The unique dietary needs of exotic companion mammal herbivores, including the domestic rabbit (Oryctolagus cuniculus), the guinea pig (Cavia porcellus), the chinchilla (Chinchilla lanigera), and the common degu (Octodon degus), have been thoroughly explored (Miller 2022a, 2022b). Delegating the collection of husbandry information to a veterinary nurse or technician is an efficient use of their skills, and knowledgeable nurses can certainly review husbandry problems with pet owners. Effective history-taking techniques will be discussed, as well as some common dietary mistakes made by the pet owner when caring for these animals. Finally, a review of nutritional support for these patients will be discussed.
Nutritional history-taking
Taking a thorough history is a cornerstone of exotic animal medicine: estimates of the prevalence of husbandry-related diseases vary depending on the study, but it is generally agreed that inadequate husbandry (including nutrition) is a leading cause of illness in small mammal herbivores (Hartmann, 1993; Fawcett, 2011; Jekl et al, 2011; Prebble, 2011; O'Neill et al, 2020). Always assess your patient, the diet offered, and how it is offered (Carpenter et al, 2012). Many dietary inadequacies can cause serious short-term and longterm health consequences in small mammal herbivores.
Questionnaires, either provided for clients to fill out before the practice visit, or to follow during history-taking in the examination room, are extremely useful to ensure a systematic approach to obtaining vital information. Utilising open-ended questions, where the person being questioned is invited to expand on their response, is an effective communication tool; in contrast closed-ended, ‘yes or no’ questions are regarded as less flexible in the information that is elicited (Hunter and Shaw, 2012; Donnelly, 2017). See Table 1 for examples of questions that can be applied to a small mammal herbivore history.
Table 1. Examples of closed vs. open-ended questions for history-taking
| Closed-ended question | Open-ended question | Discussion |
|---|---|---|
| ‘Do you offer your rabbit hay?’ | ‘What types of hay do you offer your rabbit, and how much does she/he eat every day?’ | The closed-ended question does not prompt the client to elaborate on the types of hay offered, or how much the patient ingests |
| ‘Does your rabbit have a water bowl or dish?’ | ‘How does your rabbit drink water, and how much does she/he drink?’ | The open-ended question helps to characterise any changes in drinking preference or quantity |
| ‘Does your rabbit get treats?’ | ‘What foods does your rabbit enjoy as treats, and how often/how much does she/he eat?’ | The closed-ended question leaves ‘treats’ open for interpretation. The open-ended question helps to identify the animal's food preferences and the quantity offered and eaten. The open-ended question also helps to identify inappropriate food offerings |
Taking and reviewing the husbandry history is an excellent way to utilise motivated and knowledgeable nurse or technician staff. Veterinary nurses who are comfortable reviewing husbandry information and recognising which details are important to elaborate on are invaluable to the exotic animal care team. The author has had personal success in practice with nurse/technician time dedicated to reviewing husbandry forms filled out by clients, having clients elaborate on details where necessary, then providing a personalised husbandry recommendation at discharge or shortly after a visit. The author has a pre-prepared document with ‘standard’ responses for common husbandry problems (e.g. excess of pellets in a diet, inappropriate treats like salt licks, etc.) that are edited and customised for individual patients where necessary. This is combined with a generic reference document on species care (care sheet) so that the pet owner has both a standardised care reference, and targeted advice for their companion.
The husbandry history should be taken at the patient's initial visit, as well as reviewed with the client at annual examinations and sick presentations to ensure that there have been no changes that may have (or will) precipitate health problems. An abbreviated questionnaire can be used at urgent care presentations to rule in or out some pathologies.
Common dietary problems identified in a detailed history
The digestive system of the hindgut fermenter is sensitive to inadequate nutrition (Miller, 2022a). The following is a discussion of some common nutritional problems and dietrelated diseases encountered in clinical practice.
Refusal to eat hay
Appropriate grass hays should be the largest proportion of the companion hindgut fermenter's diet. When a client reports that their companion animal ‘does not like hay’, or ‘refuses to eat hay’, this warrants investigation into the pet's diet and how they are being fed. Some common causes for refusal to eat hay include:
- Poor quality hay — hay should have a fresh and grassy scent, and be stored in a cool, dry place. Hay that is stored improperly may have a musty or stale odour, which is unpalatable. Hay exposed to excessive moisture may also promote fungal growth, particularly Aspergillus spp., resulting in aflatoxin development (Krishna et al, 1991; Ceniti et al, 2021). Rabbits are reported to have one of the lowest known LD50 values for aflatoxins (Clark et al, 1980), meaning they are extremely sensitive and require a relatively small dose of aflatoxin to suffer a toxic effect. so pet owners should be counselled on appropriate food storage practices for their companion animals. Hay presented to small mammal herbivores should be a mixture of all above-ground components of the plant including stems, leaves, and seed heads; hay that is predominantly made up of stems or looks ‘straw-like’ is less palatable and less nutritious.
- Excessive offering of fortified foods — hindgut fermenters are generally selective feeders, preferring food items that are high in simple carbohydrates and fat, or high in protein (Guiterrez and Bozinovic, 1998; Wolf et al, 2003; Carpenter et al, 2012; Donnelly and Vella, 2021; Quesenberry et al, 2021). Offering an excess of fortified foods (concentrates) results in inadequate intake of hay, and thus, inadequate intake of dietary fibre. The physiological signals for satiety appear to be poorly explored in these species, but this behaviour and its sequelae are well documented.
- Dental pain — medical causes of a refusal to eat hay should not be overlooked, and this emphasises the importance of a full physical examination for any patient whose presenting complaint is diet-related. Congenital or acquired dental disease may result in poor acceptance or outright refusal to eat hay, either because of oral pain or a functional inability to masticate this tough, fibrous food item. Other signs of dental disease include various clinical signs associated with poor oral ‘dexterity’ such as an unkempt coat with notable dander accumulation and perineal soiling (both caused by an inability to groom, and an inability to eat caecotrophs). These animals may also experience waxing and waning signs of gastrointestinal stasis syndrome because of unmanaged pain and inadequate fibre intake (see Figure 1 for a summary of gastrointestinal stasis syndrome clinical signs and pathophysiology). Because of the close proximity of the nasolacrimal ducts and ocular orbit to maxillary reserve crowns, epiphora and proptosis (unilateral or bilateral) may also occur. Facial swelling and asymmetry, as well ptyalism, may also be observed (Varga, 2014).
Offering mixed rations
As rabbits, guinea pigs, chinchillas and degus are selective feeders, offering mixed rations (often described as ‘muesli’ or ‘party mix’ style foods, see Figure 2) typically results in the animal selecting palatable food items at the expense of balanced nutrition (Cheeke, 1987; Varga, 2014). Rabbits tend to favour food items such as corn and flaked peas, which are low in fibre and calcium yet high in starch. Ingesting a diet made up of predominantly these food items promotes enteritis, dental disease, and obesity (Harcourt-Brown, 1996). Guinea pigs are unlikely to select food items with adequate vitamin C content, predisposing them to developing scurvy (Pignon and Mayer, 2021).
Hypercalciuria, urolithiasis
Rabbits (Eckermann-Ross, 2008), guinea pigs (O'Dell et al, 1957), and degus (Hankel et al, 2018) absorb a large proportion of dietary calcium independent of the parathyroid hormone pathway via a passive diffusion gradient, an adaptation that may serve to ensure adequate calcium availability for their hypselodont dentition's ever-growing enamel (Eckermann-Ross, 2007). Excess dietary calcium will be excreted into the urine in the form of calcium carbonate (Kennedy, 1965; Cheeke and Amberg, 1973), resulting in an opaque, white to off-white character to the urine. Uroliths and urinary sludge (opaque, sand-like urinary precipitate), identified in rabbits as well as guinea pigs, are primarily made up of calcium carbonate (Reavill and Lennox, 2020).
Video 1
Hypercalciuria, urolithiasis
Hypercalciuria [Video 1] and associated urolithiasis are common sequelae in rabbits that are fed an excess of pellets, calcium-rich food items (including alfalfa or lucerne hay (Medicago sativa) or alfalfa-based pellets, high calcium leafy greens), have limited opportunity for exercise, and are obese (DeCubellis and Graham, 2021; Di Girolamo and Selleri, 2021; Smith, 2021). Dehydration, changes in urinary pH, and urine retention may also predispose rabbits to urolith formation (Reavill and Lennox, 2020). A 2012 study suggested that urolithiasis formation in rabbits is more closely linked to poor water availability and reduced activity in lieu of dietary inclusion of alfalfa hay (e.g. a ‘high calcium diet’) (Clauss et al, 2012), however this study was performed on rabbits in a growth phase (5–6 weeks of age, for a duration of 25 weeks). The relationship between all of these factors is clearly complicated, and warrants further investigation.
In guinea pigs, obesity, urine retention, inadequate water intake, and lack of exercise, as well as a diet high in calcium, are considered risk factors for urolith development (Hawkins, 2011). A retrospective study found that a diet high in fortified pellets, low in hay, and with a poor variety of fruits and vegetables were risk factors for urolith development (Hawkins et al, 2008) (Figure 3). Another retrospective study found no correlation between increased dietary intake of calcium and urolith formation, and no correlation between offering multiple accessible water sources and urolith prevention (Edell et al, 2022). Urinary tract infection with Corynebacterium renale appears to be associated with urolithiasis (Peng et al, 1990; Okewole et al, 1991). Jolánkai et al (2006) suggested that alkaline urinary pH and increased urine specific gravity may be the most influential risk factors for the development of urolithiasis in guinea pigs. As in rabbits, further investigation is needed. Urolithiasis does not appear to be reported in degus.
Although chinchillas excrete 80% of excessive dietary calcium into the faeces and not into the urine like rabbits, guinea pigs and degus (Reavill and Lennox, 2020), calcium carbonate urolithiasis is occasionally reported (Osborne et al, 2009). Risk factors for urolithiasis development in chinchillas are unknown (Graham and Mans, 2021).
In all species, prevention of the recurrence of uroliths or urinary sludge involves reduction of dietary calcium intake, encouraging water intake via provision of multiple water sources and drenching fresh vegetables in water before offering, ensuring adequate pain management for conditions such as osteoarthritis, increasing exercise, and weight loss if the patient's body condition score suggests they are overweight.
Scurvy in guinea pigs
Guinea pigs lack a functional form of L-gulonolactone oxidase, an enzyme that converts the monosaccharide glucose to vitamin C (Nishikimi et al, 1992), thus requiring a dietary source of vitamin C. Non-breeding adults require 10–25 mg/kg/day; growing, pregnant, or lactating animals require 30 mg/kg/day (Pignon and Mayer, 2021). Many fortified diets contain the stabilised form of vitamin C, L-ascorbyl-2-polyphosphate, and fortified diets containing this form should be selected. Scurvy, a musculoskeletal disease associated with vitamin C deficiency, can occur in guinea pigs for various reasons:
- Offering a mixed ration (muesli or party mix diet) (Figure 2) — as previously discussed in Miller (2022b), guinea pigs are selective feeders and will not choose a balanced diet when offered mixed rations. Palatable contents of mixed ration diets, such as seeds, grains, flaked peas, nuts, etc., are poor sources of vitamin C.
- Poor storage of fortified diets — L-ascorbyl-2-polyphosphate rapidly degrades when exposed to air, light, and heat (starting at 30°C or 86°F (Igwemmar et al, 2013)). Stabilised vitamin C kept in dark and dry conditions at 21°C (70° F) remains viable for up to 6 months (Pignon and Mayer, 2021).
- Reliance on water-based additives — liquid vitamin C supplements intended to be mixed with the guinea pigs' water supply are not recommended, as they often discourage animals from drinking because of the aversive taste. Additionally, their stability is poor, requiring frequent water changes (Rhody, 2020; Pignon and Mayer, 2021).
- Offering fortified diets intended for another species — pellets intended for use with rabbits, chinchillas, or degus may not be supplemented with adequate vitamin C for guinea pigs, as these species do not require a dietary source of vitamin C.
Vitamin C deficiency results in defective formation of type IV collagen, laminin, and elastin, which are structural components of blood vessels, cartilage, bone, skin, and muscle (Mahmoodian and Peterkofsky, 1999). Affected animals experience joint and gingival haemorrhage, acquired dental disease because of poor function of periodontal ligaments, and increased susceptibility to infection. Clinical signs may include lethargy, hyporexia, dysrexia, anorexia, bruxism, lameness, delayed wound healing, paresis, swollen joints, and death (Pignon and Mayer, 2021).
Soft stools
The first consideration with soft stools is to ensure that the pet owner is not misidentifying caecotrophs: an occasional uneaten caecotroph found in the animal's living area may not be a cause for concern, however a significantly increased presence of uneaten caecotrophs warrants medical investigation. Caecotrophs are typically ingested directly from the anus, so any condition that prevents posturing or ingestion (e.g. obesity, arthritis, dental disease, use of an Elizabethan collar) can prevent this normal behaviour. Caecal dysbiosis (see below) can result in abnormal caecotrophs (softer texture, foul odour, malformed) that are presumably not palatable and will not be eaten (Oglesbee and Lord, 2021).
The presence of soft stools or caecotrophs, often with perineal soiling (Figure 4), is a common primary reason for presentation, or may be an incidental finding during examination. This may be caused by diet, but other causes of enteritis contributing to soft stool can include antibiotic use (Table 2), pain, stress, infection, and even genetic predisposition (Oglesbee and Lord, 2021).
Table 2. ‘PLACE’ — antibiotics associated with gut/caecal dysbiosis in hindgut fermenters
| Penicillin *Parenteral use can be safe |
| Lincomycin |
| Ampicillin, amoxicillin |
| Clindamycin, cephalosporins |
| Erythromycin |
Soft stools or caecotrophs commonly occur as a result of a disturbance in normal gut microbe populations, termed gut or caecal dysbiosis. Caecal dysbiosis is an overgrowth of pathogenic bacteria: bacterial species such as Clostridium spp. and Escherichia coli are normally present in small numbers in the rabbit caecum (Cheeke et al, 1987; Fekete 1989). Proliferation of Clostridium spiriforme can result in enterotoxaemia because of their production of iota-like toxin (Boriello and Carman, 1983; Peeters et al, 1986). Enterotoxaemic rabbits become depressed and anorexic, soft stools may develop into diarrhoea (which may be mucoid and/or bloody), hypothermic, and may die within 24–48 hours (Oglesbee and Lord, 2021).
Dietary contributors to caecal dysbiosis are as follows:
- Reduced dietary fibre intake — this is almost exclusively associated with inadequate grass hay ingestion, and is closely related to ‘refusal to eat hay’ discussed above. Animals that are provided an excess of non-hay food items, animals provided unpalatable hay, or animals with dental pain are all susceptible. Inadequate fibre intake results in a change in caecal pH and volatile fatty acid composition of digesta, and thus, microbial flora (Varga, 2014).
- Excessive digestible carbohydrate intake — an increased dietary intake of digestible carbohydrates can promote proliferation of pathogenic bacteria like E. coli and Clostridium spp.. Clostridium spp. require glucose (either ingested directly, or present as a by-product of disaccharide or starch digestion) to produce iota-like toxin (Oglesbee and Lord, 2021). It is unclear whether excessive ingestion of digestible carbohydrates alone can be responsible for caecal dysbiosis, or if the associated proportional reduction in fibre intake is the true causal factor. Varga (2014) observes that rabbits with a healthy and varied diet, and presumably a healthy population of gut microbiota, appear to be less susceptible to sudden changes in digestible carbohydrate ingestion compared with rabbits with less than ideal diets. The author corroborates this observation and frequently appreciates that animals with poor diets appear to be more likely to present with signs of caecal dysbiosis after a sudden dietary change (e.g. offered a large volume of starchy vegetable or fruit, or commercial treats with a high content of sugar such as honey or syrup).
Dietary management of caecal dysbiosis typically involves increasing fibre intake, either by excluding dietary components except hay if the patient is eating voluntarily, or by providing nutritional support of a high fibre formula intended for herbivores via syringe-feeding (or other tube feeding modalities where indicated). Other supportive care (analgesia, anxiolysis, fluid support, antimicrobial therapy, toxin sequestrants, etc.) is directed by the individual patient's presentation and the results of diagnostic testing.
Nutritional support of hospitalised herbivores
Hyporexia and anorexia are common primary reasons for presentation, and may also be sequelae of medical interventions (e.g. post-anaesthetic gastrointestinal stasis). The target species have a relatively high metabolic rate compared with other companion mammals, so the effects of a negative energy balance may occur quickly in periods of hyporexia or anorexia (van Zeeland and Schoemaker, 2021). Ileus or gastrointestinal stasis syndrome is another common complication of inadequate nutrition, and can rapidly become life-threatening. The short-term goals of nutritional support in hindgut fermenters are:
- To correct a negative energy balance — the target species are at a great risk of developing hypoglycaemia and metabolic complications such as hepatic lipidosis and ketoacidosis (especially obese or pregnant/nursing individuals). Once glycogen stores are depleted, a catabolic state occurs and the body initiates breakdown of fat and muscle stores, resulting in mobilisation of triglycerides into free fatty acids (van Zeeland and Schoemaker, 2021).
- To provide adequate fibre for normal gut function — hindgut fermenters require both indigestible fibre that stimulates gut motility, encourages caecotroph ingestion, and provide dental wear, and fermentable fibre that acts as a substrate for caecal microbes, optimises caecal pH, results in volatile fatty acid production via caecal flora (a source of energy for the host and microbes), prevents proliferation of pathogenic caecal bacteria (and subsequent development of enterotoxaemia), and contributes to the consistency of caecotrophs (Varga, 2014).
As in any veterinary patient, a holistic approach to patient care greatly benefits the hindgut fermenting herbivore. A return to normal dietary intake is rarely as simple as offering a nutritional support formula: addressing pain management, reducing stress, and providing fluid support are cornerstones of treating the patient and not just the presenting complaint.
Pain management
Hyporexia and anorexia are common signs of pain in rabbits and other small mammal herbivores (Bradley Bays, 2006a, 2006b; Johnson, 2006; Malik, 2021a), and refusal to eat or a decline in appetite are not always initially associated with disorders or disease of the alimentary tract. Because of their hindgut-fermenter physiology, untreated pain can rapidly develop into an ileus or gastrointestinal stasis event. Prompt recognition of pain can be challenging in these prey animals that will likely be exhibiting masking phenomenon in the veterinary practice, and a thorough clinical history can be an extremely useful tool in determining if the patient is demonstrating signs of pain at home. Many excellent resources are available on recognising signs of and treating pain in these species (Bradley Bays 2006a, 2006b; Johnson 2006; Latney, 2020; Malik 2021a; National Centre for the Replacement Refinement & Reduction of Animals in Research, 2015; Oliver et al, 2017).
Reducing stress
It is important to recognise that small mammal herbivores may not exhibit overt signs of stress like traditional companion animals such as dogs and cats, that typically present obvious body language to demonstrate stress and fear (Döring et al, 2009; Ellis, 2017; Ryan, 2017). Prey animals may be inherently stressed by transport to and presentation in the veterinary hospital, especially if the patient has not been acclimatised to these events. The presence of predator species in the hospital (sights, sounds, and smells of dogs, cats, and ferrets) can be a source of significant stress (Horton et al, 1974; Gidenne and Carabaño, 2006). Thus, these prey animal species should ideally be housed in a separate ward from predators, such as dogs, cats, and ferrets (Bradley Bays, 2006a, 2006b). Providing visual barriers to allow the patient to hide from view can also reduce inpatient stress (Bradley Bays, 2006a, 2006b). Furthermore, if the patient has a bonded conspecific companion, allowing the companion to be hospitalised with the patient may also help reduce stress, and reduce the likelihood of social hierarchy instability once the patient has returned to the home environment (Bradley Bays, 2006b).
Anxiolytic drugs may be considered when all other sources of stress and pain are reasonably managed, and the patient is still exhibiting signs of stress such as hyporexia or anorexia. Malik (2021b) provided a summary of anxiolytic and sedative drugs that may be used for this purpose. Additionally, preliminary results of a study by Sadar et al (unpublished data) suggested that oral gabapentin may be useful in reducing anxiety in rabbits during veterinary hospital visits, although the full results of the study remain to be published (Cox, 2022).
Fluid support
Hindgut fermenting herbivores present a challenge when assessing hydration status and estimating fluid loss, as they will initially pull fluid from their intestines to replace intravascular deficits. This results in decreased faecal output and gastrointestinal hypomotility representing early signs of dehydration, unlike other companion mammal species (van Zeeland and Schoemaker, 2021). Fluid therapy should be initiated in any patient where these clinical signs are observed. Neglecting to provide fluid therapy with concurrent nutritional support can result in the ingesta becoming desiccated and this may further worsen gut hypomotility, and could cause an obstruction. Most exotic small mammal species' daily fluid requirements are between 50–100 ml/kg/day (van Zeeland and Schoemaker, 2021). The route of administration and type of fluid selected will depend on the patient's hydration status, reason for presentation and any co-morbidities, as well as ongoing fluid losses.
Nutritional support
Nutritional support is ideally provided using a commercial formula. Selecting a formula will depend on desired macronutrient distribution, the ability to pass through a feeding tube if needed, and palatability to the patient. Enteral nutrition is preferred in hindgut fermenters, as there are little data on the application of total or partial parenteral nutrition (TPN or PPN, respectively). Experimental application of TPN in rabbits resulted in hepatic portal disease, hepatocellular degeneration, and colonic stasis (van Zeeland and Schoemaker, 2021).
Enteral feeding can be provided to hyporexic or anorexic patients via several means, depending on the patient's compliance or willingness to eat with assistance, mentation, and the patient's illness and comorbidities (Figure 5).
Syringe feeding
This simple administration route is acceptable for patients that are alert enough to ingest food either voluntarily, or with some assistance. The patient can be gently restrained with a towel-wrap, and the tip of the syringe is introduced into the diastema between the incisors and premolars. The formula is delivered at a steady rate as the patient masticates and swallows the formula. Patients may demonstrate a preference for formula flavour and type of syringe tip, so ensuring that the hospital stocks adequate options for patients is important (Figures 6 and Video 2). Some patients will take prepared formula willingly from a syringe or bowl.
Video 2
Syringe feeding
Nasogastric feeding tube
Nasogastric tube placement can be performed in the awake rabbit or guinea pig (although sedation may be required). Indications include anorexia for 24 hours or longer, or patients undergoing oral, oesophageal, gastric, or biliary tract surgery. An excellent review of tube placement is provided by Paul-Murphy et al (2013) and van Zeeland and Schoemaker (2021).
Oesophagostomy feeding tube
Anaesthesia is required for oesophagostomy tube placement. The rabbit's narrow oral cavity makes placement difficult. Oesophageal feeding may be preferred in patients with significant trauma to the oro-pharyngeal cavity, necessitating longer-term feeding. This technique is described in detail by van Zeeland and Schoemaker (2021).
Calorie intake
Patient calorie needs may be calculated using the standard formula for basal metabolic rate (BMR) in mammals, BMR = 70 X BW0.75 (kcal/day) where BW is the patient's bodyweight in kilograms (van Zeeland and Schoemaker, 2021). Alternatively, where investigations have occurred to determine a species' daily energy requirements (DER) or maintenance energy requirements (MER), these formulae may be used, instead (see Miller, 2022b). The patient's energy needs are then divided by the selected formula's energy density to obtain the weight or volume of formula to feed over a 24-hour period. This weight or volume is then divided by the number of desired feedings (e.g. 4–6 feedings over a 24-hour period is typical) to obtain the weight or volume of each feeding. See Table 3 for an example of how this is calculated.
Table 3. Example of feeding volume calculations
| Your patient is a 9-month-old, male intact guinea pig (Cavia porcellus) that weighs 950 g, therefore BW = 0.95 kg |
| You decide to calculate your patient's BMR using the standard formula for mammals, BMR = 70 X BW0.75 (kcal/day)BMR = 70 X 0.950.75 (kcal/day) BMR = 70 X 0.962 (kcal/day)BMR = 67.358 kcal/day |
| You select a nutritional support formula with the following metabolisable energy (ME) data:2660 kcal/kg of dry product24 kcal/tbsp of prepared product |
| To calculate the weight of dry product that your patient needs for 24 hours, you will divide the patient's BMR by the dry product's energy density:67.358 kcal/day ÷ 2660 kcal/kg = 0.025 kg/day = 25.3 grams of dry product/day |
| Alternatively, you may divide the patient's BMR by the prepared product's energy density:67.358 kcal/day ÷ 24 kcal/tbsp = 2.807 tbsp/day = 42.10 ml/day |
| You decide to provide this patient with four support feedings over a 24-hour period: 42.10 ml ÷ 4 = 10.5 ml per feeding |
It should be emphasised that the feeding plan obtained using the above formulae is a starting point. Individual patient needs will vary based on species, age, neuter status, environmental temperature, activity level, and the disease process. Patient bodyweight changes, hydration status, and faecal output will help to determine the suitability of the plan, and adjustments can be made as necessary. Patient bodyweight should remain stable or minimal gain can be observed as gut contents and hydration are restored. The author has found success by making small adjustments in calorie intake (5–10% of feeding volume from the initial feeding calculation) based on patient condition. Patients are not expected to experience an improvement in body or muscle condition score during a brief hospitalisation.
Conclusions
A thorough husbandry and nutrition history acquired and interpreted by a knowledgeable veterinary team member is an invaluable source of information. Diet-related illnesses that hindgut fermenters may develop with inappropriate nutrition or dietary management are numerous and can be life-threatening. Nutritional support in these species aims to provide adequate calories to reverse a negative energy balance, and to provide adequate dietary fibre to stimulate gastrointestinal motility. There are various routes of enteral nutrition to use depending on the patient's signalment and reason for presentation.
KEY POINTS
- Husbandry-related diseases, including nutritional disease, are a common cause of illness in exotic companion animals.
- The veterinary nurse is in an excellent position to take a thorough husbandry and nutritional history to identify nutritional diseases and problems in dietary management.
- Nutritional support in hindgut fermenting herbivores is centred around restoring a negative energy balance and providing adequate fibre to stimulate gut motility.
- Hyporexic and anorexic patients benefit from a holistic treatment plan including not only nutritional support, but analgesia, fluid support, and efforts to reduce their stress (especially as inpatients).