Enteral/Parenteral Nutrition in Foals and Adult Horses Practical Guidelines for the Practitioner

Closed laceration of the trachea, esophagus and guttural pouches in a mare caused by blunt trauma

A mare was admitted for progressive swelling of the neck, lethargy and anorexia. Radiography revealed perilaryngeal, peritracheal, and periesophageal emphysema. Endoscopy revealed pharyngeal and tracheal roof collapse, and a small laceration on the trachea. Treatment with antimicrobials, fluids, and flunixin was initiated. To prevent exacerbation of the emphysema, temporary tracheostomy was performed. Clipping for the tracheostomy revealed a hoofprint mark on the ventral neck. Subsequent endoscopies revealed laceration of the esophagus and guttural pouch septum communicating with the visceral compartment of the neck. Four days after admission, an esophagostomy was performed to prevent leakage of ingesta into the neck and allow feeding. Complications occurred: Deep cervical infection requiring surgical drainage; Esophageal impaction with shavings on one occasion causing extensive mucosa erosions; Laminitis managed with restricted physical activity and corrective farriery. Tracheostomy tube removal, esophagostomy tube removal, and patient discharge occurred 10, 36 and 51 days after admission, respectively. The mare did well after discharge and returned to competing in children's showing classes. Blunt trauma to the neck can lacerate the trachea, esophagus and guttural pouches causing emphysema and deep cervical infection, which can be treated with antimicrobials, temporary tracheostomy, temporary esophagostomy, surgical drainage, and supportive care.

Treatment of a Mandibular Diastemal Fracture Using Locking Compression Plate and Cerclage Wire in a Mare

This report describes the combination of two surgical fracture repair techniques and the postoperative management of a mandibular diastemal fracture in a two-year-old mare. The mare was referred to a veterinary hospital with a laceration over the body of the right mandible. Radiographic assessment revealed two mesial fracture lines involving the second premolar tooth and a ventrally displaced bone fragment. The mare was treated under general anesthesia and the fracture was corrected using open reduction and plate fixation. A 3.5 mm narrow 15-hole locking compression plate with seven locking screws were used in a bridge form. Cerclage wire was also used to anchor the incisor teeth to the second and third premolar teeth. The cerclage wire and incisor teeth were covered with polymethylmethacrylate to prevent implant failure and avoid injury to the oral mucosa. Implants were removed 55 days after surgery and the mare was discharged from hospital five days later. The mare returned for cerclage wire removal after 90 days and was allowed to resume exercise thereafter. The combination of two surgical techniques, proper implant choice and appropriate postoperative management, including use of pelleted feed, contributed to successful bone healing and return to function.

Effects of total parenteral nutrition associated with glutamine, enteral fluid therapy with or without glutamine, and fluid therapy on the acid-base and electrolyte balance of horses starved after exploratory laparotomy

This study aimed to evaluate the effects of the total parenteral nutrition associated with glutamine, enteral fluid therapy with or without glutamine, and fluid therapy on the acid–base and electrolyte balance of horses starved after exploratory laparotomy. Sixteen healthy male and female adult horses of mixed breed, aged between 4 and 14 years, and having a mean body weight of 248.40 ± 2.28 kg and a body score index of 3–4 (scale of 1–5) were divided into four groups with four animals per group. After an adaptation period of 30 days, they were randomly divided into four experimental groups: enteral fluid therapy, enteral fluid therapy associated with glutamine, total parenteral nutrition associated with glutamine, and parenteral fluid therapy. The experiment was further divided into two phases: Phase 1 and Phase 2. In Phase 1, an exploratory laparotomy was performed, treatments were administered to the groups and the horses received no food or water other than those given to their respective groups. In Phase 2, the animals were re-fed. Each phase had a total duration of 144 h. Venous blood samples were collected every 24 h throughout the experimental period for blood gas and electrolyte analyses. The following parameters were evaluated: pH, partial pressure of carbon dioxide, total carbon dioxide, bicarbonate, base shift, anion gap, sodium, potassium, chloride, total calcium and magnesium. Completely randomized designs with a 4 × 7 factorial scheme (groups × harvest time) in Phase 1 and a 4 × 6 factorial scheme (groups × harvest time) in Phase 2 were used with four replications. All values were considered significant when p≤0.05 (95% probability). Blood pH, bicarbonate concentration, and base shift in the PARGL group decreased, indicating metabolic acidosis. Changes in the acid–base and electrolyte balance were more intense in the PARGL group than in the other groups. These results demonstrated the need to monitor blood gas and electrolyte balance in horses with food restriction under nutritional support or prolonged fluid therapy so that such changes are promptly corrected.

Comparison of two glucose-monitoring systems for use in horses

OBJECTIVE

To determine the accuracy of 2 interstitial glucose-monitoring systems (GMSs) for use in horses compared with a point-of-care (POC) glucometer and standard laboratory enzymatic chemistry method (CHEM).

ANIMALS

8 clinically normal adult horses.

PROCEDURES

One of each GMS device (Dexcom G6 and Freestyle Libre 14-day) was placed on each horse, and blood glucose concentration was measured via POC and CHEM at 33 time points and compared with simultaneous GMS readings. An oral glucose absorption test (OGAT) was performed on day 2, and glucose concentrations were measured and compared.

RESULTS

Glucose concentrations were significantly correlated with one another between all devices on days 1 to 5. Acceptable agreement was observed between Dexcom G6 and Freestyle Libre 14-day when compared with CHEM on days 1, 3, 4, and 5 with a combined mean bias of 10.45 mg/dL and 1.53 mg/dL, respectively. During dextrose-induced hyperglycemia on day 2, mean bias values for Dexcom G6 (10.49 mg/dL) and FreeStyle Libre 14-day (0.34 mg/dL) showed good agreement with CHEM.

CLINICAL RELEVANCE

Serial blood glucose measurements are used to diagnose or monitor a variety of conditions in equine medicine; advances in near-continuous interstitial glucose monitoring allow for minimally invasive glucose assessment, thereby reducing stress and discomfort to patients. Data from this study support the use of the Dexcom G6 and Freestyle Libre 14-day interstitial glucose-monitoring systems to estimate blood glucose concentrations in horses.

Obesity-Related Metabolic Dysfunction in Dairy Cows and Horses: Comparison to Human Metabolic Syndrome

Obesity has become a serious health problem with frequent occurrence both in human and animal populations. It is estimated that it may affect over 85% of the human population and 70–80% of horses and cows by 2030. Fat cow syndrome (FCS) is a combination of metabolic, digestive, infectious, and reproductive disorders that affects obese periparturient dairy cows, and occurs most frequently in loose-housing systems, where periparturient and dry cows are fed and managed in one group disregarding the lactation stages. Equine metabolic syndrome (EMS) was named after human metabolic syndrome (MetS) and has insulin dysregulation as a central and consistent feature. It is often associated with obesity, although EMS may occur in a lean phenotype as well. Other inconsistent features of EMS are cardiovascular changes and adipose dysregulation. Laminitis is the main clinical consequence of EMS. MetS holds a 30-years old lead in research and represents a clustering of risk factors that comprise abdominal obesity, dyslipidemia, hypertension, and hyperglycemia (impaired fasting glucose or type 2 diabetes mellitus—T2DM), which are associated with doubled atherosclerotic cardiovascular disease risk, and a 5-fold increased risk for T2DM. The main aim of this review is to provide critical information for better understanding of the underlying mechanisms of obesity-related metabolic dysfunction in animals, especially in cows and horses, in comparison with MetS. Human medicine studies can offer suitable candidate mechanisms to fill the existing gap in the literature, which might be indispensable for owners to tackle FCS, EMS, and their consequences.

Current Concepts in Fluid Therapy in Horses

Despite the frequent inclusion of fluid therapy in the treatment of many conditions in horses, there are limited studies available to provide evidenced-based, species-specific recommendations. Thus, equine fluid therapy is based on the application of physiology and extrapolation from evidence in other veterinary species and human medicine. The physiologic principles that underly the use of fluids in medicine are, at first glance, straightforward and simple to understand. However, in the past 20 years, multiple studies in human medicine have shown that creating recommendations based on theory in combination with experimental and/or small clinical studies does not consistently result in best practice. As a result, there are ongoing controversies in human medicine over fluid types, volumes, and routes of administration. For example, the use of 0.9% NaCl as the replacement fluid of choice is being questioned, and the theoretical benefits of colloids have not translated to clinical cases and negative effects are greater than predicted. In this review, the current body of equine research in fluid therapy will be reviewed, connections to the controversies in human medicine and other veterinary species will be explored and, where appropriate, recommendations for fluid therapy in the adult horse will be made based on the available evidence. This review is focused on the decisions surrounding developing a fluid plan involving crystalloids, synthetic colloids, and plasma.

Terms, Definitions, Nomenclature, and Routes of Fluid Administration

Fluid therapy is administered to veterinary patients in order to improve hemodynamics, replace deficits, and maintain hydration. The gradual expansion of medical knowledge and research in this field has led to a proliferation of terms related to fluid products, fluid delivery and body fluid distribution. Consistency in the use of terminology enables precise and effective communication in clinical and research settings. This article provides an alphabetical glossary of important terms and common definitions in the human and veterinary literature. It also summarizes the common routes of fluid administration in small and large animal species.

Manufacturing Process, In Vivo and In Vitro Digestibility Assessment of an Enteral Feeding Product Hydrolyzed from Locally Available Ingredients Using Commercial Enzymes

A ready-for-use enteral feeding product was manufactured based on energy standard mixing using hydrolyzed products from local foods (i.e., loin pork, carrot, pumpkin, soybean, rice, and potato). When compared to enteral foods based on defined ingredients, the manufactured product is more cost-effective, appropriately functional and has similar physicochemical properties. Relative protein digestibility for in vitro value was tested by using enzyme pepsin, pH-drop and pH-stat method with three different enzymes. The product was shown to be easily digested with an in vivo digestibility value of 89.7%. Molecule sizes of components in the product ranged from 3.5 to 8.5 kDa, determined by SDS-PAGE, and the average molecular weight was 1.52 kDa, determined by Gel Permeation Chromatography (GPC) method. In terms of nutritional value, the product achieved a caloric density of 1 kcal/mL, dietary fibers of 1.48 g per 100 mL and provided both oligomeric and monomeric forms of protein. In addition, the product has the leucine: isoleucine: valine ratio of 2:1:1, thus facilitating the absorption of the protein. In conclusion, the manufactured enteral feeding product has been shown to be appropriate for providing nutritional support for patients.