EXOTIC-Evaluating and Stabilizing Critically Ill Rabbits.part I

8/14/2019 EXOTIC-Evaluating and Stabilizing Critically Ill Rabbits.part I

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20TH ANNIVERSARY Vol. 21, No. 1 January 1999

FOCAL POINT

KEY FACTS

5Knowledge of the commondifferentials for diagnosing

critically ill rabbits allows rapid

assessment and stabilization.

Evaluating andStabilizing CriticallyIll RabbitsPart IUniversity of Wisconsin University of California, DavisJan C. Ramer, DVM Keith G. Benson, DVM

Joanne Paul-Murphy, DVM

ABSTRACT: Critically ill rabbits can be challenging patients, especially because they can easily

become stressed. Although the principles behind emergency and critical care medicine are the

same 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.

As domestic rabbits become more popular household pets, they represent a

growing 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, 23 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:

sObserving 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 rabbits bodyweight,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 typicallyhave a higher percentage of heterophils than of leukocytes, which will be re-flected in the complete blood count (CBC).5

ABDOMINAL DISCOMFORT OR ENLARGEMENTRabbits with abdominal discomfort, enlargement, or both generally tolerate a

s A rabbit that has been anorectic

for more than 3 days can quickly

deterioriate and may require

aggressive fluid therapy and

forced feeding.

s Dyspneic rabbits require

stabilization before a physical

examination can be conductedor diagnostic procedures

initiated.

s In general, red urine from a rabbit

is caused by porphyrin pigments;

however, true hematuria can

occur.

s Because rabbits are sensitive

to heat stress, they may be

collapsed or seizuring on

presentation; slow intravenousrehydration and cooling are

advised.

Refereed Peer ReviewCE


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thorough physical examination. Important aspects ofthe history include whether the patient is eating, defe-cating, and urinating and its reproductive status (seeDiagnostic Differentials for Rabbit Disorders).

Gastrointestinal StasisRabbits with gastrointestinal (GI) stasis often have a

history 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; ifthe 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 motility79 (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 consistentwith 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 1999 20TH ANNIVERSARY Small Animal/Exotics

P A T I E N T H I S T O R Y s A G G R E S S I V E R E H Y D R A T I O N s A C U T E A B D O M I N A L P A I N

Abdominal Discomfort

or Enlargement

sGastrointestinal stasis,obstruction, foreign body,

trichobezoar

s Uterine adenocarcinoma

s Urinary calculi

s Pyometra, dystocia

Anorexia

s Malocclusion of incisors or

cheek teeth

s Gastrointestinal stasis or

obstruction; 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 enteropathys Bacterial enteritis

s Tyzzers disease

Dyspnea

s Pneumonia

s Neoplasia

s Cardiac disease

s Abdominal distention

Red Urines 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 procynoisinfection

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 brain

abscess

s Venomous snakebite

s Lead poisoning

s Rabies

Diagnostic Differentials for Rabbit Disorders


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Small Animal/Exotics 20TH 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.911 Tho-racic radiographs to rule out pulmonary metastasis areindicated in patients with uterine adenocarcinoma. ACBC may be useful in confirming anemia or inflamma-tory response. Ovariohysterectomy is indicated.

UrolithiasisA 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 common

in 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 manual expressionof the urinary bladder in patients with nonobstructive

A B D O M I N A L E N L A R G E M E N T s U R E T H R A L O B S T R U C T I O N s S E R U M C H E M I S T R I E S

TABLE ICritical Care Drug Therapy for Rabbits

Agent Dose a Route Indication

Atropine25,26 00.5 SC, IM Bradycardia

Buprenorphine16,25

0.010.05 SC every 612 hr AnalgesiaCisapride8 0.5 SC every 812 hr GI motility

Dexamethasone27 0.52 IM, IV bolus Antiinflammatory

Diazepam8 13 IV, IM Anticonvulsant, tranquilizer

Doxapram25,28 25 SC, IV every 15 min Respiratory stimulant

Enrofloxacin29 515 IM, PO every 1224 hr Antibiotic

Epinephrine

1:10,000 (0.1 mg/ml) 0.2 IV 1015 min Cardiac arrest

1:1000 (1 mg/ml) 0.20.4 Intratracheally followedby vigorous ventilation

Furosemide2 14 IV every 68 hr Diuretic

LRS or other isotonic fluids26 100 ml/kg/hr IV, IO to effect Hypovolemic shock

Lidocaine without epinephrine 12 IV bolus Intratracheal24 antiarrhythmic

Meclizine5 212 PO every 24 hr Motion sickness

Metoclopramide5 0.21 PO, SC every 68 hr GI motility Metronidazole26 20 PO every 12 hr Enterotoxemia

Midazolam5 12 IM Antianxiety

Naloxone27 0.010.1 IV, IM Narcotic reversal

Pyrimethamine20 Toxoplasmosis

Trimethoprim-sulfamethoxazole26,29 1530 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 Ringers solution; PO= oral; SC= sub-cutaneous.


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calculi. Surgery is required if there are obstructive cal-culi.

ANOREXIAAnorexia, a common nonspecific sign in rabbits, can

be caused by stress from pain, systemic disease, or anxi-ety (see Diagnostic Differentials for Rabbit Disorders).Failure to eat for more than 2 to 3 days is a potentialemergency.12 A complete physical examination is indi-cated and generally well tolerated.

Dental MalocclusionMalocclusion of the incisors and cheek teeth molars

and premolars frequently causes drooling, which canresult in saliva-matted fur or dermatitis under the chin.Malocclusion of the incisors can be easily confirmed byvisual inspection and corrected by trimming. The

cheek teeth may also be maloccluded, even when theincisors appear to be normal; thorough examination ofthe cheek teeth frequently requires sedation or anesthe-sia. Abscesses of the cheek teeth are common and maybe seen grossly as a large firm mass on the mandible.Radiographs may show apical abscessation or abnormalplacement of the cheek teeth.

Before trimming maloccluded incisors with a dentaldrill, the patient should be sedated, although some rab-bits require anesthesia. Rabbits with severe incisor mal-occlusion requiring frequent trimming may benefitfrom surgical extraction. The cheek teeth can be

trimmed with a bone rongeur or dental drill while therabbit is anesthetized.13 Abscesses must be aggressivelydebrided and curetted and require extraction of the in-volved tooth. Surgical extraction of the cheek teeth isdifficult, and the prognosis is guarded; but with inten-sive postoperative care, appropriate systemic antibiotics,and good wound management, some rabbits can makea full recovery.13

Gastrointestinal StasisGastrointestinal stasis is a common cause of anorexia

in rabbits and, as previous described, they generally re-

spond to aggressive fluid therapy, forced feeding or in-creased fiber in the diet, and GI motility-enhancingdrugs (Table I).

Lead PoisoningLead poisoning can result in anorexia and lethargy.

Radiographs may show metallic opacity in the GI tract.Blood lead levels are diagnostic. Anemia may be pres-ent. Lead toxicosis in rabbits can be treated as in othersmall mammals (i.e., 27.5 ml/kg of subcutaneous calci-um ethylenediaminetetraacetic acid every 6 hours for 5days).14

Systemic DiseaseOther systemic diseases (e.g., respiratory disease, uro-

genital disease) and pain from fractures, lacerations, orother injuries can cause anorexia.2,3,57,11,12,15,16

Hepatic LipidosisAnorexia can quickly result in hepatic lipidosis in rab-bits. The liver enzymes alanine transaminase and aspar-tate transaminase become elevated and the rabbit maybe ketotic.7,12All anorectic rabbits need supportive care(fluid therapy and forced feeding) as described earlier.

DIARRHEAInappropriate Diet

A rabbit with intermittent soft stools described as di-arrhea by an owner often has a history of being fed alow-fiber diet, high-carbohydrate diet or a new diet. In-

appropriate diet can cause changes in the cecal pH orintestinal disbiosis (see Diagnostic Differentials forRabbit Disorders). Affected rabbits tolerate physical ex-amination well. In many patients, no abnormalitiesmay be found and fecal examinations will be negativefor parasites. Most rabbits respond well to correction ofthe diet.3,57

High-carbohydrate diets can cause severe disbiosisand diarrhea, followed by depression, dehydration, andanorexia. Intestinal fluid and gas may be palpable in theabdomen. Ileus may occur, resulting in gas-distendedbowel loops and abdominal pain (Figure 1). Fecal ex-

aminations will be negative. Affected rabbits need sup-portive care as described for GI stasis. Rabbits withileus may benefit from mild forced exercise several timesdaily.

Inappropriate Antibiotic TherapyInappropriate antibiotic therapy may result in GI dis-

biosis and watery and sometimes bloody diarrhea. Nar-row-spectrum antibiotics (e.g., amoxicillin, ampicillin,clindamycin, some cephalosporins, erythromycin, lin-comycin, penicillin; Table I) can suppress normal GIflora, thereby allowing other flora to proliferate, which

leads to changes in the intestinal pH. The resultant in-crease in volatile fatty acid production causes severe en-teritis, which can sometimes progress to enterotoxemiacaused by iota-like toxins from an overgrowth ofClostrid-ium spiroforme.2,3,57,9Affected rabbits are very ill and re-quire hospitalization, fluid therapy, and forced feedingor feeding through a nasogastric tube. The offendingantibiotic should be stopped.

Rabbits with enterotoxemia may benefit from the ad-ministration of metronidazole and/or a broad-spectrumantibiotic (e.g., fluoroquinolone or trimethoprimsul-famethoxazole).


D E N T A L A B S C E S S E S s H I G H - C A R B O H Y D R A T E D I E T S s N A R R O W - S P E C T R U M A N T I B I O T I C S


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CoccidiosisCoccidia of the genus Eimeriaare common parasitesof the GI tract and liver in rabbits.2,3,57 Clinical signs ofdiarrhea are generally apparent in young rabbits, butadult rabbits can also be affected. Clinical signs canrange from mild intermittent diarrhea to severe hemor-rhagic diarrhea. Oocysts are evident on fecal flotation.Treatment consists of supportive care and anticoccidialdrugs.

Mucoid EnteritisMucoid enteritis (i.e., increased production of cecal

mucus for an unknown reason) is generally found inyoung rabbits.7 Rabbits with mucoid enteritis may bedehydrated and anorectic. Supportive care is required;the condition is associated with high morbidity andmortality. Intermittent mucoid stools are evident inmany rabbits with mild disbiosis, which can be re-solved through dietary management (high fiber, lowcalcium).

Bacterial EnteritisBacterial enteritis, an uncommon cause of diarrhea in

rabbits, can be caused bySalmonella, Pseudomonas, and

Campylobacter-like species. Often rabbits with bacterialenteritis quickly develop septicemia.7 Fecal culture andsensitivity studies must be completed before appropri-ate antibiotic therapy can be selected. An empiricbroad-spectrum antibiotic (e.g., trimethoprimsul-famethoxazole or enrofloxacin) can be administered

while waiting for culture results. Aggressive fluid thera-py and supportive care are required.

Tyzzers DiseaseTyzzers disease, which is caused byClostridium pili-

form, is uncommon, although it can result in severe wa-

tery diarrhea, depression,and death in weanling rab-bits. A chronic form canoccur in adult rabbits. Theprimary sign is weight loss.

Tyzzers disease is difficultto diagnose antemortem.Serologic assays (e.g., indi-rect fluorescent antibody orenzyme-linked immunosor-bent assay) are available,and fecal polymerase chainreaction assays have beendeveloped but are not com-monly used in routine diag-nostic testing.17 Treatmentis palliative.7,17

DYSPNEA A dyspneic rabbit is a true emergency and may re-quire supportive care before any physical examinationor diagnostic tests are performed. Even minimal re-straint may result in respiratory arrest.6 Severely affect-ed rabbits should be placed in an oxygen cage before aphysical examination is attempted. After a dyspneicrabbit has been stabilized, the physical examinationshould be performed in a low-stress environment. Alow flow of oxygen (1 L/min) close to the rabbits noseis frequently beneficial during the examination.

Respiratory DiseaseUpper airway disease caused byPasteurella multocidaisthe most common respiratory disease found in domesticrabbits, although Bordetellaand Moraxellacan also causeairway disease.18 Affected rabbits may have a history ofintermittent nasal or ocular discharge or may be acute onpresentation. Physical findings may include mucopuru-lent discharge from the nose and/or eyes (Figure 2).Thoracic auscultation may reveal referred upper respira-tory sounds or crackles and wheezes in affected lungfields if pneumonia is present. Rabbits with severe upperairway disease may be dyspneic because of mucopurulent

plugs in the nares and are immediately more comfortableafter the nares have been cleared. Bacterial pneumoniamay not be apparent to owners until very late in thecourse of disease5 (Figure 3). Deep culture and sensitivitystudies of the discharge from the nares can help clini-cians select the appropriate antibiotic for treatment. Ra-diographs are useful in diagnosing pneumonia. Rabbits

with pneumonia require antibiotic therapy (Table I) andmay also benefit from oxygen therapy and nebulization.

NeoplasiaPrimary neoplasia (e.g., thymoma, metastatic neopla-

C O M M O N P A R A S I T E S s S E P T I C E M I A s U P P E R A I R W A Y D I S E A S E s P N E U M O N I A

Figure 1A

Figure 1B

Figure 1(A) Ingesta-filled stomach and (B) gas-distendedbowel loops caused by inappropriate diet and severe coccid-iosis.


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leg, which is a congenital conditionthat can affect young rabbits (Fig-ure 6). Rabbits with splay leg retainskin sensation and normal bladderfunction.

EncephalitozoonosisEncephalitozoon cuniculi, an intra-

cellular protozoan, can result in pro-gressive posterior paresis in rabbits.Positive antibody titers to E. cuni-culiin rabbits with compatible clini-cal signs is suggestive of infection;however, definitive diagnosis canonly be made by histopathologicidentification of the organism.20

There is no effective treatment for

encephalitozoonosis, although anec-dotal reports indicate suppressionof clinical signs with administrationof benzimidazoles, which have suc-cessfully been used to treat AIDS pa-tients with encephalitozoonosis.2123

TORTICOLLISTorticollis (wry neck or head tilt)

is a common clinical sign presentedby rabbits (see Diagnostic Differ-entials for Rabbit Disorders). It can

occur acutely and progress rapidly(Figure 7). Rabbits with severe tor-ticollis may roll in the direction ofthe head tilt and may have nystag-mus.

Otitis MediaP. multocida infection producing

otitis media is the most commoncause of torticollis in rabbits.5,20

There may be a history of upperrespiratory disease. Mucopurulent

discharge behind the tympanicmembrane might be noted, or themembrane may be ruptured. Nys-tagmus is rarely noted.

Rear limb paresis is rare, al-though Pasteurellacan cause en-cephalitis, which can result in moregeneralized neurologic signs. Cul-tures of the aural discharge are di-agnostic in the event of tympanic membrane rupture.Skull radiographs to confirm changes in the bulla areuseful. Measurement of antibody titers to P. multocida

has questionable diagnostic valuebecause most rabbits have previousexposure to the organism and there-fore measurable antibody titers.20

Pasteurellosis can be treated with

enrofloxacin, but torticollis maypersist if the middle ear has beenpermanently damaged. Meclizinehas been useful in reducing disori-entation in rabbits with torticollis.8

EncephalitozoonosisE. cuniculiinfection is another

common cause of torticollis, espe-cially in rabbits younger than 2 yearsof age. Affected rabbits may present

with an acute head tilt only or may

have a history of progressive general-ized neurologic signs. The externalears are normal. The diagnosis andtreatment of encephalitozoonosis-caused torticollis are the same as forrabbits with posterior paresis.

Baylisascariosisand Listeriosis

Although they are uncommon,Baylisascarisand Listeria infectionshave been documented as the cause

of neurologic signs (including torti-collis) in rabbits. Rabbits infectedwith Baylisascarismay have hay orbedding contaminated with rac-coon feces. An oral route of infec-tion is suspected in rabbits with lis-teriosis. Antemortem diagnosis israre. These infections can be diag-nosed by histopathologic studies.5,20

No effective treatment for Baylisas-caris infection has been published,

whereas rabbits with listeriosis have

been treated with tetracycline.20

ToxoplasmosisToxoplasmosis is an uncommon

cause of torticollis and other neuro-logic signs in rabbits. Infection isbelieved to occur primarily by in-gestion of infected cat feces. Sero-logic tests are available for ante-

mortem diagnosis, and affected rabbits can be treated with pyrimethamine combined with a sulfonamidedrug.20

P R O T O Z O A s W R Y N E C K s R E A R L I M B P A R E S I S s P A S T E U R E L L O S I S

Figure 4Dilated cardiomyopathy in a rabbit.

Figure 5A urine dipstick test is useful forquick assessment of hematuria.

Figure 6Splay leg in a young rabbit.


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Trauma As with other mammals, cranial

nerve trauma can cause torticollisin rabbits. Such trauma may be re-vealed while reviewing the history

or other signs of trauma during thephysical examination. Radiographsare necessary to identify a skullfracture. Aggressive supportive careand treatment of clinical signs arerequired.

COLLAPSE AND SEIZURESeizures are uncommon in rabbits but, when they oc-

cur, may indicate a serious condition (see DiagnosticDifferentials for Rabbit Disorders). If the rabbit isseizuring on presentation, intravenous diazepam should

be administered.8

Heat StressRabbits are very susceptible to heat stress, especially if

exposed to elevated ambient temperatures. Heat-stressed rabbits may be dehydrated, weak, and disori-ented and may have seizures. The body temperature isoften higher than 106F (normal, 100F to 104F). Af-fected rabbits should be cooled slowly with intravenousfluids and given a tepid bath.11

Pregnancy Toxemia

Pregnancy toxemia usually occurs in overweightdoes near the end of pregnancy but can also occur inpostparturient and pseudopregnant does. Affectedrabbits are weak, ataxic, and depressed; and the signscan quickly progress to coma and death. In addition,affected rabbits are ketonuric, which can be detectedon a urine dipstick test. Treatment includes intra-venous lactated Ringers solution and 5% dextrose.11,20

CollapseCollapsed, weak, or disoriented rabbits are a true

emergency and diagnostic challenge. Causes include

trauma, heat stress, encephalitozoonosis, pasteurellosis,venomous snakebite, lead poisoning, starvation, hepat-ic lipidosis, and (rarely) rabies.20 There is one report ofrabies in a pet rabbit with a history of encountering a

wild skunk.24 The diagnosis and treatment of these dis-eases have already been discussed. Nonspecific sup-portive care is necessary during diagnostic workup.

REFERENCES1. Gehrke BC: Results of the AVMA survey of US pet-owning

households on companion animal ownership. JAVMA211(7):160170, 1997.

2. Harrenstein L: Critical care of ferrets,rabbits, and rodents. Semin Avian Ex-otic Pet Med3(4):217228, 1994.

3. Jenkins JR: Rabbits, in Jenkins JR,Brown SA (eds): A PractitionersGuide to Rabbits and Ferrets. Lake-

wood CO, The American AnimalHospital Association, 1993, pp 242.

4. Paul-Murphy J: Little critters: Emer-gency medicine for small rodents.Proc Fifth Intl Vet Emer Crit CareSymp:714718, 1996.

5. Harkness JE, Wagner JE: The Biologyand Medicine of Rabbits and Rodents.Baltimore, Williams & Wilkins,1995, p 8.

6. Hillyer EV: Pet rabbits. Vet Clin North Am Small Anim Pract24(1):2565, 1994.

7. Jenkins JR: Gastrointestinal diseases, in Hillyer EV, Quesen-berry KE (eds): Ferrets, Rabbits and Rodents: Clinical Medicineand Surgery. Philadelphia, WB Saunders Co, 1997, pp 176

188.8. Carpenter JW, Mashima TY, Rupiper DJ: Exotic Animal

Formulary. Manhattan KS, Greystone Publications, 1996.9. Gentz EJ, Harrenstein, LA, Carpenter JW: Dealing with gas-

trointestinal, genitourinary, and musculoskeletal problems inrabbits. Vet Med90(4):365372, 1995.

10. Stein S, Walshaw S: Rabbits, in Laber-Laird K, Swindle M,Flecknell P (eds): Handbook of Rodent and Rabbit Medicine.Oxford, Pergamon, 1996, pp 183218.

11. Paul-Murphy J: Reproductive and urogenital disorders, inHillyer EV, Quesenberry KE (eds): Ferrets, Rabbits and Ro-dents: Clinical Medicine and Surgery. Philadelphia, WBSaunders Co, 1997, pp 202211.

12. Brown SA, Rosenthal KL: The anorexic rabbit. Proc TNAVC:

788, 1997.13. Jenkins JR: Soft tissue surgery and dental procedures, inHillyer EV, Quesenberry KE (eds): Ferrets, Rabbits and Ro-dents: Clinical Medicine and Surgery. Philadelphia, WBSaunders Co, 1997, pp 227239.

14. Swartout MS, Gerken DF: Lead-induced toxicosis in twodomestic rabbits.JAVMA191(6):717719, 1987.

15. Eisele PH: Signs of pain in small mammals. Proc TNAVC:795796, 1997.

16. Eisele PH: Analgesia in small mammals. Proc TNAVC:796799, 1997.

17. Besch-Williford C: Tyzzers disease in rabbits. Proc HouseRabbit Soc Vet Conf Rabbit Med Proced Pract:113117,1997.

18. Deeb BJ: Respiratory disease and the Pasteurellacomplex, in

Hillyer EV, Quesenberry KE (eds): Ferrets, Rabbits and Ro-dents: Clinical Medicine and Surgery. Philadelphia, WBSaunders Co, 1997, pp 189201.

19. Samman S, Fussell SH, Rose CI: Porphyria in a New Zea-land white rabbit. Can Vet J32:622623, 1991.

20. Gentz J, Carpenter JW: Neurologic and musculoskeletal dis-ease, in Hillyer EV, Quesenberry KE (eds): Ferrets, Rabbitsand Rodents: Clinical Medicine and Surgery. Philadelphia,

WB Saunders Co, 1997, pp 220226.21. Katiyar SK, Edlind TD: In vitro susceptibilities of the AIDS-

associated microsporidian Encephalitozoon intestinalis to al-bendazole, its sulfoxide metabolites, and 12 additional benz-imidazole derivatives. Antimicrob Agents Chemother41(12):27292732, 1997.


S U P P O R T I V E C A R E s D I A Z E P A M s I N T R A V E N O U S F L U I D S

Figure 7Torticollis in a wild rabbit.


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22. Didier ES, Rogers LB, Brush AD, et al: Diagnosis of dissem-inated microsporidian Encephalitozoon hellem infection byPCR-southern analysis and successful treatment with alben-dazole and fumagillin. J Clin Micro 24(4):947952, 1996.

23. Joste NE, Rich JD, Busam KJ, Schwartz DA: Autopsy verifi-cation ofEncephalitozoon intestinalis(microsporidiosis) erad-ication following albendazole therapy. Arch Path Lab Med120(2):199203, 1996.

24. CDC Veterinary Public Health Notes: Rabbit rabies.JAVMA179:84, 1981.

25. Carpenter JW, Mashima TY, Gentz EJ, Harrenstein L: Car-ing for rabbits: An overview and formulary. Vet Med90(4):340364, 1995.

26. Paul-Murphy J: Emergency medicine and critical care for rab-bits. Proc Fifth Intl Vet Emerg Crit Care Symp:724726, 1996.

27. Gillett CS: Selected drug dosages and clinical reference data,in Manning PJ, Ringler DH, Newcomer CE (eds): The Biol-ogy of the Laboratory Rabbit, ed 2. San Diego, Academic PressInc, 1994, pp 467472.

28. Huerkamp MJ: Anesthesia and postoperative management

of rabbits and pocket pets, in Bonagura JD (ed): Kirks Cur-rent Veterinary Therapy. XII. Small Animal Practice. Philadel-phia, WB Saunders Co, 1995, pp 13221327.

29. Quesenberry KE: Rabbits, in Birchard SJ, Sherding RG(eds): Saunders Manual of Small Animal Practice. Philadel-phia, WB Saunders Co, 1994, pp 13451362.

About the AuthorsDrs. Ramer and Paul-Murphy are affiliated with the

Department of Surgical Sciences, School of Veterinary

Medicine, University of Wisconsin, Madison, Wisconsin

and Dr. Benson is a resident in Zoological Medicine at the

School of Veterinary Medicine, University of California,

Davis, California. Dr. Paul-Murphy is a Diplomate of the

American College of Zoological Medicine.

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EXOTIC-Evaluating and Stabilizing Critically Ill Rabbits.part I