Abstract
Nutritional support for critically ill patients is paramount to any rehabilitation program. Debilitated sea turtles, including animals described by the lethargic loggerhead syndrome are no exception. Several techniques have been described to provide nutritional support. These range from fluid supplementation, use of the alimentary tract with force feeding (e.g., fish gruel) or surgical options for the placement of feeding tubes (e.g., esophagostomy tubes). These methods may not provide enough nutritional support and may present an increased risk to the patient from aspiration of food items placed in the esophagus when gastrointestinal motility is decreased. As a result, nutritional support of non-responsive depressed loggerhead sea turtles is a continual challenge for the clinician. An alternative method to supply nutritional support is through intravenous access and total parenteral nutrition (TPN). This method is commonly utilized in humans, as well as domestic small and large animal practices; however, the use of TPN in aquatic species has not been described. In the case of TPN therapy, there are at least three considerations; long term venous access, formulation of the nutritional supplement and 24 hour supportive care to the patient. This presentation looks at the placement of a long term indwelling intravenous catheter to deliver total parenteral nutrition (TPN). Through formulation of a diet with increasing levels of amino acids and fatty acids, clinicians were able to supply the nutritional requirements for a total of 12 days in a debilitated loggerhead turtle. As with any innovative technique, complications can arise. These include thrombus formation at the site of catheter placement, infections and displacement of the indwelling catheter as a result of patient activity. However, with careful monitoring of the patient and the use of readily available drug delivery products, this method of nutritional support can be successfully employed.
Acknowledgements
The authors wish to thank Infuserve America, Largo, Florida for donation of parenteral nutrition supplies and the University of Florida, College of Veterinary Medicine for financial support.
References
1. Clore E, et al. Retrospective evaluation of parenteral nutrition in alpacas: 22 cases (2002–2008). J Vet Intern Med. 2001;25:598–604.
2. Di Bello A, et al. Ultrasound-guided vascular catheterization in loggerhead sea turtles (Caretta caretta). J Zoo Wildlife Med. 2010;41(3):516–518.
3. Gillnaders L, et al. A prospective study of catheter-related complications in HPN patients. Clin Nutr. 2011.
4. Krause J, McKenzie, H. Parenteral nutrition in foals: a retrospective study of 45 cases (2000–2004). Equine Vet J. 2007;39(1):74–78.
5. Norton T, Walsh M. Sea turtle rehabilitation. Zoo and Wild Animal Medicine. St. Louis, MO: Elsevier Saunders; 2012.
6. Whitaker B, Krum H. Medical management of sea turtles in aquaria. Zoo and Wild Animal Medicine, Current Therapy 4. Philadelphia, PA: WB Saunders Co.; 1999:217–231.
7. Wyneken J, et al. Medical care of sea turtles. Reptile Medicine and Surgery. St. Louis, MO: Saunders Elsevier; 2006.