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1 January 1999
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
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
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.
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
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