You are on page 1of 9

20TH ANNIVERSARY Vol. 21, No.

1 January 1999

CE Refereed Peer Review

Evaluating and
FOCAL POINT Stabilizing Critically
★Knowledge of the common
differentials for diagnosing
critically ill rabbits allows rapid
Ill Rabbits—Part I
assessment and stabilization.
University of Wisconsin University of California, Davis
Jan C. Ramer, DVM Keith G. Benson, DVM
KEY FACTS Joanne Paul-Murphy, DVM
■ A rabbit that has been anorectic ABSTRACT: Critically ill rabbits can be challenging patients, especially because they can easily
for more than 3 days can quickly become stressed. Although the principles behind emergency and critical care medicine are the
deterioriate and may require same for all mammals, the presenting signs and diagnostic differentials differ. This article de-
aggressive fluid therapy and scribes the common presenting signs for rabbits in critical condition and discusses some di-
forced feeding. agnostic procedures and therapeutic measures. Part II will address specific therapeutic tech-
niques, pain abatement, and nutritional support.
■ Dyspneic rabbits require

A
stabilization before a physical s domestic rabbits become more popular household pets, they represent a
examination can be conducted growing segment in small animal practices.1 Diagnosing critically ill rabbits
or diagnostic procedures can, however, be challenging, even for experienced clinicians. In addition,
initiated. special handling techniques must be followed when examining rabbits or perform-
ing diagnostic procedures. In general, the principles of emergency and critical care
■ In general, red urine from a rabbit practices are the same for all mammals, 2–3 but it is important to evaluate critically ill
is caused by porphyrin pigments; rabbits efficiently and stabilize them before initiating potentially stressful diagnostic
however, true hematuria can tests. Although obtaining a thorough clinical history and performing a systematic
occur. physical examination are important, often the critical condition of a rabbit on pre-
sentation necessitates addressing immediate life-threatening problems.
■ Because rabbits are sensitive Unless life-threatening conditions require immediate attention, some general
to heat stress, they may be guidelines we recommend include:
collapsed or seizuring on
presentation; slow intravenous ■ Observing a critically ill rabbit in a cage or carrier before handling to assess
rehydration and cooling are general attitude, respiratory rate and character, and fecal and urine output
advised. and consistency.
■ 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
Compendium January 1999 20TH ANNIVERSARY Small Animal/Exotics

Diagnostic Differentials for Rabbit Disorders

Abdominal Discomfort ■ Enterotoxemia ■ Encephalitozoon cuniculi


or Enlargement ■ Coccidiosis infection
■ Gastrointestinal stasis, ■ Mucoid enteropathy
obstruction, foreign body, ■ Bacterial enteritis Torticollis
trichobezoar ■ Tyzzer’s disease ■ Otitis media (pasteurellosis)
■ Uterine adenocarcinoma ■ Baylisascaris procynois infection
■ Urinary calculi ■ Toxoplasmosis
Dyspnea
■ Pyometra, dystocia ■ Encephalitozoonosis
■ Pneumonia
■ Listeriosis
■ Neoplasia
Anorexia ■ Cranial nerve trauma
■ Cardiac disease
■ Malocclusion of incisors or
■ Abdominal distention
cheek teeth Collapse or Seizure
■ Gastrointestinal stasis or ■ Heat stress
obstruction; hepatic lipidosis Red Urine ■ Pregnancy toxemia
■ Environmental stress ■ Porphyrin (normal) ■ Trauma
■ Lead poisoning ■ Uterine adenocarcinoma, ■ Encephalitozoonosis
■ Systemic disease (e.g., endometrial venous aneurysm, ■ Pasteurella-caused brain
pneumonia, coccidiosis) abortion abscess
■ Pain ■ Cystitis, pyelonephritis, ■ Venomous snakebite
urolithiasis ■ Lead poisoning
Diarrhea or Mucoid Stools ■ Rabies
■ Inappropriate antibiotic therapy Posterior Paresis
■ Inappropriate diet ■ Vertebral fracture or luxation

thorough physical examination. Important aspects of water bottle or syringe. Grass hay and high-fiber veg-
the history include whether the patient is eating, defe- etables also need to be offered. If the rabbit is not eat-
cating, and urinating and its reproductive status (see ing, hospitalization to administer intravenous or in-
Diagnostic Differentials for Rabbit Disorders). traosseous fluids is indicated. A nasogastric feeding
tube may be placed, or the rabbit may be force fed
Gastrointestinal Stasis through a syringe. Metoclopramide and/or cisapride
Rabbits with gastrointestinal (GI) stasis often have a promote GI motility7–9 (Table I).
history of inappropriate diet, decreased appetite, small
fecal pellets, or stress in the household. A firm, doughy Gastrointestinal Obstruction or Foreign Bodies
mass palpable in the cranial abdomen is consistent with Infrequently, rabbits present with an acute abdomen
GI stasis or the presence of a trichobezoar.6,7 Obstruc- that is painful on palpation. They may be hypothermic,
tion, which must be ruled out before treatment for sta- bloated, tachycardic, or tachypneic. These animals
sis can be initiated, can be confirmed by radiography; if must be evaluated quickly and efficiently and stabilized
the rabbit is defecating, however, obstruction is im- via fluid therapy, pain management, and possibly de-
probable. A pneumogastrogram can help confirm the compression.
presence of a trichobezoar, which does not require sur- A firm mass in the cranial abdomen is consistent
gical removal unless the pylorus is obstructed. with obstruction of the pylorus. Decompression of the
Rabbits with GI stasis or nonobstructive trichobe- tympanic stomach by passing a nasogastric or an oro-
zoars are best managed with aggressive rehydration and gastric tube may be necessary before other diagnostic
increased fiber in the diet. If the rabbit is eating and tests can be performed. Intussusception or foreign bod-
drinking, oral electrolyte solutions can be offered in a ies can occur in the small intestine and are sometimes

PATIENT HISTORY ■ AGGRESSIVE REHYDRATION ■ ACUTE ABDOMINAL PAIN


Small Animal/Exotics 20TH ANNIVERSARY Compendium January 1999

TABLE I
Critical Care Drug Therapy for Rabbits
Agent Dose a Route Indication
Atropine25,26 0–0.5 SC, IM Bradycardia
Buprenorphine16,25 0.01–0.05 SC every 6–12 hr Analgesia
Cisapride8 0.5 SC every 8–12 hr GI motility
Dexamethasone27 0.5–2 IM, IV bolus Antiinflammatory
Diazepam8 1–3 IV, IM Anticonvulsant, tranquilizer
Doxapram25,28 2–5 SC, IV every 15 min Respiratory stimulant
Enrofloxacin29 5–15 IM, PO every 12–24 hr Antibiotic
Epinephrine
1:10,000 (0.1 mg/ml) 0.2 IV 10–15 min Cardiac arrest
1:1000 (1 mg/ml) 0.2–0.4 Intratracheally followed
by vigorous ventilation
Furosemide2 1–4 IV every 6–8 hr Diuretic
LRS or other isotonic fluids26 100 ml/kg/hr IV, IO to effect Hypovolemic shock
Lidocaine without epinephrine 1–2 IV bolus Intratracheal
2–4 antiarrhythmic
Meclizine5 2–12 PO every 24 hr Motion sickness
Metoclopramide5 0.2–1 PO, SC every 6–8 hr GI motility
Metronidazole26 20 PO every 12 hr Enterotoxemia
Midazolam5 1–2 IM Antianxiety
Naloxone27 0.01–0.1 IV, IM Narcotic reversal
Pyrimethamine20 Toxoplasmosis
Trimethoprim-sulfamethoxazole26,29 15–30 PO every 12 hr Bacterial enteritis
Tetracycline29 50 PO every 12 hr Listeriosis
Yohimbine27 0.2 IV Xylazine reversal
aUnless 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.

palpable. Radiographs, pneumogastrograms, and posi- Urolithiasis


tive-contrast GI studies are helpful in diagnosing the A history of stranguria or dysuria and a full, firm uri-
obstruction. Surgery is required; the prognosis is poor nary bladder are consistent with urethral obstruction.
because postoperative return of normal GI motility is Affected rabbits are depressed, and the abdomen is
difficult to achieve.2,3,6,7,9,10 painful. Catheterization is indicated to relieve urethral
obstruction. Infrequently, ureteral calculi result in hy-
Reproductive Disorders dronephrosis. Multiple renal cysts, which are common
Reproductive disorders must be considered in intact in geriatric rabbits, can be confused with hydronephro-
female rabbits that present with abdominal discomfort sis but can be confirmed by ultrasonography or intra-
or enlargement. Pyometra and uterine adenocarcinoma venous urography.11
can be palpated as fluctuant or doughy masses in the Urinalysis may show hematuria, crystalluria, or
caudal abdomen. Vaginal bleeding can occur in does pyuria. The urine pH of normal rabbits is alkaline and
with uterine adenocarcinoma. Fetuses are palpable in does not change in rabbits with urolithiasis. Crystal-
rabbits with dystocia. Radiography and abdominal ul- luria is common in rabbits and does not directly corre-
trasonography can help confirm a diagnosis.9–11 Tho- late with the presence of uroliths.11 Serum chemistries
racic radiographs to rule out pulmonary metastasis are and CBCs can help to assess hydration and renal function.
indicated in patients with uterine adenocarcinoma. A Medical treatment includes aggressive fluid therapy,
CBC may be useful in confirming anemia or inflamma- decreased calcium in the diet, and manual expression
tory response. Ovariohysterectomy is indicated. of the urinary bladder in patients with nonobstructive

ABDOMINAL ENLARGEMENT ■ URETHRAL OBSTRUCTION ■ SERUM CHEMISTRIES


Compendium January 1999 20TH ANNIVERSARY Small Animal/Exotics

calculi. Surgery is required if there are obstructive cal- Systemic Disease


culi. Other systemic diseases (e.g., respiratory disease, uro-
genital disease) and pain from fractures, lacerations, or
ANOREXIA other injuries can cause anorexia.2,3,5–7,11,12,15,16
Anorexia, a common nonspecific sign in rabbits, can
be caused by stress from pain, systemic disease, or anxi- Hepatic Lipidosis
ety (see Diagnostic Differentials for Rabbit Disorders). Anorexia can quickly result in hepatic lipidosis in rab-
Failure to eat for more than 2 to 3 days is a potential bits. The liver enzymes alanine transaminase and aspar-
emergency.12 A complete physical examination is indi- tate transaminase become elevated and the rabbit may
cated and generally well tolerated. be ketotic.7,12 All anorectic rabbits need supportive care
(fluid therapy and forced feeding) as described earlier.
Dental Malocclusion
Malocclusion of the incisors and cheek teeth molars DIARRHEA
and premolars frequently causes drooling, which can Inappropriate Diet
result in saliva-matted fur or dermatitis under the chin. A rabbit with intermittent soft stools described as di-
Malocclusion of the incisors can be easily confirmed by arrhea by an owner often has a history of being fed a
visual inspection and corrected by trimming. The low-fiber diet, high-carbohydrate diet or a new diet. In-
cheek teeth may also be maloccluded, even when the appropriate diet can cause changes in the cecal pH or
incisors appear to be normal; thorough examination of intestinal disbiosis (see Diagnostic Differentials for
the cheek teeth frequently requires sedation or anesthe- Rabbit Disorders). Affected rabbits tolerate physical ex-
sia. Abscesses of the cheek teeth are common and may amination well. In many patients, no abnormalities
be seen grossly as a large firm mass on the mandible. may be found and fecal examinations will be negative
Radiographs may show apical abscessation or abnormal for parasites. Most rabbits respond well to correction of
placement of the cheek teeth. the diet.3,5–7
Before trimming maloccluded incisors with a dental High-carbohydrate diets can cause severe disbiosis
drill, the patient should be sedated, although some rab- and diarrhea, followed by depression, dehydration, and
bits require anesthesia. Rabbits with severe incisor mal- anorexia. Intestinal fluid and gas may be palpable in the
occlusion requiring frequent trimming may benefit abdomen. Ileus may occur, resulting in gas-distended
from surgical extraction. The cheek teeth can be bowel loops and abdominal pain (Figure 1). Fecal ex-
trimmed with a bone rongeur or dental drill while the aminations will be negative. Affected rabbits need sup-
rabbit is anesthetized.13 Abscesses must be aggressively portive care as described for GI stasis. Rabbits with
debrided and curetted and require extraction of the in- ileus may benefit from mild forced exercise several times
volved tooth. Surgical extraction of the cheek teeth is daily.
difficult, and the prognosis is guarded; but with inten-
sive postoperative care, appropriate systemic antibiotics, Inappropriate Antibiotic Therapy
and good wound management, some rabbits can make Inappropriate antibiotic therapy may result in GI dis-
a full recovery.13 biosis and watery and sometimes bloody diarrhea. Nar-
row-spectrum antibiotics (e.g., amoxicillin, ampicillin,
Gastrointestinal Stasis clindamycin, some cephalosporins, erythromycin, lin-
Gastrointestinal stasis is a common cause of anorexia comycin, penicillin; Table I) can suppress normal GI
in rabbits and, as previous described, they generally re- flora, thereby allowing other flora to proliferate, which
spond to aggressive fluid therapy, forced feeding or in- leads to changes in the intestinal pH. The resultant in-
creased fiber in the diet, and GI motility-enhancing crease in volatile fatty acid production causes severe en-
drugs (Table I). teritis, which can sometimes progress to enterotoxemia
caused by iota-like toxins from an overgrowth of Clostrid-
Lead Poisoning ium spiroforme.2,3,5–7,9 Affected rabbits are very ill and re-
Lead poisoning can result in anorexia and lethargy. quire hospitalization, fluid therapy, and forced feeding
Radiographs may show metallic opacity in the GI tract. or feeding through a nasogastric tube. The offending
Blood lead levels are diagnostic. Anemia may be pres- antibiotic should be stopped.
ent. Lead toxicosis in rabbits can be treated as in other Rabbits with enterotoxemia may benefit from the ad-
small mammals (i.e., 27.5 ml/kg of subcutaneous calci- ministration of metronidazole and/or a broad-spectrum
um ethylenediaminetetraacetic acid every 6 hours for 5 antibiotic (e.g., fluoroquinolone or trimethoprim–sul-
days).14 famethoxazole).

DENTAL ABSCESSES ■ HIGH-CARBOHYDRATE DIETS ■ NARROW-SPECTRUM ANTIBIOTICS


Small Animal/Exotics 20TH ANNIVERSARY Compendium January 1999

tery diarrhea, depression,


and death in weanling rab-
bits. A chronic form can
occur in adult rabbits. The
primary sign is weight loss.
Tyzzer’s disease is difficult
to diagnose antemortem.
Serologic assays (e.g., indi-
rect fluorescent antibody or
enzyme-linked immunosor-
bent assay) are available,
Figure 1B and fecal polymerase chain
Figure 1—(A) Ingesta-filled stomach and (B) gas-distended reaction assays have been
bowel loops caused by inappropriate diet and severe coccid- developed but are not com-
iosis. monly used in routine diag-
Figure 1A
nostic testing.17 Treatment
is palliative.7,17
Coccidiosis DYSPNEA
Coccidia of the genus Eimeria are common parasites A dyspneic rabbit is a true emergency and may re-
of the GI tract and liver in rabbits.2,3,5–7 Clinical signs of quire supportive care before any physical examination
diarrhea are generally apparent in young rabbits, but or diagnostic tests are performed. Even minimal re-
adult rabbits can also be affected. Clinical signs can straint may result in respiratory arrest.6 Severely affect-
range from mild intermittent diarrhea to severe hemor- ed rabbits should be placed in an oxygen cage before a
rhagic diarrhea. Oocysts are evident on fecal flotation. physical examination is attempted. After a dyspneic
Treatment consists of supportive care and anticoccidial rabbit has been stabilized, the physical examination
drugs. should be performed in a low-stress environment. A
low flow of oxygen (1 L/min) close to the rabbit’s nose
Mucoid Enteritis is frequently beneficial during the examination.
Mucoid enteritis (i.e., increased production of cecal
mucus for an unknown reason) is generally found in Respiratory Disease
young rabbits.7 Rabbits with mucoid enteritis may be Upper airway disease caused by Pasteurella multocida is
dehydrated and anorectic. Supportive care is required; the most common respiratory disease found in domestic
the condition is associated with high morbidity and rabbits, although Bordetella and Moraxella can also cause
mortality. Intermittent mucoid stools are evident in airway disease.18 Affected rabbits may have a history of
many rabbits with mild disbiosis, which can be re- intermittent nasal or ocular discharge or may be acute on
solved through dietary management (high fiber, low presentation. Physical findings may include mucopuru-
calcium). lent discharge from the nose and/or eyes (Figure 2).
Thoracic auscultation may reveal referred upper respira-
Bacterial Enteritis tory sounds or crackles and wheezes in affected lung
Bacterial enteritis, an uncommon cause of diarrhea in fields if pneumonia is present. Rabbits with severe upper
rabbits, can be caused by Salmonella, Pseudomonas, and airway disease may be dyspneic because of mucopurulent
Campylobacter-like species. Often rabbits with bacterial plugs in the nares and are immediately more comfortable
enteritis quickly develop septicemia.7 Fecal culture and after the nares have been cleared. Bacterial pneumonia
sensitivity studies must be completed before appropri- may not be apparent to owners until very late in the
ate antibiotic therapy can be selected. An empiric course of disease5 (Figure 3). Deep culture and sensitivity
broad-spectrum antibiotic (e.g., trimethoprim–sul- studies of the discharge from the nares can help clini-
famethoxazole or enrofloxacin) can be administered cians select the appropriate antibiotic for treatment. Ra-
while waiting for culture results. Aggressive fluid thera- diographs are useful in diagnosing pneumonia. Rabbits
py and supportive care are required. with pneumonia require antibiotic therapy (Table I) and
may also benefit from oxygen therapy and nebulization.
Tyzzer’s Disease
Tyzzer’s disease, which is caused by Clostridium pili- Neoplasia
form, is uncommon, although it can result in severe wa- Primary neoplasia (e.g., thymoma, metastatic neopla-

COMMON PARASITES ■ SEPTICEMIA ■ UPPER AIRWAY DISEASE ■ PNEUMONIA


Compendium January 1999 20TH ANNIVERSARY Small Animal/Exotics

sia) may cause dyspnea. Radio- bits with endometrial venous


graphs are useful for diagnosis. The aneurysm may be severely anemic
prognosis is poor. (packed cell volume of 10% or high-
er) and require whole blood transfu-
Cardiac Disease sion. Uterine adenocarcinoma and
As can occur in other mammals, endometrial venous aneurysm re-
cardiac disease in rabbits can result quire ovariohysterectomy after the
in pulmonary edema and dyspnea. animal has been stabilized.
There may be a history of exercise Abortion can be confirmed by
intolerance. 18 A murmur may or thoroughly evaluating the patient
may not be auscultated during the history, including drug administra-
physical examination. Radiographs tion and previous abortions. Ab-
and echocardiograms are useful in dominal radiographs along with
confirming cardiac disease (Figure Figure 2—Mucopurulent discharge from a rab- palpation can verify the diagnosis
4). Furosemide can relieve pul- bit with pasteurellosis. and confirm the presence of re-
monary edema (Table I). Other tained fetuses. If retained fetuses are
cardiac medications used in the confirmed, 1 to 2 U of intramus-
treatment of dogs and cats can be cular or subcutaneous oxytocin
administered to rabbits with car- should be administered. If the fe-
diac disease. tuses are not expelled within 1
hour, a cesarean section should be
Abdominal Distention performed; the prognosis is guarded
Abdominal distention can result for these patients. 11 The fetuses
in dyspnea caused by compression should be examined to rule out in-
of the relatively small thorax by ab- fectious causes of abortion.
dominal contents. Treatment is the
same as that recommended for ab- Urinary Tract Disease
dominal enlargement. Urinary tract disorders (e.g., cys-
titis, pyelonephritis, urolithiasis)
RED URINE can also result in hematuria; diag-
Red urine is frequently perceived nosis and treatment should be
as an emergency by rabbit owners based on standard procedures fol-
but is often caused by nonpatholog- lowed in small animal medicine.9,11
ic porphyrin pigments, although
true hematuria can be an emergen- POSTERIOR PARESIS
cy.11,19 When hematuria is suspected, Vertebral Fracture and
a urine dipstick test or examination Luxation
of sediment for intact erythrocytes Fracture of L-7, the most com-
can be useful for quick assessment mon reason for sudden onset of
(Figure 5). posterior paresis in rabbits (see Di-
Figure 3—Bronchopneumonia is evident in
agnostic Differentials for Rabbit
this radiograph of a rabbit presented with res-
Reproductive Disorders piratory distress. Disorders), often results from im-
Uterine adenocarcinoma, en- proper handling but can occur if a
dometrial venous aneurysm, and rabbit is startled. 20 A gentle and
(less commonly) abortion should be suspected in intact careful physical examination may also reveal a loss of
female rabbits with hematuria.9,11 A fluctuant, lobulated skin sensation and a flaccid, full urinary bladder. Ra-
mass may be palpable in the caudal abdomen and a soft diographs can confirm an L-7 fracture (although there
tissue mass evident on radiographs of rabbits with uter- may be no lesion with luxation), and treatment should
ine adenocarcinoma or endometrial venous aneurysm. be initiated immediately. Dexamethasone is useful in
Abdominal ultrasonography is also useful for confirming reducing swelling of the spinal cord. The urinary blad-
a diagnosis and can be used to measure the masses. Tho- der may need to be expressed regularly until clinical
racic radiographs are indicated to rule out pulmonary signs improve.
metastasis if uterine adenocarcinoma is suspected. Rab- Fracture of L-7 should not be confused with splay

CARDIAC MEDICATIONS ■ PORPHYRIN PIGMENTS ■ ABORTION ■ PARALYSIS


Small Animal/Exotics 20TH ANNIVERSARY Compendium January 1999

leg, which is a congenital condition has questionable diagnostic value


that can affect young rabbits (Fig- because most rabbits have previous
ure 6). Rabbits with splay leg retain exposure to the organism and there-
skin sensation and normal bladder fore measurable antibody titers.20
function. Pasteurellosis can be treated with
enrofloxacin, but torticollis may
Encephalitozoonosis persist if the middle ear has been
Encephalitozoon cuniculi, an intra- permanently damaged. Meclizine
cellular protozoan, can result in pro- has been useful in reducing disori-
gressive posterior paresis in rabbits. entation in rabbits with torticollis.8
Positive antibody titers to E. cuni-
culi in rabbits with compatible clini- Encephalitozoonosis
cal signs is suggestive of infection; E. cuniculi infection is another
however, definitive diagnosis can common cause of torticollis, espe-
only be made by histopathologic cially in rabbits younger than 2 years
identification of the organism. 20 of age. Affected rabbits may present
There is no effective treatment for with an acute head tilt only or may
encephalitozoonosis, although anec- have a history of progressive general-
dotal reports indicate suppression Figure 4—Dilated cardiomyopathy in a rabbit. ized neurologic signs. The external
of clinical signs with administration ears are normal. The diagnosis and
of benzimidazoles, which have suc- treatment of encephalitozoonosis-
cessfully been used to treat AIDS pa- caused torticollis are the same as for
tients with encephalitozoonosis.21–23 rabbits with posterior paresis.

TORTICOLLIS Baylisascariosis
Torticollis (wry neck or head tilt) and Listeriosis
is a common clinical sign presented Although they are uncommon,
by rabbits (see Diagnostic Differ- Baylisascaris and Listeria infections
entials for Rabbit Disorders). It can have been documented as the cause
occur acutely and progress rapidly of neurologic signs (including torti-
(Figure 7). Rabbits with severe tor- collis) in rabbits. Rabbits infected
ticollis may roll in the direction of with Baylisascaris may have hay or
the head tilt and may have nystag- Figure 5—A urine dipstick test is useful for bedding contaminated with rac-
mus. quick assessment of hematuria. coon feces. An oral route of infec-
tion is suspected in rabbits with lis-
Otitis Media teriosis. Antemortem diagnosis is
P. multocida infection producing rare. These infections can be diag-
otitis media is the most common nosed by histopathologic studies.5,20
5,20
cause of torticollis in rabbits. No effective treatment for Baylisas-
There may be a history of upper caris infection has been published,
respiratory disease. Mucopurulent whereas rabbits with listeriosis have
discharge behind the tympanic been treated with tetracycline.20
membrane might be noted, or the
membrane may be ruptured. Nys- Toxoplasmosis
tagmus is rarely noted. Toxoplasmosis is an uncommon
Rear limb paresis is rare, al- cause of torticollis and other neuro-
though Pasteurella can cause en- logic signs in rabbits. Infection is
cephalitis, which can result in more believed to occur primarily by in-
Figure 6—Splay leg in a young rabbit.
generalized neurologic signs. Cul- gestion of infected cat feces. Sero-
tures of the aural discharge are di- logic tests are available for ante-
agnostic in the event of tympanic membrane rupture. mortem diagnosis, and affected rabbits can be treated
Skull radiographs to confirm changes in the bulla are with pyrimethamine combined with a sulfonamide
useful. Measurement of antibody titers to P. multocida drug.20

PROTOZOA ■ WRY NECK ■ REAR LIMB PARESIS ■ PASTEURELLOSIS


Compendium January 1999 20TH ANNIVERSARY Small Animal/Exotics

Trauma 2. Harrenstein L: Critical care of ferrets,


As with other mammals, cranial rabbits, and rodents. Semin Avian Ex-
otic Pet Med 3(4):217–228, 1994.
nerve trauma can cause torticollis 3. Jenkins JR: Rabbits, in Jenkins JR,
in rabbits. Such trauma may be re- Brown SA (eds): A Practitioner’s
vealed while reviewing the history Guide to Rabbits and Ferrets. Lake-
or other signs of trauma during the wood CO, The American Animal
physical examination. Radiographs Hospital Association, 1993, pp 2–42.
4. Paul-Murphy J: Little critters: Emer-
are necessary to identify a skull gency medicine for small rodents.
fracture. Aggressive supportive care Proc Fifth Intl Vet Emer Crit Care
and treatment of clinical signs are Symp:714–718, 1996.
required. 5. Harkness JE, Wagner JE: The Biology
Figure 7—Torticollis in a wild rabbit. and Medicine of Rabbits and Rodents.
Baltimore, Williams & Wilkins,
COLLAPSE AND SEIZURE 1995, p 8.
Seizures are uncommon in rabbits but, when they oc- 6. Hillyer EV: Pet rabbits. Vet Clin North Am Small Anim Pract
cur, may indicate a serious condition (see Diagnostic 24(1):25–65, 1994.
Differentials for Rabbit Disorders). If the rabbit is 7. Jenkins JR: Gastrointestinal diseases, in Hillyer EV, Quesen-
seizuring on presentation, intravenous diazepam should berry KE (eds): Ferrets, Rabbits and Rodents: Clinical Medicine
8 and Surgery. Philadelphia, WB Saunders Co, 1997, pp 176–
be administered. 188.
8. Carpenter JW, Mashima TY, Rupiper DJ: Exotic Animal
Heat Stress Formulary. Manhattan KS, Greystone Publications, 1996.
Rabbits are very susceptible to heat stress, especially if 9. Gentz EJ, Harrenstein, LA, Carpenter JW: Dealing with gas-
exposed to elevated ambient temperatures. Heat- trointestinal, genitourinary, and musculoskeletal problems in
rabbits. Vet Med 90(4):365–372, 1995.
stressed rabbits may be dehydrated, weak, and disori- 10. Stein S, Walshaw S: Rabbits, in Laber-Laird K, Swindle M,
ented and may have seizures. The body temperature is Flecknell P (eds): Handbook of Rodent and Rabbit Medicine.
often higher than 106°F (normal, 100˚F to 104˚F). Af- Oxford, Pergamon, 1996, pp 183–218.
fected rabbits should be cooled slowly with intravenous 11. Paul-Murphy J: Reproductive and urogenital disorders, in
fluids and given a tepid bath.11 Hillyer EV, Quesenberry KE (eds): Ferrets, Rabbits and Ro-
dents: Clinical Medicine and Surgery. Philadelphia, WB
Saunders Co, 1997, pp 202–211.
Pregnancy Toxemia 12. Brown SA, Rosenthal KL: The anorexic rabbit. Proc TNAVC:
Pregnancy toxemia usually occurs in overweight 788, 1997.
does near the end of pregnancy but can also occur in 13. Jenkins JR: Soft tissue surgery and dental procedures, in
Hillyer EV, Quesenberry KE (eds): Ferrets, Rabbits and Ro-
postparturient and pseudopregnant does. Affected
dents: Clinical Medicine and Surgery. Philadelphia, WB
rabbits are weak, ataxic, and depressed; and the signs Saunders Co, 1997, pp 227–239.
can quickly progress to coma and death. In addition, 14. Swartout MS, Gerken DF: Lead-induced toxicosis in two
affected rabbits are ketonuric, which can be detected domestic rabbits. JAVMA 191(6):717–719, 1987.
on a urine dipstick test. Treatment includes intra- 15. Eisele PH: Signs of pain in small mammals. Proc TNAVC:795–
796, 1997.
venous lactated Ringer’s solution and 5% dextrose.11,20 16. Eisele PH: Analgesia in small mammals. Proc TNAVC:796–
799, 1997.
Collapse 17. Besch-Williford C: Tyzzer’s disease in rabbits. Proc House
Collapsed, weak, or disoriented rabbits are a true Rabbit Soc Vet Conf Rabbit Med Proced Pract:113–117,
emergency and diagnostic challenge. Causes include 1997.
18. Deeb BJ: Respiratory disease and the Pasteurella complex, in
trauma, heat stress, encephalitozoonosis, pasteurellosis, Hillyer EV, Quesenberry KE (eds): Ferrets, Rabbits and Ro-
venomous snakebite, lead poisoning, starvation, hepat- dents: Clinical Medicine and Surgery. Philadelphia, WB
ic lipidosis, and (rarely) rabies.20 There is one report of Saunders Co, 1997, pp 189–201.
rabies in a pet rabbit with a history of encountering a 19. Samman S, Fussell SH, Rose CI: Porphyria in a New Zea-
wild skunk.24 The diagnosis and treatment of these dis- land white rabbit. Can Vet J 32:622–623, 1991.
20. Gentz J, Carpenter JW: Neurologic and musculoskeletal dis-
eases have already been discussed. Nonspecific sup- ease, in Hillyer EV, Quesenberry KE (eds): Ferrets, Rabbits
portive care is necessary during diagnostic workup. and Rodents: Clinical Medicine and Surgery. Philadelphia,
WB Saunders Co, 1997, pp 220–226.
21. Katiyar SK, Edlind TD: In vitro susceptibilities of the AIDS-
REFERENCES associated microsporidian Encephalitozoon intestinalis to al-
1. Gehrke BC: Results of the AVMA survey of US pet-owning bendazole, its sulfoxide metabolites, and 12 additional benz-
households on companion animal ownership. JAVMA imidazole derivatives. Antimicrob Agents Chemother 41(12):
211(7):160–170, 1997. 2729–2732, 1997.

SUPPORTIVE CARE ■ DIAZEPAM ■ INTRAVENOUS FLUIDS


Small Animal/Exotics 20TH ANNIVERSARY Compendium January 1999

22. Didier ES, Rogers LB, Brush AD, et al: Diagnosis of dissem- of rabbits and pocket pets, in Bonagura JD (ed): Kirk’s Cur-
inated microsporidian Encephalitozoon hellem infection by rent Veterinary Therapy. XII. Small Animal Practice. Philadel-
PCR-southern analysis and successful treatment with alben- phia, WB Saunders Co, 1995, pp 1322–1327.
dazole and fumagillin. J Clin Micro 24(4):947–952, 1996. 29. Quesenberry KE: Rabbits, in Birchard SJ, Sherding RG
23. Joste NE, Rich JD, Busam KJ, Schwartz DA: Autopsy verifi- (eds): Saunders Manual of Small Animal Practice. Philadel-
cation of Encephalitozoon intestinalis (microsporidiosis) erad- phia, WB Saunders Co, 1994, pp 1345–1362.
ication following albendazole therapy. Arch Path Lab Med
120(2):199–203, 1996.
24. CDC Veterinary Public Health Notes: Rabbit rabies. JAVMA
179:84, 1981. About the Authors
25. Carpenter JW, Mashima TY, Gentz EJ, Harrenstein L: Car- Drs. Ramer and Paul-Murphy are affiliated with the
ing for rabbits: An overview and formulary. Vet Med 90(4): Department of Surgical Sciences, School of Veterinary
340–364, 1995. Medicine, University of Wisconsin, Madison, Wisconsin
26. Paul-Murphy J: Emergency medicine and critical care for rab-
bits. Proc Fifth Intl Vet Emerg Crit Care Symp:724–726, 1996. and Dr. Benson is a resident in Zoological Medicine at the
27. Gillett CS: Selected drug dosages and clinical reference data, School of Veterinary Medicine, University of California,
in Manning PJ, Ringler DH, Newcomer CE (eds): The Biol- Davis, California. Dr. Paul-Murphy is a Diplomate of the
ogy of the Laboratory Rabbit, ed 2. San Diego, Academic Press American College of Zoological Medicine.
Inc, 1994, pp 467–472.
28. Huerkamp MJ: Anesthesia and postoperative management