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EXOTIC-Evaluating and Stabilizing Critically Ill Rabbits.part I

EXOTIC-Evaluating and Stabilizing Critically Ill Rabbits.part I

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20TH ANNIVERSARYVol. 21, No. 1January 1999
FOCAL POINTKEY FACTS
5
Knowledge of the commondifferentials for diagnosingcritically ill rabbits allows rapidassessment and stabilization.
Evaluating andStabilizing Critically Ill Rabbits—Part I
University of WisconsinUniversity of California, Davis
 Jan C. Ramer, DVMKeith G. Benson, DVM Joanne Paul-Murphy, DVM
ABSTRACT:
Critically ill rabbits can be challenging patients, especially because they can easilybecome stressed. Although the principles behind emergency and critical care medicine are thesame for all mammals, the presenting signs and diagnostic differentials differ. This article de-scribes the common presenting signs for rabbits in critical condition and discusses some di-agnostic procedures and therapeutic measures. Part II will address specific therapeutic tech-niques, pain abatement, and nutritional support.
 A 
s domestic rabbits become more popular household pets, they represent agrowing segment in small animal practices.
1
Diagnosing critically ill rabbitscan, however, be challenging, even for experienced clinicians. In addition,special handling techniques must be followed when examining rabbits or perform-ing diagnostic procedures. In general, the principles of emergency and critical carepractices are the same for all mammals,
2
3
but it is important to evaluate critically illrabbits efficiently and stabilize them before initiating potentially stressful diagnostictests. Although obtaining a thorough clinical history and performing a systematicphysical examination are important, often the critical condition of a rabbit on pre-sentation necessitates addressing immediate life-threatening problems.Unless life-threatening conditions require immediate attention, some generalguidelines we recommend include:
s
Observing a critically ill rabbit in a cage or carrier before handling to assessgeneral attitude, respiratory rate and character, and fecal and urine outputand consistency.
s
Limiting the quantity of blood for samples to 1% of the rabbit
s body  weight,
4
especially in dwarf breeds. If only a small volume of blood is ob-tained, diagnostic tests must be prioritized based on suspected diagnoses.Practitioners should also note that rabbits with infectious diseases typically have a higher percentage of heterophils than of leukocytes, which will be re-flected in the complete blood count (CBC).
5
ABDOMINAL DISCOMFORT OR ENLARGEMENT
Rabbits with abdominal discomfort, enlargement, or both generally tolerate a
s
A rabbit that has been anorecticfor more than 3 days can quicklydeterioriate and may requireaggressive fluid therapy andforced feeding.
s
Dyspneic rabbits requirestabilization before a physicalexamination can be conductedor diagnostic proceduresinitiated.
s
In general, red urine from a rabbitis caused by porphyrin pigments;however, true hematuria canoccur.
s
Because rabbits are sensitiveto heat stress, they may becollapsed or seizuring onpresentation; slow intravenousrehydration and cooling areadvised.
Refereed Peer Review
CE
 
thorough physical examination. Important aspects of the history include whether the patient is eating, defe-cating, and urinating and its reproductive status (seeDiagnostic Differentials for Rabbit Disorders).
Gastrointestinal Stasis
Rabbits with gastrointestinal (GI) stasis often have ahistory of inappropriate diet, decreased appetite, smallfecal pellets, or stress in the household. A firm, doughy mass palpable in the cranial abdomen is consistent withGI stasis or the presence of a trichobezoar.
6,7
Obstruc-tion, which must be ruled out before treatment for sta-sis can be initiated, can be confirmed by radiography; if the rabbit is defecating, however, obstruction is im-probable. A pneumogastrogram can help confirm thepresence of a trichobezoar, which does not require sur-gical removal unless the pylorus is obstructed.Rabbits with GI stasis or nonobstructive trichobe-zoars are best managed with aggressive rehydration andincreased fiber in the diet. If the rabbit is eating anddrinking, oral electrolyte solutions can be offered in a water bottle or syringe. Grass hay and high-fiber veg-etables also need to be offered. If the rabbit is not eat-ing, hospitalization to administer intravenous or in-traosseous fluids is indicated. A nasogastric feedingtube may be placed, or the rabbit may be force fedthrough a syringe. Metoclopramide and/or cisapridepromote GI motility 
7
9
(Table I).
Gastrointestinal Obstruction or Foreign Bodies
Infrequently, rabbits present with an acute abdomenthat is painful on palpation. They may be hypothermic,bloated, tachycardic, or tachypneic. These animalsmust be evaluated quickly and efficiently and stabilizedvia fluid therapy, pain management, and possibly de-compression. A firm mass in the cranial abdomen is consistent with obstruction of the pylorus. Decompression of thetympanic stomach by passing a nasogastric or an oro-gastric tube may be necessary before other diagnostictests can be performed. Intussusception or foreign bod-ies can occur in the small intestine and are sometimes
Compendium 
January 199920TH ANNIVERSARYSmall Animal/Exotics
PATIENT HISTORY
s
AGGRESSIVE REHYDRATION
s
ACUTE ABDOMINAL PAIN
Abdominal Discomfortor Enlargement
s
Gastrointestinal stasis,obstruction, foreign body,trichobezoar
s
Uterine adenocarcinoma
s
Urinary calculi
s
Pyometra, dystocia
Anorexia
s
Malocclusion of incisors orcheek teeth
s
Gastrointestinal stasis orobstruction; hepatic lipidosis
s
Environmental stress
s
Lead poisoning
s
Systemic disease (e.g.,pneumonia, coccidiosis)
s
Pain
Diarrhea or Mucoid Stools
s
Inappropriate antibiotic therapy
s
Inappropriate diet
s
Enterotoxemia
s
Coccidiosis
s
Mucoid enteropathy
s
Bacterial enteritis
s
Tyzzer’s disease
Dyspnea
s
Pneumonia
s
Neoplasia
s
Cardiac disease
s
Abdominal distention
Red Urine
s
Porphyrin (normal)
s
Uterine adenocarcinoma,endometrial venous aneurysm,abortion
s
Cystitis, pyelonephritis,urolithiasis
Posterior Paresis
s
Vertebral fracture or luxation
s
Encephalitozoon cuniculi 
infection
Torticollis
s
Otitis media (pasteurellosis)
s
Baylisascaris procynois 
infection
s
Toxoplasmosis
s
Encephalitozoonosis
s
Listeriosis
s
Cranial nerve trauma
Collapse or Seizure
s
Heat stress
s
Pregnancy toxemia
s
Trauma
s
Encephalitozoonosis
s
Pasteurella 
-caused brainabscess
s
Venomous snakebite
s
Lead poisoning
s
Rabies
Diagnostic Differentials for Rabbit Disorders
 
Small Animal/Exotics20TH ANNIVERSARY
Compendium 
January 1999
palpable. Radiographs, pneumogastrograms, and posi-tive-contrast GI studies are helpful in diagnosing theobstruction. Surgery is required; the prognosis is poorbecause postoperative return of normal GI motility isdifficult to achieve.
2,3,6,7,9,10
Reproductive Disorders
Reproductive disorders must be considered in intactfemale rabbits that present with abdominal discomfortor enlargement. Pyometra and uterine adenocarcinomacan be palpated as fluctuant or doughy masses in thecaudal abdomen. Vaginal bleeding can occur in does with uterine adenocarcinoma. Fetuses are palpable inrabbits with dystocia. Radiography and abdominal ul-trasonography can help confirm a diagnosis.
9
11
Tho-racic radiographs to rule out pulmonary metastasis areindicated in patients with uterine adenocarcinoma. A CBC may be useful in confirming anemia or inflamma-tory response. Ovariohysterectomy is indicated.
Urolithiasis
 A history of stranguria or dysuria and a full, firm uri-nary bladder are consistent with urethral obstruction. Affected rabbits are depressed, and the abdomen ispainful. Catheterization is indicated to relieve urethralobstruction. Infrequently, ureteral calculi result in hy-dronephrosis. Multiple renal cysts, which are commonin geriatric rabbits, can be confused with hydronephro-sis but can be confirmed by ultrasonography or intra-venous urography.
11
Urinalysis may show hematuria, crystalluria, orpyuria. The urine pH of normal rabbits is alkaline anddoes not change in rabbits with urolithiasis. Crystal-luria is common in rabbits and does not directly corre-late with the presence of uroliths.
11
Serum chemistriesand CBCs can help to assess hydration and renal function.Medical treatment includes aggressive fluid therapy,decreased calcium in the diet, and manualexpressionof the urinary bladder in patients with nonobstructive
ABDOMINAL ENLARGEMENT
s
URETHRAL OBSTRUCTION
s
SERUM CHEMISTRIES
TABLE ICritical Care Drug Therapy for Rabbits
 AgentDos
RouteIndicatio
 Atropine
25,26
0
0.5 SC, IMBradycardiaBuprenorphine
16,25
0.01
0.05 SC every 6
12 hrAnalgesiaCisapride
8
0.5 SC every 8
12 hrGI motilitDexamethasone
27
0.5
2 IM, IV bolusAntiinflammatorDiazepam
8
1
3 IV, IMAnticonvulsant, tranquilizerDoxapram
25,28
2
5 SC, IV every 15 minRespiratory stimulantEnrofloxacin
29
5
15 IM, PO every 12
24 hrAntibioticEpinephrine1:10,000 (0.1 mg/ml)0.2 IV 10
15 minCardiac arrest1:1000 (1 mg/ml)0.2
0.4 Intratracheally followedby vigorous ventilationFurosemide
2
1
4 IV every 6
8 hrDiureticLRS or other isotonic fluids
26
100 ml/kg/hrIV, IO to effectHypovolemic shocLidocaine without epinephrine1
2 IV bolusIntratracheal2
4 antiarrhythmicMeclizine
5
2
12 PO every 24 hrMotion sicknessMetoclopramide
5
0.2
1 PO, SC every 6
8 hrGI motilitMetronidazole
26
20 PO every 12 hrEnterotoxemiaMidazolam
5
1
2 IMAntianxietNaloxone
27
0.01
0.1 IV, IMNarcotic reversalPyrimethamine
20
ToxoplasmosisTrimethoprim-sulfamethoxazole
26,29
15
30 PO every 12 hrBacterial enteritisTetracycline
29
50 PO every 12 hrListeriosis Yohimbine
27
0.2 IVXylazine reversal
Unless otherwise indicated, the dose is in mg/kg.
GI 
= gastrointestinal;
IO 
= intraosseous;
IM 
= intramuscular;
IV 
= intravenous;
LRS 
= lactated Ringer
s solution;
PO 
= oral;
SC 
= sub-cutaneous.

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