Re:Dimox (acetazolamide)

Dear Anna:

The pouch kit is only useful in resulting cases of pouch bloat and pouch emphysema, which result from gas building up within the seahorses pouch. As the gas accumulates in its trapped within the marsupium, the seahorse becomes increasingly buoyant and the pouch becomes increasingly swollen and distended. In severe cases, this will be the seahorse floating like a cork at the top of the aquarium, unable to swim or feed normally.

In less severe cases, the seahorse will have to struggle mightily to stay submerged and cannot use its normal upright swimming posture. Rather, it may swim upside down or with its dorsal fin pointing towards the top of the tank, and the seahorse will be reluctant to release its grip on its hitching post because of the positive buoyancy.

Here are the instructions for using the pouch kit to perform an antibiotic pouch flush, if you feel confident that pouch gas is the problem in your case:

<Open quote>
Pouch Wash

The antibiotic pouch kit should be like a fire extinguisher in the kitchen and used only in an emergency and NEVER as a prophylactic. Please perform this procedure in a separate vessel so that the antibiotic wash does not flow into the holding tank. You may wish to trim the plastic tip of the syringe attachment to accommodate the orpheus of your seahorse. You can express the air in the pouch by gently inserting this tip into the opening.

PLEASE KEEP REFRIGERATED shake well before using

What you need to do:

First: Find someone to help you!

Second: Keep the head and gill area of the seahorse submerged at all times! You may cut the end of the tip to fit your needs.

Third: The Procedure should be preformed in a separate hospital tank where the antibiotic flush will not harm your biological filter:

*Have one person hold the seahorse upside down with the head in the water and his tail and abdomen out of the water. He may wrap his tail firmly around your finger. Insert the tip of the pipette into the opening in the pouch being careful not to insert it too far. (You may cut the end of the tip to fit your needs.)

*Gently massage out any air bubbles into the pipette.

*Remove the pipette and express the air bubbles from the pipette.

*Rinse the tip of the pipette with alcohol and let dry.

*Withdraw approximately 2 ml’s of pouch wash into the pipette. The quantity will actually vary according to the size of the males pouch. The extra large males can easily use 2 mls of pouch wash and the smaller males less than one.

*Reinsert the tip into the pouch and gently force the liquid into the pouch and then gently suck it out. Do this twice and then release the male into his tank.

*He may seem slightly stunned or shocked. Don’t panic! Simply turn off the lights and allow the male to rest. If you have any red shrimp he may enjoy them at this time.

*You may have to repeat this procedure again the following day.

*Return him to his normal diet of frozen mysis shrimp enriched with Vibrance the day after the procedure.

*You may email ocean rider with questions, or if you are a member of the Ocean Rider Club ask them for assistance. <Close quote>

In your case, you were unable to release any trapped gas by massaging or burping his pouch, and in the photograph you sent, his pouch does not appear to be bloated and swollen. It looks perfectly normal and flaccid except for a tiny portion at the uppermost part of the pouch near the flank of the seahorse, which appears just a bit puffy. If your stallion is having postural problems and swimming upside down, but it is not due to gas trapped within its pouch, then it is most likely likely due either to gas building up within its abdominal cavity (internal GBS) or to a hyperinflated swimbladder. (The pouch kit is not an appropriate treatment for either of these conditions, Anna.) When gas builds up within the coelom or abdominal cavity of the seahorse, the abdomen and thoracic area of the seahorse often become bloated. This was not evident in the photograph you sent, but it is most obvious when the seahorse is viewed head-on rather than from your profile view.

Treatment with the carbonic anhydrase inhibitor acetazolmide (brand name Diamox) is helpful in treating internal GBS and overinflated swim bladders due to GBS. As you know, the acetazolmide/Diamox can be administered either as a series of intramuscular injections, orally via feeder shrimp bioencapsulated with the medication, or as baths (prolonged immersion) in your hospital tank.

I will discuss all three methods for administering the Diamox below, Anna.

The suggested treatment regimen for acetazolmide injections is as follows:
Inject acetazolamide at a dosage of 2-3 mg/kg intradermally or
intramuscularly every five to seven days for up to three treatments.
For best results, add ceftazidime (Fortaz) injections to the
treatment regimen at a dosage of 22 mg/kg intramuscularly every 5-7
days, again for up to three treatments. (Ceftazidime is an antibiotic). If these drugs prove hard to find, the acetazolamide injections alone appear to be nearly as effective as the combination treatment.

In order to determine the proper dosage for the intramuscular injections, you need to be able to weigh the seahorses accurately, and you must obtain the injectable form of the medications (it is not feasible to prepare a solution of the medication using Diamox tablets).

Due to their bony exoskeleton, injections are particularly challenging with seahorses. Seahorses store their limited fat reserves primarily in their tail, which is the most muscular part of their body. The meaty part at the base of the tail is best suited for IM injections. If you attempt the intramuscular injections, I would suggest targeting the base of the tail just beneath the pouch using a ventral approach with a shallow angle of attack. The needle should be directed between the scutes/plate margins for ease of penetration through the skin. The external area can be rinsed with sterile saline or a drop of a triple antibiotic ophthalmic solution applied prior to needle penetration.

Acetazolamide can also be administered orally by injecting a solution
made from Diamox (the tablet form of acetazolamide) into feeder
shrimp or the tablets can be used to administer acetazolamide as a
7-10 day series of baths, as explained below:

Acetazolamide Baths (prolonged immersion)

The recommended dosage is 250 mg of acetazolamide per 10 gallons with a 100% water change daily, after which the treatment tank is retreated with the sole light at the dosage indicated above (Dr. Martin Belli, pers. com.). Continue these daily treatments and water changes for up to 7-10 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 7-10 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 affects 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 seahorse usually show improvement of the tail bubbles within three days. Dr. Martin Belli reports they nearly 100% success rate when this treatment regimen is followed for 7-10 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.

If you prefer, you can also administer the acetazolamide orally, providing your H. reidi is still eating, which will allow you to treat the affected seahorse in the main tank amidst familiar surroundings and in the company of its tankmates where it is the most comfortable. You get the acetazolamide into the food by preparing a solution of the medication, as described below, and then injecting it into live feeder shrimp or even the large Piscine Energetics frozen Mysis relicta. The medication is deactivated fairly quickly once you prepare the solution for injecting, so you must prepare a new acetazolamide solution each day during the treatment period. Here’s how to proceed:

Administering Acetazolamide Orally

I have found that acetazolamide is often more effective when it’s ingested and administering the medication orally allows you to treat the seahorse in the main tank where he’s most comfortable and relaxed.

If you can obtain a small syringe with a fine needle, the acetazolamide solution can simply be injected into feeder shrimp or even frozen Mysis. Mic Payne (Seahorse Sanctuary) used this method of administering acetazolamide successfully when he had recurring problems with GBD due to maintaining a population of Hippocampus subelongatus in shallow tanks only 16-inches (40 cm) deep:

"Seahorses maintained in this system are susceptible to gas bubble disease. Specimens with bubbles around the eyes or under the epidermis of the tail are readily treated with acetazolamide (Diamox tablets 250 mg). Mix a very small amount of crushed tablet with water and inject it into several glass shrimp that are then frozen. These are then fed to the target animal at the rate of two per day for four days. Bubbles disappear on the second day."

Hawaiian volcano shrimp or red feeder shrimp (Halocaridina rubra) work great for this. If a fine enough needle is used, they will survive a short while after being injected — long enough for their twitching and leg movements to attract the interest of the seahorse and trigger a feeding response.

Leslie Leddo reports that a 1/2 cc insulin syringe with a 26-gauge needle was ideal for injecting frozen Mysis or live red feeder shrimp. They plump up when injected and ~1/2 cc is about the most of the solution they can hold. There bodies will actually swell slightly as they are slowly injected and excess solution may start to leak out. The 26-gauge needle is fine enough that it does not kill the feeder shrimp outright; they survive long enough for the kicking of their legs and twitching to assure that they will be eaten.

Administering the Diamox orally in this way is the least stressful way to medicate the seahorse, so you may want to consider trying that first before you resort to the IM injections or Diamox baths.

While you are working to line up the Diamox, Anna, there are a couple of other things that you can do to provide your stallion with some immediate relief in the meantime. For example, gradually reducing the water temperature and lowering the salinity of the aquarium can minimize problems with pouch emphysema and other forms of gas bubble syndrome (GBS), and will also make the seahorse less buoyant, which will make it easier for him to swim and eat.

Gradually lowering the salinity or specific gravity is done as if performing a normal water change, except that the replacement water is simply treated tap or RO water without the salt (Don Carner, pers. com.). (If the replacement water is RO/DI or other softened source, then a buffering agent should be employed to prevent pH and alkalinity drops; Thiel, 2003.) Make sure the freshwater you add is thoroughly mixed with the remaining saltwater in the tank as you proceed. This will assure that your salinity/specific gravity readings are accurate. Monitor the lowering closely so as to not reduce it too fast. Achieving the desired specific gravity (1.015-1.017) over a period of several hours is fine (Don Carner, pers. com.). The bacteria colony in the biofilter will survive, the seahorses and fish will survive just fine, and your cleanup crew should also be unaffected (Don Carner, pers. com.).

CAUTION! When lowering the salinity or specific gravity in your seahorse tank, be very careful as you add the freshwater when you approach the target salinity. You do NOT want to overshoot the mark and drop the salinity too far! Seahorses tolerate low salinity very well up to a certain point, but they cannot withstand salinities below 13.3 ppt (specific gravity = 1.010) indefinitely. Salinities below 1.010 may be fatal to seahorses in a matter of days, if not hours. Just take care when the specific gravity in your seahorse tank is nearing the desired level of 1.015-1.017 and you should be in great shape. There is a big enough difference between a specific gravity of 1.015-1.017 and the dangerous level of 1.010 to provide a large margin for error and make this process very safe.

Once you have reduced the specific gravity in your seahorse tank to 1.015-1.017, you can maintain it at that level indefinitely thereafter. When it aquarium has had an outbreak of gas bubble syndrome, reducing the specific gravity to 1.015-1.017 has many benefits. It makes it easier for the seahorses to osmoregulate, increases the amount of dissolved oxygen the water can hold it makes it easier for the seahorses to breathe, helps eliminate protozoan parasites and ectoparasites in general, and helps to minimize problems with gas supersaturation and therefore GBS.

But if you should want to return the specific gravity in your seahorse tank to normal at some point for any reason, be sure to do so very gradually. In that case, when you are ready to return the system to normal salinity, simply reverse the process, remove some of the low salinity water in the aquarium and replace it with high salinity water. Take your time and raise the salinity slowly and gradually. Fish can become dehydrated if the salinity is increased too rapidly, so be methodical and raise the salinity over a period of several days. Don’t hesitate to take a full two weeks to return the specific gravity to normal levels again in small increments. The salinity can be reduced relatively rapidly very safely, but it must be raised again very gradually in order to avoid the risk of dehydration.

Best of luck treating your stallion and resulting his buoyancy problems, Anna!

Respectfully,
Pete Giwojna

Post edited by: Pete Giwojna, at: 2009/02/04 23:10

Post edited by: Pete Giwojna, at: 2009/02/04 23:13