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.     

Monitoring the critically ill equine patient.

Measurements of physiologic parameters, such as blood pressure or lactate concentration, are useful to detect occult derangements, such as tissue hypoxia and dysoxia. These tools are also useful in determining the effects of therapy. Monitoring techniques are now widely available for the intensive management of critically ill horses and foals. A number of these have evolved into noninvasive or minimally invasive devices and procedures and provide information that can be used for earlier and more dynamic therapeutic intervention. The goal of increased monitoring is to improve the level of care in the ICU; L ultimately. increased survival of critical patients is the motivation behind enhanced monitoring of physiology, with particular attention being paid to trends or alterations over time. This review highlights practical and informative monitoring tools and techniques and provides normal reference values from the literature.     

Ventilatory support of the critically ill foal.

Critically ill foals often have respiratory failure and benefit from respiratory support. Conventional mechanical ventilation using modem mechanical ventilators is easily adapted to foals. Establish-ing ventilator settings is a dynamic process aided by constant monitoring of blood gas values, end-tidal carbon dioxide, airway pressures, respiratory volumes, airway resistance, and respiratory compliance. Early weaning is as important as timely initiation of ventilation.     

Anesthesia of the critically ill equine patient.

There is a plethora of information regarding anesthetic management of horses; however, controlled studies of the critically ill equine patient are few.These patients should be managed like any equine anesthetic candidate but much more stringently:I. Preoperative evaluation and appropriate therapy may represent the difference between life and death during the intraoperative and recovery periods. 2. The anesthetic induction and maintenance protocol should be based on the individual situation of the veterinary facility and personnel("comfort zone"). 3. Appropriate monitoring and intraoperative supportive measures are essential. 4. The anesthetic period is a significant perturbation to homeostasis. Even if the horse seems to have done well (ie, as indicated by the cardiopulmonary values), a problem-free anesthetic period does not guarantee a successful recovery, and close monitoring should continue until the horse is ambulatory. 5. Critically ill patients are often in a negative energy balance. Supportive measures to ensure an adequate caloric intake, such as enteral or parenteral nutrition, facilitate healing and return of homeostasis.     

Monitoring the critically ill patient

Monitoring is the key to a successful critical care endeavor. It is the only way in which we know if we did a good thing and if we did enough of it (or too much). Oftentimes, the decision to treat or not to treat is made difficult by the paucity of information available. The secret is to make an intuitive decision and then monitor the patient to see if it was the right or the wrong decision. Most wrong decisions can be caught and corrected long before the patient has suffered the consequences. Go forth, and monitor!     

Analgesia and sedation in the critically ill

Objective: To summarize the challenges to recognizing pain in critically ill patients, the rationale for treatment even in the absence of signs of pain, and the therapeutic options available in the intensive care environment. Etiology: Pain is one of many stressors challenging the critically ill patient, and may in turn be multifactorial in nature. Common causes include local and systemic inflammation, injuries, diagnostic and therapeutic procedures, immobilization, and thrombosis. Diagnosis: Critically ill animals with pain may not demonstrate overt behavioral or physiologic signs of distress. Therefore, pain must be assumed to be present for animals whose condition puts them at risk. Therapy: Currently available analgesic and sedative drugs and methods of delivery are described. Several useful analgesics and sedatives may be co‐administered as fluid additives to provide continuous therapy. Prognosis: There is growing evidence that the neuroendocrine stress response to severe injury or illness may become sufficiently intense to contribute to morbidity and mortality. Many therapeutic analgesic and sedation options provide good control of pain and stress, and in some circumstances this may improve the outcome of critical illness.     

Nutrition considerations for the aged horse

As the proportion of aged horses within the general equine population appears to be increasing in the UK and other developed countries, it is important to be aware of the changing dietary requirements associated with the ageing process and age-related diseases. This review provides guidelines for optimal nutrition of the older horse with practical approaches to improve or maintain body condition and support general health.     

Nutrition and fuel utilization in the athletic horse

Substrate depletion and end product accumulation are two important factors in exercise fatigue. Fatigue during long-term exercise results from a depletion of muscle and liver glycogen and coincides with an inability to maintain blood glucose levels. During high intensity exercise, the rapid catabolism of carbohydrate and the resultant production of lactate and hydrogen ions cause a reduction in muscle pH that inhibits maximum force generation. Dietary manipulations that can influence carbohydrate status or lactate accumulation may be beneficial to performance. In human athletes, carbohydrate loading and carbohydrate supplementation can enhance endurance time during long-term exercise. These practices have not been explored extensively in the equine athlete, although glycogen loading does not enhance the performance of horses during short-term intense work. Short-term work can be detrimentally affected if glycogen levels are inadequate. The most marked effect of exercise on nutrient requirements is in the energy requirement. Horses in heavy training may require more energy than they can consume on a conventional diet. Fat has been added to horse diets to increase energy density, usually at levels between 6% and 12% of the total diet. Although protein requirements may be slightly increased in the working horse, supplementing protein as a means of adding calories is not an efficient practice. In addition, although studies with horses are not available, human studies indicate that there are no benefits to vitamin supplementation above required levels. At this point, more is unknown than is known about feeding performance horses. Most information on fuel utilization is extrapolated from studies with rats and humans. Areas that have received little attention but are critical to optimizing feeding practices are the timing of pre-event feeding and the determination of ideal body composition in equine athletes of different types.     

Fluid therapy in the critically ill patient

Fluid therapy products for use in the critically ill patient are described. Various specific clinical syndromes are described in detail, including shock, hypoalbuminemia, heart failure, liver failure, diabetic keto-acidosis and pancreatitis. Pathophysiology and specific therapeutic recommendations are given for these clinical syndromes.     

Coagulopathy of the critically ill equine patient

Objective – To review the hemostasis literature relevant to development of coagulopathy in the critically ill equine patient.
Data Source – Original scientific and review articles.
Human Data Synthesis – Inflammation plays a critical role in the activation and amplification of clot formation, as well as the impairment of physiologic anticoagulant mechanisms, and fibrinolysis. Earlier identification of coagulopathy in patients at risk and restoration of physiologic hemostasis may result in better outcome. Development of scoring systems based on information other than coagulation markers alone may better identify patients with subclinical coagulopathy.
Veterinary Data Synthesis – Critically ill equine patients commonly at risk for coagulopathy include those with severe gastrointestinal disease, septic foals, and adults subjected to severe systemic inflammatory response syndrome. Publications provide information regarding coagulation markers helpful for identification of hemostatic dysfunction in specific patient populations, as well as information regarding the influence of coagulopathy on outcome. Data regarding clinically relevant information on therapeutic intervention are lacking.
Conclusions – The relationship between inflammation and endotoxemia and development of coagulopathy is better understood in both human patients and the critically ill equine patient. Prospective clinical trials evaluating clinically relevant and financially feasible approaches to treatment are still needed.     

Nutritional requirements of the critically ill patient

The presence or development of malnutrition during critical illness has been unequivocally associated with increased morbidity and mortality in people. Recognition that malnutrition may similarly affect veterinary patients emphasizes the need to properly address the nutritional requirements of hospitalized dogs and cats. Because of a lack in veterinary studies evaluating the nutritional requirements of critically ill small animals, current recommendations for nutritional support of veterinary patients are based largely on sound clinical judgment and the best information available, including data from experimental animal models and human studies. This, however, should not discourage the veterinary practitioner from implementing nutritional support in critically ill patients. Similar to many supportive measures of critically ill patients, nutritional interventions can have a significant impact on patient morbidity and may even improve survival. The first step of nutritional support is to identify patients most likely to benefit from nutritional intervention. Careful assessment of the patient and appraisal of its nutritional needs provide the basis for a nutritional plan, which includes choosing the optimal route of nutritional support, determining the number of calories to provide, and determining the composition of the diet. Ultimately, the success of the nutritional management of critically ill dogs and cats will depend on close monitoring and frequent reassessment.     

Hypocalcemia in a critically ill patient

Objective: To present a case of clinical hypocalcemia in a critically ill septic dog. Case summary: A 12‐year old, female spayed English sheepdog presented in septic shock 5 days following hemilaminectomy surgery. Streptococcus canis was cultured from the incision site. Seven days after surgery, muscle tremors were noted and a subsequent low serum ionized calcium level was measured and treated. Intensive monitoring, fluid therapy, and antibiotic treatment were continued because of the sepsis and hypocalcemia, but the dog was euthanized 2 weeks after surgery. New or unique information provided: Low serum ionized calcium levels are a common finding in critically ill human patients, especially in cases of sepsis, pancreatitis, and rhabdomyolysis. In veterinary patients, sepsis or streptococcal infections are not commonly thought of as a contributing factor for hypocalcemia. Potential mechanisms of low serum ionized calcium levels in critically ill patients include intracellular accumulation of calcium ions, altered sensitivity and function of the parathyroid gland, alterations in Vitamin D levels or activity, renal loss of calcium, and severe hypomagnesemia. Pro‐inflammatory cytokines and calcitonin have also been proposed to contribute to low ionized calcium in the critically ill. Many veterinarians rely on total calcium levels instead of serum ionized calcium levels to assess critical patients and may be missing the development of hypocalcemia. Serum ionized calcium levels are recommended over total calcium levels to evaluate critically ill veterinary patients.     

Bacteriological culture of blood from critically ill neonatal calves.

The objectives of this study were to estimate the prevalence of bacteremia in critically ill, neonatal calves with severe diarrhea or depression, and to describe the variety of bacteria involved. Two studies were conducted in the summers of 1991 and 1993 involving 190 neonatal calves, 1-day to 19-days-old. Bacteremia was detected by blood culture in 31% (28/90) of calves in study 1, and in 24% (19/79) of ill calves and 0% (0/21) of control calves in study 2. Bacteria cultured from blood included Escherichia coli (51% of all isolates), other gram-negative enterics (25.5%), gram-negative anaerobes (5.9%), gram-positive cocci (11.8%), and gram-positive rods (5.9%). Among clinically ill calves, the average age was significantly lower in the blood culture-negative group (5.5 d) than in the blood culture-positive group (7.5 d) (P = 0.004). Mean serum IgG concentration was significantly (P = 0.0001) lower in blood culture-positive calves (1.146 g/L) than in blood culture-negative calves (3.077 g/L). The mortality rate was significantly (P < 0.0001) higher in the blood culture-positive group (57.4%) than in the blood culture-negative group (15.1%). Bacteremia appeared to be a frequent entity in this particular rearing situation. Early recognition of the problem, as well as appropriate treatment, may be beneficial in increasing survival rates. Results also support the need to address the failure of passive transfer of maternal antibodies to prevent bacteremia in calves.