alprazo's "salvage protocol"

[Humblefish]

Reposted with permission.

Salvage protocol for very sick fish.

Almost daily I read a post from someone describing a fish sick from either ich or velvet and can predict that it will not make it to the morning.

There are several techniques that can be employed to reduce the metabolic demands on the fish, reduce stress, decrease the damage from its immune response and possibly keep the fish alive until you are able to eradicate the parasite.

1. Decrease the temperature to 72F for most tropical fish.

2. Decrease the salinity to 1.017 or lower

3. Increase the oxygen saturation to greater than 150% by the addition of pure O2.

4. Turn the lights off

5. Intramuscular injection of dexamethasone at 0.5 mg/kg

Though I have never used all of these techniques together, I have used them all and have been surprised to find that fish swimming the following morning. These are recommendations and should be adjusted to the situation.

 

[RMS18]

Gotta change your name to Dr. Sickfish

 

[Humblefish]

Wanted to add a recent post from alprazo to this thread:

I just wanted to comment on velvet. It has an ability to infect like no other, the lethality is extremely high and the course is surprisingly fast. It probably has caused more people to leave the hobby than any other disease with total wipe outs within days of exposure. Often it is too late once you even think your fish may have it. That said, with practice and experimentation, I have learned how to save many fish from even late stages of it disease.

Velvet kills like ich, another other single celled parasite, by causing inflammation and eventually edema (swelling) of gills. The thickened gill inhibits oxygen exchange. The fish breathes faster and harder in an attempt to increase the exchange, but in doing so, metabolism increases as fish demands more oxygen. This viscous cycle ends by the fish fatiguing and finally suffocating or having a heart attack due to lack of oxygen and tremendous cardiac strain.

Several steps can be taken to break this cycle and salvage the fish.

First it is important to decrease metabolic demand and this can be done by:

- Decreasing the temperature - I shoot for 70 or lower over several hours.
- Decreasing the Specific Gravity to 1.015 (can be done immediately)

Next you want to increase the oxygen saturation in the water. This will promote better exchange. I aim for a 200% dissolved oxygen level with my YSI DO meter. (Measurement is not 100% necessary).

- Pure oxygen is easily bought from either a welding supply store or a medical supply house. Oxygen is cheap and useful for several applications like power outages and transporting. You also want an airstone that produces a superfine bubble. They are typically made for pure gas and have warnings about using air.
- Temperature reduction - This not only reduces metabolism in the fish, but it will also increase the waters capacity to carry dissolved oxygen.


Edema reduction: Steroids


Just like giving a shot in the knee - it helps to reduce the swelling.


- Intramuscular dexamethasone with an estimated dose of 1-2 mg/kg into the muscle on the side of the dorsal ridge. (impossible to be precise in small fish)

I sounds difficult but it is not. A tuberculin syringe with a 27 gauge needle to draw up the solution and a 30 gauge needle to inject.


Following the above protocol, I have witnessed more than a couple of fish recover from assured demise.

I also recommend treating with chloroquine. Formalin unfortunately is an irritant and theoretically could worsen the gill edema.

BTW - the same protocol can be use with ICH.

 

[omykiss001]

This thread feels like a sticky to me. Great info especially the temp reduction and oxygen saturation. I'm almost positive this is why I lost my PBT from ich. I only dropped to 74 as did not know tolerance for lower. I may have dedicated O2 tank and regulator might be a bit spendy for hopefully the rare time you'd need it. Otherwise great info.

 

[Humblefish]

This thread feels like a sticky to me. Great info especially the temp reduction and oxygen saturation. I'm almost positive this is why I lost my PBT from ich. I only dropped to 74 as did not know tolerance for lower. I may have dedicated O2 tank and regulator might be a bit spendy for hopefully the rare time you'd need it. Otherwise great info.

The problem is there are already too many stickies in the fish disease forum. I wonder if there's a way to organize them better into folders? @revhtree

 

[Humblefish]

Went ahead and made this thread a sticky. If you are dealing with marine velvet disease, the information contained here and also in this thread is the best chance to save your fishes lives: https://www.reef2reef.com/threads/defeating-marine-velvet-disease.217570/

 

[MarsRover]

Just now reading this and I would like to put out a warning about using pure (or even nearly 100%) O2 gas.

Many people think that because any old joe or jane can go pick up a bottle of O2, or because it is in nearly every medical office, that it is inherently safe. This is not true.

Pretty much everything ignites easily in pure O2 gas. When picking this up from a welding or medical supply place, make sure you also pick up the assorted accoutrement required to get the O2 to your air stone and don't leave this stuff running when you're not home! A small leak in airline tubing, plus a teeny tiny arc can equal fiery death by explosion. Remember, certain materials nearly spontaneously ignite in the presence of pure O2...

Also folks, please don't leave O2 cylinders in your hot cars/garages/in the sun....i've seen this way to many times....

Recall the early Apollo Missions... please be careful.

I know we all love our pets, and we all would probably run into a burning house to save them if we could, but they are not worth the death of yourself or family (or neighbors for that matter) due to careless handling of O2 cylinders.

Tons of info about dangers and the safe handling of O2 can be found online. One decent example: http://www.airproducts.com/~/media/files/pdf/company/safetygram-33.pdf

 

[Manthanol]

I know this is an old post but after reading alprazo's thread above I was wondering where would be the best muscle location on a fish to give the Dexamethasone IM injection? Like in humans we get injection in the gluts, delts, quads etc. I would like to incorporate injections in future treatments.

 

[Seawitch]

Reposted with permission.

Salvage protocol for very sick fish.

This information from @alprazo is fantastic and contains information that I've never seen before. Is alprazo a scientist?

 

[Seawitch]

I know this is an old post but after reading alprazo's thread above I was wondering where would be the best muscle location on a fish to give the Dexamethasone IM injection? Like in humans we get injection in the gluts, delts, quads etc. I would like to incorporate injections in future treatments.

Fish intramuscular (IM) injections are often given up high on the back to the side of the dorsal fin. That way you don't risk hitting any major organs if you angle the needle toward the head or toward the tail.

 

[Manthanol]

Fish intramuscular (IM) injections are often given up high on the back to the side of the dorsal fin. That way you don't risk hitting any major organs if you angle the needle toward the head or toward the tail.

Thanks for the info Seawitch, I'd guessed that would the best area but didn't know for sure. It's always good to be certain before sticking the needle in. I have experience injecting mice and other lab animals but never fish. Do you know of any research articles describing IM dose per fish body weight?

 

[Seawitch]

Thanks for the info Seawitch, I'd guessed that would the best area but didn't know for sure. It's always good to be certain before sticking the needle in. I have experience injecting mice and other lab animals but never fish. Do you know of any research articles describing IM dose per fish body weight?

@Humblefish said in the earlier post, "- Intramuscular dexamethasone with an estimated dose of 1-2 mg/kg into the muscle on the side of the dorsal ridge. (impossible to be precise in small fish)". Obviously this is going to be extremely difficult to dose in small fish, and you'd need to weigh the fish on a pretty precise and accurate scale. You're also going to need a super small syringe and super small needle. I'm going to discuss this with my vet, who is happy to help. I have experience with injecting cats and dogs. I have three special-needs dogs.

I mean 1 teaspoon of water is about 5ml or about 5 grams of water. 5 grams of water is about 100 drops. So 1 gram is about 20 drops. Imagine trying to dose a gobie.

 

[Deltatail14]

I don’t know if this will help but I’ve seen a video from king of DIY on YouTube and he made O2 from a piece of potato in a bottle of hydrogen peroxide and he put a airline through the lid. This might be a good replacement for those who can’t get an o2tank.

 

[Victoria M]

I don’t know if this will help but I’ve seen a video from king of DIY on YouTube and he made O2 from a piece of potato in a bottle of hydrogen peroxide and he put a airline through the lid. This might be a good replacement for those who can’t get an o2tank.

Is this for real? That is crazy!

 

[Victoria M]

How on earth do you figure out how much dexamethasone to give a fish...

 

[Lasse]

Two things with pure oxygen use. Never, ever use any oils or oiled tools together with pure oxygen.
200 % saturation can cause bubble disease if it makes the nitrogen being supersaturated even in low percent like 101 % saturation of N2

Sincerely Lasse

 

[alabella1]

Two things with pure oxygen use. Never, ever use any oils or oiled tools together with pure oxygen.
200 % saturation can cause bubble disease if it makes the nitrogen being supersaturated even in low percent like 101 % saturation of N2

Sincerely Lasse

What does bubble disease look like? I am using a fluval air pump with 2x of those suction cup plastic bubblers, not true airstones I don't think. Should I change this at all? My tangs in QT are swimming on sides, losing color, not eating.

 

[Lasse]

Here is maybe the best description I have read

Sincerely Lasse