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Johns I. Paraneoplastic Syndromes in Horses. Vet Clin North Am Equine Pract 2024:S0749-0739(24)00074-9. [PMID: 39168749 DOI: 10.1016/j.cveq.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
This article discusses the reported paraneoplastic syndromes (PNSs) in horses, including the possible pathogenesis, diagnostic methods, and any treatment options. The more commonly reported PNSs in horses include cancer anorexia and cachexia, fever and increased acute phase protein concentrations, and hypercalcemia and monoclonal gammopathy. As these conditions can often be more commonly diagnosed in non-neoplastic conditions, the diagnosis of a PNS and the accompanying neoplasia can be challenging. As signs of a PNS may precede signs of the underlying neoplasia, it is important that the clinician be aware of the possible presence of a PNS.
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Affiliation(s)
- Imogen Johns
- B and W Equine Hospital, Breadstone, Berkeley, Gloucestershire GL139HG, UK.
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Fielding CL, Deane EL, Major DS, Mayer JR, Love JC, Peralez MS, Magdesian KG. Effects of calcium supplementation to resuscitation fluids in endurance horses: A randomized, blinded, clinical trial. J Vet Intern Med 2023; 37:1216-1222. [PMID: 37129859 DOI: 10.1111/jvim.16715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 04/06/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND The addition of calcium to resuscitation fluids is a common practice in horses, but studies evaluating the effects of calcium supplementation are limited. In healthy horses, decreases in heart rate and changes in serum electrolyte concentrations have been reported. HYPOTHESIS Calcium gluconate administration at a rate of 0.4 mg/kg/min to eliminated endurance horses with metabolic problems will affect heart rate, gastrointestinal sounds, and serum electrolyte concentrations. ANIMALS Endurance horses eliminated from the Tevis Cup 100-mile (160 km) endurance ride for metabolic problems and requiring IV fluid therapy were eligible. METHODS Sixteen horses were randomly assigned to receive 0.4 mg/kg/min of calcium (23% calcium gluconate solution) over 1 hour diluted in 10 L of a non-calcium containing isotonic crystalloid (CAL group) or 10 L of a non-calcium containing isotonic crystalloid (CON group). Staff members administering the fluids were blinded to treatment group. Blood samples were collected and physical examinations performed before and after treatment. Heart rates were recorded every 15 min during fluid administration. Data were compared using 2-way analysis of variance (ANOVA) with repeated measures for continuous variables and Fisher's exact test for categorical variables. RESULTS Calcium was associated with lower heart rates 45 min after starting the infusion (P = .002). Gastrointestinal sounds were less likely to improve in the calcium group compared with the control group (P = .005). An increase in plasma phosphorus concentration (P = .03) was associated with calcium administration. CONCLUSIONS Intravenous calcium supplementation to endurance horses eliminated from competition after development of metabolic problems may decrease heart rate but impairs improvement in gastrointestinal sounds.
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Affiliation(s)
| | - Emma L Deane
- Loomis Basin Equine Medical Center, Penryn, California, USA
| | - Dustin S Major
- Loomis Basin Equine Medical Center, Penryn, California, USA
| | | | | | | | - K Gary Magdesian
- The Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, USA
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Adami C, Westwood-Hearn H, Bolt DM, Monticelli P. Prevalence of Electrolyte Disturbances and Perianesthetic Death Risk Factors in 120 Horses Undergoing Colic Surgery. J Equine Vet Sci 2019; 84:102843. [PMID: 31864468 DOI: 10.1016/j.jevs.2019.102843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
The objective of this study was to determine the prevalence of intraoperative electrolyte disturbances and risk factors associated with perianesthetic death in horses undergoing colic surgery. The files of 120 horses meeting the inclusion criteria were reviewed. Data retrieved from the medical records, including demographic data and the occurrence of electrolyte disturbances and other intraoperative complications, were analyzed with a two step-approach by univariate and multivariate logistic regression models. Hypocalcemia was the most represented electrolyte disturbance (52.5%), followed by hypokalemia (30.0%) that was associated with intraoperative administration of salbutamol (P = .045). Perianesthetic death occurred in 46 horses, accounting for an overall mortality rate of 38.3%. Risk factors associated with death were anesthetic duration (P = .001), body weight (P = .020), presence of gastric reflux before anesthesia (P = .021), and intraoperative tachycardia (P = .043) and acidosis (P = .025). The mortality in the study population was comparable to previously reported findings. Based on the study findings, it is advisable to optimize hemodynamics prior to anesthesia, in order to prevent intraoperative tachycardia that is associated with increased risk of death. Heavier horses and those with gastric reflux may have a higher risk of fatalities, and intraoperative salbutamol administration may contribute to hypokalemia.
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Affiliation(s)
- Chiara Adami
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK.
| | - Holly Westwood-Hearn
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK
| | - David M Bolt
- Department of Clinical Sciences and Services, Equine Referral Hospital, Royal Veterinary College, University of London, Hatfield, UK
| | - Paolo Monticelli
- Department of Clinical Sciences and Services, Royal Veterinary College, University of London, Hatfield, UK
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Roeleveld PP, de Klerk JCA. The Perspective of the Intensivist on Inotropes and Postoperative Care Following Pediatric Heart Surgery: An International Survey and Systematic Review of the Literature. World J Pediatr Congenit Heart Surg 2017; 9:10-21. [PMID: 29092664 PMCID: PMC5764149 DOI: 10.1177/2150135117731725] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: Inotropes are frequently being used in children undergoing heart surgery to prevent or treat low cardiac output syndrome (LCOS). There is only limited evidence that inotropes actually positively influence postoperative outcome. Our aim was to describe the current international practice variation in the use of inotropes following congenital heart surgery. Methods: We developed an online survey regarding the postoperative use of inotropes. We sent an invitation to all 197 registered members of the Pediatric Cardiac Intensive Care Society (PCICS) to participate in the survey. We also performed a systematic review of the literature. Results: Ninety-eight people (50%) responded, representing 62 international centers. Milrinone is routinely used perioperatively by 90 respondents (97%). Adrenaline/epinephrine is routinely used by 43%, dopamine by 36%, dobutamine by 11%, and levosimendan by 6%. Steroids are used routinely by 54% before initiating cardiopulmonary bypass. Vasopressin is used by 44% of respondents. The development of LCOS is monitored with lactate in 99% of respondents, physical examination (98%), intermittent mixed venous saturation (76%), continuous mixed venous saturation (13%), echocardiography (53%), core–peripheral temperature gap (29%), near-infrared spectrometry (25%), and 4% use cardiac output monitors (PiCCO, USCOM). To improve cardiac output, 42% add/increase milrinone, 37% add adrenaline, and 15% add dopamine. Rescue therapy is titrated individually, based on the patients’ pathophysiology. A systematic review of the literature failed to show compelling evidence with regard to the benefit of inotropes. Conclusions: Despite the lack of sufficient evidence, milrinone is used by the vast majority of caregivers following congenital heart surgery.
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Affiliation(s)
- Peter P Roeleveld
- 1 Department of Pediatric Intensive Care, Leiden University Medical center, Leiden, The Netherlands
| | - J C A de Klerk
- 2 Department of Neonatal Intensive Care, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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Afonso T, Giguère S, Rapoport G, Barton MH, Coleman AE. Cardiovascular effects of pimobendan in healthy mature horses. Equine Vet J 2015; 48:352-6. [DOI: 10.1111/evj.12432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/10/2015] [Indexed: 11/26/2022]
Affiliation(s)
- T. Afonso
- Department of Large Animal Medicine; College of Veterinary Medicine; University of Georgia; Athens USA
| | - S. Giguère
- Department of Large Animal Medicine; College of Veterinary Medicine; University of Georgia; Athens USA
| | - G. Rapoport
- Department of Small Animal Medicine and Surgery; College of Veterinary Medicine; University of Georgia; Athens USA
| | - M. H. Barton
- Department of Large Animal Medicine; College of Veterinary Medicine; University of Georgia; Athens USA
| | - A. E. Coleman
- Department of Small Animal Medicine and Surgery; College of Veterinary Medicine; University of Georgia; Athens USA
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Dawson DR. Toxins and adverse drug reactions affecting the equine nervous system. Vet Clin North Am Equine Pract 2011; 27:507-26. [PMID: 22100042 DOI: 10.1016/j.cveq.2011.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article provides an overview of the more common toxins and adverse drug reactions, along with more rare toxins and reactions (Table 1), that result in neurologic dysfunction in horses. A wide variety of symptoms, treatments, and outcomes are seen with toxic neurologic disease in horses. An in-depth history and thorough physical examination are needed to determine if a toxin or adverse drug reaction is responsible for the clinical signs. Once a toxin or adverse drug reaction is identified, the specific antidote, if available, and supportive care should be administered promptly.
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Affiliation(s)
- Dominic R Dawson
- William Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, One Garrod Avenue, Davis, CA 95616, USA.
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Borer KE, Corley KTT. Electrolyte disorders in horses with colic. Part 2: calcium, sodium, chloride and phosphate. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2006.tb00470.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Schauvliege S, Van den Eede A, Duchateau L, Pille F, Vlaminck L, Gasthuys F. Influence of calcium chloride on the cardio-respiratory effects of a bolus of enoximone in isoflurane anaesthetized ponies. Vet Anaesth Analg 2009; 36:101-9. [PMID: 19239648 DOI: 10.1111/j.1467-2995.2008.00435.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the influence of calcium chloride (CaCl(2)) on the cardio-respiratory effects of enoximone in isoflurane anaesthetized ponies. STUDY DESIGN Prospective consecutive experimental trial. Animals Six healthy ponies, weighing 287 +/- 55 kg were included in this study. METHODS After sedation (romifidine, 80 microg kg(-1)), anaesthesia was induced with midazolam (0.06 mg kg(-1)) and ketamine (2.2 mg kg(-1)) and maintained with isoflurane in oxygen. The ponies' lungs were ventilated to maintain normocapnia. After 90 minutes, a bolus of enoximone (0.5 mg kg(-1)) was administered, followed by a CaCl(2) infusion (0.5 mg kg(-1) minute(-1) over 10 minutes) (treatment EC). Sodium, potassium, ionized and total calcium concentrations, cardiovascular variables and blood-gases were measured in the 120 minutes after treatment. Using a mixed model anova, the results were compared to those of a previous report [Vet Anaesth Analg, 34 (2007) 416], evaluating the effects of 0.5 mg kg(-1) enoximone in the same ponies and under identical circumstances (treatment E). Both an overall comparison and comparisons at specific time points after treatment were performed (alpha = 0.05). RESULTS Although ionized and total calcium concentrations were higher during treatment EC, the cardio-respiratory effects of enoximone were comparable for both treatments. A small but significant difference in packed cell volume was detected. CONCLUSIONS AND CLINICAL RELEVANCE Calcium chloride did not enhance the effects of enoximone in normocalcaemic anaesthetized ponies.
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Affiliation(s)
- Stijn Schauvliege
- Department of Surgery and Anaesthesia of Domestic Animals, University of Ghent, Merelbeke, Belgium.
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Foreman JH, Constable PD, Waggoner AL, Levy M, Eppley R, Smith GW, Tumbleson ME, Haschek WM. Neurologic Abnormalities and Cerebrospinal Fluid Changes in Horses Administered Fumonisin B1Intravenously. J Vet Intern Med 2004. [DOI: 10.1111/j.1939-1676.2004.tb00165.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Durando MM, Reef VB, Birks EK. Right ventricular pressure dynamics during exercise: relationship to stress echocardiography. Equine Vet J 2002:472-7. [PMID: 12405736 DOI: 10.1111/j.2042-3306.2002.tb05468.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Thorough evaluation of myocardial function remains difficult to evaluate under exercising conditions. This study described right ventricular (RV) pressure dynamics during and immediately following exercise. Nine Thoroughbreds without evidence of cardiac disease completed treadmill exercise at 110% of the speed necessary to elicit VO2max while RV pressures were recorded. RV pressure dynamics were calculated at rest, maximal speed and at 10 s intervals for 2 min after exercise. Stress echocardiography was performed at rest and within 120 s after exercise. Mean dP/dtmax and dP/dtmin values were significantly greater at maximal speed and up to 30 s immediately postexercise than at rest and all time points from 60 to 120 s postexercise. Mean dP/dtmax and dP/dtmin were not significantly different from resting values after 60 s postexercise. Tau (the time constant for ventricular relaxation) decreased significantly with exercise, but was not significantly different from rest at time points from 60 to 120 s following exercise. Mean % fractional shortening (FS) increased postexercise; however, the coefficient of variability was large. Wall motion indices also showed large variability postexercise. These temporal changes in normal horses suggest that exercising RV pressure dynamics may provide a better estimation of cardiac function during exercise than postexercise stress echocardiography.
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Affiliation(s)
- M M Durando
- Department of Clinical Studies, University of Pennsylvania, Kennett Square 19348, USA
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Toribio RE, Kohn CW, Chew DJ, Sams RA, Rosol TJ. Comparison of serum parathyroid hormone and ionized calcium and magnesium concentrations and fractional urinary clearance of calcium and phosphorus in healthy horses and horses with enterocolitis. Am J Vet Res 2001; 62:938-47. [PMID: 11400854 DOI: 10.2460/ajvr.2001.62.938] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate calcium balance and parathyroid gland function in healthy horses and horses with enterocolitis and compare results of an immunochemiluminometric assay (ICMA) with those of an immunoradiometric assay (IRMA) for determination of serum intact parathyroid hormone (PTH) concentrations in horses. ANIMALS 64 horses with enterocolitis and 62 healthy horses. PROCEDURES Blood and urine samples were collected for determination of serum total calcium, ionized calcium (Ca2+) and magnesium (Mg2+), phosphorus, BUN, total protein, creatinine, albumin, and PTH concentrations, venous blood gases, and fractional urinary clearance of calcium (FCa) and phosphorus (FP). Serum concentrations of PTH were measured in 40 horses by use of both the IRMA and ICMA. RESULTS Most (48/64; 75%) horses with enterocolitis had decreased serum total calcium, Ca2+, and Mg2+ concentrations and increased phosphorus concentrations, compared with healthy horses. Serum PTH concentration was increased in most (36/51; 70.6%) horses with hypocalcemia. In addition, FCa was significantly decreased and FP significantly increased in horses with enterocolitis, compared with healthy horses. Results of ICMA were in agreement with results of IRMA. CONCLUSIONS AND CLINICAL RELEVANCE Enterocolitis in horses is often associated with hypocalcemia; 79.7% of affected horses had ionized hypocalcemia. Because FCa was low, it is unlikely that renal calcium loss was the cause of hypocalcemia. Serum PTH concentrations varied in horses with enterocolitis and concomitant hypocalcemia. However, we believe low PTH concentration in some hypocalcemic horses may be the result of impaired parathyroid gland function.
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Affiliation(s)
- R E Toribio
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus 43210, USA
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