V Vol. 22, No.
3 March 2000
CE Refereed Peer Review
FOCAL POINT
★ Ferrets are subject to several
diseases that require prompt
recognition and specific
diagnostic steps to ensure
adequate critical care.
KEY FACTS
■ Ferret physiology, as well as
response to medical therapy, is
similar to that of domesticated
cats and dogs.
■ Because spinal injury is rare
in ferrets, hindlimb paresis is
typically a sign of weakness
and not intervertebral disk
disease.
■ Young ferrets are notorious
for ingesting foreign matter,
particularly rubber items.
■ Urinary obstruction in male
ferrets has been associated
with prostatomegaly and
hyperandrogenism.
■ The effects of isoflurane gas on
ferret hematology is profound
and can have consequences
for blood transfusion and
interpretation of diagnostic
samples.
Evaluating and
Stabilizing the
Critical Ferret:
Initial Assessment, Differential
Diagnosis, and Diagnostic Plan
University of California Indianapolis Zoo, Indianapolis, Indiana
Keith G. Benson, DVM Jan C. Ramer, DVM
University of Wisconsin
Joanne Paul-Murphy, DVM
ABSTRACT: Because of their small size and unique diseases, critically ill ferrets can be a diag-
nostic and treatment challenge for clinicians. Ferrets are often in advanced stages of a disease
process at the time of presentation, necessitating aggressive supportive care. History and clin-
ical signs can be vague; thus the differential diagnosis list may include many disorders, such
as metabolic disease, toxicity, cardiac disease, neurologic disease, and neoplasia.
T
o appropriately render emergency care to critically ill ferrets, clinicians
must use their familiarity with common diseases of ferrets and knowl-
edge of principles of basic small animal critical care. The initial diagnos-
tic plan depends on the history and clinical signs (Table I). The results of diag-
nostic tests aid clinicians in diagnosing the disorder and developing a treatment
plan (Table II1–5). This article focuses on common presenting signs, associated
differentials, and initial diagnostic and therapeutic plans that are specific to fer-
rets. Dyspnea, gastrointestinal disorders, urethral obstruction, anemia, and car-
diac and endocrine disorders are discussed.
DYSPNEA
As with any dyspneic patient, supportive care may supersede the acquisition of di-
agnostic samples. Oxygen therapy is advised before, during, and after any stressful
procedure. The initial diagnostic plan should be directed toward determining
whether the ferret has pulmonary, cardiac, or extrathoracic disease. Differential diag-
noses include heart disease (e.g., cardiomyopathy, valvular disease, dirofilariasis),
pleural effusion, pulmonary edema, intrathoracic neoplasia (e.g., mediastinal lym-
phoma), canine distemper, influenza, or pneumonia. The following have been re-
Compendium March 2000 Small Animal/Exotics

TABLE I Thoracic radiographs are essential to

Diagnostic Differentials and Initial Diagnostic Plan by Clinical Signs
determine whether intrathoracic disease is
present. Thoracocentesis may be both
Differential Diagnosis Initial Diagnostic Plan diagnostic and therapeutic. Electrocar-
Dyspnea diography is useful in the diagnosis of
Pneumonia Complete blood count arrhythmia, and echocardiography is in-
Cardiomyopathy Serum chemistry and electrolytes dicated in patients with suspected heart
Dirofilariasis Thoracic radiography disease. A quick assessment of hemat-
Mediastinal lymphoma Electrocardiogram ocrit and total solids helps to rule out
Canine distemper Echocardiogram anemia, and a complete blood count can
Influenza Thoracocentesis help to establish a diagnosis of infectious
Tracheal wash or neoplastic disease. Transglottal tra-
cheal wash, although useful in establish-
Weakness (“the flat ferret”) ing the presence of pathogens in the low-
Cardiomyopathy Hematocrit/total solids (stat.) er airway, is limited by the relatively
Hypoglycemia, insulinoma Blood glucose (stat.) small size of the trachea (i.e., 2.5 to 3.5
Hyperestrogenism Serum chemistry and electrolytes mm in diameter). The approach is made
Dirofilariasis Abdominal radiography through the oropharynx, and contami-
Influenza Thoracic radiography
nation is difficult to avoid.
Neoplasia, lymphosarcoma, other Distemper immunofluorescence
Dyspneic ferrets must be monitored
Canine distemper antibody on conjunctival scrape
closely throughout the diagnostic work
Nausea, Vomiting, Anorexia to avoid undue stress. A severely dyspne-
Foreign body ingestion Blood glucose (stat.) ic ferret may tolerate only oxygen thera-
Trichobezoars Complete blood count py and initial furosemide therapy. Place-
Helicobacter Serum chemistry and electrolytes ment of a patent intravenous catheter is
Megaesophagus Abdominal radiography a priority in order to facilitate adminis-
Metabolic disease tration of medications if respiratory or
Insulinoma cardiac arrest occurs.

Diarrhea WEAKNESS AND HEMIPARESIS

Campylobacter Complete blood count Ferrets are often presented for hind-
Epizootic catarrhal enteritis Serum chemistry and electrolytes limb paresis or paralysis; the condition
Helicobacter Specific cultures can be associated with a wide variety of
Proliferative enteritis Fecal floats, smears causes, but primary spinal disease is rare.
Rotavirus Abdominal radiography
A minimum diagnostic database (i.e.,
Salmonella Abdominal ultrasound
complete blood count, serum chemistry
Parasitism
Gastrointestinal lymphoma, and electrolytes, and radiographs of the
other neoplasm chest and abdomen) should be gathered.
Insulinoma, lymphosarcoma, anemia,
Urethral Obstruction, Dysuria and thoracic disease are the most com-
Prostatomegaly Hematocrit/total solids (stat.) mon causes of weakness. Placement of
Urinary calculi Complete blood count an intravenous or intraosseous catheter
Serum chemistry and electrolytes for replacement of fluid deficits during a
Urine culture 24-hour period is important.
Urinalysis
Abdominal radiography NAUSEA, VOMITING,
Abdominal ultrasound AND DYSPHAGIA
Differential diagnoses for vomiting
ported: bacterial pneumonia caused by Streptococcus zoo- include obstructive disease (e.g., foreign body, trichobe-
epidemicus, Streptococcus pneumoniae, and streptococci zoar, neoplasm), megaesophagus (Figure 2), helicobac-
groups C and G; Klebsiella species; Pseudomonas species; Es- terial gastritis, inflammatory bowel disease, and insuli-
cherichia coli; and, rarely, fungal pneumonia caused by Blas- noma. Palpation and abdominal radiographs can
tomyces dermatitidis (Figure 1) and Coccidioides immitis.6–8 usually determine whether obstructive disease is pres-

INTRATHORACIC DISEASE ■ THORACOCENTESIS ■ AVOIDANCE OF STRESS

Small Animal/Exotics Compendium March 2000

TABLE II Most ferrets with gastroin-

Formulary
testinal disease have the pri-
mary signs of anorexia and
Drug Dose Route Indication nausea, as opposed to vomit-
Digoxin 9
0.1 mg once daily PO Cardiomyopathy ing. Nausea may be exhibited
as ptyalism, lip smacking, and
Furosemide 9 2–4 mg/kg IV, IM Abdominal or thoracic bruxism.
effusion, pulmonary edema Hypoglycemia in ferrets
can also manifest as ptyalism,
Enalapril9 0.5 mg/kg every other day PO Cardiomyopathy pawing at the mouth, and
dysphagia. The blood glucose
Dexamethasone 9 0.5–2 mg/kg IV Shock level should be determined: if
NaPO4 it is less than 40 mg/dl, or if
the ferret is clinically weak, an
Diazepam20 1–2 mg/kg IM Seizure control, oral sugar solution or intra-
tranquilization venous dextrose should be
given. Administration of these
Doxapram21 5–11 mg/kg IV Respiratory stimulant
substances before collection of
Gonadotropin- 20 mc/ferret; IM Induce ovulation
diagnostic samples interferes
releasing repeat in 2 weeks Terminate estrus with diagnosis. Ferrets with
hormone22 if necessary insulinoma may develop elec-
trolyte imbalances, especially
Human 100 IU/ferret; IM Stimulate ovulation, hypokalemia; therefore, elec-
chorionic repeat in 2 weeks terminate estrus trolytes should be monitored
gonadotropin22 if necessary during dextrose therapy.

Lactated Ringer’s 100 ml/kg IV Shock dose DIARRHEA

solution 60–80 ml/kg IV, SC Fluid therapy Diarrhea in ferrets may be a
result of infection (e.g., Cam-
Prednisone19 0.25–2 mg/kg PO Hypoglycemia pylobacter species, Salmonella
IV = intravenous; IM = intramuscular; SC = subcutaneous; PO = oral. species, Helicobacter mustelae,
parasites, epizootic catarrhal en-
teritis, rotavirus) or some oth-
ent; an obstruction mandates immediate surgical inter- er disorder (e.g., proliferative enteritis, eosinophilic en-
vention. Young ferrets are notorious for ingesting for- teritis). Ferrets with diarrhea can become profoundly
eign matter, particularly rubber items. dehydrated and therefore require emergency supportive
Ferrets that have no evidence of obstructive disease care. The high metabolic rate and short gastrointestinal
can receive antiemetics, such as metoclopramide, to re- transit time in these animals contribute to rapid dehy-
duce fluid loss. Electrolyte abnormalities in clinically dration. The initial diagnostic plan includes abdominal
dehydrated animals must be radiographs or ultrasonography
corrected. Intravenous or in- (or both) to rule out obstruc-
traosseous fluid therapy is man- tive disease. A complete blood
datory in patients with mod- count and serum chemistry
erate to severe dehydration, panel are necessary to evalu-
although mild dehydration ate the ferret’s metabolic sta-
may be managed with subcu- tus, although these tests rarely
taneous fluid administration. provide a diagnosis. Initiating
Supportive care should be treatment with broad-spec-
provided until surgical correc- trum antibiotics pending cul-
tion of obstructive disease, or ture and sensitivity data is
medical management of un- reasonable, given the number
derlying medical conditions, Figure 1—Radiographic appearance of blastomycosis in a of bacterial enteritides that
ferret.
can be instituted. can affect domesticated fer-

OBSTRUCTIVE DISEASE ■ FLUID THERAPY ■ HYPOGLYCEMIA

Compendium March 2000 Small Animal/Exotics

Figure 2—Contrast esophagram of a ferret with megaesopha-

gus.
Figure 3—Ultrasonogram of an enlarged cavitated prostate in
a hob with hyperadrenocorticism.
rets. If culture results are negative, antibiotics should be
discontinued.
istry panel with electrolytes, and urinary cultures are in-
URETHRAL OBSTRUCTION dicated if active urinary sediment is present.
Urethral obstruction is primarily a disease of male fer- Establishment of a patent intravenous fluid line, rapid
rets (hobs) but has also been reported in females (jills).9 resolution of hyperkalemia, and establishment of urine
Urinary obstruction in hobs has been associated with flow is critical to short-term survival of the patient. Hobs
prostatomegaly secondary to adrenal disease and hyperan- and jills may be catheterized with a 3.5-Fr red rubber
drogenism9 (Figure 3). Cystic and urethral calculi (Figure catheter.10 Passing a urinary catheter in a hob can be
4) are common; struvite (i.e., challenging because the ure-
magnesium ammonium phos- thral opening is small and dif-
phate) crystals are the most ficult to locate. Prostatomegaly
common. Bacterial cystitis may impede placement of the
may accompany cystic calculi. urinary catheter, and general
Anamnesis includes stranguria, anesthesia is recommended for
dysuria, pollakiuria, and often adequate urethral relaxation.
hematuria. Ferrets with stru- In cases of recalcitrant urethral
vite crystals often have a histo- stones or plugs, careful cysto-
ry of an inappropriate diet, centesis, followed by cystoto-
such as dog food or low-quali- my with antegrade urethral
ty adult cat food. flushing, may be the only re-
A large, turgid bladder is course. If this fails, the clini-
evident on physical examina- cian should be prepared to per-
tion, although not all hobs form perineal urethrostomy.
with prostate enlargement Ferrets with prostatomegaly
have complete urinary tract usually have adrenal cortical
obstruction. The initial diag- hyperplasia, adenomatous
nostic plan includes abdomi- changes, or adenocarcinoma
nal radiographs, ultrasonogra- with overproduction of andro-
phy, or both and assessment gens. The neoplastic or hyper-
and correction of electrolyte plastic adrenal gland must be
and acid–base abnormalities. removed to effect a resolution.
Ferrets may be acidotic and Uncomplicated hyperplasia of
hyperkalemic if the obstruc- the prostate usually resolves to
tion has persisted for more the point where the animal
than 12 to 24 hours. Com- Figure 4—Urethral calculi in a hob. The stones have filled can urinate without difficulty
the urethra proximal to the os penis.
plete urinalysis, serum chem- in a few days.9 Prostatitis and

PROSTATOMEGALY ■ ADRENAL DISEASE ■ CYSTOCENTESIS

Small Animal/Exotics Compendium March 2000

prostatic cysts carry a poorer of whole blood from one or

prognosis. Transmural bacteri- more donors. To date, distinct
al migration with septic peri- blood groups have not been
tonitis has a poor prognosis. identified in ferrets, making
the likelihood of an adverse
ANEMIA transfusion reaction low.12
Ferrets that have had signif- Severe depression of the
icant or prolonged hemor- hematocrit can preclude im-
rhage (e.g., gastrointestinal mediate ovariohysterectomy
bleeding; trauma; ingestion of in jills with persistent estrus
vitamin K antagonist rodenti- and hyperestrogenemia. Ovu-
cides; and, on rare occasions, lation should be induced in
adrenal gland disease) present Figure 5—Swollen vulva in a jill with hyperestrogenism. these patients with human
with weakness secondary to chorionic gonadotropin or
anemia. Jills in prolonged es- gonadotropin-releasing hor-
trus with hyperestrogenemia and resultant aplastic ane- mone injections, and periodic blood transfusions
mia may be severely anemic with a hematocrit less than should be given until the ferret has stabilized.
12 (Figure 5). Anamnesis may reveal that a jill has been
in estrus for several months or that it has a history of CARDIOMYOPATHY
trauma or melena. The initial diagnostic plan includes Dilated cardiomyopathy is the most common cardiac
immediate measurement of the hematocrit and total problem in adult ferrets.1,13,14 This disorder is usually
solids, a complete blood count, thoracic and abdominal seen in older ferrets with a history of coughing, weak-
radiographs, and abdominocentesis to rule out internal ness, hindlimb paresis, vomiting, anorexia, and/or
bleeding. weight loss. Signs of heart failure in ferrets are similar to
Isoflurane anesthesia can have adverse effects on the those in other mammals, including tachypnea, tachycar-
hemogram of ferrets by sequestering erythrocytes in the dia, ascites, hepatomegaly, pulmonary edema, hypother-
spleen, which may exacerbate poor oxygen-carrying ca- mia, cyanosis, weakness, posterior paresis, and thready
pacity in anemic ferrets.11 Initial stabilization includes in- pulses.1,15 A holosystolic murmur and crackles can be
travenous or intraosseous catheterization and transfusion auscultated at the seventh or eighth intercostal space.1 The
initial diagnostic plan includes chest radiographs; elec-
trocardiography; and, when possible, echocardiography.
The normal radiographic appearance of the cardiac
silhouette in ferrets is more globoid than that of cats.
Radiographic signs include pulmonary venous conges-
tion, pulmonary edema, and pleural effusion1 (Figure
6). The most common electrocardiographic finding is

Figure 6A Figure 6B
Figure 6—(A) Ventrodorsal and (B) lateral radiographs of cardiomyopathy and pulmonary edema in a ferret.

HYPERESTROGENISM ■ BLOOD TRANSFUSION ■ HEART FAILURE

Compendium March 2000 Small Animal/Exotics

sinus tachycardia, although ventricular premature com-
plexes and atrial premature complexes are occasionally
recorded. Tall R waves, QRS prolongation, and ST de-
pression have also been reported with this disease.16
Echocardiographic findings are likely to include in-
creased left ventricular end-diastolic and end-systolic
dimensions, decreased fractional shortening, an en-
larged left atrium, mitral regurgitation, and right ven-
tricular enlargement.1,17 Initial management includes
supplemental oxygen and furosemide for diuresis. Tho-
racocentesis can be useful for therapy and diagnosis.
Digoxin is indicated for supraventricular tachyarrhyth-
mia and myocardial failure. Enalapril is recommended
as a balanced vasodilator.1,18
INSULINOMA
Pancreatic beta-cell tumors and the associated hyper-
insulinemia are very common.19–22 Ferrets are often pre-
sented shortly after a hypoglycemic episode. Ferrets
with hypoglycemia are dull, stuporous, ataxic, dehy-
drated, and hypothermic and salivate excessively. 22
Blood glucose levels measured during a hypoglycemic
crisis are usually less than 60 mg/dl. Blood glucose lev-
els of animals that present after resolution of the hypo-
glycemic episode may be in the 60- to 90-mg/dl range.
Diagnosis of insulinoma when the blood glucose level
is greater than 70 mg/dl requires evaluation of the in-
sulin–glucose ratio.
Nutrical® (EVSCO Pharmaceuticals, Buena, NJ),
corn syrup, or 50% dextrose may be applied to the oral
mucous membranes of a hypoglycemic ferret. Placement
of an intravenous or intraosseous catheter facilitates glu-
cose administration. A large bolus of glucose may cause
a rebound release of insulin. The goal of therapy is to re-
turn the ferret to a euglycemic state, as opposed to a hy-
perglycemic state. Prednisone antagonizes the effects of
insulin and helps to maintain euglycemia. Fluid deficits
should be corrected, and supplemental potassium
should be administered as dictated by serum electrolyte
evaluation. Correction of hypoglycemia, dehydration,
and electrolyte imbalances is generally followed by sur-
gical excision of the islet cell tumors.
SUMMARY
This article describes some of the diseases of ferrets
that are commonly seen in a critical care setting. Clini-
cians should focus on ferret-specific diseases and causes
mentioned here, but their experience with dogs and
cats can also provide useful guidance through diagnosis
and therapy for critically ill ferrets.

Produce the ultimate in dental x-rays

Atlas of Canine & Feline
DENTAL RADIOGRAPHY
Thomas W. Mulligan • Mary Suzanne Aller • Charles A. Williams
Mary Suzanne Aller, Editor
248 pages, 846 radiographs with arrow RATED
overlays to indicate notable features ★★★★★
■ Practical tips throughout
■ More than 840 real-case images with indicative arrows
■ State-of-the-art techniques for the beginning practitioner,
$
80 technician, and specialist
■ Precise information on positioning, supplies and equipment, processing,
$89 safety, film handling, and more

% off!
■ First in the field 10 CALL OR FAX TODAY TO ORDER
800-426-9119 • Fax: 800-556-3288
■ 846 reference radiographs
Price valid only in the US, Canada, Mexico, and the Caribbean.
VLS
VE T E R I N A RY
BOOKS
L E A R N I NG SYS T E M S
Request international pricing. Email: books.vls@medimedia.com
Small Animal/Exotics
About the Authors
Dr. Benson is a resident in Zoological Medicine, School of
Veterinary Medicine, University of California, Davis, Cali-
fornia. Dr. Ramer is a staff veterinarian at the Indianapolis
Zoo, Indianapolis, Indiana. Dr. Paul-Murphy is the chief of
service of the Special Species Health Service at the
School of Veterinary Medicine, University of Wisconsin,
Madison, Wisconsin.
REFERENCES
1. Stamoulis ME: Cardiac diseases in ferrets. Semin Avian Ex-
otic Pet Med 4:43–48, 1995.
2. Brown SA: Ferrets, in Jenkins JR, Brown SA (eds): A Practi-
tioner’s Guide to Rabbits and Ferrets. Lakewood, CO, Ameri-
can Animal Hospital Association, pp 43–111, 1993.
3. Hillyer EV: Ferret endocrinology, in Kirk RW, Bonagura JD
(eds): Current Veterinary Therapy XI Small Animal Practice.
Philadelphia, WB Saunders Co, 1992, pp 1185–1186.
4. Hillyer EV, Brown SA: Ferrets, in Birchard SJ, Scherding
RG (eds): Saunders’ Manual of Small Animal Practice.
Philadelphia, WB Saunders Co, 1994, pp 1317–1344.
5. Carpenter JW, Mishima TY, Rupiper DJ: Exotic Animal
Formulary. Manhattan, KS, Greystone Publications, 1996.
6. Fox JG: Bacterial and mycoplasmal diseases, in Fox JG (ed):
Biology and Diseases of the Ferret. Philadelphia, Lea & Feb-
iger, 1988, pp 197–216.
7. Fox JG, Pearson RC, Groham JR: Virals and chlamydial dis-
eases, in Fox JG (ed): Biology and Diseases of the Ferret.
Philadelphia, Lea & Febiger, 1988, pp 217–234.
8. Du Val-Hudelson KA: Coccidiomycosis in three European
ferrets. J Zoo Wildl Med 21:353–357, 1990.
9. Hillyer EV: Urogenital diseases, in Hillyer EV, Quesenberry
KE (eds): Ferrets, Rabbits and Rodents—Clinical Medicine
and Surgery. Philadelphia, WB Saunders Co, 1997, pp
44–53.
Compendium March 2000
10. Marini RP, Esteves MI, Fox JG: A technique for catheteriza-
tion of the urinary bladder in the ferret. Lab Anim 28:
155–157, 1994.
11. Marini RP, Jackson LR, Esteves MI, et al: Effect of isoflu-
rane on hematologic variables in ferrets. Am J Vet Res 55:
1479–1483, 1994.
12. Manning DD, Bell JA: Lack of detectable blood groups in
domestic ferrets: Implications for transfusion. JAVMA 197:
703–707, 1990.
13. Stamoulis ME, Miller MS, Hillyer EV: Cardiovascular dis-
eases, in Hillyer EV, Quesenberry KE (eds): Ferrets, Rabbits
and Rodents—Clinical Medicine and Surgery. Philadelphia,
WB Saunders Co, 1997, pp 63–76.
14. Miller MS: Ferret cardiology. Proc North Am Vet Conf :735,
1993.
15. Greenlee PG, Stephens E: Meningeal cryptococcosis and
congestive cardiomyopathy in a ferret. JAVMA 184:840,
1984.
16. Smith SH, Bishop SP: The electrocardiogram of normal fer-
rets, and ferrets with right ventricular hypertrophy. Lab
Anim Sci 35:268, 1985.
17. Lipman N, Fox JG: Clinical, functional, and pathologic
changes associated with a case of dilatative cardiomyopathy
in a ferret. Lab Anim Sci 37:210, 1987.
18. Ensley PK, Van Wickle T: Treatment of congestive heart
failure in a ferret. J Zoo Wildl Med 13:23, 1982.
19. Elie MS, Zerbe CA: Insulinoma in dogs, cats, and ferrets.
Compend Contin Educ Pract Vet 17(1):51–59, 1995.
20. Caplan ER, Peterson ME, Mullen HS, et al: Diagnosis and
treatment of insulin-secreting pancreatic islet cell tumor in
ferrets: 57 cases (1986–1994). JAVMA 209:1741–1745,
1996.
21. Ehrhart N, Withrow SJ, Ehrhart EJ, Wimsatt JH: Pancreatic
beta cell tumors in ferrets: 20 cases (1986–1994). JAVMA
209:1737–1740, 1996.
22. Kaufman J, Schwarz P, Mero K: Pancreatic beta cell tumor
in a ferret. JAVMA 185:998–1000, 1984.