This article is from an earlier edition of the Rat Health Care booklet. Current editions have this information in chart form. Order one today! Check out the info at Rat Books
by Debbie “The Rat Lady” Ducommun
First aid is care given in an emergency. Sometimes, first aid is not enough, and your rat will also require veterinary care. If you must rush your rat to the vet, be sure to call first to let them know you’re coming. That way they’ll be prepared to help as soon as you arrive.
A rat can experience respiratory distress without any warning, whether or not she has had previous respiratory symptoms. The signs of respiratory distress are gasping through the mouth, or dashing about in a panic. Severe labored breathing can also be considered respiratory distress. The rat may or may not have blue extremities. Respiratory distress is extremely unpleasant—one of the most distressing experiences there is—and must be treated immediately.
One of the first things to try is to get the rat to breathe air moistened by a humidifier or a shower running in the bathroom. You can also boil water on the stove, but do not let the rat inhale the steam directly, as that can burn the lungs. Hold the rat at least 3' away from the steam.
If it seems like the rat might have mucus in the throat that is blocking the free passage of air, see choking (below).
If the rat is still having trouble breathing, and the problem is constricted breathing passages (like asthma) a bronchodilator will help. The best treatment is a subcutaneous (subQ) injection of aminophylline, which will expand the breathing passages. In most cases, this will stop the respiratory distress within a matter of minutes. It is also recommended that the rat be given a subQ injection of dexamethasone to reduce inflammation in the lungs.
If aminophylline isn’t available, you can try an asthma inhaler. You can buy an asthma inhaler called Asmanefrin over the counter. Or you can use an inhaler that you or a friend has on hand. Take an empty cardboard toilet paper roll and put the inhaler on one end and the other over the rat’s face. Put one puff of the medication in the tube. Try to keep the rat there for as long as possible to make sure she inhales the medicine.
If a bronchodialator doesn’t help within 15 minutes, you can try an injection of furosemide, a diuretic that will quickly flush excess fluid out of the lungs.
If none of these treatments work, the rat must be put in oxygen. If the rat doesn’t improve on oxygen it means her lungs are no longer able to work and she should be euthanized. If the rat does improve on oxygen, then you have some time to wait for other medications to work.
Once you get the rat out of respiratory distress, she should be put on both amoxicillin and Baytril or doxycycline. She may need continued treatment twice a day with aminophylline, an anti-inflammatory (either prednisone or an NSAID), furosemide, and perhaps even enalapril and atenolol for congestive heart failure.
Because of the arrangement of the rat’s throat, true choking is rare. If your rat appears to be choking the most likely cause is a piece of food or other substance stuck in her throat. This can cause gagging and drooling. A rat who is gagging will open her mouth wide and pull her ears back.
As long as the rat can breathe, don’t do anything accept try to comfort her. Anything you try to do to stop the gagging may make the situation worse. The offending food will eventually pass down in most cases. You might try offering your rat a small piece of bread to see if that will help push the food down, but do not use doughy bread which might make things worse.
If your rat is having real trouble breathing, and not just labored breathing, you can try doing the Heimlich maneuver, by pressing sharply up and in underneath your rat’s ribcage.
Or you can do a procedure called “the fling” which uses centrifugal force. Hold your rat firmly around the neck with one hand, and by the base of the tail with the other to hold her securely. Make sure there are no objects within an arm’s length. Lift the rat overhead and bring her down in a rapid arc, so that at the end of the path she’s tail up and head down. This can be repeated 3-4 times, then give the rat a rest, check her breathing, and see if anything is visible in the mouth. This is extremely effective in dislodging objects or mucus in the throat.
If neither of these techniques helps, you can put your mouth over the rat’s mouth and try sucking the obstruction out. Be sure you do not cover the rat’s nose. If the rat is still having trouble breathing, try a shot of dexamethasone.
If choking or gagging persists for more than 6 hours, take your rat to the vet. There may be an object lodged in the throat too big to pass down, or there might be a tumor or some other problem. Sometimes respiratory disease can cause gagging and choking due to swelling of the airway and/or too much mucus.
If your rat gags frequently, she may have mega-esophagus, a problem where the nerves to the esophagus are defective. In this case the rat must be put on a liquid diet. Offer free choice of Ensure adult nutritional drink or a similar product. Also give the rat a liquid vitamin B supplement to supply 1 mcg of B12 daily. Be sure keep all paper away from the rat as eating paper can cause a fatal blockage.
Lethargy in rats is a serious symptom that needs immediate attention. Give your rat a full exam to look for other signs, especially dehydration and lumps in the abdomen. Even if your rat is not dehydrated, he might have low blood sugar or an electrolyte imbalance. Try to get him to drink some juice, a sports drink, or sugar water with a pinch of salt. If your rat is dehydrated, try to get him to drink 1-2 ounces. If he refuses to drink, a dehydrated rat needs warmed saline solution for injected under the skin.
One rare cause of lethargy is pesticide poisoning. This will also cause the pupils to be constricted so they do not expand in the dark. If your home has recently been sprayed with pesticides you’ll need to rush your rat to the vet for an injection of atropine.
If the sugary drink does not cause your rat to improve within 30 minutes, it is very important that your rat be treated with amoxicillin ASAP. One of the main causes of lethargy in rats is a secondary bacterial infection. Mycoplasma is the primary bacterial infection in most rats but does not usually cause symptoms of lethargy. In my experience the best treatment for secondary infections in rats is amoxicillin. Baytril, which most vets prescribe for rats, is not as effective for most cases of secondary infection in rats, and doxycycline, which can be quite effective in treating mycoplasma, is absolutely not effective for secondary infections. I know of many many cases of rats who seemed to be dying who recovered within just a day or two of treatment with amoxicillin, while I also know of many cases of rats who died within 12-24 hours of exhibiting lethargy that went untreated. For this reason, I recommend that all rat owners have amoxicillin capsules on hand. For more information on using amoxicillin see www.ratfanclub.org/resp.html.
Another possible cause of lethargy is heat stroke. See more info below toward the bottom of this article.
If you suspect poisoning in your rat (or other pet), here is the phone number for the ASPCA Poison Control Center: 888-4ANI-HELP..
You must have a credit card to use this number and you’ll be charged $65 per case. This number is active 24 hours a day. Be ready to provide:
1. your name, address and phone number;
2. the species, breed, age, sex, weight and number of animals involved;
3. the poison, and if known, details such as amount of poison ingested, time since exposure, etc.
4. the problems your animal is experiencing.
Strokes are more common in older rats, but they can occur in younger rats too, although rarely. A stroke can be caused by either a cerebral hemorrhage or by a blood clot in a brain artery. More rarely, a stroke can also be caused by a brain abscess or tumor. The most common sign of a stroke is weakness or paralysis, which can affect the whole body or only a part of it. During a massive stroke, there may also be loss of consciousness, convulsions, and irregular breathing. It is also possible for rats to have a series of minor strokes that cause increasing symptoms. A hemorrhage from a pituitary tumor can cause symptoms similar to a stroke.
Even after a massive stroke, a rat can recover either partially or completely, so don’t give up on a rat who is suddenly paralyzed. It may take a week or more to see any improvement.
A severe stroke can leave a rat too weak to move or eat on his own, so you will need to hand-feed him. Wrap your rat in a towel and hold him upright on your chest. Mix up some powdered soy infant formula and put it in your rat’s mouth a little at a time with an eyedropper or syringe (without a needle). You may have to experiment with the consistency of the formula; it might work better thin or thick.
Feed your rat at least 3 times a day. A 1-lb. rat can eat about 10 ml of formula at a time, and needs to take in about 30 ml of fluid each day. A smaller or larger rat will need proportionally more or less formula. The formula should supply all the fluid he needs; additional plain water is not usually necessary. A stroke patient may also need help with warmth and hygiene. For long-term care, see my Rat Health Care booklet.
Head Tilt and Rolling
These symptoms are usually caused by an inner ear infections, which is fairly common. The infection mayt be caused by mycoplasma or a secondary bacteria such as Streptococcus moniliformis or Pseudomonas. The infection causes inflammation in the inner ear, affecting the rat’s balance. This will cause the rat to hold his head tilted to one side. Without treatment, the loss of balance can get so bad the rat will roll over and over and is unable to eat. An inner ear infection can result in a permanent head tilt, especially if the symptoms are untreated. An inner ear infection can also cause facial paralysis (see page 41 in my Rat Health Care booklet.)
An inner ear infection requires immediate treatment. I recommend using either enrofloxacin and amoxicillin together, or chloremphenicol. An anti-inflammatory, either a steroid or an NSAID, must also be given to reduce the swelling in the ear. Prednisone, which is the most effective, can be given at 1 mg/lb twice a day, or ibuprofen at 15-60 mg/lb 2 to 4 times a day.
Other possible causes of a head tilt are a pituitary tumor or stroke, but the treatment for either is the same as for an inner ear infection.
Bleeding from Nose, Ear or Mouth
For bleeding from the nose, try holding ice to the bridge of the nose. You can also give your rat ice cream or a popsicle to eat, and hopefully the cold will penetrate the nose and help. Wipe the blood from the nostrils to help clear them so your rat can breathe.
Bleeding from inside the mouth can also be difficult to deal with since it’s so hard to see where the blood may be coming from. It’s possible for a rat to accidently bite his tongue, and bleeding can also occur from a mouth tumor or from an injury to or tumor in the throat. Giving your rat ice cream or a popsicle may help stop the bleeding.
For bleeding from an ear, try putting pressure and/or ice against the base of the ear. Infection or cancer are the most common causes of bleeding from inside the ear, but occasionally a rat will accidentally puncture his eardrum while cleaning his ear with his toenails.
If you cannot stop the bleeding after trying all these methods, you will need to take your rat to the vet where he can anesthetized for more effective procedures, such as suturing. There is also a product called Gel Foam which is a protein that becomes very sticky on contact with blood which may be able to stop bleeding from an injury. Your vet can also give a rat an injection of vitamin K to help blood clotting.
Bleeding from inside the nose is most commonly caused by an infection, which can erode away the tissue, opening a blood vessel. The size and number of the vessels determines the amount of bleeding. After you get the bleeding stopped, bleeding from the nose needs to be treated with an antibiotic. I recommend amoxicillin. This is also the treatment I recommend for an ear infection. For information on using amoxicillin see the article on Respiratory and Heart Disease, or email me at firstname.lastname@example.org.
Accidents & Injuries
Accidents such as a rat getting stepped on, or falling from a height are pretty common. I’ve witnessed young rats who have experienced loss of consciousness or convulsions after a fall, and then appeared to recover completely within a few minutes. However, one of these babies started having seizures at one year of age, so immediate treatment with an anti-inflammatory such as dexamethasone after such a fall is recommended. I also know of rats who have broken their neck, nose, or leg from a fall, so you should observe your rat carefully after an accident. Being stepped on is especially dangerous since it can cause internal bleeding. If your rat appears lethargic, you may need to take her the vet. A vet can give an injection of dexamethasone to reduce swelling and a pain medication. Or you can give ibuprofen (see more info below) for swelling and pain.
Wounds & Injuries
For surgical incisions that have been chewed open, see the article on Surgery at www.ratfanclub.org/surgery.html.
The body skin of rats contains few pain receptors, and minor wounds usually bleed little and heal quickly. Rats heal so quickly wounds less than 1 ½" long do not need to be stitched. You really don’t need to do any treatment. The rat will lick it clean, and would lick off any medication anyway. If the wound seems to be painful for the rat you can apply a little Bactine. (This is also helpful for treating scratches rats sometime inflict on humans!) A rat with an open wound must be kept in a spotless cage with only rags or shredded paper because litter may contaminate the wound.
These two pictures show how fast even a severe skin wound can heal in a rat. The first picture was taken shortly after Eeyore was wounded by another rat. The bite went completely through the skin, and the underlying muscle was visible. It was about an inch long. It even looked like the penis was half ripped off. A day later you can barely tell there was an injury!
Wounds to Extremities
The feet, ears, tail and mouth all have a considerable blood supply, and injuries to these areas can cause profuse bleeding. The first step to stop the bleeding is to apply direct pressure for two minutes. If the bleeding continues, put some flour in a small container and press the bleeding area into the flour, or press some flour onto the wound. The flour will help the blood to clot. Cornstarch can also be used, as well as a commercial product to stop bleeding. Another thing to try is holding ice against the injury. The cold will reduce the blood flow.
If the injury is a severed toe or tail tip, you may have to apply a tourniquet. Tie string as close to the end of the extremity as possible. Tighten the tourniquet until the bleeding slows to an ooze. Do not tighten the tourniquet too much, or you could cause additional damage. Remove the tourniquet after 20 minutes to see if the bleeding has stopped, or can now be stopped using the other methods. If not, replace the tourniquet and take your rat to the vet.
If a toenail is bleeding, the best way to stop it is to use styptic powder or a silver nitrate stick. Flour or cornstarch can also be used like styptic powder. Press some into the end of the nail.
After a wound to a toe, it’s common for the toe to swell quite a bit and turn red. It’s not usually necessary to treat this condition and after a week or two, the toe will heal. If you like, you can give the rat an anti-inflammatory such as ibuprofen to help bring down the swelling. (See more info below.)
Ibuprofen interferes with blood clotting, so if your rat has a severe injury with profuse bleeding, you do not want to use ibuprofen that day. For pain you can use acetaminophen (Tylenol) at 90-140 mg/lb every 4-12 hours. Choose the dose according to the severity of the pain and possible length of use, with lower doses for repeated use. Overdoses can damage the liver.
If a rat is picked up by the tip of her tail, the skin will often be pulled off. This is called “degloving.” The bare end of the tail will usually dry up and fall off on its own. See photos below. You can apply Bactine to help with the pain. Observe the tail for any sign of infection, such as pus or a bad smell (this is rare) and if this occurs, consult your veterinarian. Sometimes a rat will chew at the tail. If this happens, try treatment with an analgesic. You can give ibuprofen at a dose of 60 mg/lb twice a day. (See more info below.) If that doesn’t help, you’ll have to have your vet perform an amputation.
This series of photos shows the later stages in the healing of a degloved tail. Most of the dead part of the tail has already fallen off.
Dec. 22, 2010
Feb. 6, 2011 March
Another common accident is a rat getting her leg caught in the wire of the cage. (1" X ½" mesh floors should be covered or removed to prevent this.) Treat the rat with ibuprofen at a dose of 60 mg/lb twice a day. (See more info below.)
If swelling persists after 24 hours, or if the swelling gets worse, you will probably need to take your rat to the vet for an injection of dexamethasone (at 1 mg/lb) which should reduce the swelling within 12 hours. Swelling of the foot can be dangerous because it can cut off the circulation of the foot, leading to more swelling, creating a vicious cycle. The vet might want to take an x-ray, but this will likely be a waste of money, even if the leg is broken. Most broken legs in rats can heal on their own, even breaks near the ankle joint that are floppy. You do not need to keep the rat isolated or quiet. Treat the pain and swelling with ibuprofen at a dose of 60 mg/lb twice a day. A compound fracture, where the bone breaks the skin, is much more serious and you must take your rat to a vet as the leg may need to be pinned or amputated, and treatment with an antibiotic (I recommend amoxicillin) is necessary.
If a swollen foot looks like it is puffed up with fluid, you can try soaking it in a warm Epsom salts solution, which will help to draw excess fluid out through the skin. The easiest way to soak a foot is to put the solution in a small baggie to put the rat’s foot in.
I once had a rat who developed pain in his ankles from being on a wire floor without actually getting his legs caught. There was no swelling but he demonstrated pain by holding one foot up or limping on it. When I moved him to a cage without wire floors, the pain went away.
Here are pictures showing the healing of a broken leg. This is Basil, with a compound fracture of the tibia and fibula. The first picture was just before surgery on 3/30/10. The jagged ends of the bone were cut off and the bone tractioned back into place. The skin was closed with 2 Michel wound clips (2rd photo) which was enough to hold the fracture in place. Just 3 days after the fracture was repaired he was using that foot to lightly scratch his head. 5 days after the surgery he was putting light weight on the foot. 2 weeks after the surgery he was walking normally on the foot! The third picture was on 4/19/10, just before he was neutered.
Sudden severe swelling, especially on the face, can occur from an injury or from an insect or spider bite. You can treat swelling with ibuprofen (see below). Or you can take your rat to the vet for a shot of dexamethasone. (Swellings can also be abscesses, which can appear fairly suddenly.)
An injury to the flap of the ear can result in a hematoma. This is a pocket of blood that forms under the skin. DO NOT try to lance a hematoma because this can cause profuse bleeding that is difficult to stop. A hematoma of the ear will eventually resolve on its own, although this may disfigure the ear. It this bothers you, you can have your vet repair the hematoma surgically.
Ibuprofen is an NSAID, a non-steroidal anti-inflamatory. It is a more effective pain killer and anti-inflammatory than aspirin or acetaminophen. It interferes with blood clotting but only while it is in the system. Chronic use can cause bleeding, ulceration, and perforation of the stomach. It can cause fluid retention and decreased blood flow to the kidneys, so is more risky to use in the elderly, with heart or kidney disease, or with diuretics. The dose is 15-60 mg/lb 2-4 times a day. Lower doses are for analgesia, higher for inflammation.
You can use you can either crush up a tablet or use liquid baby medications. Most rats like berry flavored Motrin. To figure out the dose, look on the bottle to see how many mg/ml. Figure out how many ml to use to give your rat the proper number of mg. It’s a good idea to give the rat a treat afterwards to mask the bad aftertaste that may cause your rat to refuse the medication the second time.
The typical ibuprofen caplet is 200 mg. Since the dose per lb for inflammation is 60 mg, the caplet contains about three 1-lb doses. Depending on the weight of your rat, you would adjust up or down. So for a 1-lb rat, cut the caplet into thirds. Grind up the dose into a fine powder on a small plate with a spoon and scrape into some soft food. Some suggestions include baby food, pudding, mashed avocado, yogurt, brown sugar and carob powder, honey, peanut butter mixed with jelly, moistened graham cracker, non-fat cream cheese, margarine, Nutri-Cal, pasta sauce, and as a last resort, ice cream, frosting, cheesecake, or even butterscotch or chocolate syrup! Use only enough food to mask the taste of the medicine so your rat will eat it all immediately. Adding a bit of salt will help counter the bitter flavor of medicines. If your rat refuses to eat the doctored food voluntarily, those in paste form can be smeared on his mouth, or even on the backs of his ears so he will groom the paste off and eat it.
The dose most vets prescribe for rats is too low. Metacam (generic name meloxicam) is an NSAID, and therefore works the same way as ibuprofen. The liquid sold by vets is for dogs, and since dogs do not metabolize NSAIDs well, the dog dose is very low (only 0.1 mg/lb). Rats metabolize NSAIDs very well, in fact, so well that the dose of ibuprofen for inflammation in rats is 60 mg/lb 2-4 times a day. (Exotic Animal Formulary, AAHA, 1995, 2001 and Drug Dosage in Laboratory Animals, 3rd ed. Borchard et al, 1990)
By comparing the human dose of ibuprofen to that for rats, and then looking at the human dose of meloxicam (which is 7.5 to 15 mg a day), it appears that the best dose of Metacam for rats is 1 to 2.25 mg/lb. Since the concentration of the Metacam liquid is 1.5 mg/ml, a 1-lb rat would need 0.6 to 1.5 ml. In addition, although meloxicam is only given once a day to humans and dogs, because the rat’s metabolism is so much higher, it needs to be given more often to rats. I recently talked with a rat owner giving Metacam to a rat with severe pain, and she reports that once a day was not often enough.
Because rats are so small, and not well adapted to heat, they can succumb to heat stroke quickly. Situations that can cause heat stroke include leaving your rat in the sun or outside in warm weather, too close to a heater, or on a heating pad. The symptoms of heat stroke can include drooling and lethargy or unconsciousness. The tail will be quite warm to the touch. You must quickly cool the rat by submerging her up to her neck in lukewarm water. Also encourage her to drink an electrolyte beverage or water containing some sugar and salt. If she doesn’t recover quickly, rush her to your vet.
Shock & CPR
There are two types of shock we need to be concerned about: electrical shock and physiological shock. Electrical shock can occur when a rat chews through a power cord. Electrocution can cause unconsciousness and can also stop breathing. In this case, you must do mouth-to-nose respiration to start the breathing again.
Place your lips around the rat’s nose and blow into her lungs. You will have to blow fairly hard, enough to make the chest expand, but not too hard. After blowing 2-3 times, check to see if breathing has started. If not, firmly massage the chest for a couple of seconds and then blow in their nose again. Alternate the chest massage with blowing into the lungs. Firmly slapping the body can also stimulate breathing. Do not give up too easily. You may have to work for several minutes to restore the breathing.
Electrocution can also cause burns, especially to the mouth. Burns are not always obvious on animals with fur so if your rat has been electrocuted, a veterinary exam is good precaution.
Physiological shock is a condition where the circulation system shuts down because of blood loss, extreme stress, or other failure of normal body systems, and is an extreme emergency. The symptoms include extreme lethargy, dull eyes, and low body temperature. Keep your rat warm and her head lower than her body while rushing her to the vet for an injection of dexamethasone and possible fluid therapy.
Severe pain in the tail, such as when you accidentally step on a rat’s tail, can cause a rat to quickly scoot backwards, a somewhat unexpected sign. Another sign of tail pain is when a rat keeps turning to look at his tail, or keeps licking his tail. If you don’t see any injury to the skin of the tail, the most likely cause of pain is the dislocation of a tail joint, which usually happens at the base of the tail. This can cause the rat to have trouble finding a comfortable position. Obviously if you touch the tail there and the rat reacts with pain that’s where the cause is. When the base of the tail is dislocated, you can try holding the middle of the tail and gentle and slowly but firmly pulling straight back to see if you can pop the tail joint back into place. I've had good success with this in more than one case. It would probably help to give the rat a large dose of ibuprofen at least 30 minutes before trying this procedure to help reduce the pain first. It is very rare for a rat to actually break his tail, while dislocations are not that uncommon. If pulling on the tail causes severe pain, then you’ll want to take your rat to the vet or to a chiropractor. See more info in the back injury section.
paralysis in a rat can be caused by a displaced vertebra. My chiropractor has
successfully treated 4 of my rats with jaw/neck/back misalignments. Such a
problem won't get better until the vertebra or joint is properly
realigned. This is not something a vet can detect unless they are
trained in chiropractic. Many human chiropractors are willing to treat
animals as a challenge. Here in
Diarrhea & Constipation
Diarrhea isn’t common in rats, and is usually caused by sensitivity to a medication. If the diarrhea is severe, you may need to discontinue the medication. Occasionally, diarrhea can be caused by a temporary upset in the intestinal flora (good bacteria in the intestines) which can be treated with probiotics (good bacteria for the intestines). One source of probiotics is yogurt containing active cultures (check the label), but a better source is a probiotic product from a health food store, pet shop or feed store. Dose is not critical; you can’t give too much. Mix it in soft food. If the rat is on an antibiotic, give the probiotics at least 2 hours before or after giving the antibiotic otherwise the antibiotic will kill the good bacteria. If the diarrhea is going to respond to the probiotics, you should see an improvement within a few days.
For sudden severe diarrhea, you can give Pepto-Bismol at 1 drop/oz body weight three times a day, or Immodium at 1/10 the human dose.
For a rat who isn’t on any mediations, chronic diarrhea that doesn’t respond to probiotics is most likely caused by a serious problem with the intestines. In young rats it can be caused by megacolon. In older rats the most common cause is something like intestinal cancer.
Constipation is usually caused by low water intake or sometimes a reaction to a medication, or intestinal disease. Encourage fluid intake with soft foods and liquids. Canned pumpkin works especially well.
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