Maintaning hydration on Amikacin

[littlemay]

Hi all,

For those who have been following my adventures in reptile sickness (http://www.aussiepythons.com/forum/general-reptile-discussion-42/blister-disease-208775/) you may know that snuffles is about to have a course of the antibiotic Amikacin added to his current course of Fortum.

Now the vet has informed me that Amikacin can be hard on the kidneys and that it is imperative to maintain high levels of hydration during treatment. The vet has recommended a 20 minute bath daily to encourage drinking, however i know i've read on here that some people have better results with maintaining hydration using a powerade/hydralyte solution? Was hoping someone might be able to provide me with some more info on this.

 

[Pythoninfinite]

I just had a re-read of the info in the appendix of "The More Complete Chondro" by Greg Maxwell. He indicates he treats his RIs with a combination of Fortaz (in Oz "Fortum") and Amikacin.

To quote:

"Amikacin is hard on the renal system (kidneys) and each injection must be followed up with a subcutaneous injection of of 5 - 10ml of fluid such as lactated ringers using multiple injection sites. Withhold food for the duration of the treatment." Presumeably you could use injectable water as well. Subcut injections are easy to give, so it's something you could do yourself if your vet is prepared to set you up with the stuff and the syringes. The antibiotics are injected intramuscularly, and you should use an area about 1/3 way down the body to avoid proximity to the kidneys.

When I've needed it, my vet mixes the Fortum and loads the syringes (usually 7, one every 3 days for 21 days) with the required doses, and I bring them home immediately and freeze them (Fortum has a short life when mixed with water), thawing them out just prior to use.

I believe injecting the hydration fluids might be a better option than allowing the sick snake to make its own judgements with regard to hydration, unless you can see it drinking copiously during the bathing process. I would just place the snake in a tub of tepid water with the lid on and allow it to relax in the water - if you actively "bath" it, it may be disinclined to drink, and you'll need to watch out for water just running straight back out, so always keep its head high as you remove it from the water and place it back in its cage.

Jamie

 

[littlemay]

I just had a re-read of the info in the appendix of "The More Complete Chondro" by Greg Maxwell. He indicates he treats his RIs with a combination of Fortaz (in Oz "Fortum") and Amikacin.

To quote:

"Amikacin is hard on the renal system (kidneys) and each injection must be followed up with a subcutaneous injection of of 5 - 10ml of fluid such as lactated ringers using multiple injection sites. Withhold food for the duration of the treatment." Presumeably you could use injectable water as well. Subcut injections are easy to give, so it's something you could do yourself if your vet is prepared to set you up with the stuff and the syringes. The antibiotics are injected intramuscularly, and you should use an area about 1/3 way down the body to avoid proximity to the kidneys.

When I've needed it, my vet mixes the Fortum and loads the syringes (usually 7, one every 3 days for 21 days) with the required doses, and I bring them home immediately and freeze them (Fortum has a short life when mixed with water), thawing them out just prior to use.

I believe injecting the hydration fluids might be a better option than allowing the sick snake to make its own judgements with regard to hydration, unless you can see it drinking copiously during the bathing process. I would just place the snake in a tub of tepid water with the lid on and allow it to relax in the water - if you actively "bath" it, it may be disinclined to drink, and you'll need to watch out for water just running straight back out, so always keep its head high as you remove it from the water and place it back in its cage. Jamie

Thanks for your reply, so far i've been injecting with pre-loaded then frozen fortum injections for the last 30 days. The only thing that would concern me with injecting water is the stress, he absolutely hates the injections and that would be three of them in one wack.

My plan was to get a big tub from bunnings, drill some holes in the lid and just let him soak as you say. I'll monitor him during this time to see if he's drinking and if not discuss the option of injecting fluids with the vet.

I'm also concerned with withholding food during this time - he has so far not refused any feeds but is still losing condition. I'm worried that without food he will deteriorate faster.

 

[Pythoninfinite]

I think that, if the new antibiotic begins to work (should be obvious fairly quickly as a change in demeanour/general appearance) then a pause in feeding should be of little consequence. I'd give it a week or two, and then see how things are. The non-feeding probably has something to do with reducing the overall load on the kidneys, and don't forget that digestion is initially energy intensive and ramps up the metabolism significantly in the early stages.

For me, I'd give the new drug the best chance to work on a snake with a stable metabolism.

Jamie

 

[littlemay]

That's a good point, i want to give the new antibiotics the best chance of working so we'll see how we go.

 

[bigguy]

Have the vet give you a bag of Hartmans solution, and inject 10 to 20 ml's under the skin in different locations in the front half of the body every time you give the amikacin. You can never depend on a snake drinking and the kidneys MUST be kept flushed while on numerous antibiotics or risk major KIDNEY DAMAGE. Don't worry about the stress, kidney damage is far worse

Gentermyicin was another very very strong antibiotic harsh on the kidneys

 

[the_brad]

The reason it hates the injection is because the fortum, it can damage/bruise the muscle. it should be bearly notice the fluid injections

 

[-Peter]

Just use water, direct into the stomache with dosing needle. Subcutaneous is no quicker than ingestion and you want to flush the kidneys not make them work harder sorting out the added enzymes etc in Hartmans and such.

 

[littlemay]

Thanks everyone for your input, i will be picking up Snuffles this afternoon and will discuss the various options mentioned in this thread with the vet then.

 

[bigguy]

The trouble is with placing fluid down the throat is quite often sick snakes turn off their stomachs. This means the fluids will not be absorbed and just go straight through and miss the kidneys. By injecting fluids under the skin it has no choice but to go through the kidneys and flush them.