*Salvage protocol for treating very sick fish*

[Humblefish]

Reposted with permission. @alprazo

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.

 

[Humblefish]

Another relevant post from @alprazo:

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.

 

[drstardust]

Soooo where does one get dexamethasone? lol

 

[Humblefish]

They used to sell it here: https://www.koinet.net/j/index.php/component/joodb/article/2-treatment-master/37-dexamethasone.html

But below looks like the same medication:

DEXAMETHASONE (Generic) Injectable Solution, 2 mg/mL, 100-mL multi-dose vial - Chewy.com

Buy Dexamethasone (Generic) Injectable Solution, 2 mg/mL, 100-mL multi-dose vial at Chewy.com. FREE shipping and the BEST customer service!

www.chewy.com

Dexamethasone for Animal Use Bimeda - Safe.Pharmacy|Inflammation and Pain | Livestock Rx | Farm

Free Shipping on most orders over $49. Great Low Price. Dexamethasone for Animal Use Bimeda Safe.Pharmacy|Inflammation and Pain | Livestock Rx | Farm

www.valleyvet.com

I personally wouldn't inject any higher than 1 mg/kg with fish. Not suitable for small fish IME.

 

[Humblefish]

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.

 

[drstardust]

Wow that's cool. I had no idea it was so accessible.

 

[Quicklynx]

Another relevant post from @alprazo:

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.

I never would've thought of Dexamethasone for fish, but it absolutely makes sense.

If I ever have to do this in the future I will take a video of it. I have 10 years experience as a Vet Tech and a few years as a RT, so I've stuck my fair share of all animals, including humans!

 

[futuretotm]

1-2 mg/kg is a pretty small dose.
Weighing the fish isn't a possibility.
The linked product contains 2mg per CC

So for a half Kg fish = ~one pound fish = 0.5-1mg indicated dose, and hence a 1/8 to 1/4cc of the 2mg/cc medication listed?

How much does a common size tang weigh?

 

[Humblefish]

@futuretotm It's impossible to be precise with small fish. I know a full sized Hippo Tang (12 inches) typically weighs around 20 ounces (500-600 grams). Intramuscular dexamethasone still has efficacy as low as 0.5mg/kg, so I would err on the side of caution.

 

[futuretotm]

@futuretotm It's impossible to be precise with small fish. I know a full sized Hippo Tang (12 inches) typically weighs around 20 ounces (500-600 grams). Intramuscular dexamethasone still has efficacy as low as 0.5mg/kg, so I would err on the side of caution.

Thank you as always.

 

[AndyR83]

Just curious, are any of the other common glucocorticoids (i.e. hydrocortisone, methylprednisone, etc.) acceptable for use in this setting? With human patients I tend to use several of these drugs interchangeably based on whichever one the pharmacy happens to have on hand on any given day (don’t get me started.) The dosing varies a bit from one drug to the next, but generally any of them will do the job equally well with only a few limited exceptions.

 

[Humblefish]

Just curious, are any of the other common glucocorticoids (i.e. hydrocortisone, methylprednisone, etc.) acceptable for use in this setting? With human patients I tend to use several of these drugs interchangeably based on whichever one the pharmacy happens to have on hand on any given day (don’t get me started.) The dosing varies a bit from one drug to the next, but generally any of them will do the job equally well with only a few limited exceptions.

How about triamcinolone?

Effect of exogenous corticosteroids on circulating virus and neutralizing antibodies in striped bass (Morone saxatilis) infected with infectious pancreatic necrosis virus - PubMed

Corticosteroids have been reported to induce immunosuppression in fish exposed to many types of bacterial antigens. We document a similar phenomenon in fish exposed to infectious pancreatic necrosis virus (IPNV). Fingerling striped bass that were injected with the steroid triamcinolone acetonide...

pubmed.ncbi.nlm.nih.gov

 

[blackstallion]

@Humblefish Currently my Sailfin and Purple Tang are battling Velvet in a QT. I started treating them on Monday evening with 2.0ppm Copper Power. Here is what the Sailfin looked like on Monday.

I performed a 5 minute FW dip on both just an hour ago to try and ease their suffering.

Here is a picture of the Sailfin now. Apart from the bad case of HLLE, is the redness due to his inflamed gills, or is it more likely an infection? I have Kanaplex and Furan-2 I can use but I haven't yet.

Since by the time I caught this, there were velvet spots all over them and in their gills, what are the odds that they'll pull through?

I am following your advice with bringing down the temperature, I have had it at around 78 as I thought this would speed up the parasites life cycle and make it die off quicker, but it seems logical that the lower temperate will hold more O2 in the water and slow the fish metabolic rate.

Any help would be greatly appreciated.

 

[Jessican]

@Humblefish Currently my Sailfin and Purple Tang are battling Velvet in a QT. I started treating them on Monday evening with 2.0ppm Copper Power. Here is what the Sailfin looked like on Monday.

View attachment 7661

I performed a 5 minute FW dip on both just an hour ago to try and ease their suffering.

Here is a picture of the Sailfin now. Apart from the bad case of HLLE, is the redness due to his inflamed gills, or is it more likely an infection? I have Kanaplex and Furan-2 I can use but I haven't yet.

Since by the time I caught this, there were velvet spots all over them and in their gills, what are the odds that they'll pull through?

I am following your advice with bringing down the temperature, I have had it at around 78 as I thought this would speed up the parasites life cycle and make it die off quicker, but it seems logical that the lower temperate will hold more O2 in the water and slow the fish metabolic rate.

Any help would be greatly appreciated.

View attachment 7662

Given that redness, it looks to me like you have both velvet and a bacterial infection at play here. You might want to read over this thread: https://humble.fish/community/index.php?threads/the-bacterial-infection-predicament.1330/

 

[AndyR83]

If that was my fish I’d do a H2O2 bath now as well. The appropriate concentration is 150ppm for 30 minutes. You can achieve this by adding 20ml of 3% H2O2 per gallon of bath water (another way of calculating the dose is 1.25ml per cup.)

This fish absolutely still has a chance! I’ve had them looking this bad or worse and end up surviving unscathed! We’re here to help

 

[Jessican]

If that was my fish I’d do a H2O2 bath now as well. The appropriate concentration is 150ppm for 30 minutes. You can achieve this by adding 20ml of 3% H2O2 per gallon of bath water (another way of calculating the dose is 1.25ml per cup.)

This fish absolutely still has a chance! I’ve had them looking this bad or worse and end up surviving unscathed! We’re here to help

The only reason I didn’t suggest a peroxide bath (because that’s totally my go-to) is because of the redness around the face. A peroxide bath may unfortunately be detrimental with open wounds like that.

 

[Humblefish]

Given that redness, it looks to me like you have both velvet and a bacterial infection at play here. You might want to read over this thread: https://humble.fish/community/index.php?threads/the-bacterial-infection-predicament.1330/

+1 A 90 minute bath using Ruby Reef Rally (1 teaspoon per gallon) would really help in this situation. It would a) Provide temporary relief for velvet b) Help with the secondary infection.

If that was my fish I’d do a H2O2 bath now as well.

The redness makes doing a H2O2 bath prohibitive.

 

[blackstallion]

+1 A 90 minute bath using Ruby Reef Rally (1 teaspoon per gallon) would really help in this situation. It would a) Provide temporary relief for velvet b) Help with the secondary infection.



The redness makes doing a H2O2 bath prohibitive.

Unfortunately, I do not have any Ruby Reef Rally on hand.

I can go ahead and order some, which wouldn't be here until probably mid week next week, which may be to late for these guys.

Is it not worth medicating with Kanaplex/Furan-2/Metro?

 

[Humblefish]

Is it not worth medicating with Kanaplex/Furan-2/Metro?

That may keep the infection at bay, but it won't completely clear until after the fish are out of copper. Copper is an immunosuppressant which hinders the fish from completely overcoming a bacterial infection.

 

[blackstallion]

That may keep the infection at bay, but it won't completely clear until after the fish are out of copper. Copper is an immunosuppressant which hinders the fish from completely overcoming a bacterial infection.

Understood regarding the infection not clearing until after the Copper is taken out.

How often would Ruby Reef Rally baths need to be administered during the 30 day Copper treatment?

And does this also mean if I'm using Kanaplex/Furan-2, it would need to be for the full 30 days as well?

Just trying to determine if it's worth ordering the Ruby Reef Rally and wait until next week instead of dosing Kanaplex/Furan-2 now.