DOI
https://doi.org/10.18849/ve.v8i1.561Abstract
Question
In sea turtles presenting for cold-stunning (sustained hypothermia), what blood analytes routinely evaluated at intake provide the most prognostic value?
Clinical bottom line
Category of research question
Prognosis.
The number and type of study designs reviewed
Ten studies were included in this evaluation including the following study designs: eight retrospective case series, one cross-sectional, and one retrospective cohort.
Strength of evidence
Weak.
Outcomes reported
The most consistent finding across all included studies in cold-stunned sea turtles was acidosis (suspected both respiratory or metabolic components) characterised by reduced blood pH, elevated partial pressure of carbon dioxide (pCO2), and reduced partial pressure of oxygen (pO2). However, this finding was not necessarily linked with failure of rehabilitation. Rather, sea turtles presenting for cold-stunning that did not survive rehabilitative therapy were typically in extreme states of homeostatic derangement involving acidosis, but often in conjunction with additional abnormalities (e.g. anaemia, sepsis, organ failure or dysfunction, pneumonia, etc.).
Conclusion
As might be expected, the evaluated literature did not reveal a single or series of blood analytes that were definitively linked with the success or failure of rehabilitation in sea turtles presenting for cold-stunning. However, they did identify analytes that may provide the most clinical value in this clinical situation including packed cell volume (PCV), estimated white blood cell count (WBC), total and / or ionised calcium, pH, potassium (K), and lactate. Review of the available studies on the topic provides insightful information that can aid clinicians addressing this syndrome to triage and treat affected individuals most effectively. It also elucidated areas of opportunity for further research.
How to apply this evidence in practice
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
References
Anderson, E. T., Harms, C. A., Stringer, E. M. & Cluse, W. M. (2011). Evaluation of hematology and serum biochemistry of cold-stunned green sea turtles (Chelonia mydas) in North Carolina, USA. Journal of Zoo and Wildlife Medicine. 42(2), 247–255. DOI: https://doi.org/10.1638/2010-0217.1
Berkson, H. (1966). Physiological adjustments to prolonged diving in the Pacific green turtle (Chelonia mydas agassizii). Comparative Biochemistry and Physiology. 18(1), 101–119. DOI: https://doi.org/10.1016/0010-406X(66)90335-5
Carminati, C., Gerle E, Kiehn LL. & Pisciotta RP. (1994). Blood chemistry comparison of healthy vs. hypothermic juvenile Kemp’s ridley sea turtles (Lepidochelys kempii) in the New York Bight. Proceedings of the 14th Annual Workshop on Sea Turtle Conservation and Biology. 203–207.
Griffin, L. P., Griffin, C. R., Finn, J. T., Prescott, R. L., Faherty, M., Still, B. M., & Danylchuk, A. J. (2019). Warming seas increase cold-stunning events for Kemp’s ridley sea turtles in the northwest Atlantic. PLoS ONE. 14(1). DOI: https://doi.org/10.1371/journal.pone.0211503
Hunt, K. E., Innis, C. & Rolland, R. M. (2012). Corticosterone and thyroxine in cold-stunned Kemp’s ridley sea turtles (Lepidochelys kempii). Journal of Zoo and Wildlife Medicine. 43(3), 479–493. DOI: https://doi.org/10.1638/2011-0149R1.1
Innis, C. J., Tlusty, M., Merigo, C. & Weber, E. S. (2007). Metabolic and respiratory status of cold-stunned Kemp’s ridley sea turtles (Lepidochelys kempii). Journal of Comparative Physiology. B, Biochemical, Systemic, and Environmental Physiology. 177(6), 623–630. DOI: https://doi.org/10.1007/S00360-007-0160-9
Innis, C. J., Ravich, J. B., Tlusty, M. F., Hoge, M. S., Wunn, D. S., Boerner-Neville, L. B., Merigo, C. & Weber, E. S. (2009). Hematologic and plasma biochemical findings in cold-stunned Kemp’s ridley turtles: 176 cases (2001–2005). Journal of the American Veterinary Medical Association. 235(4), 426–432. DOI: https://doi.org/10.2460/javma.235.4.426
Innis, C. & Staggs, L. (2017). Cold-Stunning. In: C. Manire, T. Norton, B. Stacy, C. Innis, & C. Harms, eds., Sea Turtle Health & Rehabilitation. Plantation, FL: J. Ross, 675–687.
Innis, C. J. (2019). Medical management and rehabilitation of sea turtles. In: S. Divers & S. Stahl, eds., Mader’s Reptile and Amphibian Medicine and Surgery, 3rd ed. St. Louis, MO: Elsevier, 1382–1388.
Innis, C. J., McGowan, J. P. & Burgess, E. A. (2019). Cold-stunned loggerhead sea turtles (Caretta caretta): initial vs. convalescent physiologic status and physiologic findings sssociated with death. Journal of Herpetological Medicine and Surgery. 29(3–4), 105–112. DOI: https://doi.org/10.5818/19-06-204.1
Keller, K. A., Innis, C. J., Tlusty, M. F., Kennedy, A. E., Bean, S. B., Cavin, J. M. & Merigo, C. (2012). Metabolic and respiratory derangements associated with death in cold-stunned Kemp’s ridley turtles (Lepidochelys kempii): 32 cases (2005–2009). Journal of the American Veterinary Medical Association. 240(3), 317–323. DOI: https://doi.org/10.2460/JAVMA.240.3.317
Kohen, C. J., Hopper, K., Kass, P. H. & Epstein, S. E. (2018). Retrospective evaluation of the prognostic utility of plasma lactate concentration, base deficit, pH, and anion gap in canine and feline emergency patients. Journal of Veterinary Emergency and Critical Care. 28(1), 54–61. DOI: https://doi.org/10.1111/vec.12676
Kraus, D. R. & Jackson, D. C. (1980). Temperature effects on ventilation and acid-base balance of the green turtle. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 239(3), R254–R258. DOI: https://doi.org/10.1152/ajpregu.1980.239.3.R254
Lutz, P. L. & Bentley, T. B. (1985). Respiratory Physiology of Diving in the Sea Turtle. Copeia. 1985(3), 671. DOI: https://doi.org/10.2307/1444761
Lutz, P. L., Bergey, A. & Bergey, M. (1989). Effects of temperature on gas exchange and acid-base balance in the sea turtle Caretta caretta at rest and during routine activity. Journal of Experimental Biology. 144(1), 155–169. DOI: https://doi.org/10.1242/jeb.144.1.155
McNally, K. L. & Innis, C. J. (2020). Plasma biochemistry and hematologic values of cold-stunned loggerhead sea turtles (Caretta caretta). Journal of Herpetological Medicine and Surgery. 30(2), 88. DOI: https://doi.org/10.5818/19-08-209.1
Mones, A. B., Gruber, E. J., Harms, C. A., Lohmann, C. M. F., Lohmann, K. J. & Lewbart, G. A. (2021). Lactic acidosis induced by manual restraint for health evaluation and comparison of two point-of-care analyzers in healthy loggerhead sea turtles (Caretta caretta). Journal of Zoo and Wildlife Medicine. 52(4), 1195–1204. DOI: https://doi.org/10.1638/2021-0029
Moon, D. Y., MacKenzie, D. S. & Owens, D. W. (1997). Simulated hibernation of sea turtles in the laboratory: I. feeding, breathing frequency, blood pH, and blood gases. The Journal of Experimental Zoology. 278(6), 372–380.
Powell, A. L., Tuxbury, K. A., Cavin, J. M., Stacy, B. A., Frasca, S., Stacy, N. I., Brisson, J. O., Solano, M., Williams, S. R., McCarthy, R. J. & Innis, C. J. (2021). Osteomyelitis in cold-stunned Kemp’s ridley sea turtles (Lepidochelys kempii) hospitalized for rehabilitation: 25 cases (2008–2018). Journal of the American Veterinary Medical Association. 259(10), 1206–1216. DOI: https://doi.org/10.2460/JAVMA.20.08.0443
Rockwell, K. E., Innis, C. J., Merigo, C. & Prescott, R. (2017). The effect of delayed hospitalization in cold-stunned Kemp’s ridley turtles (Lepidochelys kempii). Journal of Herpetological Medicine and Surgery. 27(3), 93–96. DOI: https://doi.org/10.5818/17-05-114.1
Saint‐Pierre, L. M., Hopper, K. & Epstein, S. E. (2021). Retrospective evaluation of the prognostic utility of plasma lactate concentration and serial lactate measurements in dogs and cats presented to the emergency room (January 2012 – December 2016): 4863 cases. Journal of Veterinary Emergency and Critical Care. 32(1), 1–151. DOI: https://doi.org/10.1111/vec.13106
Stabenau, E. K., Heming, T. A. & Mitchell, J. F. (1991). Respiratory, acid-base and ionic status of Kemp’s ridley sea turtles (Lepidochelys kempi) subjected to trawling. Comparative Biochemistry and Physiology Part A: Physiology. 99(1–2), 107–111. DOI: https://doi.org/10.1016/0300-9629(91)90243-6
Stacy, N. I., Innis, C. J. & Hernandez, J. A. (2013). Development and evaluation of three mortality prediction indices for cold-stunned Kemp’s ridley sea turtles (Lepidochelys kempii). Conservation Physiology. 1(1). DOI: https://doi.org/10.1093/CONPHYS/COT003
Turnbull, B. S., Smith, C. R. & Stamper, A. M. (2000). Medical implications of hypothermia in threatened loggerhead (Caretta caretta) and endangered Kemp’s ridley (Lepidochelys kempi) and green (Chelonia mydas) sea turtles. Joint Conference of the American Association of Zoo Veterinarians and the International Association of Aquatic Animal Medicine. 31–35. [online]. Available from: https://www.vin.com/doc/?id=3864468 [Accessed 29 Nov 2021].
Wood, S. C., Gatz, R. N. & Glass, M. L. (1984). Oxygen transport in the green sea turtle. Journal of Comparative Physiology B. 154(3), 275–280. DOI: https://doi.org/10.1007/BF02464407
Wyneken, J., Mader, D. R., Weber, E. S. & Merigo, C. (2006). Medical care of sea turtles. In: D. Mader, ed., Reptile Medicine and Surgery, 2nd ed. St. Louis, MO: Elsevier, 972–1007.
Zacher, L. A., Berg, J., Shaw, S. P. & Kudej, R. K. (2010). Association between outcome and changes in plasma lactate concentration during presurgical treatment in dogs with gastric dilatation-volvulus: 64 cases (2002–2008). Journal of the American Veterinary Medical Association. 236(8), 892–897. DOI: https://doi.org/10.2460/javma.236.8.892
License
Copyright (c) 2023 McCaide Wooten
This work is licensed under a Creative Commons Attribution 4.0 International License.
Veterinary Evidence uses the Creative Commons copyright Creative Commons Attribution 4.0 International License. That means users are free to copy and redistribute the material in any medium or format. Remix, transform, and build upon the material for any purpose, even commercially - with the appropriate citation.
