# crackling air bubbles under skin after sub q fluids



## SnowyShiloh (Apr 8, 2009)

Rory already has a thread about his gut problems, but this is a different enough topic that I think it warrants it's own thread. Rory was at the vet yesterday and got subcutaneous fluids injected under the skin on his back. Paul is the one who picked him up from the vet, so I didn't touch him until 11 or so last night. When you run your hands over his back, sides and stomach, you can feel air bubbles crackling under his skin. You can also hear it quite distinctly. He still had it going on as of about 6 hours when I saw him last (I'm at school), which was well over 12 hours since he was given the sub q fluids.

I called the vet and she said that it's very unusual, especially since the bubbles can be felt and heard on his sides and stomach instead of just his back. She's afraid he may have an infection going on (probably from the fluid injection) and the bacteria is forming gas bubbles under his skin. Hopefully when I get home in 2 hours the crackles will be gone, but she wants to prescribe him an antibiotic if it's still there.

Does anyone have experience with this? It's rather worrying :nerves1 Anyone know what antibiotic should be prescribed?


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## myheart (Apr 8, 2009)

I had to give Luna her sub-q's last Sunday, and noticed a crackling also, but it was prior to giving them. I was tenting up her skin to insert the needle, and I kept hearing a crackling noise. I wasn't sure if I should continue because of it. I ended up finding a spot on her other shoulder that did not crackle, and used that side instead.

I asked the vet about it, and he said that it was probably air trapped under her skin. I didn't poke around on her anywhere else because I was focused on the shoulder area for her fluids, so I don't know about crackling sounds anywhere else on her body. Anyhow, I haven't heard the crackling sounds since...

Not sure if that helps you, but I wonder if they had trouble giving the fluids and had to insert the needle more than once letting air under his skin. I guess I would be kind of leery about the infection line of thought especially if the only way the infection was introduced was when they did the fluids. 

Hope everything goes well for Rory and this is not an infection. 

myheart


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## degrassi (Apr 8, 2009)

I dont' know about rabbits but my brother had that crackling under the skin(felt like crunching rice crispies when you touched him) after he had a pneumothorax, had a chest tube and had to be put on a ventilator. Its called subcutaneous emphysema. They didn't treat it though, it went away on its own. After he was released from the hospital it took about a week for it to go away and all the air under his skin to be absorbed. 

Not sure why giving sub Q fluids would cause this or even if that is what your bunny has. Sorry 
*
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## SnowyShiloh (Apr 8, 2009)

Degrassi, yeah I've always associated the crackling under the skin with people who have had lung injuries. It's very odd. Rory's sounds like if you popped tiny bubblewrap. I don't think he has anything wrong with his lungs though. I wonder why they would have had to put the needle for the sub q fluids in more than one spot? He wasn't dehydrated, the vet just wanted to make sure he was extra hydrated. Unfortunately the vet who gave him fluids yesterday is not working today so we don't know if they had to poke him more than once.

Hopefully an hour from now I'll be able to report back that Rory doesn't have the crackles anymore!


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## SnowyShiloh (Apr 8, 2009)

Scary, the Wikipedia article for subcutaneous emphysema says it can be caused by punctures to the gastrointestinal system (he's been having gut issues and was given metoclopramide, a motility drug, yesterday without my knowing) or by a gas gangrene infection under the skin.


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## degrassi (Apr 8, 2009)

I'd contact the vet again once you check to see how your bun is doing. The cracklely skin is definitely not normal. 

If they want to give an antibiotic make sure they check to see if he's actually got an infection, not something else. You dont' want to give an already sick bunny unnecessary meds.


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## Maureen Las (Apr 8, 2009)

I think that it's like myheart said ..air trapped under the skin


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## SnowyShiloh (Apr 8, 2009)

I'm home! Rory seems okay, thank God. He had me really worried. He's running around the living room right now. He's still crackly but not as much as last night. He feels skinnier than yesterday too, but maybe that's normal since he's getting over stasis and hasn't been eating as much as normal? Good thing is he ate his pellets while I was gone. He's also alternating between breathing harder than normal and breathing normally.

I called the vet and she said I could either wait and see how he is tomorrow, or come in and get antibiotics now. It's a hard decision because they can go downhill so quickly, but like Degrassi said we don't want to give him more medicine if it isn't necessary. Also, the vet said she would give him Baytril. How effective would that be if he really has an infection? I told her I'd call back in a few minutes after I decide what to do!


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## pamnock (Apr 8, 2009)

I agree with the vet - it's crepitus (skin crackling due to gas formation under the skin or an anarobic bacterial infection) most likely due to the injection. Clostridium is usually the bacteria associated with the infection.



Pam


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## pamnock (Apr 8, 2009)

*SnowyShiloh wrote: *


> Also, the vet said she would give him Baytril. How effective would that be if he really has an infection? I told her I'd call back in a few minutes after I decide what to do!



Baytril can be used for Clostridium infections.

Pam


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## SnowyShiloh (Apr 8, 2009)

Pam, I was just feeling him more and the bubbles seem to move around. When I got home they were just on his back, right side and stomach but now they've moved to his left side toeo. Shall I call the vet back and take her up on the offer of Baytril? She said if I'm worried I can also bring Rory back in to be looked at and weighed. He weighed 4.9 pounds yesterday and according to my kitchen scale, he weighs 4.5 pounds today.


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## pamnock (Apr 8, 2009)

I'd start right on the Baytril and also get him back in to be examined.

Pam


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## SnowyShiloh (Apr 8, 2009)

Will do, Pam, thanks for the quick advice!


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## SnowyShiloh (Apr 8, 2009)

Rory and I are home. Poor boy was miserable at the vet, I had to hold him in the waiting room and even while he was being examined because he'd try to climb up me if I set him down! According to the vet scale, he weighs 4.6 pounds, so down .4 pounds from yesterday. His tummy feels normal now so that's good. He isn't dehydrated either. The vet was amazed by how extensive his crackles are, they're on his back, belly, right side and down on one flank. They kind of migrate around when you touch them. It doesn't seem to be causing him any pain and he doesn't have any wounds or lesions or anything, and his temperature is 102.9 degrees. The vet said up to 104 is normal for a bunny, so no fever. The vet thinks it could be from the sub q fluids and it should dissipate within the next 2 days if it is. We got Baytril just in case, he will get 1 mL twice a day until the bottle runs out.

Oh yeah, I should say that a lot of his poops are strung together with fur, so that's good because he's getting rid of all the extra fur in his belly!


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## myheart (Apr 9, 2009)

Good to hear that Rory isn't in danger of an infection, or anything major!! Like I said, the crackling noise really kind of scared me when I was going to do Luna's sub-q's. At least I know that it could be something normal from doing needle insertions under the skin. 

The only thing I would say, is to make sure you keep Rory's tummy flora in check, especially if he has had tummy troubles and is now on an antibiotic. If he seems a bit off, try some bene-bac to get his tummy back to normal. Bene-bac is just a gel or powder that helps to stimulate the growth of good/necessary flora in the GI track. I keep some on hand at all times. 

myheart


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## tonyshuman (Apr 9, 2009)

Geez, one thing and then another! It is a pretty scary thing and I'm glad you took him in. Hopefully the baytril will take care of the infection. I would not have suspected pneumothorax because that requires a puncture of the tissue surrounding the lungs and is most commonly caused by stabbing trauma, and I doubt the sub-q injections would have been given in a way to disrupt the tissue surrounding the lungs.


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## SnowyShiloh (Apr 9, 2009)

Yeah, the sad thing is that Rory probably would have been just fine if I HADN'T taken him to the vet in the first place 2 days ago! I took him to the vet and now he has whatever on Earth he has as a consequence. So much for trying to be a good bunny mommy. 

The vet said she didn't think Rory needs Benebac, but I ignored her advice and continued to give him some last night. I only have one more dose of the Benebac gel left so we'll need to go to Petco tomorrow. I e-mailed PetAg, the company that makes Bene-Bac, to ask if the jars of powdered Bene-Bac are supposed to be sealed. A nice lady wrote back and said they are supposed to be sealed, but their machine isn't that great and the seals have a tendency to come off and stick to the lid when they're opened so they don't look like they're sealed. She offered to send me some brand new Benebac from their own supplies to use until they get a new machine which seals the jars better. Isn't that nice? I'll still need to buy some Benebac gel tomorrow but hey at least I'll have some on hand for the future!

Rory is still full of crackles today but seems to be feeling pretty good! Hooray! I wasn't worried he had lung damage (there would be no reason for him to have it) but I was worried he may have intestinal damage because I read that metoclopramide can cause the intestines to tear if given to a bunny with a hair blockage because of the intestines straining against the blockage. Of course I would expect a bunny to be really obviously sick if they had that, but I hadn't had a good look at Rory in 8 hours and anything could happen in 8 hours. I cannot tell you how relieved I was to find him sitting in his cage when I got home yesterday!

Oh, one last question... Rory was prescribed Baytril, 1 mL twice a day until the bottle runs out. The bottle is 25 ounces so that's 12 days of Baytril! Does that seem excessive? The vet made it apple flavored and Rory actually is taking it pretty well, which is a relief.


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## SnowyShiloh (Apr 9, 2009)

Ooh, also, MyHeart, the vet said this definitely isn't normal. He has so many bubbles under his skin. On his back, sides, stomach and flank. About 30 square inches of his body has crackles under the skin, almost anywhere you touch him crackles!


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## tonyshuman (Apr 9, 2009)

I think if it were something other than an infection under the skin, like lung or GI damage, he'd be really sick. A tear in the intestines would lead to sepsis pretty quickly, I think.

I just wonder how common it is for sub-q's to do this. Did they not use a sterile needle or clean the injection site?


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## SnowyShiloh (Apr 9, 2009)

Claire, I was wondering that too. I suppose it would be hard to sterilize the area because they'd have to shave off a patch of fur! But Rory had that bald patch already, could have just cleaned it. Maybe that's not just something they normally do.

Here are some photos of Beanie from last night:

















Oh also last night I had a dream about you and Tony! I dreamed Tony was older than he is and hadn't binkied in a long time, but you had a webcam filming him all the time and I managed to look at his webcam just in time to see him binky. Also for some reason you were only about 12 years old and you got scared/excited because you had your window open and a moose stuck his head in your bedroom.


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## dquesnel (Apr 9, 2009)

*tonyshuman wrote: *


> I think if it were something other than an infection under the skin, like lung or GI damage, he'd be really sick. A tear in the intestines would lead to sepsis pretty quickly, I think.


I have seen a rabbit that had a tear (very small) in the intestine continue eating etc for almost a week, as if nothing had happened. This particular rabbit was acting like he was in slight discomfort, however. 

Not trying to scare SnowyShiloh though, like I said in her other thread I had thought that Rory's bubbles were due to the sub q injection and I do still think that, even if it seems like excessive air bubbles under the skin. There could have been air inside the sub q bag. A little bit of air feels like a lot under the skin.

I do think it was a good idea to put him on a precautionary Baytril, I would do the same. And the Benebac is a great idea too.

If the crackling does not go away within 48 more hours, it means new air is generating and at that point the cause should be re-evaluated. The thing about metaclopromide is that is is REALLY unlikely to cause intestinal rupture, IF the rabbit has a gut that is somewhat moving. If the rabbit had a gut that wasn't moving at all, and there appeared to be an obstruction, rupture is much more likely. However, I got the feeling that Rory was not obstructed, so I think you and him are in the clear 

Keep us posted!


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## DazyDaizee (Apr 9, 2009)

I would assume that infection would take more than 12 hours to cause signs like that.

SubQ fluids can lead to air under the skin (regardless of the sterility of the injection site or needle) if there is any air trapped in the line, especially. Occasionally bags will get some air trapped inside, and this creates air bubbles that flow through the line and into the pet. It seems like a lot of air in this case.. but I wouldn't expect that crackly sounds 12 hours after fluids is anything more than air...


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## tonyshuman (Apr 9, 2009)

Look how cute Rory Bean is! I just want to boop his nose!

That dream sounds just like me--I frequently say "moose" instead of swearing, and I really want to have a webcam to watch my bunnies all day. Not really 12 years old, though...

DazyDaizee has a good point about bubbles in the line causing the crackling. In any case, I hope it goes away soon.


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## myheart (Apr 10, 2009)

*SnowyShiloh wrote: *


> Ooh, also, MyHeart, the vet said this definitely isn't normal. He has so many bubbles under his skin. On his back, sides, stomach and flank. About 30 square inches of his body has crackles under the skin, almost anywhere you touch him crackles!



Oh Geesh.... Something else for me to worry about with Luna and her sub-q's...:nerves1

myheart


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## JadeIcing (Apr 10, 2009)

How is he?


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## Haley (Apr 10, 2009)

Also, I just saw your question about Baytril. 12 Days is pretty normal for a round of the antibiotic.


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## SnowyShiloh (Apr 10, 2009)

Sorry about the delay, I just got home from class. Today and yesterday I was super busy with school, got 2 hours of sleep last night and still have to finish a project that's due online tonight. Unnngh. As for Rory, he still has his crackles but now they're pretty much limited to his back. He's also still not completely back to himself, he hardly touched his pellets today while I was gone though he did eat a little piece of pineapple and some parsley. He ate a little romaine lettuce too.


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## SnowyShiloh (Apr 11, 2009)

Aw, Rory's being so cute tonight... He's binkying like a crazy bunny! While I was at school today he also spent a lot of time chewing up the carpet in his cage. What the heck, he isn't eating much food but will eat carpet?! Not exactly what his body needs right now. He still has bubbles but they're only on his back over his spine, hopefully they'll be gone by this time tomorrow. He's also nearing the end of his shed and I only got 1/4 the amount of fur off him compared to a few days ago. Of course, now Skyler is in a crazy molt. I'm a bit concerned because the backs of Skyler's ears are really dry and flakey. He has ear dandruff! It's not on the inside though and it isn't hurting him, he seemed to enjoy me scratching them.


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## Maureen Las (Apr 11, 2009)

*DazyDaizee wrote: *


> I would assume that infection would take more than 12 hours to cause signs like that.
> 
> SubQ fluids can lead to air under the skin (regardless of the sterility of the injection site or needle) if there is any air trapped in the line, especially. Occasionally bags will get some air trapped inside, and this creates air bubbles that flow through the line and into the pet. It seems like a lot of air in this case.. but I wouldn't expect that crackly sounds 12 hours after fluids is anything more than air...



You should always open the line over a bucket or pailand run the line open with solution flowing out until you don't see any bubbles in the line . 

I learned this as a nurse.


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## pamnock (Apr 11, 2009)

*DazyDaizee wrote: *


> I would assume that infection would take more than 12 hours to cause signs like that.



Clostridium can spread in the skin so rapidly that signs can sometimes be noted within an hour.

In the intestinal system, it can cause death within hours.

Pam


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## DazyDaizee (Apr 11, 2009)

angieluv wrote:


> You should always open the line over aÂ  bucket or pailÂ and run the line open with solution flowingÂ  out Â until you don't see any bubbles inÂ  the line .
> 
> I learned this as a nurse.



At least at the animal hospitals I've worked at, this has always been the case, and I assume it's common practice. I know that in Vet medicine, the same SubQ fluid bag is commonly used on different patients, which just the needle being changed. Though I've never seen it cause problems in the way of infection or disease spreading, I have seen bags that have already had the lines cleared of air end up with more air in the line as the bag is moved around to different areas to treat different patients. So perhaps the person administering the fluids just didn't realize?

Pam: Good to know about Clostridium. I've never heard of it being related to SubQ fluids before, so I didn't really think about it.


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## pamnock (Apr 11, 2009)

*DazyDaizee wrote: *


> Pam: Good to know about Clostridium. I've never heard of it being related to SubQ fluids before, so I didn't really think about it.



It could actually be spread during any procedure.

Pam


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