08/11/2023
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Choking in rabbits:
Choking is one of the scariest things that a pet owner can witness. If you know what choking looks like, you might have a chance to intervene in time to help your bunny before it’s too late. If you are a veterinarian, it’s also important to know what follow-up care might be needed if you get a call from an owner that their rabbit has just choked.
First, we should get our definition of choking straight. There are two different things that are commonly referred to as “choking”. The type of choking that we think of first is obstruction of the airway by something (usually food). The second type of choking is esophageal obstruction, in which a bolus of something (again, usually food) gets stuck in the esophagus. Both of these can be very distressing to rabbits, but a tracheal obstruction is a true emergency that needs immediate intervention if your rabbit is going to survive.
Here is how these episodes differ:
True choking (tracheal obstruction) means that no air can move in or out of the lungs. A rabbit who is choking will look distressed initially. They may have their mouth wide open, show the whites of the eyes, or paw at their mouth. They are unable to make any noise, because no air can move past their larynx. Within seconds or minutes, they will begin to lose consciousness and, if the obstruction cannot be relieved, they will die.
An esophageal “choke” means that food is stuck in the esophagus (for you equine fans, this is also what horse people refer to as “choke”). Because nothing can get past, and because esophageal obstruction is very irritating, rabbits will start to hypersalivate. The excessive fluid cannot get past the obstruction, so it will start to come back up out of the nose or mouth. Fluid bubbling out of the nose is often the color of whatever is causing the obstruction. The rabbit appears uncomfortable, may extend their head and neck, repeatedly attempt to swallow, and may paw at their mouth. If very distressed, the rabbit may dart around and vocalize. Sometimes, the excessive saliva produced or the repeated swallowing dislodges the obstruction. If that occurs, the rabbit will suddenly be back to normal and resume eating like nothing happened. If the obstruction persists, fluid will keep pouring from the mouth or nose and a rabbit may get that fluid into their lungs, causing difficulty breathing and rattling sounds in the lungs. Throughout all of this, a rabbit with an esophageal choke continues to be able to move air in and out of their lungs because their airway is NOT obstructed.
Obviously, neither of these situations is ideal, but an airway obstruction is much more acutely fatal when compared to an esophageal obstruction. Regardless of the cause, a rabbit might need immediate first aid and also will likely need follow up veterinary care. First aid for choking means dislodging the obstruction. There is a technique for rabbits called the “centrifugal swing” that I think rabbit owners should know how to perform should they ever be in the unfortunate situation of witnessing a choke incident. This technique isn’t risk-free due to the delicate nature of a rabbit's spine, and should be reserved for rabbits who clearly can’t get any air into their lungs or who are distressed from an esophageal obstruction.
This is a good resource for learning about the centrifugal swing: http://vgr1.com/choking/
(Note that the video on this site shows a rabbit with an esophageal “choke”- he’s repeatedly swallowing and extending his neck, but doesn’t appear to be in severe distress nor at risk of losing consciousness. It’s a short video, but I think I can make out the sound of clicking while he’s breathing, which means he is moving air in and out of his lungs. I think if the episode is lasting long enough that you can get it on video and the rabbit isn’t so distressed that you are intervening, it’s likely an esophageal obstruction and not a tracheal obstruction.)
After either type of choke, the risk of aspiration of food material into the lungs is high. There is also a high likelihood that food material has ended up in the nasal passages. In some cases, choking incidents can lead to fluid buildup in the lungs called non-cardiogenic pulmonary edema. All of these warrant a vet visit, chest radiographs, and likely medication. I think if a patient has an esophageal obstruction but clears it quickly and never has any nasal discharge, it’s probably okay to forego a vet visit. If the rabbit required intervention (a centrifugal swing), had nasal discharge, or showed any signs of respiratory distress, he should have a followup exam with a vet. Even after surviving a choke event, there can still be fatal complications. Get thee to a vet!
Choking can be a random fluke event (just like it can be in humans), or could be a sign of predisposing causes like dental disease. Rabbits who prove to be prone to choking should be fed with certain precautions, such as moistening their pellets with water, scattering their pellets on the floor to slow down pellet consumption, or feeding from a “slow feed” style dish.
I hope this helps both pet owners and veterinarian alike to know what choke looks like in bunnies and follow-up care they might need after an episode!
