Treating Dropsy in Bettas

A step-by-step guide to all my tricks and tips

Now that we’ve discussed what Type 1 dropsy is and what it looks like, we can move onto what to do about it. The treatment is the same for all stages of pineconing regardless of how advanced it may be. A fish showing pre-dropsy signs will receive the same care as a Stage 4 fish. I have developed these dropsy protocols to be as clear and easy to understand as possible. A lot of what you see online can give mixed signals as of what to do or be difficult to parse. A lot of the information I’ve found online can be harmful as well, giving out hurtful, incorrect, or outdated information that won’t help your betta.

It’s important to realize that the face of dropsy care is shifting drastically. Not so long ago this disease was thought of as a death sentence with a 100% fatality rate. While the hobby might be willing to now believe some bettas might be saved, most of the fish keepers out there are grind-locked over the best ways to go about it. There is conflicting information everywhere. My goal here is to share what I have learned and what I’ve found works best for me. I’ll also go into detail about why I do the things I do. A lot of what I’ve learned was through repeated experimentation. Running a betta rescue and dealing with several hundred sick bettas gave me the opportunity to try different things, constantly adjusting and manipulating factors in order to achieve the best results.

Worm, an emaciated rescue betta showing Type 1, Stage 3 dropsy. Survived: Yes, after 1 month of treatment.

As discussed in the first part of this series, we now know what dropsy is and how to identify it. Swift action should be taken at the first sign of dropsy.

Here’s what you’ll need:

• A hospital or quarantine tank not exceeding 1 gallon in size.

• Methyline Blue

• Kanaplex

• Plain unscented Epsom salt

• A source of tannins (optional)

The hospital tank is where all treatments will be conducted. It should be smaller, unheated, and unfiltered. I use bare Beanie Baby display cases that I only fill halfway, equaling 30 ounces of water. You can use anything though, as long as the medications are dosed to the correct water volume. The tank should be unfiltered because carbon filters will remove the medications and antibiotics from the water column and non-carbon filters create too much water movement in smaller spaces. The tank should be left to reach room temperature (Between 68-74 degrees) and should remain unheated for two reasons: One, I do not trust heaters in containers this small. The risk of over overheating is too high and there’s also a fire risk to consider. Two: My theory is that the slower a betta’s metabolism is, the higher the chance of recovery. More on this topic later.

Methylin Blue and Kanaplex are two fish-specific antibiotics that I use in tandem with my dropsy cases. They are safe to use together and gentle on fish while covering a wide range of potential infections. You should use these two medications even with zero infections visible since the issue may be internal. With bettas that show obvious external signs of infection such as finrot or infected body wounds, these two antibiotics will treat those infections as well, playing a vital part to the betta’s overall recovery. If you can only use one of these or are only able to locate one, that should be fine. I like using both to cover a wider range of issues but they’re both good antibiotics that should do the job. They can be found online or in some local fish stores. I recommend keeping them on-hand in case of emergencies such as this since shipping will take time if you order them once symptoms start to show.

Now, the most important thing that you’ll need is plain unscented Epsom salt. This can be found in most drugstores or convenience stores for humans— they’re used in bath soaks and to help sprains and foot issues. A lot of these salts have additives added for human benefit such as herbs or lavender oil for nice smells but these are all toxic to bettas— you NEED to purchase a plain one with zero additives, nothing but the pure magnesium salt.

Optional: For bettas suffering fin issues or who come out of tannin-heavy tanks, I like to add a dash of fresh tannins as well. The tannins will help prevent further infection and lower the pH to mimic their home tank. It won’t help the dropsy but can help keep them more comfortable during treatment. Note: If tannins are used, do NOT use Methylin Blue. The two do not mix well and should not be used together.

Now that you’ve got your supplies together, here’s what to do:

Creating the Hospital Tank.

Since this is where all treatments will be conducted, the hospital tank is the root of treating dropsy in bettas. This tank forms the very foundation of care.

Fill the hospital tank with fresh, clean, conditioned water. You may need a lid to prevent jumping. First add in your plain unscented Epsom salt. The amount will vary depending on how much water you’re using. I use roughly 1/2 tablespoon per 30 ounces of water. Mix the salt in well. You want everything to dissolve easily with no crystals left behind. A taste test should be zingy with no burning (Note: Do NOT drink the tank water, please. A single drop on your tongue works.) Once your salt is dissolved and mixed in, you can add the antibiotics. There are instructions for dosing on the bottles but I tend to overdose, using two drops of methylin blue in 30 ounces and 1/2 spoon (the one that comes in the kanaplex bottle, not a regular spoon) of Kanaplex. The kanaplex should dissolve easily and the methylin blue should leave the water blue tinted but still clear and easy to see through. If you get a color that looks like blue Gatorade, you’ve used too much. Start over and try again.

Float your betta in this hospital tank until the temperatures match to prevent temperature shock, just like you would after a large water change or tank change. Now this is the tricky part, since there are some bettas out there who are super sensitive to salt and will react poorly to the sudden change. If your betta becomes stressed or starts gasping, remove them at once and let them rest and recover, then try again at 1/2 the salt content and repeat until a comfortable level is reached. You can slowly up the salt content over time up to the 1/2 tablespoon per 30 ounces of water as they adjust.

The betta should remain in this mixture for 24 hours. After that, add another 1/2 tablespoon of plain unscented Epsom salt, reaching a total of 1 table spoon per 30 ounces of water. If they’re salt sensitive, add the second 1/2 tablespoon slowly over several hours. They should remain in this new, higher salt content for another 24 hours. At the end of this 24 hour period, perform a 100% water change, adding back all of the antibiotics and the full dose of salt. This pattern should repeat every 48 hours, resulting in a full water change every two days. Offer food every single day, remove all uneaten food at once. Try live or frozen if they refuse their normal diets but don’t get discouraged if they won’t eat.

It’s important to note that even when caught early, pineconing will worsen in the face of treatment until it kicks in. This means a pre-dropsy betta might display Stage Two or Three even while in treatment. They will get worse first. Don’t lose hope— defeating dropsy takes time. It took me a solid month once to see improvement, and that betta made a full recovery. The average amount of time hangs around 2 weeks to recovery after the initial worsening period. In short, if your betta survives in treatment for 5 days, their chance of recovery improves drastically. If after 5 days they continue to worsen or secondary factors such as infection or injury start taking their troll, it’s time to reassess if treatment is the kindest option for your fish.

I won’t lie— dropsy treatment is rough. The bettas hate it. It makes them feel sick, listless, and droopy. It is incredibly harsh on them, but it’s also a necessary evil.

Online, you’ll see a lot of sources that instruct you to do salt baths or salt dips at much, much lower salt contents than what I’m suggesting. A lot of people think bettas cannot stand these kinds of salt contents and that, if necessary, a salt bath is the best way to handle dropsy. But, I’ve found that salt baths as a concept are something the fish keeping community should be readying themselves to move away from. They are stressful, often too stressful for already fragile, weakened bettas, and the sudden swings in salt content often do far more harm than good.

But why use salt at all?

Plain Unscented Epsom salt taken from Target’s online website

Epsom salt is the single most important tool in the battle against dropsy. It is more important that any antibiotic. The trick to defeating dropsy can be as simple as managing the symptoms long enough for the body and the antibiotics to do their job. remember, you are dealing with organ malfunction. In humans this is considered deadly and requires extensive hospitalization to reverse, hospitalization we have no access to for bettas. Dropsy kills through pineconing first and foremost— a deadly amount of free-fluid builds up in the body and shuts them down. The Epsom salt works by pulling off this free-fluid and removing it from the body, allowing the medications to work on whatever infection or imbalance caused the dropsy in the first place. Human use it for sprains and edema for the same reasons— to remove free fluid and reduce swelling. The concept is the same in bettas.

Since the goal of dropsy treatment is to stop the pineconing from killing your fish for long enough the meds have a chance to work, anything that helps with that should be used to your favor, such as a slower metabolism like I mentioned earlier. This is why I allow the hospital tanks to go unheated. Colder water slows the metabolism, slowing the advance of infections while having no such effect on the rate the salt works. It might add up to a minor difference, but that minor difference could mean the difference between recovery or not.

If the Epsom salt is the reason why free-fluid stops building up, leaving the bettas in a salt concentrate 24/7 should offer them the most benefit as opposed to a 15 minute salt dip every three hours. Plus with work and school and sleep relying on these salt baths is inconsistent and stressful for everyone involved. I’ve found that bettas can tolerate a much, much higher Epsom salt concentrate than online sources would suggest, though the bettas are not going to be happy about it. Again, dropsy treatment is rough but necessary.

As the salt works it’s magic, an equilibrium should be reached where the pineconing remains stagnant without worsening. This means the dropsy is still happening but the salt is removing the fluid as it’s made. This is when the meds kick in, hopefully targeting whatever infections started this. Over time, the rate of the dropsy should go down, resulting in the Epsom salt removing free fluid faster than it’s being replaced so that the pineconing begins to recede, leaving flat scales behind as it does.

Congratulations! Your betta is no longer pineconed. Now what?

Keep them in treatment for at least another 4 days only if no external infections are visible. If external infections are still active, continue treatment until they are gone, such as in finrot or infected wounds. Wait until they show signs of healing to end treatment or you risk a relapse. By this point your fish has been in the salt concentrate for a long time. They’ll need to be weaned off slowly to prevent shock. The best way is to perform a 100% water change and add back only 1/2 the salt, then perform another 100% water change the following day to remove the rest of the salt. Watch them closely for lethargy or relapse— some dropsy cases can be managed and will seem to go away but will always return after treatment. These cases stem from non-infectious origins, the most common being cystic kidneys or internal tumors and cancers.

Young, previously healthy fish will have an easier time recovering than older fish who are experiencing secondary troubles. Always monitor Quality of Life and make judgement calls as needed. Dropsy is a killer through and through and the treatment is harsh and hated. I believe in giving fish a fighting chance but that doesn’t mean prolonging suffering past kindness’ sake. Not every dropsy case is winnable, especially with Type Two. But I hope that these protocols offer you and your betta the best chance of success.

A betta rescue showing Type Two dropsy. Note the lack of swelling or abdominal fluid as well as the active finrot and emaciation. Survived: No.

A before and after of Frost, a betta rescue with Type 1, Stage 4 dropsy. Survived: Yes.