Dear Vicki:

Pete Giwojna

Dear Vicki:

I’m very sorry to hear about the problem your female has developed with positive buoyancy. The positive buoyancy and the large external gas bubble she has developed near her anal area are both indications of gas bubble syndrome (GBS), and Diamox (brand-name acetazolamide) is indeed the appropriate treatment for this problem, just as you said. (Metronidazole will not be useful in this case, Vicki.)

If you can describe the external gas bubble your female has developed in her anal area in more detail – the size, coloration, transparency, and exact location of the subcutaneous emphysema – that would also be helpful, Vicki.

But in the meantime, let’s discuss how to obtain the acetazolamide and use it properly to treat this problem in more detail.

Unfortunately, obtaining Diamox (the tablet form of acetazolamide) can often be a Catch-22 situation for hobbyists. It is a prescription drug often used for treating glaucoma, hydrocephaly, epilepsy, congestive heart failure, and altitude sickness in humans so you have to get it from your Vet or perhaps your family doctor. Regrettably, Veterinarians are often unfamiliar with using Diamox to treat gas bubble syndrome in seahorses — it is sometimes used by vets to treat glaucoma and cats or dogs or as a diuretic to treat certain conditions in horses (the four-legged kind), but your veterinarian will probably never have heard of gas bubble disease or treating it with carbonic anhydrase inhibitors. Many pet owners are on very good terms with their Vets, who are accustomed to prescribing medications for animals, so it’s often best to approach your Vet first about obtaining Diamox despite the fact they may never have heard of it until you brought it to their attention. Your family doctor, of course, will be familiar with such medications and have Diamox on hand but it can sometimes be difficult to get your MD to jump that final hurdle and prescribe it for a pet. Either way, it can be tough to get the medication you need under these circumstances.

However, I would always exhaust those possibilities first before I considered an alternative source for the Diamox. Do a search for “carbonic anhydrase inhibitor” on the “Seahorse Life and Care” discussion forum on the Ocean Rider website (, and print out some of the detailed information that’s been posted regarding gas bubble disease and how it’s treated using Diamox and present that to your family veterinarian and/or your family practitioner. Bring photographs of your seahorse with the positive buoyancy problem and be prepared to bring the seahorse in for a visit, if necessary. (Veterinarians are prohibited by law from prescribing medications to treat an animal they have not personally seen and examined. If you have had a close personal relationship with your vet over a period of years, they are often willing to bend that rule in the case of fish, but you may well have to bring the ailing seahorse in for a quick checkup to get the desired results.)

If your veterinarian is unfamiliar with Diamox, Vicki, then I would recommend ordering the medication from Drs. Foster’s and Smith at the following URL, in which case Pet Pharmacy will then contact your vet for you in order to obtain the necessary prescription authorization:

Once you have obtained the acetazolamide (brand name Diamox), it is very effective in treating subcutaneous emphysema or external bubbles when it is administered as a 4-8 day series of baths, as explained below:

Acetazolamide Baths (prolonged immersion)

The recommended dosage is 250 mg of acetazolamide per 10 gallons (25 mg/gallon) with a 100% water change daily, after which the treatment tank is retreated with the acetazolamide at the dosage indicated above (Dr. Martin Belli, pers. com.). Continue these daily treatments and water changes for a minimum of 4 consecutive days (stubborn cases may need to be continued for twice as long, or up to 8 days) for best results (Dr. Martin Belli, pers. com.).

The acetazolamide baths should be administered in a hospital ward or quarantine tank. Acetazolamide does not appear to adversely affect biofiltration or invertebrates, but it should not be used in the main tank because it could be harmful to inhibit the enzymatic activity of healthy seahorses.

Using the tablet form of acetazolamide (250 mg), crush the required amount to a very fine powder and dissolve it thoroughly in a cup or two of saltwater. There will usually be a slight residue that will not dissolve in saltwater at the normal alkaline pH (8.0-8.4) of seawater (Warland, 2002). That’s perfectly normal. Just add the solution to your hospital tank, minus the residue, of course, at the recommended dosage:

Place the affected seahorse in the treatment tank as soon as first dose of medication has been added. After 24 hours, perform a 100% water change in the hospital tank using premixed water that you’ve carefully aerated and adjusted to be same temperature, pH and salinity. Add a second dose of newly mixed acetazolamide at the same dosage and reintroduce the ailing seahorse to the treatment tank. After a further 24 hours, do another 100% water change and repeat the entire procedure until a total of up to 4-8 treatments have been given. About 24 hours after the final dose of acetazolamide has been added to the newly changed saltwater, the medication will have lost its effectiveness and the patient can be returned directly to the main seahorse tank to speed its recovery along.

One of the side effects of acetazolamide baths is loss of appetite. Try to keep the affected seahorse eating by plying it with its favorite live foods during and after treatment, until it has fully recovered.

The affected seahorse typically show improvement of the external bubbles within three days, in which case the four-day series of Diamox baths will resolve the situation. Dr. Martin Belli reports they nearly 100% success rate treating subcutaneous emphysema when this treatment regimen is followed for 4-8 days, and most cases clear up in less than a week. For best results, the Diamox should be used in conjunction with a good broad-spectrum antibiotic to help prevent secondary infections. A good aminoglycoside antibiotic such as kanamycin or neomycin would work well for this.

Best of luck obtaining the Diamox you will need to resolve your female’s buoyancy problem once and for all, Vicki. Hopefully, it will also resolve the external bubbles she has developed near her anal area at the same time. If not, let me know right away since there are a couple of other treatment options we can try if the Diamox is not effective in your case.

Pete Giwojna, Ocean Rider Tech Support

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