Administration of 5% Human Serum Albumin in a Critically Ill Aldabra Tortoise (Aldabrachelys gigantea) with Hypoalbuminemia
Institute of Veterinary Clinical Science of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
A 10-year-old, male, captive Aldabra tortoise (Aldabrachelys gigantea) presented with decreased activity, appetite, and constipation for 3 months. Husbandry was considered non-optimal. Hematology, plasma biochemical analysis, and physical examination showed the tortoise was dehydrated. Radiographs demonstrated constipation. Initial treatment consisted of fluid therapy, enrofloxacin, metoclopramide, and husbandry improvements. After one week of treatment, the patient’s condition did not improve. Considering the difficulty and stress of force-feeding, we placed an esophagostomy tube under general anesthesia. Vomiting developed after feeding mineral oil through the tube. Subsequently, intraosseous placement of a 14-gauge catheter in the right tibia followed by infusion of partial parenteral nutrition was performed. In the following days, penile prolapse, hematochezia, and anemia developed. The swollen penis was amputated after failure of manual reduction. A blood transfusion was attempted to correct the anemia. However, hemolysis was noted after blood from the conspecific Aldabra tortoise used for the transfusion came into contact with the citrate anticoagulant1, which had never before been recorded. Moreover, radiography demonstrated accumulation of fluid in the coelomic cavity, indicating hypoproteinemia and low oncotic pressure. Using a treatment performed in small animal medicine patients with hypoproteinemia2,3, a commercially available 25% solution of human albumina was diluted to a 5% solution with 0.9% NaCl solution, and it was infused at a rate of 2 ml/kg/h for a total dose of 706 ml, which equaled a 10 ml/kg dose2,3. No obvious complications were noted during or after administration. The patient voided a large amount of urine the same day as human albumin administration, and within four days there was some resolution radiographically of the coelomic cavity fluid accumulation. The tortoise recovered gradually and uneventfully and continues to be asymptomatic for the last 7 months.
a. Commercially available 25% human albumin product (Albutein 25%), Grifols Biologicals Inc., Los Angeles, CA, USA
1. Martinho F. Indications and techniques for blood transfusion in birds. J Exot Pet Med. 2009;18(2):112–116.
2. Trow AV, EA Rozanski, AM deLaforcade, DL Chan. Evaluation of use of human albumin in critically ill dogs: 73 cases (2003–2006). J Am Vet Med Assoc. 2008;233:607–612.
3. Vigano E, L Perissinotto, VRF Bosco. Administration of 5% human serum albumin in critically ill small animal patients with hypoalbuminemia: 418 dogs and 170 cats (1994–2008). J Vet Emerg Crit Care. 2010;20(2):237–243.