• Abstract and Figures
• Public Full-text

CRITICAL CARE OF RABBITS Eric Klaphake, DVM, DABVP (Avian), DACZM, DABVP (Reptile-Amphibian) Cheyenne Mountain Zoo, Colorado Springs, CO The term “emergency” obviously means different things to different people. My definition of an emergency is an issue which requires immediate intervention to prevent death, irreversible disease/injury progression, or pain. However, a client’s definition(s) of emergency often include: they “just noticed the problem,” “this was a convenient time to come in,” they “starting to feel guilty about the issue,” they “thought it would die a long time ago, and it has not,” and of course anything involving blood. Another possibility to consider is something normal appearing to an individual not aware that such things are normal in that species. Trying to summarize all the emergencies that might be seen is beyond the scope of a one hour lecture, however; the most common presentations for rabbits will be covered. With exotic animals, problems may present at a very advanced stage or clients may not have the finances/desire to pay for the more advanced diagnostics and therapeutics that can be provided with what they view as a disposable pet. Therefore, you may need to have The Quality of Life Talk sooner than one might expect. While one should always offer the highest level of care or referral, many times this is the first time an individual has brought a rabbit into a veterinarian and they often expect cost of care to reflect size of animal. As with all animals, emergencies often place the client into a very emotional state. As a veterinary team, our first job is to manage the welfare of the patient, however, we also have to be very careful about discounting or not receiving proper payment for our services. Once stabilized, clients should be provided both the short term picture and prognosis, but also provided a longer term view of where things may be headed. A common question asked to both the veterinarian is “If it was your ….” I prefer to always answer this honestly and often provide two forms of answer: “if this pet means everything to me (or my child)”, and “if I care about the animal’s well-being and do not want it to suffer, but there are limits to where I want to go.” Unfortunately, euthanasia as an option becomes the gorilla in the room, but should be discussed from the very beginning if it is a viable option. With some of these presenting conditions, providing client guidance as to determining points of exit can be helpful, along with providing hospice care versus hospitalized care or euthanasia options only. A finally challenge with many exotics are owner-present euthanasias. Many times, the final injection will be delivered intracardiac, so preparing a client for this is critical. It goes without saying that intracardiac injections without prior general anesthesia are considered inhumane in any animal. GENERALITIES The following are general recommendations for common issues that clients may call the clinic regarding and suggested advice to provide. * Minor bleeding- apply direct pressure to the area for 5-10 minutes. Come in if not stopping. * Major bleeding - apply direct pressure to the area and come in immediately. * Minor bleeding from the toe nail - apply kwik stop, cornstarch, flour or a bar of soap to the nail. Come in if not stopping. * Diarrhea-If allowed to go untreated, the animal can become dehydrated quickly. * Decreased appetite/fecal production- If a drop in the animal’s weight, decreased interest in food, decreased amount of fecal production, or increased salivation, come in sooner versus later. * Hyperthermia- Most small mammals cannot tolerate high temperatures above 85-90 F. The animal will be collapsed and panting. Mist with cool water and put ice packs near the animal. Soaking an animal in cold water can send them into shock and further complicate the situation. Bring in immediately. * Coughing, sneezing, runny nose, eye discharge, and open mouth breathing are symptoms of respiratory distress. Keep the animal warm (75-80 F) and quiet with minimal handling, and bring in immediately. BIG 3 PRESENTATIONS While not completely correct, remember that rabbits are basically “stomachs wrapped in fur” and that their gastrointestinal systems function most closely to that of a horse, so triage and treat in a similar manner. Rabbits are considered geriatric at five years of age. Like ferrets, pet rabbits are often allowed free roam of the house, there is no such thing as “rabbit proofed,” they often interact directly with dogs/cats, and they love to eat/chew on bad things. Three common presentations of pet rabbits are described below. The most common presentation is the rabbit that is not eating nor defecating, with variations such as: eating, not defecating; not eating, but defecating; or eating and defecating but not in a normal manner. The most common issue is usually dehydration. However, other rule outs include: trichobezoars, foreign bodies, toxins, incorrect diet, incorrect use of antibiotics, dental disease, and neoplasia. Once the rabbit is stable, initial diagnostics should include: a complete blood cell count, serum chemistries, and radiographs. Placement of an IV or IO catheter may be warranted, but can be challenging to maintain in these rabbits unless they are extremely lethargic, as they often chew through the catheter lines. In many cases, SQ fluids are a better way to go, however, if the rabbit is shocky, this may not be the best method to attempt. I generally administer 150 mL/kg as a bolus, and if absorbing well, repeat every 6-8 hours as indicated. If gastrointestinal motility is a concern, injectable treatment versus oral medication is preferred. Nutritional support (a fine grind herbivore critical care) should be initiated. If a foreign body seems unlikely, then metoclopramide should be considered. Supplementation with famotidine and maropiant may of benefit. Pain management should be an important component of managing the case, considering that gastrointestinal distention can be extremely painful, including the use of NSAID’s and/or opioids (remember the latter can have gastrointestinal motility effects). With rabbits, it is critical to be aware that certain drugs can cause severe problems in rabbits, including: systemic corticosteroids, fipronil, and oral penicillins/cephalosporins. A second common presentation in rabbits is ocular discharge/facial swelling. Clinical signs can include: unilateral or bilateral ocular discharge and soft or firm swellings on the face. Rule outs include: pasteurellosis, tooth root abscess, nasolacrimal duct blockage, allergies, an ocular foreign body, neoplasias, and overgrown molars/premolars. Initial diagnostics should include: a complete blood cell count, serum chemistries, radiographs, bacterial and fungal culture sensitivity and cytology of discharge and/or swelling, an oral examination under anesthesia, and a nasolacrimal duct flush. Fluid therapy may be necessary as described previously. If the teeth appear abnormal with an anesthetic exam or via dental radiography, trims and/or extractions may be necessary. As rabbit pus does not drain well, surgical excision of defined abscesses or neoplasias may be warranted. For difficult locations of abscesses, incomplete removals, or in critical patients, the use of honey or super-saturated sugar packing techniques may be of value. For cultures, it is of greatest value to submit a piece of the abscess wall rather than aspirated pus, as the latter is often actually sterile. When culture is not an option, parenteral penicillin can be considered, as it will not influence GI dysbiosis as much as oral treatment. Antibiotic-impregnated polymethylmethacralate beads can be effective to pack an infected site, with antibiotic selection based on culture and ability to be incorporated into the beads. Pain management needs to be considered as well for both the disease as well as for potential treatments. A final common presentation is the rabbit with a head tilt, ataxia, or circling. Clinical signs can include the aforementioned, along with nystagmus, rolling, and hyperesthesia. Rule outs include: pasteurellosis, trauma, Encephalitozoan cuniculi, toxoplasmosis, heat stroke, neoplasia, hepatic disease, and ear mites. Initial diagnostics should include: a complete blood cell count, serum chemistries, radiographs, and an otic examination under sedation—rabbits are extremely touchy about ear evaluation. If available, a CT scan may provide a better evaluation of more subtle disease. Other tests to consider include a Pasteurella titer, an E. cuniculi titer, and toxoplasmosis titers (IgG and IgM). While these can all be run, the value and interpretation of single values is debatable. Ideally, paired titers (two to four weeks apart) sent in together are the gold standard, but of little use in the here and now. Again the benefits of injectable treatments, nutritional support, fluids, metaclopramide, and pain management should be assessed. Other medications, such as corticosteroids (despite the extreme sensitivity of rabbits to this class of drugs), albendazole, and prophylactic antibiotics such as enrofloxacin or a sulfa drug may be considered by the veterinarian. Other emergency rabbit presentations can include: caudal paresis, heat stroke, ripped off limbs, fractures, bloat, severe pruritis, overgrown/broken off incisors, screaming rabbits, fecal matting of the perineal region (usually diarrhea), urine scald, “sandoliths” (rabbits tend to get calcium sand obstruction of the urethra vs a stone form), maggots (and a slight permutation—Cuterebra), and broken off toenails. With neurologic presentations, do not forget they are mammals and rabies can occur. NORMAL GI ANATOMY AND PHYSIOLOGY Rabbits in the wild use their sensitive lips to grasp their food. These have specialized receptors that help to compensate for the fact that because of rabbit ocular positioning, they can not see what is happening by the mouth. They have a long diastema, rostrally positioned incisor teeth and a cleft upper lip (‘‘hare-lip’’). The food is then ground by the premolars and molars.

Load more

  13

Copy Link