Patient: "Spinner" 14 year old QH gelding
Presenting complaint:Watery Diarrhea
Spinner was admitted to Willamette Valley Equine's 1infectious disease isolation unit for treatment of severe diarrhea of several days duration. Unfortunately, Spinner was not responding to medical treatment given at home by his primary veterinarian so he was hospitalized at Willamette Valley Equine for intensive care.
When he arrived at the hospital, Spinner was immediately given a 2physical examination and blood was drawn for laboratory analysis. The 3skin turgor test showed he was dehydrated and his 4GI motility was increased. He had watery green diarrhea. His 5heart rate was also elevated at 54 beats per minute. Spinner's 6mucous membranes were bright red, not the normal pale pink color. The laboratory analysis on Spinner's blood confirmed that he was dehydrated (his 7PCV was 62%) and 8hypoproteinemic (total protein 4.5 g/dl). He also had severe 9blood electrolyte abnormalities (low sodium, chloride, potassium). Spinner was diagnosed with 10Colitis.
Spinner was treated with large amounts of IV fluids and electrolytes to correct his dehydration and electrolyte abnormalities. He was also given a plasma transfusion to boost his low blood protein levels. Spinner received low doses of 11banamine every 6 hours to help fight inflammation and 12antibiotics to fight off bacteria that might be causing his diarrhea. Samples of his manure were collected and sent to a laboratory for bacterial culture and toxin analysis. Willamette Valley Equine's doctors and technicians monitored Spinner closely to make sure that he had plenty of food, water, and IV fluids at all times. Spinner had a physical examination and blood work performed every 4-6 hours. Analysis of Spinner's manure revealed toxins from Clostridium bacteria. This bacteria is known to cause severe diarrhea in horses and other species, including people.
Spinner slowly improved over the next week. He was able to come off IV fluids after 6 days and went home 4 days later. At home, Spinner was housed separately from the other horses for about 4 weeks, until recheck manure samples were negative for the Clostridium toxins or other organisms such as Salmonella. Spinner's owners report that he is gaining weight and starting to act like his old self again!
1Infectious Disease Isolation Unit: This is a separate hospital area designed to house horses that have potentially contagious diseases. Protective boots, gowns and gloves are worn by staff and visitors when they are in the isolation area and all equipment is used on one individual case and disinfected regularly. These precautions not only protect other horses in the hospital, but also protect the horse in isolation from being exposed to other pathogens while they are trying to recover from their current illness. In addition, some types of diarrhea in horses can affect people, especially old, young or people with compromised immune systems. Horses admitted to the isolation unit include horses with severe diarrhea and horses with infectious upper respiratory diseases such as influenza or strangles.
2Physical Examination: A physical examination gives your veterinarian important clues to how sick or healthy your horse may be. Vital signs, including temperature, pulse and respiration are checked, the lungs and intestinal sounds are listened to, and the mucous membranes and digital pulses are felt.
3Heart Rate: Normally, the horse's resting heart rate should be between 30 and 48 beats per minute. Elevated heart rates can indicate pain or shock in horses. You can listen to your horse's heart with a stethoscope on the chest just behind the elbow, or feel the pulse on an artery on the jaw or fetlock.
4Skin Turgor Test: This test is a simple way to see if your horse may be dehydrated. Pinch up a fold of skin just under his eye. When you let go, the skin should fall back down and smooth out. If it stays tented for more than 3 or 4 seconds, your horse maybe getting dehydrated. A blood test may be necessary to indicate the level of dehydration.
5GI Motility: Normally, when you listen to your horse's flank area you can hear intermittent gentle gurgling sounds. This is the large intestine at work, mixing and digesting food. In horses that have diarrhea, these sounds can be very loud, and constant. When the colon is irritated, it often has increased activity, which passes the food faster and decreases water reabsorption, resulting in loose manure.
6Blood Electrolytes: Electrolytes are ions such as sodium, potassium, chloride, and bicarbonate. These are normally present in blood and tissue in specific amounts and are essential for proper function of all of the body's internal organs. Often when a horse has colitis, the not only lose fluid and protein from their blood, but also valuable electrolytes. These must be replaced through IV fluids, electrolyte paste or powder, and mineral blocks. Since high levels of electrolytes can be dangerous as well, when a horse is receiving electrolytes in IV fluids, the blood electrolyte levels must be monitored very closely.
7Colitis: Inflammation of the large intestine or colon, causing watery diarrhea and severe dehydration, hypoproteinemia, and electrolyte abnormalities. This can be a life threatening condition and often the horse needs intensive care to survive. Several organisms can cause colitis. The bacteria, Salmonella and Clostridium, can cause severe, life threatening diarrhea. The organism responsible for Potomac horse fever can also cause diarrhea. Often it can be hard to isolate the offending organism. Analysis and culture of the manure can sometimes isolate the organism or the toxins it makes, but often, the inciting cause for the diarrhea goes undetected. Treating horses with colitis can be very complex, and often the treatments change daily or even hourly! The most important part of treating horses with colitis is keeping the dehydration and electrolyte abnormalities under control with high volume IV fluids supplemented with electrolytes.
8Mucous membranes: Normally, a horse's mucous membranes should be pale pink. When a horse is very sick, the gums will appear bright red. This usually means that the horse is fighting toxins released by bacteria.
9PCV (Packed cell volume): This blood test helps your veterinarian determine how dehydrated your horse is. The packed cell volume (PCV) is a measure of the percentage of cells to fluid in your horse's blood. Normally the PCV should be between 30 to 44 %. When a horse is dehydrated, the percentage of fluid in the blood drops and the percentage of cells increase. In Spinner's case, his PCV was very high at 62% because he was losing body fluid due to severe diarrhea. This test is also known as HCT or hematocrit.
10Hypoproteinemic (low blood protein): Normally when a horse gets dehydrated from not drinking, the percentage of protein (total protein or TP) increases. However, in Spinner's case, he was very dehydrated (high PCV), yet his TP was low at 4.6 g/dl (normal 6-7 g/dl). This happens in cases of severe diarrhea (colitis). The large colon becomes so inflamed that both protein and fluid from within the tissues and blood are lost in the diarrhea. Horses that are severely hypoproteinemic often require a plasma transfusion or treatment with colloidal fluids such as hetastarch.
11Banamine: This is a non-steroidal anti-inflammatory drug used in horses to fight inflammation, pain, and the effects of bacterial toxins. This drug should always be used only under the advice of your veterinarian.
12Antibiotics: These are drugs that kill bacteria. They are used to treat diarrhea when it is known to be caused by a specific bacteria, or when a certain bacteria is suspected to be causing the bacteria. Unfortunately, antibiotics can sometimes indirectly cause diarrhea too, by killing off the "good" bacteria normally present in the colon to help with digestion. In many cases, if a horse has gotten colitis while on antibiotics for another reason, the best antibiotic is often no antibiotics at all. Your veterinarian will decide what treatments are best for your horse depending on the individual case.