In sea turtles presenting for cold-stunning (sustained hypothermia), what blood analytes routinely evaluated at intake provide the most prognostic value?

Abstract

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.