Nutritional considerations for horses with colitis. Part 1: Nutrients and enteral nutrition

The equine colon is the primary site of fibre digestion and water absorption. It is therefore not surprising that colitis and associated colonic dysfunction can result in severe nutritional derangements, which can be exacerbated by reduced feed intake in affected horses. Dietary management of colitis is important for optimum recovery. In broad terms, it should prioritise provision of nutrients to horses that otherwise have reduced appetites. In some forms, such as right dorsal colitis, as well as those with chronicity, nutritional recommendations include restricting or eliminating long‐stem roughage from the diet and feeding a complete pelleted diet. Voluntary enteral nutrition is preferred, but horses that are not ingesting enough to meet the minimum recommended requirements as outlined, should be fed via nasogastric tube (if tolerated – no reflux, no ileus and no colic present; faecal output present). Parenteral nutrition may be necessary in some cases, as some colitis cases do not tolerate enteral feeding for reasons such as colic, intestinal dysmotility or abdominal distension. Timing and constitution of nutritional intervention is vital and should be tailored to the individual patient to prevent further complications of the disease process.     

Nutrition for critical gastrointestinal illness: feeding horses with diarrhea or colic.

Horses with GI diseases such as colic and diarrhea are often intolerant of adequate enteral nutrition. Nutritional intervention should be an early part of therapeutic management in such cases. Protein and energy malnutrition in critically ill horses can have deleterious effects, including poor wound or incisional healing, reduced immunity, and weight loss. Early enteral or parenteral support should be provided to supply resting DE requirements in the equine ICU.     

Nutritional management of the foal with diarrhoea

Diarrhoea is a common problem in the neonatal and suckling foal. In certain circumstances supplemental nutrition is necessary depending on the age of foal, severity of diarrhoea and presence of other systemic manifestations. Nutritional supplementation can be provided either enterally or parenterally. Enteral nutrition is superior to parenteral nutrition because it is the most natural and physiologically sound means to provide nutritional support. Parenteral nutrition may be warranted if the foal is unable to receive or tolerate enteral nutrition. Dextrose alone or with amino acids and lipids can provide appropriate nutrition when enteral feeding is not tolerated. As soon as the foal stabilises enteral feeding can be reintroduced.     

Primary gastric impaction in horses: A retrospective study of 20 cases (2005–2008)

Primary gastric impaction is an uncommon condition. Furthermore, the factors associated with gastric impaction and the optimal method of treatment are not clear. The aim of this article is to describe the clinical findings, treatment and outcome of horses with a primary gastric impaction. Medical records of horses that presented with a primary gastric impaction between 2005 and 2008 were reviewed and 20 horses with a primary gastric impaction identified. Diagnosis of a primary gastric impaction was made if the horse had been fasted for a minimum of 16 h, a concretion of ingesta precluded visualisation of the margo plicatus and there was no evidence of concurrent intestinal pathology. Thirteen of 20 (65%) horses were presented on an emergency basis. The most common complaint was inappetence (50%) followed by acute colic (35%) and recurrent colic (35%). On initial examination for colic, all horses had a normal heart rate and 7 of 20 (35%) had decreased gastrointestinal borborygmi. All horses were treated with enteral fluid therapy. The median dose of fluids administered per day was 5 doses (range 1–8 doses) of 2–10 l of isotonic electrolyte solution. The median length of treatment until resolution was 2 days (range 1–5 days). Eighteen of 20 (90%) horses survived to discharge. Primary gastric impaction appears to be a condition with clinical signs of inappetence and mild abdominal discomfort. This is the largest group of horses reported that were treated with enteral fluid therapy for a gastric impaction and it was concluded that enteral fluid therapy was of value in this study.     

AN EXAMINATION OF THE CALCIUM AND PHOSPHORUS NUTRITION OF THOROUGHBRED RACEHORSES

SUMMARY The calcium and phosphorus nutrition of thoroughbred racehorses was assessed by analysis of serum and urine samples collected from 90 horses in 1975 and 139 horses in 1980–81 at racetracks in Melbourne. Horses that were excreting greater than 15 μmole Ca/mosmole and which had a calcium to creatinine clearance ratio greater than 2.5% were considered to have adequate Ca intake. Horses that were excreting greater than 15 μmole P/mosmole and which had a phosphorus to creatinine clearance ratio greater than 4% were considered to have excessive phosphorus intake. Sixty-percent of the horses sampled had adequate Ca intake, and 44% had excessive intakes of P. Twenty-five percent of the horses were excreting more P in urine than Ca. This would indicate these horses were subjected to nutritional secondary hyperparathyroidism, and horses entered in races by 53 of 99 trainers were in this category. It may be concluded that a high proportion (40%) of thoroughbred racehorses receive inadequate calcium nutrition while they are fed high-grain diets during racing.     

Effects of enteral and intravenous fluid therapy, magnesium sulfate, and sodium sulfate on colonic contents and feces in horses

OBJECTIVE: To assess changes in systemic hydration, concentrations of electrolytes in plasma, hydration of colonic contents and feces, and gastrointestinal transit in horses treated with IV fluid therapy or enteral administration of magnesium sulfate (MgSO4), sodium sulfate (NaSO4), water, or a balanced electrolyte solution. ANIMALS: 7 horses with fistulas in the right dorsal colon (RDC). PROCEDURE: In a crossover design, horses alternately received 1 of 6 treatments: no treatment (control); IV fluid therapy with lactated Ringer's solution; or enteral administration of MgSO4, Na2SO4, water, or a balanced electrolyte solution via nasogastric intubation. Physical examinations were performed and samples of blood, RDC contents, and feces were collected every 6 hours during the 48 hour-observation period. Horses were muzzled for the initial 24 hours but had access to water ad libitum. Horses had access to hay, salt, and water ad libitum for the last 24 hours. RESULTS: Enteral administration of a balanced electrolyte solution and Na2SO4 were the best treatments for promoting hydration of RDC contents, followed by water. Sodium sulfate was the best treatment for promoting fecal hydration, followed by MgSO4 and the balanced electrolyte solution. Sodium sulfate caused hypocalcemia and hypernatremia, and water caused hyponatremia. CONCLUSIONS AND CLINICAL RELEVANCE: Enteral administration of a balanced electrolyte solution promoted hydration of RDC contents and may be useful in horses with large colon impactions. Enteral administration of either Na2SO4 or water may promote hydration of RDC contents but can cause severe electrolyte imbalances.     

Total parenteral nutrition in four healthy adult horses

Total parenteral nutrition was accomplished in 4 healthy adult horses. During the 10-day study, the horses were not permitted to ingest food or water. Body weight was maintained at 94% of initial values without clinical evidence of dehydration. Serum urea nitrogen and triacylglycerol concentrations decreased during the study, without other significant hematologic or biochemical changes. Horses adapted without problems to the routine of IV feeding and confinement. All horses were healthy at the conclusion of the study. It was concluded that intravenous feeding with a lipid-glucose-amino acid-electrolyte solution was an acceptable method of maintaining nutrition in the healthy adult horse.     

Treatments to promote colonic hydration: enteral fluid therapy versus intravenous fluid therapy and magnesium sulphate

Although large intestine impactions are commonly treated with i.v. fluids combined with the osmotic laxative MgSO4, enteral fluids are less expensive and also appear to be efficacious for impactions. Therefore, this study was conducted to compare the systemic and gastrointestinal effects of enteral fluids with the changes produced by i.v. fluids combined with MgSO4. Four horses with a fistula in the right dorsal colon alternately received both treatments in 2 periods one week apart. Sixty litres of fluids were administered continuously (10 l/h) through a venous catheter or a nasogastric tube. Magnesium sulphate (1 g/kg bwt) was administered via nasogastric tube before i.v. fluid therapy. Two horses had mild abdominal discomfort at the end of enteral fluid therapy. Pollakiuria, hypostenuria, increased bodyweight, increased faecal and ingesta hydration, and decreased PCV, plasma protein and plasma magnesium were produced by both treatments. Abdominal distention and more pronounced changes in bodyweight and ingesta hydration were seen with enteral fluids. Intravenous fluids plus MgSO4 produced hypocalcaemia and more pronounced changes in plasma protein. These results indicate that enteral fluid therapy is more effective in promoting ingesta hydration and produces less pronounced systemic effects than i.v. fluid therapy plus MgSO4.     

Equine Nutrition in the United States: A Review of Perceptions and Practices of Horse Owners and Veterinarians

Nutrition plays a critical role in equine health. The horse owner and/or manager has a multitude of equine nutrition sources available to them, with preferences for how, and from whom, this information is delivered. Despite this, poor feeding practices continue to negatively affect the health, wellness, and welfare of equids and have a detrimental impact on the environment. The veterinarian is the primary expected source of equine nutrition information; yet, little is known about their recognition and acceptance of such a role. Doubt has arisen concerning the quality and provision of nutrition education within the veterinary curriculum and subsequent continuing education. Moreover, the value equine nutrition education plays in the veterinarian's practice philosophy, and the resulting provision of such in clinical practice, remains under evaluated. This review examines the present state of equine nutrition and how horses are being fed in practice, in the United States. It considers feeding horses from the horse owner's perspective and the expected role the veterinarian plays in such. Last, it goes on to evaluate this expected role from the veterinarian's perspective, examining how current nutrition education and practices may be falling short and offering recommendations for future research.     

Enteral fluid therapy in large animals

Enteral fluids administered alone, or in conjunction with intravenous fluids, are reported to be useful for the treatment of dehydration and electrolyte loss associated with diarrhoea in a number of species, following exercise in horses and for feed impaction of the large intestine of horses. Enteral fluids are suitable for treatment of mild to moderately dehydrated patients with some intact intestinal epithelium and motile small intestine. In patients that will drink voluntarily or tolerate nasal intubation the use of enteral fluids may avoid the complications associated with intravenous fluid administration. However the labour costs associated with repeated nasal intubation in intensively managed patients requiring large volumes of fluids may make the use of enteral fluids less economical than intravenous fluid administration. Enteral fluid use alone is contraindicated in patients that are severely dehydrated and/or in hypovolaemic shock, however, if used in conjunction with intravenous fluids, the effects of villous atrophy and malnutrition may be ameliorated and the duration of hospitalisation shortened. There is a variety of commercially available enteral fluids available to veterinary practitioners. While the key components of these fluids are sodium, chloride and carbohydrates, the amounts of ions and other ingredients such as potassium, alkalising agents, amino acids and shortchain fatty acids may vary. The species of the animal, the underlying condition, and the constituents of the fluid, should influence the choice of an enteral fluid.     

益生菌对肠内营养治疗并发腹泻的调节作用

为研究益生菌对行肠内营养治疗患者肠道适应性的调节作用,采用随机数表将157 例患者分为研究组（n＝101）和对照组（n＝56）,进行双盲、随机对照研究。根据Harris-Benedict公式测算基础能量消耗,氮供给量0.2 g/（kg?d）,研究组给予肠内营养＋益生菌,对照组给予肠内营养,治疗期10 d。统计患者的基础人口学资料及临床信息,于肠内营养治疗前和治疗后第10天观察并记录患者的体质量、体质量指数等指标,评价肠道及肾脏等重要脏器的营养代谢状况。结果表明：肠内营养治疗后第10天,2 组患者的营养不良     

Nutritional and clinicopathological effects of post operative parenteral nutrition following small intestinal resection and anastomosis in the mature horse

REASONS FOR PERFORMING STUDY: There is an absence of data describing the nutritional requirements and nutritional status of horses following surgery for colic; furthermore, the potential effect of parenteral nutrition (PN) on improving nutritional status in such cases is unknown. HYPOTHESIS: Post operative colic cases suffer from a potentially detrimental negative energy balance and the PN formulation developed in this study would lead to clinicopathologically detectable improvements in the subjects' nutritional status. METHODS: Several clinicopathological variables, some known to be associated with nutritional status, were compared in 2 groups of horses in the post operative period following colic surgery; Group N (n = 15) were treated with PN and Group C (n = 15) were starved routinely. RESULTS: Group N had significantly lower serum concentrations of triglycerides, total bilirubin, albumin and urea and significantly higher serum concentrations of glucose and insulin compared with Group C in the post operative period. CONCLUSIONS: The control group of horses demonstrated significant clinicopathological evidence of starvation and the described PN protocol resulted in a demonstrably improved nutritional status in the treated horses. POTENTIAL RELEVANCE: Further study is required to investigate clinical benefits and possible harmful side effects of post operative parenteral nutrition before the technique can be advocated for widespread use in practice.     

Antimicrobial therapy in neonatal foals

There are several differences in treatment of neonatal foals with antimicrobials, compared to mature horses. Firstly, the dose of many antimicrobials is different in the foal. For orally administered drugs, this may also affect their efficacy, due to different enteral absorption. Secondly, neonatal foals are not yet hindgut fermentors and this allows antimicrobials with a high propensity to cause colitis in mature horses to be used. Thirdly, toxicities are different and some antimicrobials used in mature horses, such as enrofloxacin, are not suitable for use in foals. Foal-specific information is therefore needed for their safe and effective treatment with antimicrobials.     

河曲马牧草和全血矿物质营养状况的研究

对河曲马主要牧草和全血１０种矿物质营养状况进行了研究,结果表明,当地牧草中Ｓｅ、Ｚｎ含量极显著低于ＮＲＣ（１９８９）规定的马营养需要量（Ｐ〈０．０１）,而Ｃａ含量较高,Ｐ含量较低,造成牧草中Ｃａ、Ｐ比较严重失谳（Ｃａ：ｐ达７．６～８．３：１）,同时发现牧草中Ｃｕ含量在马营养需要量的临界水平,全血矿物元素含量的分析表明,所测元素性别间均无显著差异（Ｐ〉０．０５）。     

Nutrition and feeding of the geriatric horse.

Little is known regarding nutrient requirements and feeding of geriatric horses, and more effort should be placed on this area of equine nutrition research. That which is known suggests that some geriatric horses may not have different requirements than other mature horses, whereas others affected by disease or poor dentition may have special nutritional needs. In general, rations for geriatric horses should be based on high-quality roughage supplemented with complementary minerals and vitamins. The need for additional energy aside from that provided by the forage can be supplied by adding energy concentrates, such as cereal grains or fat, to the ration. Processing techniques involving heat, such as pelleting and extruding, are advised when cereal grains are included in the ration so as to improve starch digestibility in the small intestine and avoid starch overload in the hindgut and it subsequent problem (ie, colic, laminitis). In addition, the environment in which geriatric horses are fed should be one that promotes ease of ration consumption and eliminates factors thar impair feed consumption, such as competition from other horses and the need to travel relatively long distances (eg, grazing marginal pastures). Finally, strict attention should be paid to the body condition of geriatric horses so as to evaluate adequacy of the ration and the general health of the horse.     

A Retrospective Study of the Use of Total Parenteral Nutrition in Dogs and Cats

The records of all dogs and cats receiving total parenteral nutrition (TPN) over a 43-month period were examined retrospectively. Dextrose, amino acids, lipids, electrolytes, and vitamins were administered by central venous catheter according to published nutrient recommendations; 72 dogs and 12 cats were studied, accounting for 380 patient days of TPN. Duration of TPN administration was 1–14 days with a mean of 4.5 days. Most animals required TPN because of gastrointestinal dysfunction, and more than half of them gained weight during TPN administration. Mechanical complications were frequent. Metabolic complications, especially lipid and glucose intolerance, were also commonly seen. Septic complications were the least frequently encountered, but resulted in patient morbidity and may have contributed to mortality. Most animals receiving TPN were returned to enteral nutrition and discharged. For critically ill animals unable to tolerate enteral alimentation, TPN can be supportive therapy in the treatment of the primary disease.     

Esophagostomy Feeding Tube Use and Placement in Exotic Pets

Providing enteral nutrition to injured or ill exotic animal patients by means of assisted feedings minimizes catabolism and gastrointestinal morbidity associated with anorexia, while optimizing immune system and organ function, and providing nutritional precursors necessary for healing. When determining the nutritional needs of a debilitated animal, it is important to account for both metabolic rate and energy requirements. Providing enteral nutrition via a feeding tube utilizes the functional gastrointestinal tract in patients that cannot or will not eat. Additionally, administration of food through a feeding tube is significantly less stressful for patients than restraint and syringe feeding. Feeding tube placement should be considered in any animal where the stress associated with syringe feeding is likely to result in significant morbidity or when the need for an extended period of assisted feeding is required.     

Use of a human enteral feeding preparation for treatment of hyperlipemia and nutritional support during healing of an esophageal laceration in a miniature horse.

Nasogastric infusion of a human enteral feeding preparation was effective in reversing hyperlipemia in an anorectic miniature horse with an esophageal laceration. The nutrient preparation was delivered every 4 hours by gravity flow through a 12 F enteral feeding tube. Within 48 hours of initiating enteral nutrition, the hyperlipemia had resolved. Signs of intolerance to the preparation were not observed, and further weight loss was prevented. The use of a human enteral formula was a convenient and successful alternative for the treatment of hyperlipemia in the horse.     

Early enteral nutrition in young dogs suffering from haemorrhagic gastroenteritis

The purpose of this study was to investigate clinical and metabolic effects of combined parenteral and oral nutrition compared with parenteral nutrition in young dogs with haemorrhagic gastroenteritis in a prospective clinical study. Dogs with acute gastroenteritis received either parenteral nutrition (group PN, n = 9) or combined parenteral and early enteral nutrition (group EN, n = 10). Infusions were compounded from amino acids, lipids, glucose and electrolyte/glucose solutions [149 g/l glucose, 20 g/l triglycerides, 40 g/l amino acids and 4009 kJ metabolizable energy/l (957 kcal ME/l)], and supplemented with potassium, phosphate and trace elements. Group EN received additionally a hydrolysed diet (74 kJ/kg BW(0.75) on day 2 and 148 kJ/kg BW(0.75) on days 3 and 4). Glucose, triglycerides, protein, albumin, fibrinogen, urea, creatinine, alkaline phosphatase, glutamate dehydrogenase and glutamate pyruvate transaminase were measured before and during the infusions, haematological traits only before the infusions. Statistics included two-factorial anova and subsequent t-test or Wilcoxon test (P < 0.05). All dogs of group EN survived compared with seven of nine patients in group PN. Most dogs in the EN group vomited within half an hour after introduction of oral feeding on day 2 but tolerance for food increased on days 3 and 4. The general health status and faecal and blood parameters of the surviving dogs were similar (P > 0.05) between the groups. In all dogs leucocytes increased during the treatment period, haematocrit and haemoglobin levels declined. Infusions increased blood glucose and triglycerides (P < 0.05); however, no adverse signs were observed. Early enteral nutrition was possible after a short period of adaptation, however, vomiting can be a severe problem. The evaluation of clinical benefits of early enteral nutrition in young dogs with haemorrhagic gastroenteritis requires further investigations.     

Clinical nutrition of adult horses

Horses suffering from trauma, sepsis, and severe burns need 12% to 16% of protein (dry matter basis) in their diet. Since reduced appetite may be a problem, relatively energy dense (greater than 2 Mcal DE/kg) feeds should be offered. In hepatic failure, maintenance protein requirements (8% on a dry matter basis for adult horses) should be met with feeds that are high in short branched-chain amino acids and arginine but low in aromatic amino acids and tryptophan (for example, milo, corn, soybean, or linseed meal) in addition to grass hay. Vitamins A, C, and E should also be supplemented. In cases with renal failure, protein, calcium, and phosphorus should be restricted to maintenance or lower levels. Grass hay and corn are the best feeds for horses with reduced renal function. Do not offer free-choice salt to horses with dependent edema from uncompensated chronic heart failure. Following gastrointestinal resection, legume hay and grain mixtures are the feeds of choice. Horses with diarrhea should not be deprived or oral or enteral alimentation for prolonged periods of time. Liquid formulas may be used if bulk or gastrointestinal motility are a problem. Apple cider vinegar and a high grain diet may reduce the incidence of enteroliths in horses prone to this problem. Pelleted feeds will reduce fecal volume and produce softer feces for horses that have had rectovaginal lacerations or surgery. Horses with small intestinal dysfunction or resection should be offered low residue diets initially, but long-term maintenance requires diets that promote large intestinal digestion (alfalfa hay, vegetable oil, restricted grain). Geriatric horses (greater than 20 years old need diets similar to those recommended for horses 6 to 18 months old.