management of equine diarrhoea

Question 1

what are the aims of diag nostic investigations of diarrhoea in horses?

Answer 1

• Determine likely cause of D++
• Determine need for supportive therapy
• Determine need for specific therapy
• Determine risk to in-contact horses and personnel

Question 2

the management of aucte diarrhoea in young and adult horses is supportive therapy, in general terms what does this involve?

Answer 2

• fluide replament and electrolytes
• anti-inflammatories
• analgesia
• antimicrobials
• probiotics
• adsorbants
• nurtrition

Question 3

what are the principels behind fluid replacement for supportive therapy in acute diarrhoea of young and adult horses?

Answer 3

• Mild to moderate D+: May maintain hydration with voluntary drinking +/- NGT of water or electrolytes
• Moderate to severe: IVFT (Hartmans)
• decreased oncotic pressure - lost albumin from the GIT, if you bolus fluids rapidly due to low albumin they can develop oedema - need to do quickly but not bolus
• Many require KCl, some may require NaHCO3 (sodium bicarbonate) and general Na supplementation

Question 4

what are the principels behind analgesia and anti-inflammatories for supportive therapy in acute diarrhoea of young and adult horses?

Answer 4

Minimal to severe abdominal pain
* NSAIDs: Flunixin meglumine (Other COX 2 selective? esp in right dorsal colitis as could have negative effects onthe colon)
* Temporary relief: Xylazine, detomidine +/- butorphanol
* CRI: Butorphanol, Lidocaine +/- Ketamine

Question 5

what are the principels behind antimicrobials for supportive therapy in acute diarrhoea of young and adult horses? what antimicrobials are used?

Answer 5

Debateable
* If neutropaenic or signs of sepsis
◦ if neutropaenic due to all neutrophils in the intestine, won’t be able to fight off other infection therefore antimicrobial are helpful as reduce the risk of secondary infection
◦ sepsis - secondary infection therefore need antimicrobials
* Penicillin IM and Gentamicin IV
* Metronidazole PO for Clostridiosis

Question 6

what are the principels behind probiotics for supportive therapy in acute diarrhoea of young and adult horses? how is this done?

Answer 6

Faecal Transfaunation (Poo soup via NGT) - Debateable

Question 7

what are the principels behind adsorbants for supportive therapy in acute diarrhoea of young and adult horses? what abdorbant is used?

Answer 7

• Di-Tri Octahedral Smectite (Biosponge®️)
• Very useful. Better to give SID-BID via NGT

Question 8

what are the principels behind nutrition for supportive therapy in acute diarrhoea of young and adult horses? what abdorbant is used?

Answer 8

Vital
* Ideally complete pelleted diet- no grain and no hay
* If in appetent – good quality grass hay or anything!
* Can add oil (corn oil) for added calories

Question 9

what additonal treatments can be used in Right dorsal colitis?

Answer 9

• Misoprostol - promote healign of ulcers
• Psyllium may be useful

Question 10

what additonal treatments can be used in cyathostomiasis?

Answer 10

• Anthelmintics: Moxidectin
• Pre-treatment with steroids (Dexamethasone or prednisolone) - dampen down inflammation that will occur when the larvae die

Question 11

what additonal treatments can be used in sand enteropathy?

Answer 11

psyllium

Question 12

what additonal treatments can be used in lawsonia intracellularis?

Answer 12

• Doxycycline (antibiotic) - as intracellualr organism, will have to be used for many weeks

Question 13

what are the management stratergies for sepsis in acute diarrhoea?

Answer 13

Circulatory Support
* fluids
+/- Dobutamine

Flunixin
* May help to block parts of the sepsis cascade
* Lower dose? - due to association with RDC

Cryotherapy
* Critical
* Reduces incidence of laminitis in horses diagnosed with colitis
* Under-utilised
* Important: Constant low hoof temperature
* Often means replacing ice every 2 hours (24h a day)

Plasma
* £££ as lots required to make a difference to the protein levels!
* 7-10L for a 500kg horse!
* Toxin neutralisation (1-2L for a 500Kg adult horse) –> debatable

Pentoxyfyline
* ?supresses proinflammatory cytokines
* Increases RBC deformability
* Currently no published controlled clinical trials supporting its use

Polymixin B
* Prevents initiation of the proinflammatory cascase - Debatable

absorbants - biosponge

Question 14

what management would you do with a horse that has mild D+ and is normovolaemic?

Answer 14

iet
◦ Simple grass diet
◦ Pelleted diet
◦ No grains
* +/- Biosponge
* Monitoring

Question 15

what is the management of a neonatal foal with diarrhoea?

Answer 15

consider referral
* IVFT
◦ Care with sodium and acid base
* Antimicrobials (foals are said to be septic until proven otherwise)
◦ FPT - high risk of secondary infection
* GI Rest – 24-48h
◦ Partial parenteral nutrition (PPN)
◦ Total parenteral nutrition (TPN)
* Supportive care
* Secondary infections!