critically ill hors

Question 1

what electrolyte abnormalites do you see with D++?

Answer 1

low Na and CL

Question 2

what electrolyte abnormalites do you see with hypovolaemia ?

Answer 2

slightly low Na and Cl with hypovolaemia

Question 3

what electrolyte abnormalites do you see with colic?

Answer 3

low Mg and K in colic (as anorexic and these come from diet)

Question 4

what happens to:
- HR
- CRT
- jugular filling time
- temp of extrmities
- demeanour
- lactate
- PCV/TP
- creatinine
in hypovolaemia?

Answer 4

Clinical Exam
* Heart rate - increased
* Capillary Refill time - prolonged
* Jugular filling time - reduced/slowed
* Temperature of extremities - cold
* Demeanour - dull

Clinical Pathology
* Lactate - increase
* PCV/TP - increase
* Creatinine - increase

Question 5

should flunixin be goven in SIRS?

Answer 5

yes - has a positive effect on the inflammatory cascade, make sure to give full does and not a ‘anti-endotoxin’ does (this is misquoted from a paper), full does will have full effect

Question 7

what analgesia should be given to a critically ill horse?

Answer 7

• NSAIDs - flunixin, phenylbutazone
• Opioids (not butorphanol - no analgesic effect)
  ◦ Opioids do not cause ileus, pain is a cause of ileus!!
• Paracetamol (are also antipyrexic)
• Alpha-2 agonists
• Ketamine
• Lidocaine (good for visceral analgesia) can offset some of the harmful effects of NSAIDS on gut healing

Question 8

many critically ill horses will hav edysregulation of perfusion, even with correcting the hypovolaemia (still have hypotension despite adequate volume of fluids), why is this and what can you do to correct it?

Answer 8

why - vasodilation as a result of SIRS/Sepsis
Treatment:
* Positive inotropes - increased cardiac output
◦ Dobutamine
* Vasopressors - increased tone in vessels
◦ Norepinephrine

Question 9

what are the causes and treatments for ileus?

Answer 9

Causes of ileus
* Pain
* Abdominal surgery
* Drugs
* GI/abdominal disease and inflammation

potential treatments for ileus
* Prokinetics
* Analgesia
* Treatment of primary disease
* Restoration of perfusion

• Particularly concerned in horses as can lead to gastric distension and rupture as they cant vomit
  ◦ Removal of nasogastric reflux is important part of treatment

Question 10

how long can horses be starved for? what is the exception to this?

Answer 10

• Adult horses can be starved for up to 48-72 hours with minimal effect
  ◦ Care with fat ponies and donkeys – max 12-24hrs - hyperlipidaemia risk

Question 11

what can be used for partial parental nutrition in horses?

Answer 11

◦ 40-50% dextrose +/- amino acids
◦ Only use IV glucose on own for max 24hrs
◦ Glucose on own is cheap; quite expensive when need to add AA

Question 12

what is used for total parenterla nutrition in horses?

Answer 12

◦ 40-50% dextrose + AA + lipid
◦ Q expensive

Question 13

what are the aims of parenteral nutrition in horses?

Answer 13

Often don’t try to provide all caloric requirements – 10-40Kcal/kg/day - trying to prevent them coming hyperlipaemic
◦ But in horses where we are struggling to control blood glucose and have to add in insulin then we may start lower at 5kcal/kg/day

Question 14

what are the concequences of withholding food in horses?

Answer 14

Any period without food leads to GI changes
◦ Villi stunting
◦ Decreased absorptive capacity
* Predisposes to mild gastric ulceration
* Controversial RE prophylaxis and treatment
◦ Gastric acid has a purpose

Question 15

what can you do after a period of withholding food, prior to re-feedign in horses?

Answer 15

◦ Provide glutamine prior to re-feeding to ‘feed enterocytes’
◦ Q cheap – nutritional human supplement

this is done in human medicine

Question 16

what is doen to manage changes in GI flora in horses?

Answer 16

• Do nothing
  ◦ Commonly done - thinking that once feeding starts back up the GI flora will rebalance
• Care RE use of pre and pro-biotics
  ◦ Often no EBM to support their use
  ◦ May contain inappropriate or even pathogenic organisms
  ◦ Many unlikely to survive gastric acid
• Equids – transfaunation
  ◦ Poo soup

Question 17

what is the treamtment and management for thrombophlebitis in the horse?

Answer 17

• Broad spectrum antibiotics
• Anti-inflammatories
  ◦ Systemic
  ‣ Aspirin
  ‣ Other NSAIDs - platelet inactivation
  ◦ Topical
  ‣ DMSO
  ‣ Hot packs
• Heparin
  ◦ or analogues
• Vasodilators
  ◦ Glyceryltrinitrate
• Raise head - often swelling of the head can occur, raising it can increase drainage

Management:
* Alternative venous access
◦ Lateral thoracic
◦ Cephalic
* With bilateral thrombosis of the jugular veins, tracheostomy may be required - as oedema of the head and neck can result in swelling causing upper airway obstruction
* Surgical procedures to strip and/or graft the vein have been described but are rarely undertaken

Question 18

what is the first line treatment of ventricular arrhythmias in horses?

Answer 18

• IV magnesium sulphate – membrane stabilizer