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Proceedings of the Southern European

Veterinary Conference
- SEVC -
Sep. 30-Oct. 3, 2010, Barcelona, Spain

Next SEVC Conference:

Sep. 30-Oct. 2, 2011 - Barcelona, Spain

Reprinted in the IVIS website with the permission of the SEVC - AVEPA
www.ivis.org
Reprinted in IVIS with the permission of the SEVC Close this window to return to IVIS www.ivis.org

Emergency/C
mergency/Critical
/Critical care

Critical care techniques in small exotic mammals

Douglas Mader, MS, DVM, DABVP

Marathon Veterinary Hospital, Marathon, FL USA

Small mammals will present for emergent care for all the same reasons that
are seen in dog and cat medicine. Perhaps the two broadest categories that are
seen are metabollic collapse and trauma.
Trauma is a frequent cause for visits to the veterinarian by small animal
owners. Not uncommonly, these pets are owned by small children, and it is not an
infrequent occurrence for these little pets to get dropped, stepped on or bitten by
dogs and cats.
The approach should be no different than for any trauma victim. Treat life-

threatening emergencies first. Follow the ABC's, Airway, Breathing and Circulation.

Metabolic collapse, in small mammals, can be related to physical and organic

disturbanceds. A familiarity with the most common diseases seen in these patients
will better prepare the clinician in the event of an emergency situation. This
presentation will help prepare the clinician to recognize the common problems and
subsequently stabilize the patient for the first 24 hours.

Preparation
There are literally hundreds of different types of “Pocket pets” on the market.
However, in reality, there may be only a dozen or so that will present to the ER on
emergency. Most of these pets will range in size from the house mouse to a large
rabbit. As such, it is imperative that the ER is prepared to handle and house these
animals. Most importantly, understanding the unique physiological needs of these
relatively tiny patents will help in developing the necessary protocols to handle the
special needs patients.
The majority of these patients have relatively high metabolic rates compared
to the more common dog and cat patients. In addition, because of their small size,
and hence, relative large surface area to volume ratio, heat loss and subsequent
hypothermia is a big problem. Incubators or some method of warming these
patients are essential for proper emergent care.
Examination tables should be covered with a clean (preferable warm) towel
prior to placing the patient on the table. Stainless steel tables, although easy to
sanitize, act as a heat sink and can cool an already hypothermic patient rapidly.
It is preferable have a room designated for “exotics.” That way, specialty
items such as gram scales, hard plastic oral specula, small otoscope cones, and the
like will always be available. When an obtunded patient presents you will not have
to go searching for the needed items.

Proceedings of the Southern European Veterinary Conference & Congreso Nacional AVEPA, 2010 - Barcelona, Spain
Reprinted in IVIS with the permission of the SEVC Close this window to return to IVIS www.ivis.org

Fluids and venous access

There is an old adage, “if the mouth works, use it.” This holds true in dog
and cat medicine, and also works wonders with exotics. There is some weird
unwritten rule that states if you are going to be an exotic veterinarian, you MUST use
intraosseous (IO) catheters. In actuality, if you are going to be a GOOD exotic
animal veterinarian, you should evaluate your patient first, decide if fluids are
necessary, and then decide on the best route of administration.
For some trauma patients some type of venous access may be necessary.
Unless the patient is critical, very small, severely dehydrated, hypothermic and has
no accessible veins, an IO catheter should be the last choice for fluid administration.
Remember another old adage, “above all, do no harm.” IO catheters are painful, can
cause severe damage and if not placed properly, with strict adherence to asepsis,
can cause osteomyelitis.
Fluid choices will depend on the need. Again, follow the guidelines used for
dogs and cats. Let the laboratory analysis be the determining factor. If cost is an
issue and blood work is declined, then a balanced electrolyte will suffice. Published
dosages range from 30 – 90 ml/kg in the first hour. Maintenance rates will be the
same as those for dogs and cats – 60 ml/kg/day with compensation for special
losses.
Whole blood can be transfused in any of the Pocket pets as needed, pending
the availability of appropriate whole blood. Blood should be transfused from like
species to like species (i.e. rat to rat, not rat to mouse). Blood typing does not
appear to be necessary for most small mammals, and transfusion reactions are rare.
Pre-medication with diphenhydramine at 1 mg/kg, either IV or IM may be of some
benefit.
There have been anecdotal reports of successful use of hemoglobin
substitutes, such as Oxyglobin. However, substantiated research as to its
effectiveness and safety has not been published. Using synthetic hemoglobin
substitutes may be warranted but the owner needs to be appraised of the novelty of
the procedure and the potential risks prior to starting the administration.

Venipuncture, IV and IO access can be obtained as follows: (commonly used

sites)
Ferrets – Catheters: cephalic, saphenous and jugular veins. Tibial crest for IO
catheters. The vena cava and subclavian veins can be used for venipuncture.
Rabbits – Catheters: cephalic, saphenous and jugular veins. Tibial crest for IO
catheters. Note: The older literature suggests using the ear veins for catheters,
however, phlebitis is common and sloughing of the ear tip may occur. These veins
are suitable for venipuncture. In addition, the cephalic and saphenous veins work
well for venipuncture. If you are planning on placing a catheter, then save the
cepahlic vein and use the sapehenous for bleeding.
Rats, mice, hamsters, gerbils, sugar gliders etc. – Catheters: tail veins (rats),
jugular veins in all. In general, IV catheters in rats and mice are not commonly
performed in clinical practice (although, common in research). Tibial crest for IO
catheters. Venipuncture: femoral vein. Not recommended: orbital sinus or
cardiocentesis for pet rats and mice.
Guinea Pigs – Catheters: jugular vein. Tibial crest for IO catheters. Venipuncture
can be accomplished using the jugular and saphenous veins. Not recommended for
pet – vena cava.
Hedgehog – (Anesthesia almost always necessary) Catheters: jugular. IO in the
tibial crest. Bleeding from the jugular, saphenous and (in males) penile vein.

Therapy –

Proceedings of the Southern European Veterinary Conference & Congreso Nacional AVEPA, 2010 - Barcelona, Spain
Reprinted in IVIS with the permission of the SEVC Close this window to return to IVIS www.ivis.org

There are several published articles with dosages for commonly used
medications (see Carpenter, et. al.). In general, most drugs that are used in small
animal medicine can be used in small exotic pets. There are exceptions and the ER
practitioner will need to take the time to learn these.
Common emergency drugs include fluids, steroids, antibiotics, diuretics and
laxatives. Fluids, as mentioned, should be based on patient need. If in doubt,
balanced electrolytes are a good starting solution.
Common emergency antibiotics include enrofloxacin, trimethoprim-sulfa and
chloramphenicol. All of these antibiotics can be safely used in all pocket pet species
without fear of causing gastrointestinal upset or stasis.
Dexamethosone sodium phosphate and prednisolone sodium succinate are
freqently used in shock. These medications should be used judiciously as side effects
seen in small mammal medicine are also encountered with pocket pets.
Lactulose, simethicone and bulk laxatives may be needed to assist patients
with hepatic disorders and gastrointestinal blockages. Intestinal motility drugs, such
as cisapride and metaclopramide, are used but proper patient assessment is
mandatory.

Specific Problems –
The clinician needs to be familiar with the most common problems seen in
small mammals. The most important thing is to stabilize the patient.. It is usually
NOT critical to make the diagnosis immediately – rather, it is critical to keep the
patient alive with appropriate fluid support, thermotherapy, calorie replacement, etc.
Another extremely important point – it is entirely possible to kill a small
exotic patient by trying to do too much – eg. feeling it necessary to collect all the
standard data base laboratory samples within the first few minutes of the patient’s
arrival. In most instances, the collection of laboratory samples can wait until the
patient is stabilized.
For example – if a ferret presents obtunded and you feel that it is critical to
get a blood glucose, but the patient is so weak and debilitated that the manipulation
may add undue stress and potentially kill it, DON’T DO IT! Place the patient in an
incubator, administer fluids with glucose (either orally or IV), give oxygen and let it
stabilize. You can do the detective work once the patient is stabile.
Lacerations and hemorrhage usually require immediate attention. Most
rodents, rabbits and ferrets are adept at chewing out sutures. Stainless steel staples
or stainless steel sutures are recommended. Bandages are usually poorly tolerated
by these little patients and are not recommended.
Fractures and other orthopedic problems rarely need emergency repair.
These conditions should be stabilized and sent to the family veterinarian for
treatment.

SUMMARY
The approach to pocket pet emergencies should be no different than that for
dog and cats. Attention should be paid to the unique needs of the exotic pets. If
these guidelines are followed the ER doctor will have no problems treating exotic
species.

REFERENCES

Proceedings of the Southern European Veterinary Conference & Congreso Nacional AVEPA, 2010 - Barcelona, Spain
Reprinted in IVIS with the permission of the SEVC Close this window to return to IVIS www.ivis.org

1 Ferrets, Rabbits and Rodents. Quesenberry and Carpenter. W.B. Saunders.

2003 Excellent quick reference for the common pocket pets.

2 Manual of Exotic Pets. Meredith and John-Delaney. BSAVA Manual. 2010. Covers
many different species of exotic pets.

3 Radiology of Rodents, Rabbits and Ferrets: An Atlas of Normal Anatomy and

Positioning. Silverman and Tell. Elsevier. 2005. This is the most current reference
for evaluating radiographs in exotic small mammals.

Proceedings of the Southern European Veterinary Conference & Congreso Nacional AVEPA, 2010 - Barcelona, Spain