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An owner rushes into the practice, shouting that their ferret is collapsed. Most of the vets are out on calls, and the one vet in the building is operating. She shouts that she is happy for you to carry out a clinical exam and triage the patient.
As you give the ferret oxygen the owner tells you that he's 5 years old, has been on deslorelin implants, and is fed a commercial diet. He has collapsed before, but has quickly come round. This morning, he was drooling and not himself and she was just about to phone the practice when he collapsed. She just picked him up and brought him to the practice. So, where are you going to start? |
TEMPERATURE: You take the rectal temperature and find that it's 37 degrees Celsius. You know that normal is 37.8-40, so this ferret has a low body temperature. You shout to your colleague to get a blanket, and a form of heat to warm up the ferret, whilst monitoring the response to external heat.
RESPIRATION: You monitor the breathing - it doesn't look laboured. The ferret is breathing through it's nose, it's not noisy and there isn't any discharge from the nose. The respiratory rate is 50 bpm and you know that normal is 40-80bpm.
PULSE: You take the femoral pulse and listen to the heart. You can't hear any murmurs, and the pulse is regular and strong. The heart rate is around 200bpm and you know that normal is 180-250bpm.
OVERVIEW: What is their body condition like? As you've been handling the ferret you now know that they are a little thinner than you would expect. What do you do next?
RESPIRATION: You monitor the breathing - it doesn't look laboured. The ferret is breathing through it's nose, it's not noisy and there isn't any discharge from the nose. The respiratory rate is 50 bpm and you know that normal is 40-80bpm.
PULSE: You take the femoral pulse and listen to the heart. You can't hear any murmurs, and the pulse is regular and strong. The heart rate is around 200bpm and you know that normal is 180-250bpm.
OVERVIEW: What is their body condition like? As you've been handling the ferret you now know that they are a little thinner than you would expect. What do you do next?
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The vet has now joined you and you have some help. The vet takes some blood to check blood glucose levels whilst you take blood pressure. You find that the systolic blood pressure is low (90mmHg) and blood glucose is also low at 2.5mmol/Litre. What are the next steps?
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Think about how you would treat a cat or dog at this point. The ferret is hypoglycaemic, so it needs some form of glucose - you will probably have some glucose gel in your crash trolley can be given here. At the same time, someone will placing an IV catheter in order to give fluids. Different options are available here - you could use Hartmann's, saline or hypertonic saline, and we probably need some more information in order to make a decision.
After being warmed and receiving glucose and fluids the ferret is now starting to come round. The owner is relieved, and now you can stop to breathe and think about the steps you followed to deal with an emergency ferret.
In summary - when presented with a collapsed ferret, you want to think about:
If you would like to find out more about the underpinning theory here and ongoing management of this case - please read on!
Find out more about how to look after similar cases in the Advanced Programme Nursing Small Mammals.
Possible Reasons for Collapse?
A number of diseases in ferrets, as with other species of small mammal, may result in sudden collapse including infectious disease, cardiac disease, lymphoma and renal failure. However with this history, considering this ferret’s age, and without contact with other ferrets/pets/wildlife, one condition, insulinoma with resultant hypoglycaemia, is highly likely.
Emergency nursing care
Once stabilised, ongoing support is likely to focus on medications such as prednisolone to maintain glucose levels but also need to focus on nutritional support and anti-stomach ulcer medications.
After being warmed and receiving glucose and fluids the ferret is now starting to come round. The owner is relieved, and now you can stop to breathe and think about the steps you followed to deal with an emergency ferret.
In summary - when presented with a collapsed ferret, you want to think about:
- Oxygen provision
- TPR
- Providing warmth
- Blood pressure monitoring
- Assessing blood glucose levels, blood biochemistry, pcv and haematology
- Providing glucose supplementation
- Providing fluids
If you would like to find out more about the underpinning theory here and ongoing management of this case - please read on!
Find out more about how to look after similar cases in the Advanced Programme Nursing Small Mammals.
Possible Reasons for Collapse?
A number of diseases in ferrets, as with other species of small mammal, may result in sudden collapse including infectious disease, cardiac disease, lymphoma and renal failure. However with this history, considering this ferret’s age, and without contact with other ferrets/pets/wildlife, one condition, insulinoma with resultant hypoglycaemia, is highly likely.
Emergency nursing care
- One of the first things to assess in a collapsed ferret would be rectal temperature to see if supplemental heat is required as many such patients rapidly become hypothermic. Published values for rectal temperatures in the domestic ferret are somewhere between 37.8-40˚C, generally higher than many other small mammal pets. If hypothermic, placing the ferret into an incubator would be the preferred choice, but use of ‘hot-hands’, hot-air or hot water circulating systems and intravenous fluid therapy may be required
- An assessment of respiratory rate and depth (normal values being typically 40-80 breaths per minute) and heart rates (typically 180-250 beats per minute at rest with no audible murmurs) should also be taken as cardiorespiratory disease (e.g. dilated cardiomyopathy with pulmonary oedema) are common.
- Considering the likely differential diagnosis of insulinoma in this case, administration of a glucose gel, typically used in diabetes mellitus patients where a hypoglycaemic incident occurs, applied to the mucus membranes of the mouth, may be life-saving.
- Application of an indirect blood pressure monitoring device, as with cats and rabbits, to the forelimb (placing the cuff immediately below the elbow and the Doppler applied immediately proximal to the ventral carpus) is also helpful as many collapsed patients are hypotensive and hypoglycaemia in particular results in histamine release and resultant hypotension. The normal systolic blood pressure of the domestic ferret is somewhere between 120-160mmHg depending on recent/current activity levels.
- Should hypotension be determined, placement of an intravenous catheter for blood sampling and fluid plus glucose administration would be important. The cephalic vein, although small and often requiring a 25 gauge catheter, is highly likely to be the first choice. Other vessels that could be accessed would include the saphenous vein or even jugular veins.
- For profoundly hypotensive patients, use of hypertonic saline (7.2%) has been shown to rapidly improve blood pressure if administered as a slow intravenous bolus (1-3ml/kg bodyweight). Isotonic fluids must then be used to replace any potential fluid deficits remembering that a ferret’s daily maintenance fluid requirements are 75-100ml/kg/day.
- Warming the patient is also important, as if the rectal temperature is below the normal ranges (37.8-40˚C) the administration of any fluids is unlikely to result in a significant increase in blood pressure due to suppression of the adrenal-pituitary axis when body temperatures are less than 36.7˚C (98˚F).
- If intravenous access has been achieved and blood glucose levels are less than 3mmol/L, intravenous 50% glucose (diluted 50:50 with isotonic saline) given at 1-3ml/kg bodyweight should be attempted until blood glucose levels have returned to normal.
Once stabilised, ongoing support is likely to focus on medications such as prednisolone to maintain glucose levels but also need to focus on nutritional support and anti-stomach ulcer medications.
- Ongoing supportive nutrition needs to focus on energy requirements, frequency of feeding and digestibility. Typically a diet containing at least 20-30% fat, 35% protein and kcal as dry matter, is recommended for domestic ferrets.
- Energy requirements for the adult domestic ferret are typically 200-300kCal (837-1255kJ) of metabolizable energy per kilogram bodyweight
- Use of antacids are recommended as hypoglycaemia results in systemic histamine release and so an increased likelihood of stomach ulcers. Medications such as omeprazole or ranitidine have typically been used to prevent ulcers with protectants such as sucralfate being added in where actual ulcers exist.
- Prednisolone therapy, with potential surgery to remove the insulinoma (but they are often very small and difficult to locate) is typically used to manage the patient.
