Slow Bolus Administration of Parenteral Nutrition to Chronic Debilitated Sea Turtles
Chronic Debilitation Syndrome (CDS) is a fairly common condition observed in several species of sea turtles. It is a multifactorial condition that may be initiated by any number of problems, but the results are turtles with multiple organ dysfunction/failure. Upon admission, most of these turtles are extremely emaciated, cachexic, severely anemic, hypoglycemic, hypocalcemic, and most of the calcium has been eliminated from their shells, leaving the shells very soft and fragile. Specifically in loggerhead sea turtles, the intestinal tract is usually impacted with shells and has severe pathology of the stomach, small intestines, and especially the colon. Spirorchiids and nematodes are usually seen in large numbers, with the spirorchiids being in multiple organs, but primarily in the GI tract. Often these turtles will eat soon after admission, but digestion in many does not occur, with ingesta passing through and exiting with the same appearance as when it was ingested. In these animals, inanition worsens even though the animal may be consuming food orally. Total parenteral nutrition (TPN) is utilized in humans and other animals to provide intravenous nutrition. TPN is usually administered slowly via an indwelling catheter, which would require sea turtles to undergo general anesthesia (unnecessary for comatose turtles, but these were not) and the animals be kept out of water (dry-docked) for several weeks.1,2 Because of the very fragile condition of CDS loggerheads, it is felt that general anesthesia and dry-docking were not options. An alternate method of administration had to be found. By administering TPN intravenously through a needle, it was determined that turtles of 15–30 kg could tolerate a flow rate of 2.5–3 ml/kg body weight/h. Treatments of 60 ml TPN twice daily (each liter contained 48 g amino acid [Travasol], 13.5 g dextrose, and 40 g lipids [Intralipid]) have shown to be safe and effective in the small number of patients in which it has been utilized. To this point, treatments have been limited to a maximum of 60 ml per session. During treatment, the turtle must be monitored continuously to avoid extravascular administration, but most patients needing this are so lethargic that it seldom causes problems until the patient improves. With these ingredients, the refrigerated shelf life is 14 days, but without the lipids, it can be stored refrigerated for 30 days. We have now used this method in three species successfully (loggerhead [Caretta caretta], Kemp's ridley [Lepidochelys kempii], and olive ridley [Lepidochelys olivacea]). It has been suggested that intravenous use of TPN containing lipids might be helpful in cases of intoxications in sea turtles, such as brevetoxicosis, and lethargic loggerhead syndrome. This type of administration may be useful for those and other conditions, and offers an alternative to administration through an indwelling catheter.
The authors thank Randy Breton, RPh, and Infuserve America for donating TPN for the treatment of these turtles. The authors also thank the staff and volunteers at Loggerhead Marinelife Center for their assistance in the rehabilitation of these turtles.
* Presenting author
1. Cassle SE, O'Neil D, Walsh MT. Use of an indwelling venous catheter for rehabilitation in a loggerhead sea turtle (Caretta caretta). In: Proceedings from the 43rd Annual IAAAM Conference; May 12–16, 2012; Atlanta, GA, USA; pp. 57–58.
2. Cassle SE, O'Neil D, Walsh MT. 2012. Nutritional support for rehabilitation in a lethargic loggerhead sea turtle (Caretta caretta). In: Proceedings from the 43rd Annual IAAAM Conference; May 12–16, 2012; Atlanta, GA, USA; pp. 98–99.