Hi, good morning, everyone. My name is Elizabethta Manchinelli. I'm a diplomat of the European College of Zoological Medicine, Specialty Small Mammal Medicine and Surgery, and I currently work at Valley Veterinary Hospital in Cardiff.
Now, today's presentation will, mainly, look at emergency presentations is more mammals. The reason being that rodents such As guinea pigs, chinchillas, rats, and hamsters have become extremely popular pets and are nowadays very commonly seen as patients in many first opinion veterinary practises. However, the lack of familiarity with these species can extremely challenging, and this is especially true in an emergency situation.
Treatment of critically ill exotic companion mammals is often complicated by many factors and therefore, I think a basic knowledge of their needs as well as a more practical approach may help to build up confidence while treating these very interesting pets. What, what are the, our learning, learning objectives for today. So we'll learn how to recognise and prioritise common emergency presentation in many small mammal species.
We'll, try and demonstrate appropriate triage and stabilise. Techniques more tailored to the species-specific anatomy and physiology of many of these common pets presented to a veterinary practise. We'll see how to select and apply appropriate diagnostic tools and how to monitor these patients when presented to.
How to develop emergency treatment plans for critical patients. Dealing with emergencies in small mammals, several factors can make their management particularly challenging. For example, their small size and considerable anatomical and physiological diversity between species mean that often a standardised approach is not always possible.
So a one approach that fits all sometimes can complicate certain situations. In addition, The very high metabolic rate means that the clinical deterioration can occur sometimes very quickly. This added to the fact that there is often limited research and research and clinical data available for many of the species that will take into consideration, especially with regards to their response to treatment that can make Dealing especially with emergencies are particularly challenging.
No, it's certainly true that the fundamental principles of emergency and critical care. Remain largely the same as for dogs and cats, for example, and therefore can be adapted to individual species and patients. However, it is important to remember, we, as we already mentioned, that many of these species do have significant anatomical and physiological differences between each other and compared to dogs and cats.
On top of this, it is important to remember that the frequent reassessment and regular monitoring are essential in these pieces because it can help recognising early changes in the patient's condition, which then in turn allows the treatment to be adjusted promptly and may significantly improve both response to therapy and survival rates sometimes. There are some important things to remember. Prey species, including many of the small mammal species that we commonly see in practise, are particularly challenging, especially when presented as an emergency, because they are very effective at hiding signs.
Of illness and weakness, and as a result, identifying and appropriately triaging the critically ill patient can sometimes be extremely difficult. Many patients with chronic underlying disease, for example, may remain apparently stable. For a certain period of time until they suddenly decompensate, resulting in an emergency presentation.
So for this reason, a thorough but rapid initial assessment is essential, and any patient identified as critical should be immediately admitted to the hospital and stabilised with diagnostics and further investigations performed only once the stable the patient is sufficiently stable. An emergency in the small mammal world. I mean, to be honest, anything that would constitute an emergency for a dog or a cat, very much represents an emergency for many of the small mammal species we deal with.
So any sort of breathing difficulty, any loss or non-trauma, obviously collapse, inability to move, bloated appearance, seizures, dystopia, heat stress, flight. Strike, inability to pass urine or faeces for more than 12 hours, lameness, for example. What may change is our approach to these emergencies, so the time frame during which these emergencies need to be seen, and the quickness of our response to many of these emergencies, and we'll discuss this in the next few slides.
So which are some of the common symptoms these patients may be presented for. Lethargy and collapse are very common, as well as reduced appetite to anorexia. Reduced appetite to anorexia can very rapidly decompensate and if initially may not represent an immediate threat, they can commonly, very rapidly turn into something more like.
Threatening. Weight loss is very common as well, and it's important to remember that many of these symptoms are not necessarily specific to one disease. For example, guinea pigs with weight loss may have underlying pneumonia.
So it is important to know these cases certainly to have an initial assessment because respiratory distress and dyspnea certainly may be secondary to a primary respiratory. Problem, but it is also important to consider many of the differentials that may be leading to exactly the same clinical signs and never assume that respiratory distress is necessarily due to primary respiratory symptoms. So it's also important to consider this like assuming that the overall patient needs to be considered and not just the immediately presenting symptoms.
One thing I wanted to remember is chromodacriorrhea. So porphyri ocular discharge is a normal physiologic finding in many of the rodent species. It's particularly common in rats, for example, but it is generally not seen because the animal is healthy and grooming properly.
However, when rats, for example, are, are presented as an emergency for bleeding from the eye, This is not actual bleeding, but they are simply, these are simply porfering tears which are a very unspecific sign of underlying disease or stress. So this needs to be taken into consideration as well. What is perceived as an emergency from the client, what actually represents symptoms of something else that may be lurking underneath.
To handling and restraint in an emergency patient should always be dictated by the animal's clinical stability with the primary aim of minimising stress at all times. Therefore, before attempting any physical examination or restraint, the patient should be observed from a distance, and this allows an initial assessment of mentation. Respiratory rate and effort neurological status, as well as overall stress and pain levels, while also avoiding unnecessary handling.
The carrier also can be checked for evidence of urine or faeces and their appearance and their quantity. Many small mammals, particularly rodents, for example, are highly susceptible to stress, and excessive handling can rapidly worsen and already compromise the patient. And therefore, a rapid initial assessment and stabilisation should always take priority over performing a complete physical examination or performing diagnostics to achieve a definitive diagnosis.
The appropriate method of restraint will then vary considerably between species and individuals. For example, guinea pigs often tolerate minimal restraint, whereas if you have a prairie dog that may inflict painful bites and particularly fractures, then sedation or general anaesthesia may need to be considered. It's also important to remember that smaller rodents can be particularly challenging to safely handle with.
Causing any significant stress and therefore sedation or general anaesthesia may need to be considered. However, it is always important to consider the safety and the stability of that patient with regards to sedation or general anaesthesia versus stabilising the patient first and then proceeding with further steps. Having an emergency, a small mammal patient, immediate stabilisation, as we said, is priority.
The basic approach follows the familiar ABC principles, so airway, breathing, and circulation alongside, and this is very similar to humans as well, control of haemorrhage. Correction of fluid and electrolyte abnormalities as well as management of hypothermia. So for example, patients presenting with severe respiratory distress, open mouth breathing collapse, or marked weakness should receive immediate supportive care before a complete physical examination is attempted.
So for example, They may be placed in an oxygen cage with immediate rapid assessment of their respiratory system, their cardiovascular and neurological function before proceeding with any further steps. Fluid therapy in this case is is also extremely important in patients presenting with shock, for example, or severe dehydration, while ongoing nutrition and environmental support are a key components for a total overall successful critical care management. Unfortunately, not uncommon that animals presented with severe weakness or collapse then progress very rapidly in and suffer cardiorespiratory arrest.
In these cases, the, the goal of cardiopulmonary resuscitation, very similarly to other species is to restore spontaneous circulation while preserving neurological function. Now remember that in rodents, as in rabbits, for example, bradycardia commonly precedes respiratory arrest, so monitoring heart rate and perfusion during the initial emergency presentation can be extremely valuable. If respiratory arrest occurs in the presence of of a heartbeat, then establishing an airway can be essential.
However, it is important to remember that we are dealing with a species like rodents, sometimes very small, so intubation can be challenging in some cases, almost impossible in others. In these situations, high flow oxygen and positive pressure ventilation with 100% oxygen, even using a tight fitting mask. Can be important and can make the difference between life and death.
If then cardiac arrest occurs, and remember that cardiac arrest is recognised by collapse, loss of consciousness, absent pulses, and cessation of breathing, then chest compression should be started immediately alongside obviously airway management. Chest compression should be performed over the widest part of the thorax with continuous. Assessment of their effectiveness.
It's important to remember that as in other species, palpable pulses alone do not necessarily indicate adequate tissue perfusion. So ideally, although obviously practicality in this situation can limit, quite importantly, these these readings, the availability of entital CO2 or broadcast analysis can certainly provide additional information about the adequate tissue perfusion. And finally, remember that rodents have very high heart rates, so ECG may be difficult to interpret.
However, remember that if available, if recorded at faster speeds, it can be easier to interpret. I find particularly useful crash charts that are, you know, available, obviously, in an emergency situation because they can provide rapid access to protocols sometimes like the one that you see in this case, as well as rapid access to species-specific emergency. Drugs that have already been calculated based on the patient's weight.
So there are many of those available online, so I find it particularly useful in for, you know, team training as well, as well as in an emergency situation itself. Oxygen therapy in an emergency situation or, or if respiratory arrest occurs. Now if a rodent is showing signs of respiratory distress, but we are not at the stage of the patient requiring any sort of intubation or airway management, he should be immediately placed into a quiet oxygen enriched environment, and there are different ways of achieving.
This depending on the equipment available in practise. For example, if you have a face mask, this may not always be useful because unless the PET is collapsed, putting a face mask, face mask straight on the face of the patient can be particularly stressful and then can actually worsen the critical condition of the patient presented in that situation. So in those cases, an oxygen cage or an oxygen.
A tent or an induction chamber may be preferable, an incubator if available, or even a small pet carrier covered in a plastic bag to make an oxygen tent. If you have a smaller rod, then the larger unheady face masks can be used as an oxygen tent. Now it is important in all this situation to monitor the patient's temperature, especially if the patient is weak enough that can't move away.
from the area because, you know, obviously closing a patient in a very small space can induce, hyperthermia, so monitoring the temperature is extremely important in all these situations. Formal support, which is very often required in hospitalised small mammals, it must be used very carefully because obviously remember that the normal body temperature varies considerably between species, and rodents can also be particularly susceptible to heat stress. So for example, remember chinchillas are especially sensitive to elevated environmental temperatures, especially.
When the environmental temperature increases over 24 degrees, therefore, body temperature should be monitored regularly whenever, especially heat, an external heat source is provided, and this is particularly important, as I was mentioning in very weak patients or patients which may be unable to move away from a heat source if they become overheated. Now, these are different ways we could provide thermal support and always remember that hypothermia is generally considered a poor prognostic sign in many of these small mammal patients. So it could be, you know, simply enough as providing warm fluids, a warm water bottle, an electric heat pad, and a snuggle safe, or, you know, more fun.
A piece of equipment in all these situations, avoiding hypothermia, as I mentioned, but also burns and foreign body ingestion as well as corneal desiccation is absolutely essential because unfortunately we've had several cases where the patient was placed on a snugle, for example, but was too sick to move away from the heat source and we are burning. Signs underneath, you know, the, the ventral body. So this is extremely important.
Is another essential part of stabilisation, particularly in those species presented with a hypovolemic shock. Alongside rewarming, fluids can be used to correct life-threatening abnormalities in circulating volume, electrolytes, and acid-based status. The aim in all these situations is to give the minimum volume required to achieve.
Adequate perfusion using clinical parameters such as mentation, mucous membranes, capillary refill time, pulse quality, and wherever possible blood pressure, for example, temperature, urine output to guide the treatment. So these are very simple clinical parameters that can be collected at the very beginning of the presentation and monitored throughout the hospitalisation period. Now, as in other species, fluid therapy can be divided into three phases for small mammals as well, where the resuscitation phase helps to restore perfusion.
The rehydration phase helps to replace the fluid deficit, and the maintenance phase, instead provides maintenance fluids. But remember that these species usually have a higher metabolic rate and therefore relatively higher demands. During resuscitation phase, fluids should be given, parenterally, so ideally via the intravenous or the intraosseal route, and the fluid therapy plan reassessed frequently.
Dehydration should then be to body weight. Clinical signs and the deficit added to the maintenance requirements and ongoing losses. And as I said, regular monitoring is essential, including body weight, and total protein, for example, urine output, and wherever possible, blood pressure and acid-based status.
Fluid can also be worn to an appropriately high body temperature to avoid worsening hypothermia in all these situations. So, someone who provide fluids. We said that during the resuscitation phase, ideally, intravenously would be required and would be preferred.
However, it's always important to remember that many of these species do not tolerate, like, for example, rabbits, placement of an intravenous catheter consciously and therefore they either need to be collapsed or they may require heavy sedation or general anaesthesia. And especially in an emergency situation, the necessity to provide the sedation or general anaesthesia needs to be weighed against the stability of the patient itself. So wherever possible, guinea pigs and chinchillas may have an intravenous catheter placed into the cephalic or cephenous vein.
Remember they've got very short and chubby legs, so placement of a catheter is sometimes very difficult. The tailbin can be used in rats more easily, whereas smaller rodents it is often not possible to place an intravenous catheter. Now, wherever an intravenous route is available, dextrose 50% can be given as a 1 to 1 dilution with saline to treat only confirmed hypoglycemia.
Now dextrose treatment in all these situations needs to be conservative because if used not to treat confirmed hypoglycemia may induce a compartmental shift in electrolytes and water and ultimately lead to further hypovolemia. Process catheterization can be particularly useful in small mammal in an emergency situation where the intravenous access is difficult. The catter should extend approximately 1/3 to 1/2 of the medullary cavity, and a wire styler can help prevent bone debris from obstructing the catheter.
Placement is usually quite quick and is similar to a normal grade intramedullary pin placement and requires a strict aseptic technique. But remember, this procedure is painful, so it should ideally be performed in collapsed patients or ideally alternatively on General anaesthesia with local anaesthetics infiltrated into the periosteum where appropriate. The catheterin generally can remain patent for up to 72 hours with continuous fluid administration, and now the bolusis or can be used in this case.
Practically speaking, in the majority of cases, fluid administration remains extremely challenging in small mammals because of their small size, because they are continuously moving, and in some species because they simply are biting or because they are difficult to handle or they become very stressed. And therefore we often resort to the subcutaneous route of administration, even if not ideal, especially in an emergency situation. Remember that fluids can be, can be warmed to body temperature before administration without altering their composition, which can be particularly useful in hypothermic patients.
And historically, for subcutaneous fluid administration, yaluronidase has been used to facilitate the fluid fluid absorption and improve, improve distribution within the interstitial space. So if available, this is particularly useful, especially where Larger policies may be used especially to help reduce handling and stress of the patient. So when to stop with the fluid therapy, sometimes it is very difficult to understand when to start, when to stop, and what to give.
Now, an initial crystalloid bolus of 10 to 15 mL per kilo is a reasonable approach to hypovolemic patients with the treatment then carefully titrated with individual response. Now, in larger species, it may be easier, so rabbits and ferrets, for example, response can be monitored using typical bedside diagnostics. Like PCV, total solid, blood pressure, acid-base status, or even ECG or more advanced diagnostics.
But in smaller species, it's usually more difficult and we tend to follow clinical progress and clinical parameters such as mentation, pulse quality, activity levels, temperature, and urine output, which can be particularly useful to decide whether to continue or not on how to titrate accordingly the fluid therapy. So following initial resuscitation or growing fluid therapy should be ideally tailored to the underlying conditions that is suspected and continued at least until the patient is adequately hydrated, eating and drinking normally, and behaving normally as well. More of a difficult topic because certainly there are a few differences between methods used in dogs and cats transfusion medicine and exotic small mammal medicine, the biggest difference being the overall accessibility of donor animals and the feasibility of transfusion in practise.
Certainly an acute blood loss of 30 to 40% total blood volume will lead to shock and requires a fluid resuscitation, but when more than 40% of total blood loss occurs, then immediate volume resuscitation is warranted. And if the corrective measures do not lead to appropriate tissue oxygenation, then an immediate blood transfusion may need to be considered, but this is easier said than done in practise. There is also very little research into defining different blood groupings in many small mammal species.
We know that ferrets are a block group, but there are no blood. Groups identified in rodents. So what we tend to do, although a major and minor cross-match should be performed in any prior to any transfusion, what we tend to do in practise is what is called the simplified cross match, where we mix two drops of plasma of the recipient with 1 drop of whole blood from the donor on a slide at room temperature, and then a gluttyation developing within 1 minute suggests incompatibility.
Certainly, a negative test does not eliminate totally the occurrence of reaction and that's why the policies are initially started very slow, preferably with a syringe driver. So obviously you see the difficulty with smaller species where an IV cadre is very difficult or impossible. But overall, the total transfusion should not exceed 4 hours whilst constantly monitoring temperature, pulse, and respiratory rate for signs of adverse reactions.
It's a very important topic. Now, we know that rabbits and rodents compared to more common species like dogs and cats are less likely to receive analgesia. There may be a combination of unfamiliarity with the species, unfamiliarity with the drugs that may or may not be used, the drugs that cannot be used in certain species, the doses, the protocols, and the frequency of administration.
And that's why in in a paper, it was suggested that compared to dogs and cats, and for the same elective procedure, dogs and cats received 50 to 70% of cases. In other words, only 21% of rabbits and rodents received analgesia. So obviously it's also very difficult for who is unfamiliar with the normal behaviour of a species to identify.
Signs of pain. These are prey species as well that tend to mask the clinical signs until the disease is very advanced, so it's often very, difficult to identify signs of pain, especially in a clinical setting, so in a very busy clinical practise, and that's the reason why we should always be asking universal questions like, for example, is the lesion for which this patch is presented or the procedure that I'm going to perform. Going to be damaging tissues, for example, would it be painful in other species?
Would the patient have any abnormal behavioural response? If the answer to any of these questions is yes, you must assume that the animal is pain and therefore an adequate pain management protocol should be put in place. So what's the effective analgesia?
The problem is that we don't really have safe dose rates for a wide range of analgesia, for many of the species that we see in practise. There are many of these that have been established for rats and mice, but in laboratory laboratory settings, so often they can't be directly extrapolated to. Rats or pet mice or from pet rats and pet mice to other rodent species.
There is nowadays some more data available for guinea pigs and chinchillas, but we don't really have much indigos and hamsters. So therefore dosages and protocols are often extrapolated from more common species despite the lack of pharmacokinetic or a clinical efficacy study. So sometimes we Use drugs on an anecdotal level.
Let's put it this way, because we've used them for a long time, because other colleagues have used them for a long time, but we don't really know whether they work or not. So whenever possible, always check the available literature to see if there is any data, especially on the safety as well as the efficacy of certain drugs in certain species. you mentioned that, diagnostics should be delayed in an emergency situation until the patient is stable enough.
However, because many of these diagnostic tests may require sedation or general anaesthetic, obviously based on the clinical stability of the patient. It is often possible that emergency diagnostics are performed alongside the stabilisation techniques, provided obviously they do not compromise the patient's condition. So for example, if a blood sample can be safely obtained, a minimum database may be collected and may include, for example, PCB, total solids, electrolytes, block gas analysis, together with urine-specific gravity.
Other parameters may also be collected like an ECG if possible, blood pressure depending on the species, pulse oximetry, although pulse oximetry may not be particularly reliable in many of these patients. A rapid or focused ultrasound examination may also be very helpful in many of these situations, but rather than a complete abdominal or thoracic scan, which may be too prolonged in an emergency situation, specific sites can be assessed quickly for free fluid, for example, evidence of neurothorax or haemorrhage. And alongside that radiography may also be indicated depending on the situation, but remember that positioning and restraint can pose significant risks in unstable patients.
Remember, for example, think for example of a guinea pig that is presented for severe gastric distention. Certainly radiographs could prove particularly valuable in this case, but positioning for Radiographic for radiography may further compromise respiration or the cardiovascular function. So in these cases, imaging may need to be modified or delayed until the patient is stable enough, and further diagnostics, such as, for example, thoracocentesis or cytology can be performed in an emergency situation according to the specific injury or underlying disease that is suspected.
Itself can also be a significant source of stress for small mammals. So the environment is also an important part of their treatment. Rodents specifically should be kept in a warm, quiet, and secure area away from excessive noise and particularly from predator species.
Cages should have an appropriately small mesh size to prevent the Escape or injury and where possible, maintaining familiar items such as their own enclosure, for example, bedding, hides, or favourite foods can help reduce stress. Social companions, obviously in a species that are social, can also be beneficial, although in some cases a separate cage may be necessary to allow appropriate monitoring and treatment throughout the day. Monitoring of the hospitalised patient is essential in all these small mammal cases because subtle changes can indicate significant deterioration.
So sometimes it's difficult, especially if, these species hide a lot, to identify very subtle changes. So, urine and faecal output should be monitored and are relatively easy to, monitor and where possible quantified as well. Food and water intake should be measured, so using ceramic balls, for example, may help.
Minimising spillage and therefore helping with the quantification of water and food intake. And finally, spending time observing patients' behaviour, activity, and locomotion can provide valuable information about their progress because these subtone changes may may be some of the earliest indicators of improvement or deterioration. Environmental enrichment is also very important, particularly for patients requiring longer hospitalizations.
So providing appropriate heights, bedding, familiar objects, or even opportunities for normal behaviour can help significantly reduce stress and support the overall welfare during recovery. Stabilisation and fluid resuscitation can be certainly life saving in critically ill small mammals. Patients presenting with dyspnea, weakness, collapse, or trauma should receive immediate supportive care with priorities including airway, cardiovascular support, haemorrhage control, correction of fluid and electrolyte imbalances, and Treatment of hypothermia and I hope that this is clear up to this point, but nutritional support is equally important because in many of these species anorexia can rapidly lead to gastrointestinal dysfunction, dehydration, dysbiosis, and even hepatic lipidosis.
So more than 1 or 2 days without eating should be considered a critical care concern. Energy requirement can certainly be estimated using the rusting energy requirements, requirements. There are lots of formulas out there.
But remember that especially guinea pigs, chinchillas, and many of these rodent species do have a particularly high metabolic demands. Feeding should also be introduced gradually, starting at around 1/3 of the estimated requirements in small, frequent meals and then increasing as tolerated, and always provide fresh hay, greens, or appropriate recovery diets, depending on the species that you are dealing with. How do we practically provide supportive care and assisted feeding?
Now, feeding techniques should be adapted to the individual species and patients. So generally speaking, guinea pigs may readily accept food voluntarily, either from a bowl or via syringe. If syringe feeding is required, they should be held firmly but gently, taking care to minimise stress and avoid aspiration.
Chinchillas instead are often best allowed to feed at their own pace and will usually take food voluntarily. Patients and the minimal restraint are the four particularly important. So you can see here guinea pigs, they often, you know, very easily accept syringe feeding, whereas chinchillas, they may be better allowed to feed themselves off a spoon or from the syringe as well, whereas more handling may be more stressful for these species.
What about the smaller ones? In small rodents, food should be offered as soon as the patient is more alert and locomotion is evident, as they will often start eating voluntarily. It is important to, and this is for all rodent species to be honest, as well as rabbits, to keep the patient clean and dry, especially around the mouth and chin, because of any food or fluid contamination.
Could cause irritation and dermatitis and therefore should be promptly removed. An important aspect of managing the critical patient is the route of administration of any sort of treatment that is provided because when administering medications or supportive treatment, this should be selected carefully and adapted to the species and the patient. Oral medication, for example, may be disguised.
In palatable foods, depending on the species that you are dealing with. For example, rats may be more difficult to medicate, and foods such as baby food, fruit puree, smoothies, yoghurt, honey, milk paste, even Nutella sometimes may be used obviously if appropriate for the species simply to mask the flavour of the medication that is given. When injectable medications are required, then the subcutaneous route should be preferred, as opposed to the intramuscular one, which is more painful and, more stressful as well.
Intraperitoneal administration is not routinely recommended in rodents and should be avoided. At all times throughout treatment, minimising stress and excessive handling is essential. Small mammals can be very difficult to restrain safely sometimes, so do not hesitate to ask for assistance when handling or administering treatment, especially during prolonged hospital stays.
Another important aspect of medical treatment of the, many of the clinical patients presented to our practise. Antibiotics, as for any species should be ideally selected or based on culture and sensitivity wherever possible. However, do remember that the species-specific gastrointestinal anatomy and physiology are extremely important because some Antibiotics can cause severe and potentially fatal dysbiosis and enterotoxemia.
Species such as guinea pigs, chinchillas, hamsters, which have a predominantly gramme positive intestinal flora, are particularly susceptible, and there are many drugs such as beta lactams, macrolides, lycosamides that have been associated with fatal enterotoxemia. Species, although other classes of antibiotics can also cause problems, and toxicity may occur both with the oral and with some drugs, even the parenteral administration. There are also some important species, specific drug toxicities to consider, so the antibiotic selection should always be based on individual species as well as the suspected infection.
During treatment, closely monitor appetite, behaviour, and faecal production because these may change and may be early indicators of gastrointestinal complications and always obviously consider whether the antibiotics are actually required because many of the emergency situations are not caused by an infection. It's probably because they use a corticosteroids. Corticosteroids could be used cautiously in all species, particularly in critically ill patients.
Although rodents may appear less sensitive to some steroid side effects, their use in shock situations remains controversial, with no consistent evidence of benefit. The potential risks, including immune suppression, increased susceptibility to infection, hyperglycemia, gastrointestinal irritation, or ulceration, may outweigh any. Potential benefits of their use, especially prolonged or inappropriate use, can also result in more serious side effects such as skin changes, alopecia, weight loss, and potentially iatrogenic diabetes, and even significant systemic side effects, including lymphoid or splenic changes, as well as hepatic lipid accumulation have been reported when corticosteroids have been used inappropriately, and this is regardless of their route of administration.
Go through some of the common emergencies for which, many of the rodents or small mammal species are presented to our veterinary practise to see how we can apply what we just learned, in, you know, in a, in a specific situation. So let's start from generally anorexia. Many of these rodents are presented for anorexia, which is not obviously a disease.
It's a symptom of something whether due to dietary changes, whether related to gastrointestinal problems, dental disease, respiratory issues, metabolic disease, a systemic disease of any sort, or pain related. To other conditions, a PET presented for anorexia needs to be considered as an emergency. However, anorexia is not an indication of a specific disease.
It simply means that a full diagnostic workup, once the patient has been appropriately stabilised, should be performed to be able to reach the definitive diagnosis and then establish an adequate treatment or management plan. So let's start from gastrointestinal emergencies, herbivous species are especially sensitive to gastrointestinal issues ranging, ranging from dental disease to GI stasis, motility disorders that can very rapidly progress to life-threatening complications. Especially GI stasis is a complex and multifactorial condition that has been reported in many rodents.
Species as well as in rabbits, but it is not an actual diagnosis. In this case, it means that the motility has been negatively affected, but this can happen with many conditions that cause pain, anorexia, or dehydration. And therefore a primary cause for the altered gastrointestinal mobility needs to be identified once the patient has been stabilised enough.
Decreased gut motility can then lead to painful visceral gut accumulation, as well as enteric dysbiosis or dehydration of intestinal contents with potential for secondary obstruction as well. Inappropriate diets as well can lead to gastrointestinal emergencies. In a relatively recent retrospective study of 1000 guinea pigs, 13.1% of them had some sort of gastrointestinal issues, with 8 8.4% of them presented with.
Stasis 1% with gastric dilation and 3.4% with gastric dilatation and valvulus. So this is particularly common in these species and it is important to consider that prompt recognition of the emergency itself as well as the stabilisation of the patient is essential to then allow stabilisation of the patient and a complete diagnostic assessment to perform an adequate management of the case.
Dealing with gastrointestinal emergencies, we can broadly think in terms of medical versus surgical cases as we would, for example, in dogs and cats. And this approach is very useful in exotic companion mammals as well, with conditions such as gastrointestinal obstructions, for example, perforation, gastric dilatation, and vulvulus requiring a similar urgent approach. However, I would say that one of the important differences.
Is the unique gastrointestinal anatomy and physiology of many of these exotic species, and this is particularly relevant for herbivores such as rabbits, guinea pigs, for example, where conditions that would be considered relatively minor for dogs and cats can instead rapidly become serious gastrointestinal emergencies. Therefore, I would say that while the general principles of emergency management remain familiar, I would say that in this species, the threshold for intervention as well as the underlying causes must be adapted to the individual species, and sometimes the intervention needs to be much quicker than we would for more traditional species like dogs and cats. Moreover, diet and husbandry often have a major contributing factors in many of these gastrointestinal emergencies in exotic small mammals, and therefore these should always be carefully reviewed as part of the initial assessment.
In referral cases as well, it is also important to consider what treatments may have already been given and responded to this, as this can help sometimes to guide further diagnostics and therapeutic decisions. So what would be the initial clinical presentation? This can vary quite significantly.
Appetite, food intake, gastrointestinal motility are very closely interdependent in many small herbivores. And therefore, anorexia can lead to reduced gastrointestinal motility while hypomotility further reduces appetite, creating a potentially self-perpetuating cycle. Clinical signs can develop relatively slowly in some cases or can or can manifest very rapidly and it is important to look for any underlying or predisposing factors which may include some Previous surgery, dental disease, a recent stressful or painful event, but many of these signs that are here may be an indication of a significant underlying gastrointestinal issue should never be completely overlooked.
With a distended, tense, tympanic or painful abdomen may be experiencing severe gastrointestinal disease and therefore require rapid stabilisation. It is important to be familiar with the normal abdominal palpation of these species, such as, for example, rabbits and guinea pigs, and therefore be familiar with normality, their normal anatomy, because this can differ quite significantly from dogs and cats. The initial assessment, obviously, depending on the stability of the patient, you may be able to complete an initial full physical examination or you may Be able initially just to focus on perfusion and hydration.
Remember, perfusion parameters may include mentation and mucus membranes colour, capillary refill time, heart rate and rhythm, pulse quality, temperature, and wherever possible blood pressure and SPO2. Hydration that can be assessed using mucous membrane moisture, glo position, skin tinting. For example, and signs suggestive of shock may include augmentation, prolonged capillary, refill time, weak pulses, hypotension, bradycardia.
Many of these pieces are presented in the compensating shock and are presented with bradycardia, as well as tachypnea that may be a sign of stress or pain, for example, and weakness. So these are things that can be very easily. Assessed during the initial evaluation of the patient while trying to stabilise the patient itself, rather than progressing to diagnostics in the first place, like we've said many times.
So the disease in many of these small mammal species can very rapidly progress to decompensated shock and cardiovascular collapse. So just like any other veterinary species, aggressive stabilisation and supportive care, as we said, needs to be provided in a time-sensitive manner. So it is essential to obtain.
In vascular access wherever possible to provide appropriate fluid therapy, support medication, and for surgical emergencies, for example, to facilitate provision of analgesics and anaesthetic support while trying to reduce stress and anxiety that can then contribute even further to gastrointestinal hypermotility. So what do we do in this case is certainly analgesia is essential. Now remember that you may be presented with acute abdomen versus mild gastrointestinal discomfort, so you may need to evaluate whether an initial NSAIDS provision may be adequate or not.
On top of that, obviously opioids may or may not be considered. Obviously, remember that some of them can slow the motility of the guts down depending on. The dose that is provided, generally speaking, at the clinical dosages that are used, providing pain relief is more important than the potential risk of slowing the motility of the guts down.
You are also providing supportive care which may help improving the gut motility, so never spare analgesia in these situations. Protein attic drugs were indicated may be used, as well as gastric ulcer prophylaxis. Obviously avoid them if obstruction is suspected.
Antibiotics, I mean, they should be used very judiciously, as many can disrupt the normal gastrointestinal microbiota of exotic companion mammals. So they should be reserved for specific indications, for example, when you are aware there is a severe enterotoxemia, if there is a sepsis or confirmed infections where antimicrobial treatment is appropriate, but for example, for a pet presented with GI stasis, antibiotics are generally not recommended. Nutritional support should be introduced early, as mentioned, unless obviously gastrointestinal obstruction is present or immediate surgery is anticipated.
Early enteral feeding, obviously in those cases where it's not recommended, can help maintain gastrointestinal motility, reduce pain. And support the normal gut function in herbivorous species, we've already mentioned the possibility of syringe feeding of appropriate critical care diets depending on the species that may be an important part of both the medical as well as the post-operative management if surgery is required. What about diagnostics?
We've already said that obviously wherever possible, diagnostics should be delayed until the patient is stable enough. In some situations, however, diagnostics may be performed alongside stabilisation. Now, many of these species, especially in the early course of even significant gastrointestinal disease, may have subtle signs of their underlying condition, due to the fact that they are prey species and they tend to disguise outward signs of illness.
And this is particularly this phenomenon coupled with sometimes non-specific abdominal abdominal palpation findings makes it actually essential to Obtain some baseline diagnostics because it may help identify exactly where the problem may be and then direct the stabilisation even further. So two views, abdominal radiographs may provide more diagnostic information about the overall status of these small mammals in specific situations. Potentially these X-rays may be performed plain as well.
As we added water-soluble contrast, but obviously be mindful of the time that it takes for the contrast to, to, to run through the gastrointestinal tract. So the the normal gastrointestinal tract transit time in many of these species. Diagnostic imaging should include, for example, thoracic and abdominal radiograms where necessary.
Ultrasound in some situations may help. Identifying concurrent diseases, for example, or a primary issue for the current gastrointestinal, gastrointestinal, issues, for example. However, remember that the large amount of gas that sometimes accumulates when, these patients have gastrointestinal problems can hind completely, the, evaluation of, of the images.
And we will send the options to discuss with the client depending again on the stability of the patient or further down the line. It may include blood work, urine analysis and culture, stomatoscopy if dental disease or oral abscesses are identified, skull X-rays or CT, faecal analysis, ultrasound, and obviously where indicated X lab and of surgical biopsies. So what about monitoring, recovery from gastrointestinal stasis, obstruction, gastric dilation can take several days.
Supportive care should be continued whilst the gastrointestinal tract recovers. So continue fluids and assisted feeding if the patient is not eating independently yet and always monitor the body temperature very closely. Frequent abdominal palpation may also be particularly important to assess for ongoing gastric distention or discomfort.
If obstruction or persistent distention is suspected, then serial radiographs may help monitoring progress. Faecal production as well is also one of the most useful indicators of improvement, but remember that it may take 3 to 5 days or even longer sometimes to resume the normal faecal production, and the first faeces may be small, firm, soft, the mucus covered, may contain hair. So sometimes mucus is passed before normal faeces return as well, so treatment and supportive care should be continued until faecal output, appetite, and abdominal findings are clearly improving and returning towards normal.
Allergies are also extremely common reasons for presentation of many of these species to a veterinary practise. Clinical signs of respiratory disease may vary depending on which part of the respiratory system is affected and the severity of the disease because some animals are clearly present with obvious respiratory signs while others may simply show more general signs of ill health. So often it's not uncommon for guinea pigs to be presented for generalised weakness, reduced appetite, anorexia, and weight loss, and the main reason being, for example, raging pneumonia.
Importantly, many respiratory infections can also be subclinical with a few or no obvious signs at all, and in severe cases, animals may even be found dead without any previous warning. Respiratory signs are therefore not always diagnostics, diagnostics on their own, but when combined with a thorough and accurate history, for example, they can provide important clues to the underlying disease. Examination and stressful diagnostic procedures can sometimes be detrimental, and that's the reason why, as we mentioned many times, initial medical and supported treatment may need to be started before or alongside diagnostics.
So this is always important to, take into consideration. Preemptive sedation can be useful in selected patients to reduce anxiety and stress, particularly when handling is likely to worsen their condition. Remember that stress itself can exacerbate respiratory signs, potentially turning a subclinical infection into clinically occurring disease or worsening existing signs.
So assessing respiratory and heart rates can be challenging in many rodent species because of their very rapid rates. Lung fields can however be auscultated with a paediatric stethoscope, ideally while keeping the animal on the owner's arm or neck, like in the picture that you see here, to minimise stress. Crackles, wheezes, veles may all be detected, although auscultation can be relatively insensitive in some cases, particularly when pulmonary consolidation or abscessation is present.
Again, ocular or nasal discharge may or may not be present. Instead, matted or soiled four poles from repeated facial grooming can provide an important clue to respiratory disease. The plan in this case is obviously depending on the stability of the patient, a full physical examination and, further diagnostics may need to be delayed and supplemental oxygen are provided.
The patients, for example, showing tachypnea, dyspnea cyanosis, open mouth breathing, which is never a good prognostic sign, or nasal flaring or when pulse oximet. May indicate an SU to below 94%, although always remember the possible unreliability of the pulse oximeter readings. Oxygen should be ideally humidified while taking care not to cause hypothermia during treatment, as we discussed.
The duration and concentration should also be considered because prolonged exposure to high oxygen concentration can contribute to oxygen. Toxicity. Oxygen, we've already mentioned this, but could be delivered by flow by depending on how collapsed and stressed the patient is.
Face mask or an oxygen chamber, depending on the patient's tolerance and clinical conditions, where tolerated low flow oxygen providing a fraction of inspired oxygen of approximately 25 to 40% may be sufficient. And then once the patient is stable, A physical examination may be completed and medical treatment can be started with the main aim of, you know, obviously trying to identify the underlying cause of those this is often not possible in clinical practise, but the aim is to reduce inflammation. This is essential because many of these respiratory infections can modify the anatomy and the physiology.
Of the respiratory system, facilitate clearance of mucus or purulent material, minimise the structural and vascular changes within the lungs, control the clinical signs, and where appropriate because this may not always be possible, also treat the underlying infection. Remember that in many of these patients, curing the respiratory infection may not be possible because they may remain persistent. Infected and therefore the main aim may reduce simply to control and reduce the clinical signs to a level that is compatible with a good quality of life.
Nebulization therapy, either using disinfectants, hypertonic saline, or escalating to bronchodilators or steroids where necessary, may be considered as well. And remember that many of these patients because The olfaction is also being affected and may show reduced appetite to anorexia and for supportive care in the form of fluid therapy and assisted feeding may be required as well. Environmental and dietary changes are also essential to help reduce the.
On the respiratory system as well. Ultimately, small mammals can be challenging to triage, and it is not always possible to identify the primary cause immediately. A diagnostic workup is certainly important, but it should be balanced against the patient's stability.
The priority in all these cases is to provide aggressive and tailored supportive care based on the individual patient and species while monitoring. Closely for any changes. So even when the underlying diagnosis remains uncertain, which is unfortunately often the case in clinical practise, early stabilisation, appropriate supportive treatment, and frequent reassessment can significantly improve the chances of a positive outcome.
Thank you very much for your attention today.
