon.
Crush one pill and add a little water or fruit juice to make a toothpaste consistency. Carefully force-feed the mixture with a syringe or spoon. Some squirrels will simply eat the Tums tablet.
After that initial dose, give 100 mg every 4 hours. For smaller squirrels, meaning red squirrels, flying squirrels, or juveniles under 12 weeks, give 50 mg every 4 hours.
On day one, speed matters more than the type or exact amount of calcium. Going forward, most squirrels need around 500 mg per day, or 250 mg for flyers and small squirrels.
Use calcium carbonate, not calcium citrate
Long term, use plain calcium carbonate without vitamin D. It is available in powdered form on Amazon and at Petco, PetSmart, Tractor Supply, Walmart, Henry’s Pets and Chris’s Squirrels and More.
Do not use calcium citrate for treatment. It absorbs more readily, but it is only 21 percent calcium, so you have to use considerably more to hit the daily requirement.
When you read a label, what counts is elemental calcium. That is the number the dosing below refers to.
How to dose without fighting the squirrel
Force-feeding stresses an already sick animal. Mix the calcium into something it wants.
Calcium balls: mix 500 mg of calcium with half a teaspoon of peanut, almond or hazelnut butter and roll it into 5 little balls. Each ball contains 100 mg. Give one every four hours.
Calcium also mixes into formula, yogurt, baby food or fruit juice, which can be licked from a syringe or spoon. Expect to experiment.
What to watch for
Symptoms should improve within a few hours to a few days, and younger squirrels usually respond faster. If the squirrel is brighter but still paralysed, it may have a spinal injury from weakened bone.
Improvement is not a cure. Rebuilding skeletal calcium takes months.
Within 1 to 5 days the squirrel should be alert, active and eating, with no seizures or paralysis. If symptoms persist or it has ups and downs through the day, increase the dose or give smaller doses more often.
White feces, or a white film on dried urine, suggests you can reduce the dose. Smaller, more frequent doses absorb better and help with this.
Once the squirrel is eating Henry’s blocks or homemade vitamin blocks, cut the calcium dose in half. The blocks contain calcium too.
Supportive care
MBD bones break easily. Pad the bottom of the cage and keep the squirrel away from anywhere it can climb and jump from.
Heat is soothing. A heating pad on low, positioned where the squirrel cannot chew the pad or cord, or a rice buddy, which is a sock of dry rice or beans microwaved about 20 seconds.
Fix the diet, or none of this holds
Remove ALL seeds, nuts, corn and treats, including hidden stashes.
The squirrel must eat vitamin blocks every day: 2 Henry’s Healthy Blocks, homemade vitamin blocks, or a small handful of rodent blocks.
High-oxalate vegetables bind calcium and should be limited. Building the diet around a favourable calcium-to-phosphorus ratio is the whole game.
The tapering schedule
Starting on day two, most squirrels begin at 500 mg elemental calcium per day, or 250 mg for flyers and small species, divided into 5 doses given every 4 hours. Keep notes on what you give so you can adjust.
Once the squirrel is stable for 2 weeks and eating blocks daily, reduce the total daily calcium by 50 mg. Continue reducing every 2 weeks. Each stage below is 2 Henry’s or homemade vitamin blocks per day plus 5 calcium balls, one every four hours.
Weeks 1–2 — 500 mg total per day, 100 mg per ball
Weeks 3–4 — 450 mg total, 90 mg per ball
Weeks 5–6 — 400 mg total, 80 mg per ball
Weeks 7–8 — 350 mg total, 70 mg per ball
Weeks 9–10 — 300 mg total, 60 mg per ball
Weeks 11–12 — 250 mg total, 50 mg per ball
Weeks 13–14 — 200 mg total, 40 mg per ball
Weeks 15–16 — 150 mg total, 30 mg per ball
Weeks 17–18 — 100 mg total, 20 mg per ball
Week 19 — 50 mg total, 10 mg per ball
Give all 5 balls every day, one every 4 hours, for at least 8 weeks. A workable daily schedule is 6am, 10am, 2pm, 6pm and 10pm.
After the 8th week you may choose to stop the calcium balls, but you must continue the blocks and a correct diet. MBD can recur.
Relapse
If symptoms return at any point, give an emergency 100 mg dose and go back to a higher daily dose for 2 weeks. Be cautious with reductions and watch closely. Relapses are serious and often fatal.
This is a standardised protocol that will get most cases moving in the right direction. Individual squirrels differ by age, severity and other factors, and it is best to work alongside someone experienced with MBD when adjusting.
Credit
This protocol is adapted, with permission, from materials created by Danielle Bourgeois and the Squirrel Rescue Network / Squirrels Resource & Network. We are publishing it as a readable web page rather than a PDF so that rehabbers, veterinarians and search engines can actually find it.
Questions
Text 901-340-6534. Out of the Woods Wildlife Rescue & Rehab is a TWRA-permitted wildlife rehabilitation nonprofit in Memphis, Tennessee.