Budesonide Dosing

[SojiCoppelia]

Hi all,

Still evaluating a new guest who is contained but not yet caged...

Can anyone PM me with dosing for Budesonide Nasal Spray for treatment of dyspnea in an adult Eastern Gray (on the petite side, roughly 550g weight by visual estimate)?

32mcg per metered spray

I have a miniature nebulizer with a soft mask for a child, but I would appreciate ideas as to how to administer to this little lady. I presume I could situate the nebulizer near her in the hospital cage and cover the cage...

Currently breathing through her mouth, not really clicking, sounds like nasal obstruction. We were able to pull some mud/blood out of her nose and she did start to breath through it, but has a bloody nose currently. Not sure yet whether this is respiratory infection vs. injury. Continuing to assess, will listen with a stethoscope once she is safely caged. Will examine removed debris when able.

I don't have access to Meloxicam unfortunately, but do have liquid ibuprofen 50mg/1.25mL in my kit.

Thank you all

[Mel1959]

I’m not sure about the dosing of the ibuprofen. Someone else will have to help you with that. I do know it’s based on the squirrels weight, so please post a current weight.

As for the Budesonide. I was prescribed some pre-measured vials of this for putting in a nebulizer to treat my dwarf gray squirrel. Each vial contained .25mg/2ml. I was directed to hold the nebulizer hose near his nose for him to inhale.

Hope this helps.

[SamtheSquirrel2018]

Hi all,

Still evaluating a new guest who is contained but not yet caged...

Can anyone PM me with dosing for Budesonide Nasal Spray for treatment of dyspnea in an adult Eastern Gray (on the petite side, roughly 550g weight by visual estimate)?

32mcg per metered spray

I have a miniature nebulizer with a soft mask for a child, but I would appreciate ideas as to how to administer to this little lady. I presume I could situate the nebulizer near her in the hospital cage and cover the cage...

Currently breathing through her mouth, not really clicking, sounds like nasal obstruction. We were able to pull some mud/blood out of her nose and she did start to breath through it, but has a bloody nose currently. Not sure yet whether this is respiratory infection vs. injury. Continuing to assess, will listen with a stethoscope once she is safely caged. Will examine removed debris when able.

I don't have access to Meloxicam unfortunately, but do have liquid ibuprofen 50mg/1.25mL in my kit.

Thank you all

Hi SojiCoppelia and welcome back!

If I might make a few comments and suggestions; Budesonide is a steroid and it is unlikely to be of immediate benefit in the treatment of some sort of reactive airways condition (an example would be an acute where the breathing apparatus is swollen. In cases such as those, I would recommend using an inhaled Beta Agonist such as Albuterol. Budesonide and other steroids that are inhaled are used for reactive airways problems but are used primarily to lessen the likelihood for an exacerbation and possibly minimize to some extent, the degree of an exacerbation if one does occur.

In the specific case of this Squirrel, it sounds to me from what you have described that this NOT a form of reactive airways or even primarily due to swelling as what you are describing is a mechanical blockage of the nasal passages from blood and mud. Squirrels are obligate nose breathers and you can bet that this little Squirrel is trying all she can to go back to nose breathing! My suggestion would be to simply provide a cool mist of water from a cool mist vaporizer to help loosen what is blocking the nasal passages and once it is loosened, the Squirrel's attempts at breathing through her nose will help jettison what is now blocking her nose! I would like to stress that a cool mist vaporizer be use rather than a steam vaporizer because you can safely position the Cool mist vaporizer closer to the Squirrel without the risk of burns and the cool mist also helps to decrease any local swelling! Another option since you have a nebulizer is to use that but just nebulize plain cool water!

There are definitely risks to using a combination of systemic steroids and systemic NSAIDs such as Ibuprofen. These risks may be less if the steroid is inhaled rather than given systemically but the evidence suggests that there are still additional risks associated with the use of even inhaled steroids if an animal is also being given an NSAID and I simply would NOT recommend use of even an inhaled steroid if you are going to give this Squirrel and NSAID!

I am sending a dosing chart to you by PM for Ibuprofen dosing. It should help simplify things for you in that regard!

Please keep on with the updates and it is good to have you back!

Regards,
SamtheSquirrel

[SojiCoppelia]

Hi SojiCoppelia and welcome back!

Thank you! It is lovely to be back although I do wish it was under different circumstances!

When I posted, I had very little data on Miss Niamh (pronounced KNEEve in English) other than she was pawing at her nose and mouth-breathing, and appeared to have at least a nasal obstruction. So, I was just trying to get the information needed to have options at my disposal once we had done a better exam. We were able to remove some debris; here it is (nothing gory; I'm not the photographer so I apologize for less-than-ideal capture):



For scale, the debris on the right has a length about the diameter of a U.S. dime coin. It was surprising in size.

Subsequently she is now resting quietly in our "hospital cage" in a soft hideaway, with a fleece baby blanket and a water dish, gentle heating pad under one side of the cage. We gave her one plain-water nebulization immediately, which she seemed to actually like. Since then, we've run a cool-mist vaporizer in one corner of the cage. We are mindful of moisture buildup in bedding/covers.

If I might make a few comments and suggestions; Budesonide is a steroid and it is unlikely to be of immediate benefit in the treatment of some sort of reactive airways condition (an example would be an acute where the breathing apparatus is swollen. In cases such as those, I would recommend using an inhaled Beta Agonist such as Albuterol. Budesonide and other steroids that are inhaled are used for reactive airways problems but are used primarily to lessen the likelihood for an exacerbation and possibly minimize to some extent, the degree of an exacerbation if one does occur.

In the specific case of this Squirrel, it sounds to me from what you have described that this NOT a form of reactive airways or even primarily due to swelling as what you are describing is a mechanical blockage of the nasal passages from blood and mud. Squirrels are obligate nose breathers and you can bet that this little Squirrel is trying all she can to go back to nose breathing! My suggestion would be to simply provide a cool mist of water from a cool mist vaporizer to help loosen what is blocking the nasal passages and once it is loosened, the Squirrel's attempts at breathing through her nose will help jettison what is now blocking her nose! I would like to stress that a cool mist vaporizer be use rather than a steam vaporizer because you can safely position the Cool mist vaporizer closer to the Squirrel without the risk of burns and the cool mist also helps to decrease any local swelling! Another option since you have a nebulizer is to use that but just nebulize plain cool water!

Thank you, this is extremely helpful. Now that she's caged and we've had a better look, I do agree it does not seem like Budesonide will be immediately helpful (but I'm glad to have dosing information on hand since I do have it available in my kit.) I do have access to Albuterol Sulfate in the form of a standard human inhalation aerosol + actuator. at the standard 90mcg per puff concentration. I would welcome information about dosing via PM. I am assuming I will need to get an inhalor spacer e.g. the type made for cats and dogs, but if someone knows a better way I'm very open to that wisdom.

There are definitely risks to using a combination of systemic steroids and systemic NSAIDs such as Ibuprofen. These risks may be less if the steroid is inhaled rather than given systemically but the evidence suggests that there are still additional risks associated with the use of even inhaled steroids if an animal is also being given an NSAID and I simply would NOT recommend use of even an inhaled steroid if you are going to give this Squirrel and NSAID!

I am sending a dosing chart to you by PM for Ibuprofen dosing. It should help simplify things for you in that regard!

Thank you, this comment is well-taken. She has not yet been given any NSAIDs but as observation continues, I will as always be mindful of this and I'm glad this information is available to others reading this thread as well.

As of now, she continues to rest fairly quietly. Respiration becomes more labored if we disturb her. Yesterday she ate approximately one Henry's Healthy Block and a bit of fruit, plus whatever she ate before she came into our care. She also drank water last night. She has not come out of the hideaway much today other than a few peek-a-boos, so although we have things much better under control, we still have not really had a good exam. We have been primarily giving rest and supportive care (shelter, warmth, humidity) at this point. Airway is primary.

She seems to have discharge/crusting in/around her nose. Here are a couple photos, the best we could do - she swatted at us (great spiciness) so we have limited opportunity:




She is usually breathing through her nose now. Most of the time she breathes quietly but there is some "wheezing" on inspiration when disturbed. She growls if we get near (which I'm glad to see) and her vision and hearing seem to be intact. Not sure if she can smell, she doesn't show much interest in sniffing food but that's not conclusive. No obvious head injury but certainly I can't rule that out.

I will consider using a long cotton swab to attempt to get more of the mucus/debris free of her face if there is opportunity and tolerance. We are keeping either targeted nebulizer humidification, or general humidification of the cage, on a continuous basis.

I am now considering whether a respiratory infection may be present vs. irritation of the airway from debris. I'm also thinking about how/why she could have gotten so much debris in her nose, and whether there could be more injury to the head/skull/mouth that I've not yet discovered. If I've learned anything about caring for squirrels, it's that diagnosis is on an evolving basis and they're great at hiding aspects on injury/illness, so close observation is necessary.

Re: treating respiratory infection, I have access to a good range of antibiotics, including penicillins, quinolones, doxycycline, trimethoprim, etc. I will appreciate any dosing conventions as we go (I have access to Plumb's Veterinary Drug Handbook which sometimes covers rats and a few other books but consensus experience is crucial!).

And StS, I'll send you a PM as well.

Many thanks,
Soji

[SamtheSquirrel2018]

And StS, I'll send you a PM as well.
Many thanks,
Soji

PM sent back to you!
StS

[SojiCoppelia]

Just by way of update, Miss Niamh is improving. We started her on antibiotics for presumed respiratory infection and saw improvement the next day. She is now breathing through her nose again, but occasionally she is squeaky when doing so. We are also keeping her in a high humidity environment and give intensive nebulized water treatments, which she likes and sticks her snoot right into! We decided against inhaled medication for now, as the immediate respiratory crisis appears to be over.

I'm still not confident her nasopharynx is completely cleared of debris, and I'm still not sure this is an uncomplicated respiratory infection vs. chronic infection with complications vs. injury to the face/head, or some combination therein. But I feel confident from her behavior that there is no significant CNS injury. She is a spicy little lady, but happily takes her medicine with applesauce, eats and drinks of her own accord, and otherwise seems like a happy girl. I'm hopeful she can be turned around quickly.

Thank you all!
Soji

Tax:

[SamtheSquirrel2018]

Just by way of update, Miss Niamh is improving. We started her on antibiotics for presumed respiratory infection and saw improvement the next day. She is now breathing through her nose again, but occasionally she is squeaky when doing so. We are also keeping her in a high humidity environment and give intensive nebulized water treatments, which she likes and sticks her snoot right into! We decided against inhaled medication for now, as the immediate respiratory crisis appears to be over.

I'm still not confident her nasopharynx is completely cleared of debris, and I'm still not sure this is an uncomplicated respiratory infection vs. chronic infection with complications vs. injury to the face/head, or some combination therein. But I feel confident from her behavior that there is no significant CNS injury. She is a spicy little lady, but happily takes her medicine with applesauce, eats and drinks of her own accord, and otherwise seems like a happy girl. I'm hopeful she can be turned around quickly.

Thank you all!
Soji

Thanks Soji! Please keep on with updates about Miss Niamh!
Regards,
SamtheSquirrel