Frostbite in Bactrian Camels During Capture and Chemical Immobilization
The Bactrian camel (Camelus bactrianus) is a large ungulate that is native to Central Asia. These camels have two humps on their backs, distinguishing them from dromedary (or Arabian) camels (Camelus dromedarius) which have one hump. Bactrian camels have thick, wooly, sand-colored coats, although some are dark brown or even white. They average 6.5 feet in height at the shoulder; their humps account for another foot of height, and males are larger than females.1,2
Camels have been domesticated for approximately 3,500 years. There are two types of Bactrian camel: domestic and wild. These two divisions are sometimes confusing, since some formerly domesticated Bactrian camels live in the wild alongside fully wild Bactrian camels. This is significant because these variants descended from different ancestor species.1 The family from which camels originally derived evolved in North America over 46 million years ago. After camels migrated throughout Asia and the Middle East, they subsequently went extinct in their ancestral ranges on the North American continent.
Bactrian camels are diurnal, foraging and grazing throughout the day. Their upper lips are split with each half moving independently; this allows them to forage short grasses and plants that are very near to the ground.3 They can go for several months without food, and they can go a week or more without water. Their back humps store up to 80 pounds of fat, which they break down into energy when food is scarce.2,3 Among their numerous adaptations to aid them in surviving a harsh environment, Bactrian camels are the only land mammals capable of drinking brackish or salty water with no ill effects. They can also drink up to 30 gallons of water at a sitting.
Camels are social animals, living in harem groups consisting of a dominant male, several females and their offspring. Bachelor males live on their own or in bachelor herds until they acquire a harem of their own. The dominant male in a herd/harem will mate with any or all of the adult females. These will give birth to one calf or twins, which remain with their mother until they are 3 to 5 years old.1
Domesticated Bactrian camels are not considered to be endangered or threatened, but wild Bactrian camels are considered critically endangered due to hunting and predation.
What is Frostbite?
Frostbite is a freezing injury that is divided into four phases which overlap:
- Vascular stasis
- Late ischemic5
Prefreeze consists of tissue cooling with accompanying vasoconstriction and ischemia and without ice crystal formation. The freeze–thaw phase is represented by the intracellular or extracellular formation of ice crystals. This can cause protein and lipid derangement, cellular electrolyte shifts, cellular dehydration, cell membrane lysis, and cell death. In the vascular stasis phase, vessels fluctuate between constriction and dilation, and blood may leak from vessels or coagulate within them. The late ischemic phase results from progressive tissue ischemia and infarction from a cascade of events, including inflammation, vasoconstriction and emboli.5
The chemical immobilization of Bactrian camels can require extended periods of immobility in the captured animal. Hypothermia is an inherent risk to any animal undergoing chemical immobilization regardless of ambient temperature, and frostbite is an even greater risk during the winter months.6,7 While chemically-immobilized dromedary camels in their natural environment are at far lower risk for frostbite, the native environment of Bactrian camels does include periods of freezing temperatures.
The normal temperature of a healthy camel varies from about 34°C to more than 40°C.6 Due to the harsh environments that camels occupy, they have evolved with a unique ability for thermoregulation. This is referred to as adaptive hypothermia, or an ability to cool their bodies to avoid hyperthermia.
When deprived of drinking water during the summer, the Bactrian camel’s daytime body temperature variations may exceed 6°C, but in animals with access to water, the variations are similar to those found during other seasons.7 These wide variations in temperature are tolerated by the camel, whereas in other animals, if body temperatures exceed more than 2 to 3 degrees higher than lower than the norm during an immobilization event, it can be life-threatening.
Classifications of Frostbite in Bactrian Camels
The progression of frostbite encompasses four degrees of injury, and these follow the classification schemes for thermal burn injury. Early stages of frostbite are different than frostnip, which is a superficial nonfreezing cold injury associated with intense vasoconstriction on exposed skin. It should be noted that frostnip may precede frostbite, however. In these cases, ice crystals do not form within the tissue and tissue loss does not occur. Numbness and pallor resolve quickly after warming the skin.7
- First-degree frostbite causes numbness and erythema. A white or yellow, firm, and slightly raised plaque develops in the area of injury. There may be slight epidermal sloughing and mild edema is common.
- Second-degree frostbite injury causes superficial skin vesiculation. A clear or milky fluid will be present in superficial blisters surrounded by erythema and edema.
- Third-degree frostbite causes deeper hemorrhagic blisters, indicating that the injury has extended into the reticular dermis and beneath the dermal vascular plexus.
- Fourth-degree frostbite extends completely through the dermis and involves the comparatively avascular subcutaneous tissues, with necrosis extending into muscle and bone.7
It should be noted that the severity of frostbite may vary within a single extremity.
Prevention of Frostbite in Bactrian Camels
The available literature suggests that prevention is a far better methodology than treatment for frostbite, which is preventable in most cases, but often not improved by treatment. Underlying medical problems and the chemical immobilization event itself can increase risk of frostbite, so prevention must address both health-related and environmental factors. Frostbite injury usually occurs when tissue heat loss exceeds the ability of local tissue perfusion to prevent freezing of soft tissues.7 The team in the field must ensure adequate perfusion and minimize heat loss to prevent frostbite.
Preventive measures to ensure local tissue perfusion include:
- Maintaining adequate core temperature
- Maintaining adequate body hydration
- Minimizing the effects of any known diseases that might decrease perfusion
- Covering the body and head to insulate from the cold
- Minimizing any blood flow restriction
- Using supplemental oxygen in severely hypoxic conditions7
Steps should be taken to minimize exposure of the animal’s tissues to cold, such as:
- Avoid environmental conditions that predispose to frostbite if possible (e.g., below -15°C, even with low wind speeds
- Protecting exposed skin from moisture, wind, and cold
- Avoiding perspiration or wet extremities
- Increasing insulation and skin protection
- Using chemical and/or electric warmers to maintain peripheral warmth (These should be close to body temperature before being activated and must not be placed directly against skin or constrict flow)
- Regularly checking the animal’s temperature
- Recognizing frostnip or superficial frostbite before it becomes more serious
- Minimizing duration of cold exposure6,7
Treatment of Frostbite in Camels
If a camel’s body part is frozen in the field, the frozen tissue should be protected from further damage.7 Then, a decision must be made as to whether to thaw the tissue. If environmental conditions are such that thawed tissue could refreeze, it is safer to keep the affected part frozen until a thawed state can be maintained. Frostbite thaws spontaneously and should be allowed to do so if rapid rewarming cannot be easily achieved.
Hypothermia frequently accompanies frostbite and causes peripheral vasoconstriction that impairs blood flow to the extremities. Mild hypothermia may be treated concurrently with frostbite injury. Moderate and severe hypothermia should be treated effectively before treating frostbite injury.6,7
Nonsteroidal anti-inflammatory drugs (NSAIDs) block the arachidonic acid pathway and decrease production of prostaglandins and thromboxanes. These can lead to vasoconstriction, dermal ischemia, and further tissue damage.7 No studies have demonstrated that any particular anti-inflammatory agent or dosing is clearly related to outcome, however. One research model study showed 23% tissue survival with aspirin versus 0% in a control group.6,7 However, aspirin theoretically blocks production of certain prostaglandins that are beneficial to wound healing, which may be of concern following a chemical immobilization event.
Vascular stasis can result from frostbite injury, thus appropriate hydration and avoidance of hypovolemia are important for frostbite recovery. Intravenous normal saline should be given to maintain normal urine output. IV fluids should optimally be warmed before infusion and infused in small, rapid boluses, as slow infusion can result in fluid cooling and even freezing as it passes through tubing. Fluid administration should be optimized to prevent clinical dehydration.7
Low Molecular Weight Dextran (LMWD) Treatment
Intravenous low molecular weight dextran (LMWD) decreases blood viscosity by preventing red blood cell aggregation and formation of microthrombi and can be given in the field once it has been warmed. In some animal studies, the extent of tissue necrosis was found to be significantly less than in control subjects when LMWD was used, and was more beneficial if given early.7
The use of LMWD has not been evaluated in combination with other treatments such as thrombolytics. LMWD should be given if the animal is not being considered for other systemic treatments, such as thrombolytic therapy.7,8
4Haskins, S.C. (1995). Thermoregulation, hypothermia, hyperthermia. In: SJ. Ettinger. & EC. Feldman (Eds), Veterinary internal medicine (4th edition) (pp. 26–30). Philadelphia. U.S.A. W.B Saunders Company.
5Schmidt-Nielsen, K., et. al. Body Temperature of the Camel and Its Relation to Water Economy. American Journal of Physiology. 31 Dec 1956.
6McIntosh, S., et. al. Clinical Practice Guidelines for the Prevention and Treatment of Frostbite: 2019 Update. Wilderness Medical Society Clinical Practice Guidelines, Volume 30, Issue 4, Supplement S19-S32, December 01, 2019.
7McIntosh, S.E., et. al. Wilderness Medical Society practice guidelines for the prevention and treatment of frostbite: 2014 update.Wilderness Environ Med. 2014; 25: S43-S54.
About NexGen Pharmaceuticals
NexGen Pharmaceuticals is an industry-leading veterinary compounding pharmacy, offering sterile and non-sterile compounding services nationwide. Unlike other veterinary compounding pharmacies, NexGen focuses on drugs that are difficult to find or are no longer available due to manufacturer discontinuance or have yet to be offered commercially for veterinary applications, but which still serve a critical need for our customers. We also specialize in wildlife pharmaceuticals, including sedatives and their antagonists, offering many unique options to serve a wide array of zoo animal and wildlife immobilization and anesthesia requirements.
Our pharmacists are also encouraged to develop strong working relationships with our veterinarians in order to better care for veterinary patients. Such relationships foster an ever-increasing knowledge base upon which pharmacists and veterinarians can draw, making both significantly more effective in their professional roles.
The information contained in this blog post is general in nature and is intended for use as an informational aid. It does not cover all possible uses, actions, precautions, side effects, or interactions of the medications shown, nor is the information intended as medical advice or diagnosis for individual health problems or for making an evaluation as to the risks and benefits of using a particular medication. You should consult your veterinarian about diagnosis and treatment of any health problems. Information and statements have not been evaluated by the Food and Drug Administration ("FDA"), nor has the FDA approved the medications to diagnose, cure or prevent disease. Medications compounded by NexGen Pharmaceuticals are prepared at the direction of a veterinarian. NexGen Pharmaceuticals compounded veterinary preparations are not intended for use in food and food-producing animals.
NexGen Pharmaceuticals, LLC does not recommend, endorse or make any representation about the efficacy, appropriateness or suitability of any specific dosing, products, procedures, treatments, services, opinions, veterinary care providers or other information that may be contained in this blog post. NEXGEN PHARMACEUTICALS, LLC IS NOT RESPONSIBLE NOR LIABLE FOR ANY ADVICE, COURSE OF TREATMENT, DIAGNOSIS OR ANY OTHER INFORMATION, SERVICES OR PRODUCTS THAT YOU OBTAIN THROUGH THIS BLOG POST.