Page 1385 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

1360 CHAPTER 14

VetBooks.ir route and composition of those fluids. This will be Protectants/adsorbents
There are many protectants/adsorbents on the mar-
determined by: (1) the age of the foal; (2) the degree
of mucosal damage suspected; (3) the severity of hypo-
ties. The preparation used is a question of personal
volaemia and dehydration; (4) metabolic disturbances; ket, but it is important to dose with adequate quanti-
(5) milk intake; and (6) the complicity of the foal and preference. The authors use di-tri-octahedral smec-
the competence of its handlers. If oral fluids are used, tite (Bio-Sponge , at a dose of 3 tbsp [~50 ml] in
®
it is important to ensure that they contain adequate 30 ml of water p/o q6–12 h) or bismuth subsalicylate
quantities of sodium, chloride, glucose, potassium and (Pepto Bismol, at a dose of 1–2 ml/kg q8–12 h).
bicarbonate or its precursors. Many types of com-
mercially produced electrolyte solutions or powders Drugs that alter motility
are readily available, some with the option of adding Drugs that reduce intestinal motility are contrain-
glucose. Small volumes should be given frequently (up dicated in infectious cases of diarrhoea. In chronic
to 500 ml q1–2 h) either by stomach tube, dosing or non-infectious cases, loperamide has proven useful
bucket feeding. Fresh clean water should always be (0.1 mg/kg p/o q6 h, then increased incrementally
available. Intravenous fluids are extremely important to 0.2 mg/kg).
in foals with diarrhoea in order to restore circulatory
volume rapidly and correct electrolyte imbalances. Probiotics
They are ideally administered by continuous infusion There are many probiotics available and they may
via an intravenous catheter and this requires hospi- help re-establish normal gut flora, although the
talisation. In many practice situations, intermittent scientific data demonstrating this are limited. One
boluses of fluid may be necessary. In the absence of study has reported an increased incidence of diar-
laboratory results, an isotonic balanced electrolyte rhoea in foals receiving a non-commercial probiotic
solution or lactated Hartmann’s solution spiked to containing Lactobacillus pentosus.
give a 5% glucose concentration is a good starting
point. The first litre may be given as a resuscitation Analgesics and anti-inflammatory drugs
bolus to hypovolaemic foals over 20 minutes, then the Flunixin meglumine has been used in the treatment
rate of infusion decreased to 3–5 ml/kg/hour, taking of endotoxaemia and septic shock (0.25 mg/kg i/v
into account maintenance requirements and increased q8–12 h), but evidence for efficacy remains contro-
losses. Additional potassium can be added to the fluids, versial and extreme care should be taken because
but it is safer given as oral KCl (8 g/50 kg q8 h) outside of the potential for serious side-effects, especially
of a closely monitored hospital setting. Hyponatraemia in collapsed and/or hypovolaemic foals. A useful
should be corrected slowly. Blood glucose concentra- analgesic in foals is N-butylscopalammonium bro-
tions should be monitored. A plan for fluid therapy in mide (Buscopan TM ) (0.3 mg/kg i/v), or butorphanol
the future should be made. Plasma will also enhance (0.01–0.04 mg/kg i/v), which is short acting and has
immune function in addition to supplementing albu- sedative effects.
min, metabolic nutrients and clotting factors. In con-
trast to calves, foals with diarrhoea very rarely require Antibiotics
bicarbonate administration; metabolic acidosis is typi- In many cases of foal diarrhoea, the use of antibi-
cally due to hyperlactataemia, which resolves with res- otics is contraindicated; however, there are several
toration of vascular volume and peripheral perfusion. situations when they are necessary. Young foals
with sepsis and diarrhoea, or those at risk of sep-
Antiulcer medication sis, should receive antibiotics to minimise the risk
Use of prophylactic antiulcer medication in the foal of bacterial translocation across the compromised
remains controversial (see Gastroduodenal ulceration intestinal mucosa. The combinations noted in the
syndrome, p. 1349). Omeprazole is the treatment of Neonatal sepsis section (p. 1339) are the best first
choice for clinically significant gastric ulceration in choice. Metronidazole (10–15 mg/kg p/o q6–12 h)
foals that will tolerate enteral medication. is indicated for treatment of clostridial diarrhoea