Vet AI Scribe for Zoo Medicine

Nadia

Wednesday, November 12, 2025 at 7:00 AM

Amur tiger (Panthera tigris altaica), 17-year-old female — annual preventive exam under immobilisation

Subjective

Reason for Procedure

Scheduled annual preventive health examination. Keeper staff additionally report that she has been favouring the left hind limb on cold mornings and chewing predominantly on the left side for the past two months.

History

• Born on institution, 17 years old; geriatric for the species.
• Diet: commercial carnivore diet with weekly bone-in items; recent intake steady.
• Body weight trend from voluntary scale training: 118 kg one year ago, 111 kg today.
• Participates reliably in protected-contact behaviours: voluntary hand injection, tail presentation for blood draw, open-mouth for visual oral check.
• Last immobilisation 24 months ago; no complications.
• Fasted 24 hours before the procedure.

Objective

Immobilisation

• Induction: Darted in the holding area; medetomidine 0.04 mg/kg with ketamine 2.0 mg/kg IM, estimated from the training-scale weight
• Time to recumbency: 8 minutes
• Maintenance: Intubated, isoflurane in oxygen
• Monitoring: Pulse oximetry, capnography, ECG, direct blood pressure, oesophageal temperature
• Positioning: Sternal at intervals to reduce atelectasis

Vitals Under Anaesthesia

• Weight: 111 kg (down 5.9% over 12 months)
• Body condition: 4/9
• Temperature: 99.8°F at start, 98.9°F at 40 minutes — warming applied
• Heart rate: 54 bpm Respiratory rate: 12 breaths/min
• Blood pressure: 142/88 mmHg (mean 106)

Physical Exam

• Oral: Fractured right maxillary canine with direct pulp exposure; discoloured crown; mild periodontal pocketing at the right maxillary carnassial. Remaining dentition intact.
• Musculoskeletal: Reduced range of motion and crepitus in the left coxofemoral joint; moderate muscle atrophy of the left hind limb
• Integument: Coat in good condition; no ectoparasites; no wounds
• Cardiac and respiratory: No murmur; lungs clear on auscultation
• Abdomen: Both kidneys small and firm on palpation
• Ophthalmic: Mild bilateral nuclear sclerosis; no cataract; no evidence of retinal change

Diagnostics

• CBC: Within reference for the species
• Biochemistry: Creatinine 3.1 mg/dL, BUN 48 mg/dL, phosphorus 5.9 mg/dL; SDMA 29 µg/dL
• Urinalysis (cystocentesis): Specific gravity 1.016, no active sediment, UPC 0.4
• Blood pressure, awake trend from training sessions: Not established — see plan
• Radiographs: Bilateral coxofemoral degenerative joint disease, left more advanced; periapical lucency at the right maxillary canine
• Dental radiographs: Confirm periapical lucency with root canal involvement
• Abdominal ultrasound: Both kidneys reduced in size with increased cortical echogenicity and poor corticomedullary distinction

Assessment

Primary Problem List

1. Chronic kidney disease — IRIS stage 2 to 3 by creatinine, SDMA and imaging
2. Fractured right maxillary canine with pulp exposure and periapical disease — a source of chronic pain and a likely contributor to reduced intake
3. Bilateral coxofemoral osteoarthritis, left worse
4. Weight loss (5.9%) over 12 months
5. Geriatric status — care plan should shift from screening toward quality-of-life management

Assessment Notes

Two independent pain sources are present, and either would explain the keeper observations. The canine is the more urgent: an exposed pulp is a continuous source of pain and infection, and it plausibly accounts for the unilateral chewing and part of the weight loss.

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Plan

Same Anaesthetic Event

• Veterinary dental specialist on site; root canal therapy of the right maxillary canine performed under this immobilisation rather than scheduling a second event
• Full-mouth dental radiographs archived
• Blood and urine banked for the institutional serum bank
• Microchip verified; identification photographs updated

Ongoing Management

• Renal: Transition to a reduced-phosphorus carnivore diet; add a phosphate binder if phosphorus remains above reference at recheck
• Analgesia: Begin a long-term plan for the coxofemoral disease. Start gabapentin, delivered in food; reassess before adding an NSAID given the renal status.
• Environment: Lower the resting platforms and add a graded ramp to the den; increase substrate depth at favoured resting sites; supplemental heat at one platform for cold mornings
• Behavioural husbandry: Train voluntary blood pressure cuff acceptance and continue tail-vein draws, so renal monitoring no longer requires immobilisation. This is the point of the training programme — a geriatric animal should not need anaesthesia to be monitored.

Monitoring

• Voluntary tail-vein blood draw for creatinine, SDMA and phosphorus every 8 weeks
• Body weight from the voluntary scale weekly; flag any 3% change
• Keeper-recorded lameness score and chewing-side observation daily
• Faecal output and diet intake logged daily

Recovery

• Atipamezole administered intramuscularly at five times the medetomidine dose after extubation
• Recovery in a heated, padded den under continuous camera observation; keeper present but silent
• Full standing recovery at 46 minutes post-reversal; no complications

Records

• Procedure, anaesthetic times, drug doses and all findings entered into the institutional record system and reported to the species survival plan veterinary advisor

Keeper and Curator Communication:
Reviewed findings with the carnivore keeper team and the curator immediately after recovery. Explained that the tooth is the most likely cause of both the one-sided chewing and part of the weight loss, and that it was treated today. Agreed a standing target that renal monitoring happens through voluntary behaviours rather than immobilisation, and that the training plan is now a medical requirement rather than enrichment. Discussed what quality-of-life indicators the keeper team should record daily, and set a formal review at six months.

— Dr. Amara Nkemdirim, DVM, DACZM