Hi Santa,here is the article but it doesnt give a dosage.
In: NAVC Proceedings 2007, North American Veterinary Conference (Eds). Publisher: NAVC (
www.tnavc.org). Internet Publisher: International Veterinary Information Service, Ithaca NY (
www.ivis.org), Last updated: 13-Jan-2007.
Vestibulitis: The Rolling Rabbit
K.L. Rosenthal
School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Why do rabbits roll? They roll because there is a dysfunction in the rabbit’s system that controls coordinated head and body movements. The rabbit is no longer able to detect linear acceleration and rotational movements of the head. It is no longer able to control the muscles that are involved in equilibrium and position. Disease that causes rolling will affect the vestibular system. The vestibular system is organized into a peripheral vestibular system and a central vestibular system. Peripheral includes the middle/inner ear and central includes areas of the cerebellum.
THE PRESENTATION
Rabbits frequently develop neurologic disease that causes panic in owners. These rabbits are brought to your hospital or an emergency hospital for immediate evaluation and care. There is no typical signalment. All ages and intact or neutered rabbits can present for rolling. This can be seen in young rabbits or those that are geriatric that have no known health problems. What owners usually see is a rabbit that is normal, with no predisposing problems, that starts rolling. Rabbits are said to be "rolling." What this means is that the rabbit has lost its ability to balance. This is usually due to disease affecting the inner or middle ear and/or the vestibular nerve. The rabbit placed in sternal recumbency falls to one side or the other, never able to keep itself upright. Sometimes, this rolling can be violent leading to secondary injuries, although, this is less common. The most common secondary injuries include corneal abrasions and superficial skin wounds.
IMMEDIATE CARE AND EVALUATION
The first response is to stop the rolling. Unfortunately, nothing you can do will stop the rolling short of sedation or anesthesia. If the owner calls before they come in, recommend they place the rabbit in a small cage that is padded with towels. There should be no exposed metal or sharp edges. This same is true for in-hospital caging. It may not be possible to do a physical examination on this rabbit without at least one person holding the rabbit. Even then, rabbits that are "rolling" are difficult to hold for an examination. It may be impossible to perform venipuncture. A rabbit may become more "anxious" as it is held while it is unbalanced. A thorough physical examination is necessary but may not be possible. The following are essential things that should be checked. Look in both ears and check for any obvious otitis externa. It is uncommon for externa to be the cause of or associated with otitis media/interna. An ocular examination should ensure that the cornea is not punctured and, if possible, the eye should be stained if there is any chance for damage to the cornea. It is important for lesion localization to assess for nystagmus including direction. Heart and lungs should be assessed. If possible, check incisors to make sure that the teeth have not been broken. Again, if possible, check for postural deficits. In reality, there may be few vital signs to assess unless you have skilled technical help holding the rabbit. One great caution is that a rabbit that is trying to roll can twist in a towel and also kick its legs in a towel leading to vertebral fracture. This is another reason, without proper help, to limit an initial examination.
Obtaining a complete blood count and a biochemistry profile and a urine sample may not lead to the disease diagnosis but it can rule out other systemic or secondary problems. In most cases, without skilled technical help, these may be impossible to obtain. There are some who recommend putting these rabbits under anesthesia using isoflurane and placing a mask on the face. If this is not possible due to rolling, they place the rabbit in a small tank outfitted for anesthesia induction. Anesthetizing a "rolling" rabbit should not be considered lightly as risk of causing further problems while the rabbit is induced or even death is possible. If this is attempted, it is then possible to perform venipuncture and a partial physical examination. When the rabbit wakes up from anesthesia, all attempts should be made to keep the recovery area safe for the rabbit. The recovering rabbit should be treated just as the rabbit that is not put under anesthesia. It should be placed in a small cage where it can roll. All areas of the cage should be padded. No sharp areas or metal areas should be in the cage. Easy access by personnel including the ability to watch the rabbit are important. It is also important that the rabbit not be kept in an environment that is very unfamiliar and harsh. Therefore, constant lights, as might be present in an emergency room or ICU should be lessened. Unfamiliar noises from dogs and cats should be filtered out. Make sure a weight is always obtained at admission.
ACUTE CARE
Once the rabbit is in a cage, acute care can begin. It is important to note the essentials for this rabbit. It will need fluid and nutrition. Those are essentials or the rabbit may die from dehydration or become sick from secondary hepatic lipidosis. Ideally place an intravenous or intraosseus catheter. Unfortunately, it is difficult to place an these catheters in a rolling rabbit and just as difficult to keep them in place. Therefore, subcutaneous fluid boluses are substituted for intravenous fluids. Use a balanced salt solution. It is not recommended to use dextrose in the subcutaneous fluids as that appears to sting. Since it may be difficult to hold the rabbit for extended periods, many small boluses during the day may be easier to accomplish than two or three larger ones. Nutrition is more difficult to administer to these rabbits. Offer food and water in the cage as some rabbits will stop rolling soon after the episode starts. If the rabbit needs supplemental alimentation, syringe feeding with liquid products is easiest at this time. It is unlikely that the caloric needs of this rabbit will be met with syringe feeding but acute care should only last one to three days.
Other considerations would include treatment for the cause of rolling and treatment to stop the rolling. It is unlikely during the acute period that the cause of rolling will be determined. Even if the CBC and biochemistry results are known, it is unlikely those diagnostic tests will determine the cause. It is assumed in many cases that a bacterial infection in the middle or inner ear or of CN 8 is responsible for this disorder. Therefore, coverage with antibiotics is warranted. It is best to use broad spectrum coverage: antibiotics that are effective against gram positives, gram negatives, and anaerobes. A combination such as injectable penicillin and a quinolone has much merit. So does the use of a trimethoprin sulfa antibiotic along with metronidazole. The use of antihistamines, such as meclizine, has been advocated. It is not known if this is effective in rabbits with this disorder but side effects appear to be minimal. Finally, it may be necessary to use ophthalmic medication. If there is corneal disruption, medication will be needed to treat that wound. Even if the cornea is intact, usually, these rabbits are left with a head tilt and it may be important to keep that eye moist.
CHRONIC CARE
Many of these rabbits stop rolling without any care from us. Most rabbits stop rolling within one to three days. Chronic care depends on the extent of disease left over from the rolling and if the cause of rolling was determined. Most rabbits have a residual head tilt, sometimes severe. Very few of these rabbits cannot eat after a rolling episode so continued supportive nutrition is usually not necessary. Once the rabbit is no longer rolling, further diagnostics can be attempted. Skull radiographs may help identify gross bulla lesions, but more sensitive imaging techniques such as a CT or MRI of the skull are necessary for a thorough diagnostic.
This manuscript is reproduced in the IVIS website with the permission of the NAVC
http://www.tnavc.org
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