A rabbit that has stopped eating for 12 hours is an emergency. By the time the owner notices "she's just not herself today," the cecal pH has shifted, the dominant Bacteroides fermentation has slowed, and the patient is on the clock. GI stasis is the most common reason a pet rabbit ends up in your exam room, and it kills if you manage it on a canine playbook.
This is the bedside version of what to do, in order, in the first 60 minutes.
What you're treating
GI stasis (ileus, hindgut hypomotility) is a final common pathway from many causes:
Diet — insufficient long-stem fiber, sudden change of pellet brand, an empty hay rack
Pain — dental, urinary, post-surgical, anything
Stress — transport, household disruption, new pet
Subclinical disease — early E. cuniculus, atypical bacterial enteritis, hepatic disease
Anesthesia / sedation hangover
Dehydration — cold weather, illness, water bottle that quietly stopped working
The patient looks anorexic, hunched, lethargic. There may be reduced or absent fecal output, sometimes bruxism (tooth grinding). Severe cases progress to bloat, hypothermia, and shock within 24–48 hours.
The mechanism that kills is the same one that kills with antibiotic dysbiosis: cecal flora collapse, Clostridium spiroforme opportunistic bloom, iota-toxin enterotoxemia. Once that's underway, the prognosis drops fast. The whole point of treating early is to stop the cascade before it gets there.
The first 60 minutes
In rough priority order. With a tech, you can compress this into 30 minutes of parallel work.
1. Assess pain — and treat it before you finish the exam
Pain is the most common driver of stasis. A rabbit hunched in the corner with no fecal output for 18 hours is in pain. The question is where.
Quick exam targets:
Mouth. Sharp molar spurs, malocclusion, dental abscess. Most common single cause; if you don't have a good light and an otoscope, you're going to miss it. Sedation may be necessary for a real exam.
The empirical analgesic regimen — give before completing the workup if any pain finding is present:
Buprenorphine 0.03–0.05 mg/kg SC every 6–8 hours. First dose now.
Meloxicam 1.0 mg/kg PO or SC once daily. Note the dose — rabbits clear meloxicam faster than dogs and cats, and the canine 0.2 mg/kg dose doesn't reach therapeutic levels in lagomorphs. This is the single most common dosing error in primary practice.
Don't wait for a confirmed cause to start analgesia. Treat empirically; revise the plan once you can re-examine a comfortable patient.
2. Fluids
Most stasis patients are 5–10% dehydrated by the time they're noticed.
SC, warmed Hartmann's: 50–80 mL/kg, divided across two or three sites (lateral thoracic and inguinal are easiest). Onset 30–60 minutes.
IV (marginal ear vein, lateral saphenous, or cephalic) if the patient is shocky, hypothermic, or you're going to surgery.
PO absorbs more slowly than SC in a stasis patient. Don't rely on oral fluids for deficit replacement.
Warm the fluids. A 22°C bag of LRS in a 39°C rabbit is a meaningful cold-load.
Cisapride 0.5 mg/kg PO every 8–12 hours. Second-line, or first-line when you specifically want hindgut prokinetic action. Sometimes hard to source — practices that see a lot of rabbits stock it.
Don't combine the two routinely; pick one.
Caveat. Prokinetic therapy is contraindicated if you suspect mechanical obstruction (mass, foreign body, severe trichobezoar). Hyper-resonant gas on percussion is a stop sign — get imaging before you push prokinetic.
4. Nutritional support
The rabbit must eat. A few mL of slurry every 4 hours reverses the cecal hypomotility faster than any drug we have.
Oxbow Critical Care for Herbivores, Supreme Recovery Plus, or a hand-mixed pellet slurry.
10–15 mL/kg per feed via syringe, every 4–6 hours.
Some patients accept a pellet mash from a bowl once analgesia is on board; offer both.
Long-stem timothy hay should be in front of the patient continuously. Alfalfa is too rich for a stasis patient.
If the first force-feed attempt is difficult, a 30-minute window of analgesia and warm fluids often turns it around. Don't skip the feeding step because the first try was hard.
5. Imaging
If you have access:
Lateral abdominal radiograph is the standard view: gas pattern, dental disease, urolithiasis, hepatic shadow.
Ultrasound for the bladder, kidneys, and intestinal wall thickness — useful but not always necessary in straightforward cases.
Imaging is mandatory before prokinetic if there's any suggestion of obstruction. A trichobezoar with metoclopramide on board can rupture the stomach.
6. Bloodwork (when affordable)
The minimum useful set for a stasis case:
PCV / TP — hydration estimate, hepatic flag (low TP suggests hepatic disease or GI losses)
Glucose — severe stasis can drop glucose; >300 mg/dL is the warning sign for hepatic lipidosis, which is its own emergency
BUN + creatinine — dehydration vs. renal disease
Calcium — rabbits carry a lot of dietary calcium; very high values point at urolithiasis
A CBC adds value but the five above drive most decisions.
7. Hospitalization decision
Discharge criteria after the first 60 minutes:
Eating something on her own (even slurry from a bowl)
Drinking water
Producing any fecal pellets, however small
Owner can give SC fluids and oral medications every 4–6 hours
No bloat, no hypothermia, no shock signs
If any of those are missing, hospitalize for 24 hours. The home environment isn't where you want a rabbit who isn't eating.
The 24-hour reassessment
Most uncomplicated stasis cases turn around within 12–24 hours of analgesia + fluids + prokinetic + force-feeding. If the patient is back to normal eating and producing fecal pellets, discharge with:
Meloxicam PO once daily for 5 days
Continuing critical-care slurry every 6 hours until pellet output is normal
Long-stem hay ad lib
Recheck in 7 days, sooner if relapse
If the patient is not improving at 24 hours:
Re-image (gas patterns shift over 24 hours and a clear early film can hide a developing problem)
Re-examine teeth, under sedation if the conscious exam was equivocal
Bloodwork if you didn't get it on day one — especially glucose for hepatic lipidosis
Consider a second-line prokinetic
Consider antibiotic prophylaxis (TMS) if there's any soft-cecotroph or dysbiosis sign
If the patient is deteriorating — worsening bloat, falling temperature, hypoglycemia, neurologic dullness — reassess for a surgical emergency. Acute progressive bloat is a referral or surgical decision: gastric trocarization or laparotomy may be needed, and these are not GP-bench procedures.
Common errors
Underdosing meloxicam. Canine doses don't reach therapeutic levels. 1 mg/kg in rabbits, not 0.2.
Reflex oral antibiotics. Stasis isn't a bacterial infection. Don't reach for amoxicillin "just in case." Oral β-lactams cause the dysbiosis you're trying to prevent.
Skipping the dental exam. Most stasis cases trace to dental pain. Look every time, even if the owner says her teeth were checked recently.
"Let's see how she is in the morning." A 24-hour delay in stasis treatment dramatically worsens prognosis. This advice kills rabbits.
Cold fluids. Particularly in winter or in an air-conditioned exam room. Warm before administration.
Stopping the slurry too early. Fecal output should be normal before you discontinue assist-feeding. Continuing 2–3 days past apparent recovery prevents relapse.
Quick reference
Step
Drug / dose
Route
Cadence
Analgesia (opioid)
Buprenorphine 0.03–0.05 mg/kg
SC
q6–8h
Analgesia (NSAID)
Meloxicam 1.0 mg/kg
PO or SC
q24h
Prokinetic (upper GI)
Metoclopramide 0.5 mg/kg
SC
q8h
Prokinetic (lower GI)
Cisapride 0.5 mg/kg
PO
q8–12h
Fluids
Warmed Hartmann's 50–80 mL/kg
SC (or IV)
Bolus, repeat as needed
Nutrition
Critical-care slurry 10–15 mL/kg
PO via syringe
q4–6h
Antibiotic
Only if specifically indicated; TMS or metronidazole
PO or SC
q12h
All warmed. All started within the first 30 minutes of presentation when possible.
Krempels D, Cotter M, Stanzione G. Ileus in domestic rabbits. Exotic DVM Magazine. 2000;2(4):19–21.
Lichtenberger M, Lennox A. Updates and advanced therapies for gastrointestinal stasis in rabbits. Vet Clin North Am Exot Anim Pract. 2010;13(3):525–41.
BSAVA Manual of Rabbit Medicine, 2nd ed. BSAVA, 2014.
Plumb DC. Plumb's Veterinary Drug Handbook, 10th ed. Wiley, 2024.