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Jazzie in a severe state, glucose 18.2, lactate 11.6 - what does this mean? U/D #39

~ILoveMyBunny~

Alpha Buck
Wasn't going to bother you all with another thread today but I wasn't expecting the result tonight..
Long story short Jazzie wouldn't eat last night (she spooked herself with her own shadow around 10pm last night and we're assuming it was the stress of that that's caused it). I phoned first thing this morning but vet wasn't able to see her until 14.50 this afternoon. At the point of seeing her she hasn't eaten for a minimum of 17hrs. Up until vet visit she had been drinking regularly though.
She hadn't passed anything since around 10/11pm last night, with the exception of a single dropping at the vets.
Vet couldn't hear any gut movement at the time but later did an ultrasound which showed movement but a completely empty tract. Glucose and lactate were done at 15.30 and glucose is 18.2 mmol/L, lactate 11.6 mmol/L
He's given her a prognosis of 'guarded to poor'
Now I know I've asked so many things over and over again but I've never had the bloods as high as this and to be honest I'm terrified. I asked if there was any sign of obstruction and the vet said he couldn't see any but don't high results like that point towards an obstrution?
She's been sent home with emeprid, ranitidine, fibreplex and metacam. Also to have critical care.
Since there is gut movement but an empty tract and the bloods are so high would this be considered stasis or should I be concerned about an obstruction? If it's an obstruction surely she'd need surgery tonight if she was to have any hope whatsoever of surviving?
Sorry.. I'm in a bit of a panic and I don't know what to do :(
 
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Forgot to mention he said her temperature is very low for a rabbit. He thought she has spent the night outside and was surprised when I told him she was a house rabbit as she was so cold.
 
I'm so sorry about Jazzie. I can't recall the blood glucose values & have been searching for something more specific than this - but worth posting for now
Blood glucose was measured with a portable glucose meter in 907 rabbits, including 238 clinically healthy ones. Blood glucose concentrations ranged from 1.2 to 30.1 mmol/l. Diabetes mellitus was not encountered. No significant effect of sex or sedation was found. Hypoglycaemia was seen in 16 rabbits including one with an insulinoma. There was a significant relationship between blood glucose, food intake, signs of stress and severity of clinical disease. Rabbits showing signs of stress had higher blood glucose than rabbits with no signs and rabbits that were totally anorexic had higher blood glucose values than those that were eating normally or those with reduced food intake. Severe hyperglycaemia (>20 mmol/l) was associated with conditions with a poor prognosis. Rabbits with confirmed intestinal obstruction had a mean blood glucose of 24.7 mmol/l (n=18). This was significantly higher than the rabbits with confirmed gut stasis, which had a mean value of 8.5 mmol/l (n=51). The conclusion of the study was that blood glucose is a measurable parameter that can be used to assess the severity of a rabbit's condition and help to differentiate between gut stasis and intestinal obstruction in rabbits that are anorexic.

I'd be hesistant too about administering meds in case it is an obstruction (I so hope not) - if you call OOH now I guess you'd get another vet & a second opinion, i'd call & express your concerns. I hope more knowledgeable people come along soon
 
This is the information I have for glucose levels:

<4 indicates a problem
4 - 8 normal range.
8 - 14 raised, but not in the 'danger zone'
15 is of concern, needs watching, re-test in an hour or so - I've been advised that at 15 it's safe to monitor and retest hourly if OOH, but if during surgery hours I'd be getting the bunny seen for examination, painkillers etc.
15 - 20 there could well be an obstruction/partial obstruction - needs to be seen by a vet.
20+ there's like to be a full obstruction - this is an emergency and will probably require surgical intervention.

But if you look at Martlou's recent post about Ted, his glucose level was 24. I think that stress can also contribute to raised glucose levels. I don't have any information on lactate levels. I would try to keep her warm with snugglesafe or fleece.

Sending lots of vibes for her.
 
Fran had her glucose levels tested today which were 11. The vet said they were higher than normal but not so high I needed to syringe feed her as long as she continued to eat as she was doing.

Sending lots of vibes for Jazzie xxx
 
Ah Omi you bet me to it 😊.

Ted's glucose was indeed 24 and temperature low at 36. The vet was really quite concerned and described him as 'a rabbit in trouble'. No sign of any blockage on his xrays though and after 7 hours on fluids and additional loxicom (same as metacam), ranitidine and emeprid, his levels returned to normal, he started eating a few little bits and we were able to bring him home. We're 48 hours later now and he's steadily recovering. So much as we were also panicking please see that it's not necessarily as bad as you might think. Fingers crossed for Jazzie to recover very soon x
 
My first question is if the prognosis if 'guarded to poor' why is the bunny not in inpatient? Elijah frequently has blood glucose readings of 17ish when he is in stasis and it's deemed to be an obstruction slowly moving along, most of the time. (He's had 30+ admissions for this!!) So try not to worry too much at this stage.

Blood glucose reading is deemed to be an indicator rather than an absolute definite that there is a blockage/obstruction, it is at odds with the empty GI tract so as long as they've done scans/x-rays to rule out obstruction then I would be happy to syringe feed (I'd be happier for a vet nurse to be syringe feeding and closely monitoring though!). I'd say given how long it is since she has eaten and her GI tract is empty then syringe feeding is the priority but closely monitoring just in case there is something more going on. (I'd also be quite cross if I vet told me the prognosis was guarded when they'd taken so long to see the patient in the first place, I would hope the prognosis would be better the sooner they were seen!)
 
Thank you all so much. So glad to hear that Ted's recovering. I really hope he continues to do well.
What's worrying me is not only didn't they see Jazzie until 14.50pm which was a very long wait but they also didn't administer fluids as she was drinking at the time of consultation (I don't know if she was drinking in the few hours she was admitted or not)
I feel she should have been in fluids and I'm really worried that she should be getting them now. I really think the glucose test should be repeated too.
I don't know where I'd get the money for VetsNow but I can't help but feel she needs to be seen by another vet..
Trying to figure out what to do for the best here and it's not easy :(

My first question is if the prognosis if 'guarded to poor' why is the bunny not in inpatient? Elijah frequently has blood glucose readings of 17ish when he is in stasis and it's deemed to be an obstruction slowly moving along, most of the time. (He's had 30+ admissions for this!!) So try not to worry too much at this stage.

Blood glucose reading is deemed to be an indicator rather than an absolute definite that there is a blockage/obstruction, it is at odds with the empty GI tract so as long as they've done scans/x-rays to rule out obstruction then I would be happy to syringe feed (I'd be happier for a vet nurse to be syringe feeding and closely monitoring though!). I'd say given how long it is since she has eaten and her GI tract is empty then syringe feeding is the priority but closely monitoring just in case there is something more going on. (I'd also be quite cross if I vet told me the prognosis was guarded when they'd taken so long to see the patient in the first place, I would hope the prognosis would be better the sooner they were seen!)

This is exactly my question... Why wasn't she given i/v fluids as they normally do? I don't get it.. And he never mentioned her being treated overnight, plan was to send home with meds. I was the one that asked for history in case I had to take her to an out of hours vet...
They've done an ultrasound but no x-rays. I'm wondering if an ultrasound could miss an obstruction?
My normal rabbit savvy vet has the week off but I've seen this vet before with stasis buns and although his rabbit knowledge isn't as good as hers he's always done the right thing in the past. I'm confused as to why this - to put it bluntly - seems to have been so mishandled today?!
 
This is exactly my question... Why wasn't she given i/v fluids as they normally do? I don't get it.. And he never mentioned her being treated overnight, plan was to send home with meds. I was the one that asked for history in case I had to take her to an out of hours vet...
They've done an ultrasound but no x-rays. I'm wondering if an ultrasound could miss an obstruction?
My normal rabbit savvy vet has the week off but I've seen this vet before with stasis buns and although his rabbit knowledge isn't as good as hers he's always done the right thing in the past. I'm confused as to why this - to put it bluntly - seems to have been so mishandled today?!

I'm not sure on that one but I'd be slightly wary as you are. My local vet doesn't have x-ray machine available just ultrasound but she has sent buns to a branch that has x-ray machine has she doesn't feel that ultrasound will tell her enough. I don't know the ins and outs of that as my rabbit savvy vet also never uses ultrasound for stasis, they always use x-ray.
 
Are you hands on? You could get maybe a blood glucose monitor from such as Lloyds pharmacy and take a reading yourself if you are able to put a needle into the ear vein. (I've never managed it but it would be sooo useful)
 
Sorry, haven't had a chance to fully read everything yet but will a little later.
I'm taking to Vets Now. Will update later.
Thank you all for your help xx
 
Thing's aren't good :cry:the vet has been absolutely wonderful but gave me a massive shock when she came back and said her glucose had gone to 30. However she explained that the machine is calibrated to cats and dogs and isn't always accurate for rabbits and did another test about an hour later (more on that in a minute)
She did an x-ray and her stomach is filled with gas and misplaced but no obstruction visible. She consulted with an exotics specialist and sent her the x-ray and then did a full blood test to investigate the liver as she thought it might be twisted. One of the liver values is high but the others are normal. However her kindeys are very high and in very dangerous levels.
She said that surgery isn't an option right now anyway as her kineys are so bad she wouldn't make it. The real question seems to be whether this was caused by an underlying kidney problem, in which case she says she almost certainly has no chance, or whether they're so bad due to dehydration, which would make sense to me as I haven't noticed any symptoms that would indicate a kidney problem and she's gone over 24hrs like this now with her only fluid intake being whatever she drank prior to 14.30 this afternoon (I don't know if she drank at the vets or not but I'm assuming not knowing her)
She can't get a vein for an i/v at the moment so she's giving large amounts subcutaneously for the moment and will give her an i/v if/when she's got a vein that can take it.
On the full blood test her glucose came up at 19 point something. I don't know if that's because it's more accurate than the last one or if the level is dropping.
Regarding body temperature she was 36.3 but has been getting warmer as they have her on a heat pad.
Obviously she's in overnight and assuming she makes it that far we'll be collecting her at 7.45 am.
I have absolutely no idea how I'm going to pay for all this tomorow but for the moment I just need to focus on her.
Since surgery isn't an option now she's restarting motility meds etc so the only thing I can do is wait and hope I don't get a phone call.
 
Thing's aren't good :cry:the vet has been absolutely wonderful but gave me a massive shock when she came back and said her glucose had gone to 30. However she explained that the machine is calibrated to cats and dogs and isn't always accurate for rabbits and did another test about an hour later (more on that in a minute)
She did an x-ray and her stomach is filled with gas and misplaced but no obstruction visible. She consulted with an exotics specialist and sent her the x-ray and then did a full blood test to investigate the liver as she thought it might be twisted. One of the liver values is high but the others are normal. However her kindeys are very high and in very dangerous levels.
She said that surgery isn't an option right now anyway as her kineys are so bad she wouldn't make it. The real question seems to be whether this was caused by an underlying kidney problem, in which case she says she almost certainly has no chance, or whether they're so bad due to dehydration, which would make sense to me as I haven't noticed any symptoms that would indicate a kidney problem and she's gone over 24hrs like this now with her only fluid intake being whatever she drank prior to 14.30 this afternoon (I don't know if she drank at the vets or not but I'm assuming not knowing her)
She can't get a vein for an i/v at the moment so she's giving large amounts subcutaneously for the moment and will give her an i/v if/when she's got a vein that can take it.
On the full blood test her glucose came up at 19 point something. I don't know if that's because it's more accurate than the last one or if the level is dropping.
Regarding body temperature she was 36.3 but has been getting warmer as they have her on a heat pad.
Obviously she's in overnight and assuming she makes it that far we'll be collecting her at 7.45 am.
I have absolutely no idea how I'm going to pay for all this tomorow but for the moment I just need to focus on her.
Since surgery isn't an option now she's restarting motility meds etc so the only thing I can do is wait and hope I don't get a phone call.

Lordy I am so sorry to hear this news :cry:

I am hoping for a miracle for Jazzie and that she can pull through xx
 
Oh I have everything crossed for jazzie! Vibes vibe vibes. You must worried sick. Xxx

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