20TH ANNIVERSARY
1 January 1999
CE Refereed Peer Review
FOCAL POINT
★Knowledge of the common
differentials for diagnosing
critically ill rabbits allows rapid
assessment and stabilization.
KEY FACTS
■ A rabbit that has been anorectic
for more than 3 days can quickly
deterioriate and may require
aggressive fluid therapy and
forced feeding.
■ Dyspneic rabbits require
stabilization before a physical
examination can be conducted
or diagnostic procedures
initiated.
■ In general, red urine from a rabbit
is caused by porphyrin pigments;
however, true hematuria can
occur.
■ Because rabbits are sensitive
to heat stress, they may be
collapsed or seizuring on
presentation; slow intravenous
rehydration and cooling are
advised.
Vol. 21, No.
Evaluating and
Stabilizing Critically
Ill Rabbits—Part I
University of Wisconsin University of California, Davis
Jan 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.
A
s domestic rabbits become more popular household pets, they represent a
growing segment in small animal practices.1 Diagnosing critically ill rabbits
can, 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 care
practices are the same for all mammals, 2–3 but it is important to evaluate critically ill
rabbits efficiently and stabilize them before initiating potentially stressful diagnostic
tests. Although obtaining a thorough clinical history and performing a systematic
physical 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 general
guidelines we recommend include:
■ Observing a critically ill rabbit in a cage or carrier before handling to assess
general attitude, respiratory rate and character, and fecal and urine output
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
the history include whether the patient is eating, defe-
cating, and urinating and its reproductive status (see
Diagnostic Differentials for Rabbit Disorders).
Gastrointestinal Stasis
Rabbits with gastrointestinal (GI) stasis often have a
history of inappropriate diet, decreased appetite, small
fecal pellets, or stress in the household. A firm, doughy
mass palpable in the cranial abdomen is consistent with
GI 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 the
presence 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 and
increased fiber in the diet. If the rabbit is eating and
drinking, 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 feeding
tube may be placed, or the rabbit may be force fed
through a syringe. Metoclopramide and/or cisapride
promote GI motility7–9 (Table I).
Gastrointestinal Obstruction or Foreign Bodies
Infrequently, rabbits present with an acute abdomen
that is painful on palpation. They may be hypothermic,
bloated, tachycardic, or tachypneic. These animals
must be evaluated quickly and efficiently and stabilized
via fluid therapy, pain management, and possibly de-
compression.
A firm mass in the cranial abdomen is consistent
with obstruction of the pylorus. Decompression of the
tympanic stomach by passing a nasogastric or an oro-
gastric tube may be necessary before other diagnostic
tests can be performed. Intussusception or foreign bod-
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
obstruction. Surgery is required; the prognosis is poor
because postoperative return of normal GI motility is
difficult to achieve.2,3,6,7,9,10
Reproductive Disorders
Reproductive disorders must be considered in intact
female rabbits that present with abdominal discomfort
or enlargement. Pyometra and uterine adenocarcinoma
can be palpated as fluctuant or doughy masses in the
caudal abdomen. Vaginal bleeding can occur in does
with uterine adenocarcinoma. Fetuses are palpable in
rabbits with dystocia. Radiography and abdominal ul-
trasonography can help confirm a diagnosis.9–11 Tho-
racic radiographs to rule out pulmonary metastasis are
indicated in patients with uterine adenocarcinoma. A
CBC may be useful in confirming anemia or inflamma-
tory response. Ovariohysterectomy is indicated.
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 is
painful. Catheterization is indicated to relieve urethral
obstruction. 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, or
pyuria. The urine pH of normal rabbits is alkaline and
does 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 chemistries
and CBCs can help to assess hydration and renal function.
Medical treatment includes aggressive fluid therapy,
decreased calcium in the diet, and manual expression
of the urinary bladder in patients with nonobstructive

ABDOMINAL ENLARGEMENT ■ URETHRAL OBSTRUCTION ■ SERUM CHEMISTRIES

Compendium January 1999 20TH ANNIVERSARY
calculi. Surgery is required if there are obstructive cal-
culi.
ANOREXIA
Anorexia, 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 potential
emergency.12 A complete physical examination is indi-
cated and generally well tolerated.
Dental Malocclusion
Malocclusion of the incisors and cheek teeth molars
and premolars frequently causes drooling, which can
result in saliva-matted fur or dermatitis under the chin.
Malocclusion of the incisors can be easily confirmed by
visual inspection and corrected by trimming. The
cheek teeth may also be maloccluded, even when the
incisors appear to be normal; thorough examination of
the cheek teeth frequently requires sedation or anesthe-
sia. Abscesses of the cheek teeth are common and may
be seen grossly as a large firm mass on the mandible.
Radiographs may show apical abscessation or abnormal
placement of the cheek teeth.
Before trimming maloccluded incisors with a dental
drill, the patient should be sedated, although some rab-
bits require anesthesia. Rabbits with severe incisor mal-
occlusion requiring frequent trimming may benefit
from surgical extraction. The cheek teeth can be
trimmed with a bone rongeur or dental drill while the
rabbit is anesthetized.13 Abscesses must be aggressively
debrided and curetted and require extraction of the in-
volved tooth. Surgical extraction of the cheek teeth is
difficult, and the prognosis is guarded; but with inten-
sive postoperative care, appropriate systemic antibiotics,
and good wound management, some rabbits can make
a full recovery.13
Gastrointestinal Stasis
Gastrointestinal 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-enhancing
drugs (Table I).
Lead Poisoning
Lead 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 other
small mammals (i.e., 27.5 ml/kg of subcutaneous calci-
um ethylenediaminetetraacetic acid every 6 hours for 5
days).14
DENTAL ABSCESSES ■ HIGH-CARBOHYDRATE DIETS ■ NARROW-SPECTRUM ANTIBIOTICS
Small Animal/Exotics
Systemic Disease
Other systemic diseases (e.g., respiratory disease, uro-
genital disease) and pain from fractures, lacerations, or
other injuries can cause anorexia.2,3,5–7,11,12,15,16
Hepatic Lipidosis
Anorexia can quickly result in hepatic lipidosis in rab-
bits. The liver enzymes alanine transaminase and aspar-
tate transaminase become elevated and the rabbit may
be ketotic.7,12 All anorectic rabbits need supportive care
(fluid therapy and forced feeding) as described earlier.
DIARRHEA
Inappropriate Diet
A rabbit with intermittent soft stools described as di-
arrhea by an owner often has a history of being fed a
low-fiber diet, high-carbohydrate diet or a new diet. In-
appropriate diet can cause changes in the cecal pH or
intestinal disbiosis (see Diagnostic Differentials for
Rabbit Disorders). Affected rabbits tolerate physical ex-
amination well. In many patients, no abnormalities
may be found and fecal examinations will be negative
for parasites. Most rabbits respond well to correction of
the diet.3,5–7
High-carbohydrate diets can cause severe disbiosis
and diarrhea, followed by depression, dehydration, and
anorexia. Intestinal fluid and gas may be palpable in the
abdomen. Ileus may occur, resulting in gas-distended
bowel loops and abdominal pain (Figure 1). Fecal ex-
aminations will be negative. Affected rabbits need sup-
portive care as described for GI stasis. Rabbits with
ileus may benefit from mild forced exercise several times
daily.
Inappropriate Antibiotic Therapy
Inappropriate 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 GI
flora, 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 enterotoxemia
caused by iota-like toxins from an overgrowth of Clostrid-
ium spiroforme.2,3,5–7,9 Affected rabbits are very ill and re-
quire hospitalization, fluid therapy, and forced feeding
or feeding through a nasogastric tube. The offending
antibiotic should be stopped.
Rabbits with enterotoxemia may benefit from the ad-
ministration of metronidazole and/or a broad-spectrum
antibiotic (e.g., fluoroquinolone or trimethoprim–sul-
famethoxazole).
Small Animal/Exotics 20TH ANNIVERSARY
Figure 1B
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.
Figure 1A
Coccidiosis
Coccidia of the genus Eimeria are common parasites
of the GI tract and liver in rabbits.2,3,5–7 Clinical signs of
diarrhea are generally apparent in young rabbits, but
adult rabbits can also be affected. Clinical signs can
range from mild intermittent diarrhea to severe hemor-
rhagic diarrhea. Oocysts are evident on fecal flotation.
Treatment consists of supportive care and anticoccidial
drugs.
Mucoid Enteritis
Mucoid enteritis (i.e., increased production of cecal
mucus for an unknown reason) is generally found in
young rabbits.7 Rabbits with mucoid enteritis may be
dehydrated and anorectic. Supportive care is required;
the condition is associated with high morbidity and
mortality. Intermittent mucoid stools are evident in
many rabbits with mild disbiosis, which can be re-
solved through dietary management (high fiber, low
calcium).
Bacterial Enteritis
Bacterial enteritis, an uncommon cause of diarrhea in
rabbits, can be caused by Salmonella, Pseudomonas, and
Campylobacter-like species. Often rabbits with bacterial
enteritis quickly develop septicemia.7 Fecal culture and
sensitivity studies must be completed before appropri-
ate antibiotic therapy can be selected. An empiric
broad-spectrum antibiotic (e.g., trimethoprim–sul-
famethoxazole or enrofloxacin) can be administered
while waiting for culture results. Aggressive fluid thera-
py and supportive care are required.
Tyzzer’s Disease
Tyzzer’s disease, which is caused by Clostridium pili-
form, is uncommon, although it can result in severe wa-
COMMON PARASITES ■ SEPTICEMIA ■ UPPER AIRWAY DISEASE ■ PNEUMONIA
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,
and fecal polymerase chain
monly used in routine diag-
nostic testing.17 Treatment
is palliative.7,17
DYSPNEA
A dyspneic rabbit is a true emergency and may re-
quire supportive care before any physical examination
or 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 a
physical examination is attempted. After a dyspneic
rabbit has been stabilized, the physical examination
should be performed in a low-stress environment. A
low flow of oxygen (1 L/min) close to the rabbit’s nose
is frequently beneficial during the examination.
Respiratory Disease
Upper airway disease caused by Pasteurella multocida is
the most common respiratory disease found in domestic
rabbits, although Bordetella and Moraxella can also cause
airway disease.18 Affected rabbits may have a history of
intermittent nasal or ocular discharge or may be acute on
presentation. 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 lung
fields if pneumonia is present. Rabbits with severe upper
airway disease may be dyspneic because of mucopurulent
plugs in the nares and are immediately more comfortable
after the nares have been cleared. Bacterial pneumonia
may not be apparent to owners until very late in the
course of disease5 (Figure 3). Deep culture and sensitivity
studies 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) and
may also benefit from oxygen therapy and nebulization.
Neoplasia
Primary neoplasia (e.g., thymoma, metastatic neopla-
Compendium January 1999 20TH ANNIVERSARY
sia) may cause dyspnea. Radio-
graphs are useful for diagnosis. The
prognosis is poor.
Cardiac Disease
As can occur in other mammals,
cardiac disease in rabbits can result
in pulmonary edema and dyspnea.
There may be a history of exercise
intolerance. 18 A murmur may or
may not be auscultated during the
physical examination. Radiographs
and echocardiograms are useful in
confirming cardiac disease (Figure Figure 2—Mucopurulent discharge from a rab- palpation can verify the diagnosis
4). Furosemide can relieve pul- bit with pasteurellosis.
monary edema (Table I). Other
cardiac medications used in the
treatment of dogs and cats can be
administered to rabbits with car-
diac disease.
Abdominal Distention
Abdominal distention can result
in dyspnea caused by compression
of the relatively small thorax by ab-
dominal contents. Treatment is the
same as that recommended for ab-
dominal enlargement.
RED URINE
Red urine is frequently perceived
as an emergency by rabbit owners
but is often caused by nonpatholog-
ic porphyrin pigments, although
true hematuria can be an emergen-
cy.11,19 When hematuria is suspected,
a urine dipstick test or examination
of sediment for intact erythrocytes
can be useful for quick assessment
(Figure 5).
Figure 3—Bronchopneumonia is evident in
this radiograph of a rabbit presented with res-
Reproductive Disorders piratory distress.
Uterine adenocarcinoma, en-
dometrial venous aneurysm, and
(less commonly) abortion should be suspected in intact
female rabbits with hematuria.9,11 A fluctuant, lobulated
mass may be palpable in the caudal abdomen and a soft
tissue mass evident on radiographs of rabbits with uter-
ine adenocarcinoma or endometrial venous aneurysm.
Abdominal ultrasonography is also useful for confirming
a diagnosis and can be used to measure the masses. Tho-
racic radiographs are indicated to rule out pulmonary
metastasis if uterine adenocarcinoma is suspected. Rab-
CARDIAC MEDICATIONS ■ PORPHYRIN PIGMENTS ■ ABORTION ■ PARALYSIS
Small Animal/Exotics
bits with endometrial venous
aneurysm may be severely anemic
(packed cell volume of 10% or high-
er) and require whole blood transfu-
sion. Uterine adenocarcinoma and
endometrial venous aneurysm re-
quire ovariohysterectomy after the
animal has been stabilized.
Abortion can be confirmed by
thoroughly evaluating the patient
history, including drug administra-
tion and previous abortions. Ab-
dominal radiographs along with
and confirm the presence of re-
tained fetuses. If retained fetuses are
confirmed, 1 to 2 U of intramus-
cular or subcutaneous oxytocin
should be administered. If the fe-
tuses are not expelled within 1
hour, a cesarean section should be
performed; the prognosis is guarded
for these patients. 11 The fetuses
should be examined to rule out in-
fectious causes of abortion.
Urinary Tract Disease
Urinary tract disorders (e.g., cys-
titis, pyelonephritis, urolithiasis)
can also result in hematuria; diag-
nosis and treatment should be
based on standard procedures fol-
lowed in small animal medicine.9,11
POSTERIOR PARESIS
Vertebral Fracture and
Luxation
Fracture of L-7, the most com-
mon reason for sudden onset of
posterior paresis in rabbits (see Di-
agnostic Differentials for Rabbit
Disorders), often results from im-
proper handling but can occur if a
rabbit is startled. 20 A gentle and
careful physical examination may also reveal a loss of
skin sensation and a flaccid, full urinary bladder. Ra-
diographs can confirm an L-7 fracture (although there
may be no lesion with luxation), and treatment should
be initiated immediately. Dexamethasone is useful in
reducing swelling of the spinal cord. The urinary blad-
der may need to be expressed regularly until clinical
signs improve.
Fracture of L-7 should not be confused with splay
Small Animal/Exotics
leg, which is a congenital condition
that can affect young rabbits (Fig-
ure 6). Rabbits with splay leg retain
skin sensation and normal bladder
function.
Encephalitozoonosis
Encephalitozoon cuniculi, an intra-
cellular protozoan, can result in pro-
gressive posterior paresis in rabbits.
Positive antibody titers to E. cuni-
culi in rabbits with compatible clini-
cal signs is suggestive of infection;
however, definitive diagnosis can
only be made by histopathologic
identification of the organism. 20
There is no effective treatment for
encephalitozoonosis, although anec-
dotal reports indicate suppression
of clinical signs with administration
of benzimidazoles, which have suc-
cessfully been used to treat AIDS pa-
tients with encephalitozoonosis.21–23
TORTICOLLIS
Torticollis (wry neck or head tilt)
is a common clinical sign presented
by 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 of
the head tilt and may have nystag- Figure 5—A urine dipstick test is useful for bedding contaminated with rac-
mus.
Otitis Media
P. multocida infection producing
otitis media is the most common
5,20
cause of torticollis in rabbits.
There may be a history of upper
respiratory disease. Mucopurulent
discharge behind the tympanic
membrane might be noted, or the
membrane may be ruptured. Nys-
tagmus is rarely noted.
Rear limb paresis is rare, al-
though Pasteurella can cause en-
cephalitis, which can result in more
generalized 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 are
useful. Measurement of antibody titers to P. multocida
PROTOZOA ■ WRY NECK ■ REAR LIMB PARESIS ■ PASTEURELLOSIS
20TH ANNIVERSARY
Figure 4—Dilated cardiomyopathy in a rabbit. ized neurologic signs. The external
quick assessment of hematuria.
Figure 6—Splay leg in a young rabbit.
mortem diagnosis, and affected rabbits can be treated
with pyrimethamine combined with a sulfonamide
drug.20
Compendium January 1999
has questionable diagnostic value
because most rabbits have previous
exposure to the organism and there-
fore measurable antibody titers.20
Pasteurellosis can be treated with
enrofloxacin, but torticollis may
persist if the middle ear has been
permanently damaged. Meclizine
has been useful in reducing disori-
entation in rabbits with torticollis.8
Encephalitozoonosis
E. cuniculi infection is another
common cause of torticollis, espe-
cially in rabbits younger than 2 years
of age. Affected rabbits may present
with an acute head tilt only or may
have a history of progressive general-
ears are normal. The diagnosis and
treatment of encephalitozoonosis-
caused torticollis are the same as for
rabbits with posterior paresis.
Baylisascariosis
and Listeriosis
Although they are uncommon,
Baylisascaris and Listeria infections
have been documented as the cause
of neurologic signs (including torti-
collis) in rabbits. Rabbits infected
with Baylisascaris may have hay or
coon feces. An oral route of infec-
tion is suspected in rabbits with lis-
teriosis. Antemortem diagnosis is
rare. 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
Toxoplasmosis
Toxoplasmosis is an uncommon
cause of torticollis and other neuro-
logic signs in rabbits. Infection is
believed to occur primarily by in-
gestion of infected cat feces. Sero-
logic tests are available for ante-
Compendium January 1999 20TH ANNIVERSARY
Trauma
As with other mammals, cranial
nerve trauma can cause torticollis
in rabbits. Such trauma may be re-
vealed while reviewing the history
or other signs of trauma during the
physical examination. Radiographs
are necessary to identify a skull
fracture. Aggressive supportive care
and treatment of clinical signs are
required.
Figure 7—Torticollis in a wild rabbit.
COLLAPSE AND SEIZURE
Seizures are uncommon in rabbits but, when they oc-
cur, may indicate a serious condition (see Diagnostic
Differentials for Rabbit Disorders). If the rabbit is
seizuring on presentation, intravenous diazepam should
8 and Surgery. Philadelphia, WB Saunders Co, 1997, pp 176–
be administered.
Heat Stress
Rabbits 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 is
often higher than 106°F (normal, 100˚F to 104˚F). Af-
fected rabbits should be cooled slowly with intravenous
fluids and given a tepid bath.11
Pregnancy Toxemia
Pregnancy toxemia usually occurs in overweight
does near the end of pregnancy but can also occur in
postparturient and pseudopregnant does. Affected
rabbits are weak, ataxic, and depressed; and the signs
can quickly progress to coma and death. In addition,
affected rabbits are ketonuric, which can be detected
on a urine dipstick test. Treatment includes intra-
venous lactated Ringer’s solution and 5% dextrose.11,20
Collapse
Collapsed, 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 of
rabies 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.
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SUPPORTIVE CARE ■ DIAZEPAM ■ INTRAVENOUS FLUIDS
Small Animal/Exotics
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otic Pet Med 3(4):217–228, 1994.
3. Jenkins JR: Rabbits, in Jenkins JR,
Brown SA (eds): A Practitioner’s
Guide to Rabbits and Ferrets. Lake-
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About the Authors
Drs. 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.