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Introduction

When working with wildlife in your practice, many of the patients you will see will have severe traumatic injuries. Turtles are capable of surviving for several days with severe injuries, and can sometimes remain alert and responsive despite what would seem like life-threatening shell fractures. Knowing how to determine prognosis in turtles with traumatic injuries is important as it can help you to determine when a turtle might need humane euthanasia or if it has a chance of surviving with medical care.

Diagnostics

Certain rapid diagnostics can be useful to assess prognosis in turtles.

• PCV: It is very common for injured/sick turtles to present with anemia, but turtles do appear to be able to tolerate anemia better than some other species. For most turtle species, a PCV of 20-30 is considered normal. Many of the turtles in TRT present with PCV of 10% or less, and a PCV <5% is considered severe. Fluid therapy, iron injections, and Vitamin K can be useful in anemic turtles, as well as providing adequate nutrition.
• Lactate: Research from TRT has found that lactate >10 mmol/L that remains elevated or increases for the first 24 hours after admission is indicative of a poor prognosis.
• Blood smears and serum chemistry can be useful, but are difficult to interpret in reptiles without a lot of experience with turtle bloodwork. At TRT, we generally use these tools if a turtle is not responding to initial treatments.
  • Generally, the presence of many heterophils on a blood smear is generally an indication of inflammation. Heterophils with basophilic granules or that are more “blue” are considered toxic and can indicate infection. A hematology resource is linked at the end of this module.

Signs of Grave Prognosis

While every case should be examined individually, there are certain clinical signs that may indicate grave prognosis in injured turtles. Turtles with one or more of these injuries should be humanely euthanized or closely monitored for continuing decline. Finders should be informed that these turtles may not survive.

• Crushing injuries to the skull with blood coming from the mouth and nose
• Evisceration with necrosis of organs
• Punctures to both lungs
• Open-mouth breathing with damage to one or more lungs

Signs of Poor Prognosis

There are certain clinical signs that are survivable in turtles that receive appropriate treatment, but that increase the likelihood of mortality.

• Infected wounds
• Maggots in the coelom
• Fractures that cross midline on the carapace (especially if reflexes are absent in legs and tail)
• Coelomic breaches
• Exposure of one lung
• Open-mouth breathing

Signs of Non-Releasability

Some conditions, while not lethal, will interfere with a turtle’s ability to survive in the wild once released. In some cases, these turtles can be adopted out as pets or to educational facilities as long as they can maintain a high quality of life. However, if the turtle is unlikely to adapt well to captivity, humane euthanasia is the best option.

• Blindness
• Inability to eat due to facial trauma
• Missing more than one leg
• Female turtles that cannot pass eggs on their own due to pelvic trauma
• Female turtles that cannot use their back legs to dig nests
• Box turtles that cannot fully box

Quality of Life Assessments

While it can be difficult to determine quality of life in turtles, there are some behavioral signs that can be used to determine when a turtle is in need of additional care or humane euthanasia.

• Sudden onset of lethargy and depression, or progressive lethargy and depression
• Open-mouth breathing
• Inability to defecate or urinate

Additional Resources

Sack A, Butler E, Cowen P, Lewbart GA. Morbidity and mortality of wild turtles at a North Carolina wildlife clinic: A 10-year retrospective. Journal of Zoo and Wildlife Medicine 48(3): 716-724. 2017.

Saggese MD. Clinical approach to the anemic reptile. Journal of Exotic Pet Medicine 19(2):98-111. 2009.

Campbell TW. Peripheral blood of reptiles. Chapter 3 in Exotic Animal Hematology and Cytology, 4th ed. John Wiley and Sons, 2015.