ISTS Symposium43 Program/Agenda

INTRODUCTION: The health status of endangered sea turtles in the Kingdom of Saudi Arabia (KSA) is unknown as no clinical or health studies have been performed on these populations. SHAMS has established the first marine animal hospital in KSA in collaboration with KAUST to provide specialized medical treatment to debilitated sea turtles from the Saudi Red Sea in a university-level, teaching hospital environment. Insights into the health status of these species can reveal stressors that are not available by other monitoring and assessment techniques and can add valuable guidance in designing conservation measures in this critically vulnerable region. METHODS: Between 3 June and 20 November 2024, 27 sea turtles were admitted to the SHAMS/KAUST Center for Veterinary Care. Full clinical examinations (physical, morphometric, neurological, cardiopulmonary, bloodwork, gut microbiome, proteomic and imaging studies) were performed on each animal upon admission, and weekly until release. Analytes included CBC with Manual Differentiation, PCV, Total Solids, Glucose, Symmetric Dimethylarginine, Creatinine, Blood Urea Nitrogen, Uric Acid, Phosphorus, Calcium, Total Protein, Albumin, Globulin, Albumin:Globulin, Alkaline Phosphatase, Aspartate Aminotransferase, Gamma-Glutamyl Transferase, Beta Hydroxybutyrate, Total Bilirubin, Cholesterol, Amylase, Lipase, C-reactive Protein, Calgranulin MRP-126, Serum Amyloid A, Heat Shock Protein 70, Haptoglobulin, and C1q-like Protein. Imaging included ultrasonic and radiographic studies where indicated. Medical therapies, including antimicrobial, nutritional, regenerative (stem cell and platelet rich plasma), intensive (total parenteral nutrition, nebulization), integrative (acupuncture) and surgical therapies, including entero- and coelmocenteses, blood pleurodesis and fracture repair, were performed where indicated. Targeted External Weight Therapy and Behavioral Modification Therapy were administered to buoyant animals. RESULTS: 20 hawksbills (1 adult, 2 subadults, 17 juveniles; 6 males, 14 females) and seven greens (2 adults, 2 subadults, 3 juveniles; 2 males, 5 females) were admitted during the reported interval. Ninety-three percent (25/27) presented with Chronic Debilitation Syndrome (CDS), 63% (17/27) with Buoyancy Syndrome (BS), 4% (1/27) with blunt force trauma and 7% (2/27) and decompression sickness (DCS). Sixteen were successfully released (60%) and 4 deceased (16%), with an average length of hospital stay of 3.5 months. Seven are currently under care. Among the CDS and BS patients, clinical biochemical and hematological analytes revealed marked hyperuricemia, hypoproteinemia, anemia, heterophilia with toxicity, eosinophilia with toxicity, monocytosis, elevated BHB, elevated acute phase and heat shock proteins. Imaging studies in these two groups revealed mild to severe renal, enteric, and pulmonary disease. Two patients (blunt force trauma and DCS) displayed severe neurological derangements. Body condition index was normal in 80% of patients (20/25). Gut microbiome evaluation is pending. CONCLUSIONS: Profound physiologic stressors and clinical evidence of renal, enteric, and pulmonary disease were evident in most admitted patients, independent of life stage and species. Determining the causes of CDS and BS in Saudi waters requires further investigation. Acute phase and heat shock proteomic analyses revealed both clinical and subclinical markers of health deterioration, which may provide useful in identifying habitat contributions to overall health in this region and serve as clinical surveillance tools. This report represents the first comprehensive clinical assessment of sea turtles in the Middle East.

All seven sea turtle species face conservation challenges, with three classified as Critically Endangered and three as Endangered. Rescue and rehabilitation centres are critical to conservation efforts, offering medical treatment, nutritional support, environmental enrichment and eventual re-introduction and release back into the wild. However, the role of environmental enrichment in accelerating sea turtle recovery remains underexplored.

This study aimed to assess the potential of various types of enrichment—cognitive, feeding, social, physical, sensory, and structural—as a tool to improve recovery outcomes for juvenile and sub-adult Green Sea Turtles (Chelonia mydas) undergoing rehabilitation. Behavioural observations, morphometric data, and physiological indicators (blood glucose and haematocrit levels) were collected and analysed to evaluate the impact of enrichment.

Results indicated that enrichment significantly influenced species-specific behaviours, promoting exploratory swimming and diving while reducing negative stereotypic behaviours, such as repetitive pattern swimming and habituation. Morphometric changes and physiological improvements observed over time reflected both the benefits of enrichment and overall health gains associated with prolonged rehabilitation. These findings highlight the potential of enrichment to improve not only physical health but also psychological well-being, facilitating a more comprehensive approach to sea turtle recovery.

As conservation programmes increasingly emphasize holistic care, incorporating structured enrichment strategies could enhance rehabilitation outcomes and ensure the successful release of healthier individuals into the wild. This study underscores the importance of integrating enrichment into standard rehabilitative practices, advocating for its adoption as a critical tool in sea turtle rehabilitation and welfare.

Although the conservation status of the green sea turtle (Chelonia mydas) in the Southwest Atlantic Ocean has been recently revised to "Least Concern" on the IUCN Red List and "Near Threatened" in Brazil’s Red Book of Fauna, it is important to note that juveniles of this species are the most frequent to be found stranded and deceased along the Brazilian coast. To evaluate the clinical condition of these stranded green turtles, blood gas analyses were conducted immediately upon their arrival at Instituto Albatroz Rehabilitation Center, in Cabo Frio, Rio de Janeiro. After undergoing a clinical examination, 25 turtles were weighed, and 0.5 ml of blood was withdrawn from the occipital sinus. Samples were immediately analyzed using a handheld veterinary blood gas electrolyte analyzer, SG1 Blood Gas & Electrolyte Analyzer from Seamaty©. The analyzer, set to human body temperature at 37°C, was adjusted to the turtle's body temperature to accurately determine pH, partial pressure of oxygen (pO₂), and partial pressure of carbon dioxide (pCO2). Additional manual corrections, based on prior studies, were applied due to concerns about the analyzer’s temperature accuracy. All turtles were juveniles, ranging from 30.5 to 62.7 cm curved carapace length. Results were expressed as mean values with their respective standard deviations: PCV (13.6±6.11%), pH (7.22±0.18), corrected pH (7.31±0.10) lactate (Lac) (5.13±3.17mmol/L), pO₂ (65.08±15.68), corrected PO₂ (55,37±12.36), pCO₂ (57.13±14.98), corrected PCO₂ (33,79±8,53) bicarbonate (HCO3–) (29.51±11.47mmol/L), sodium (Na) (162.1±7.37mmol/L), potassium (K) (4.9±1.09mmol/L), chloride (Cl-) (115.7±8.87mmol/L) ionized calcium (iCa) (1.08±0.16mmol/L), glucose (Glu) (67,46±37,4 mg/dL), tcO2 (39.86±6.88mmol/L). This comprehensive profile provided a detailed assessment of their physiological status, offering insights into their metabolic functions and overall health. Most turtles examined were found to be in poor body condition and exhibited signs of either metabolic or respiratory acidosis, reflecting severe health complications. The values for pCO2 were notably high, particularly when considering the average cloacal temperature of 25°C in the turtles, suggesting a disrupted respiratory function. Additionally, the mean PCV values were low across most individuals, indicating potential anemia or chronic disease states. Sodium, potassium, and chloride levels were elevated, possibly due to dehydration and/or impaired kidney function. Ionized calcium levels were within range, likely due to calcium being mobilized from bones to maintain calcemia. Most turtles were hypoglycemic, suggesting malnutrition. In this study, base excess and oxygen saturation measurements were omitted due to limitations in the applicability of standard mammal-based calculation methods when applied to sea turtles. Blood gas data are crucial in the diagnosis and management of debilitated sea turtles, providing essential insights into the respiratory efficiency and metabolic status of these animals. Measurements of parameters such as pH, partial pressures of oxygen and carbon dioxide, and bicarbonate levels help veterinarians assess the turtles' acid-base balance and respiratory function. Additionally, the utilization of a handheld veterinary blood gas and electrolyte analyzer significantly enhances diagnostic accuracy and treatment efficacy, thereby improving rehabilitation success rates in veterinary practice.

The Karen Beasley Sea Turtle Rescue and Rehabilitation Center (KBSTRRC) is nonprofit sea turtle conservation organization in North Carolina, USA whose mission includes rescuing, rehabilitating, and releasing stranded sea turtles. Founded in 1997, KBSTRRC offers a long term data set of sea turtles in rehabilitation. The 2019 implementation of RaptorMed, a medical records database, is allowing exploration of the organization’s rehabilitation trends over time.

Since 1997, KBSTRRC has admitted 1,524 sea turtles, including greens (Chelonia mydas), loggerheads (Caretta caretta), and Kemp’s ridleys (Lepidochelys kempii). Overall strandings are increasing. Causes of stranding include anthropogenic factors such as boat strikes, fish hooks, and entanglement; as well as natural conditions such as cold stunning, debilitated turtle syndrome, and shark bite injury.

Admissions due to cold stunning have increased since KBSTRRC was founded. In the organization’s first decade of operation, between 1997 and 2006, a total of nine turtles were documented to have been admitted due to cold stunning. In the organization’s second decade, a total of 206 turtles were admitted due to cold stunning, and over the past eight years, a total of 377 turtles were admitted due to cold stunning. Debilitated turtle syndrome (DTS) admissions have also increased. DTS is a nonspecific diagnosis for turtles that present suffering from malnourishment, dehydration, anemia, and a heavy parasite load. In North Carolina, DTS may often be related to past cold stunning events in which a turtle survived cold stunning but didn’t fully recover.

An increasing number of turtles are admitted due to being incidentally hooked in recreational fisheries. In 2024, the highest number of turtles to date – 41 turtles – were hooked. The increase in hooked turtles may be related to increasing education and outreach efforts that encourage anglers to report hooked turtles.

Human interactions include hooked turtles, entanglement, and dredge. The percent of admissions caused by human interaction has decreased over time, however the overall numbers of admissions caused by human interaction has increased over time. Currently, admissions due to human interaction represent 24% of all admissions.

This summary presents our first in depth review of sea turtle causes of admission over time. We hope continued data examination will offer additional insight into stranding and admissions trends.

The aim of our work is to determine whether it is possible to implement a decision tree in order to aid in the decision-making surrounding the euthanasia of injured or debilitated sea turtles. Although this is often a difficult discussion to have with multiple different stakeholders involved it is a very important question to provide a framework to work from to give objectivity to the very subjective topic. The final goal is to encourage everyone involved to have these difficult discussions and highlight the key areas of concern so that in the long-term compromises to welfare don’t occur. Where euthanasia is not permitted this can still be used to understand if current treatment plans are working and heading in a positive direction rather than stagnating to then encourage changes to be made. We explored data from 2000 to 2024 at the Lampedusa sea turtle rescue to analyse how this framework may be beneficial and what more information is needed going forwards. The very nature of sea turtles makes it difficult to judge if their welfare is compromised as we would for our companion animals. Sea turtles often make seemingly miraculous recoveries from severe injuries but this can take months to years. The current literature surrounding this topic is very limited. Many of the studies focus on the causes of admission to rehabilitation centres and rarely look at the long-term consequences. There are case studies available looking into individual cases and highlighting euthanasia as a question but none go into a set of criteria to consider when asking this question. This is something that is very well rehearsed in the private veterinary sector when considering companion animals. There is a key set of welfare considerations to take into account in order to aid not only owners but also clinicians in their decisions surrounding the topic of euthanasia. By using this decision tree it provides a starting point for these discussions so that all aspects of the patients welfare are being discussed taking into account all of the relevant stakeholders. The decision tree is a collection of pathways to be followed from the moment of admission to the start of treatment. At each stage of the pathway a score is given and this will amount to a final recommendation. By having a score system it allows for dynamic assessment of a patient throughout its rehabilitation journey.