Elapid snake envenomation in horses: 52 cases (2006-2016)

BACKGROUND

Snake envenomation is a cause of morbidity and mortality in domestic animals worldwide. The clinical features of crotalid snake (pit viper) envenomation are widely reported and well described in horses but elapid snake envenomation is poorly characterised.

OBJECTIVES

To describe the presentation, clinical and laboratory findings, treatment and outcome of horses with a diagnosis of elapid snake envenomation in Australia.

STUDY DESIGN

Retrospective case series.

METHODS

Medical records of horses with a diagnosis of elapid snake envenomation (2006-2016) at several university and private veterinary practices were reviewed. Inclusion criteria comprised one or more of the following: 1) observed snakebite, 2) positive snake venom detection kit (SVDK) result, 3) appropriate clinical response to treatment with antivenom or 4) supportive post-mortem findings.

RESULTS

Fifty-two cases met the inclusion criteria. Most cases (94%) demonstrated clinical signs of neurotoxicity, characterised by generalised neuromuscular weakness. Associated neurologic signs included staggering gait, muscle fasciculations, recumbency, mydriasis, ptosis and tongue paresis. Concurrent clinically important conditions included rhabdomyolysis (50%) and haemolysis (19%). Of 18 urine samples evaluated with a SVDK, only three (17%) were positive. Overall survival was favourable (86%) among 49 horses who received antivenom. Eighteen surviving horses (43%) required more than one vial of antivenom.

MAIN LIMITATIONS

Possible cases within the searchable database were not included if horses died acutely or responded to symptomatic treatment without receiving antivenom.

CONCLUSIONS

Elapid snake envenomation is primarily a syndrome of neuromuscular weakness. Supportive anamnesis or an obvious bite site is rarely encountered. In endemic areas, this diagnosis should be considered for horses with generalised neuromuscular weakness, altered mentation, rhabdomyolysis and/or haemolysis; especially during spring and summer months. Diagnostic suspicion is best confirmed by response to treatment with antivenom.

Interpreting lactate measurement in critically ill horses: diagnosis, treatment, and prognosis

In hospitalized horses, hypovolemia and the resulting decrease in tissue perfusion is the most common cause of hyperlactatemia. Therefore, measurement of blood lactate concentration can be a useful tool for guiding fluid therapy. Similarly, measuring blood lactate concentration can be used to assess the need for and adequacy of transfusions in horses receiving whole blood. Inflammatory leukocytes within closed body cavities consume glucose and produce lactate. Simultaneous measurement of blood lactate concentration and lactate concentration of peritoneal, pleural, or synovial fluid has been used to help differentiate septic from nonseptic effusions. A fluid lactate concentration higher than the blood lactate concentration provides evidence for a bacterial cause of the effusion. In horses evaluated for colic, a peritoneal lactate concentration higher than the simultaneously measured blood lactate concentration is indicative of intestinal strangulation and ischemia. Veterinary studies have suggested that serial blood lactate measurements might be a more useful prognostic indicator than a single lactate measurement. In hospitalized adult horses and foals, blood lactate concentration is higher at all time points in nonsurvivors compared with survivors, although the differences tend to be subtle. Measuring the rate at which lactate concentrations return to normal might also prove useful in equine medicine, but this requires further investigation.

Lactate production and measurement in critically ill horses

Blood lactate concentration can be easily measured by practitioners using inexpensive point-of-care meters. Anaerobic tissue metabolism resulting from inadequate oxygen delivery (DO2) is the most important cause of an increase in blood lactate concentration in equine patients. However,hyperlactatemia also occurs under conditions of apparently adequate DO2, usually in association with sepsis and an intense inflammatory reaction. Numerous mechanisms have been proposed for aerobic hyperlactatemia, including increased Na+/K+-ATPase activity in response to inflammatory mediators; inhibition of pyruvate dehydrogenase, a key enzyme in glucose metabolism; and increased lactate production by activated inflammatory cells. The liver is responsible for most lactate metabolism, and liver disease might contribute to an increase in blood lactate concentration in some patients. Skeletal muscle is usually considered the most important source of lactate during sepsis. The roles of the lungs and the gastrointestinal tract in lactate production have been investigated but remain uncertain.

Sequential plasma lactate concentrations as prognostic indicators in adult equine emergencies

BACKGROUND

Sequential lactate concentration ([LAC]) measurements have prognostic value in that hospitalized humans and neonatal foals that have a delayed return to normolactatemia have greater morbidity and case fatality rate.

HYPOTHESIS

Prognosis for survival is decreased in horses with a delayed return to normal [LAC].

ANIMALS

Two hundred and fifty adult horses presented for emergency evaluation excepting horses evaluated because of only ophthalmologic conditions, superficial wounds, and septic synovitis without systemic involvement.

METHODS

Prospective observational study. [LAC] was measured at admission and then at 6, 12, 24, 48, and 72 hours after admission. The change in [LAC] over time ([LAC]deltaT) was calculated from changes in [LAC] between sampling points.

RESULTS

Median [LAC] was significantly (P < .001) higher at admission in nonsurvivors (4.10 mmol/L [range, 0.60-18.20 mmol/L]) when compared with survivors (1.30 mmol/L [range, 0.30-13.90 mmol/L]) and this difference remained at all subsequent time points. The odds ratio for nonsurvival increased from 1.29 (95% confidence interval 1.17-1.43) at admission to 49.90 (6.47-384) at 72 hours after admission for every 1 mmol/L increase in [LAC]. [LAC]deltaT was initially positive in all horses but became negative and significantly lower in nonsurvivors for the time periods between 24-72 hours (- 0.47, P = .001) and 48-72 hours (- 0.07, P = .032) when compared with survivors (0.00 at both time periods) consistent with lactate accumulation in nonsurvivors.

CONCLUSIONS AND CLINICAL IMPORTANCE

These results indicate that lactate metabolism is impaired in critically ill horses and [LAC]deltaT can be a useful prognostic indicator in horses.

Pre-exercise hypervolaemia is not detrimental to arterial oxygenation of horses performing a prolonged exercise protocol simulating the second day of a 3-day equestrian event

REASONS FOR PERFORMING STUDY

Hyperhydration, prior to prolonged moderate-intensity exercise simulating the 2nd day of a 3-day equestrian event (E3DEC), may induce arterial hypoxaemia detrimental to performance.

OBJECTIVES

Because moderate-intensity exercise does not induce arterial hypoxaemia in healthy horses, the effects of pre-exercise hypervolaemia on arterial oxygenation were examined during a prolonged exercise protocol.

METHODS

Blood-gas studies were carried out on 7 healthy, exercise-trained Thoroughbred horses in control and hyperhydration experiments. The study conformed to a randomised crossover design. The sequence of treatments was randomised for each horse and 7 days were allowed between studies. Hyperhydration was induced by administering 0.425 g/kg bwt NaCl via nasogastric tube followed by free access to water. The exercise protocol was carried out on a treadmill set at a 3% uphill grade and consisted of walking at 2 m/sec for 2 min, trotting for 10 min at 3.7 m/sec, galloping for 2 min at 14 m/sec (which elicited maximal heart rate), trotting for 20 min at 3.7 m/sec, walking for 10 min at 1.8 m/sec, cantering for 8 min at 9.2 m/sec, trotting for 1 min at 5 m/sec and walking for 5 min at 2 m/sec.

RESULTS

NaCl administration induced a significant mean +/- s.e. 15.5 +/- 1.1% increase in plasma volume as indicated by a significant reduction in plasma protein concentration. In either treatment, whereas arterial hypoxaemia was not observed during periods of submaximal exercise, short-term maximal exertion caused significant arterial hypoxaemia, desaturation of haemoglobin, hypercapnoea, and acidosis in both treatments. However, the magnitude of exercise-induced arterial hypoxaemia, desaturation of haemoglobin, hypercapnoea, and acidosis in both treatments remained similar, and statistically significant differences between treatments could not be demonstrated.

CONCLUSIONS

It was concluded that significant pre-exercise expansion of plasma volume by this method does not adversely affect the arterial oxygenation of horses performing a prolonged exercise protocol simulating the 2nd day of an E3DEC.

Hyperhydration prior to a simulated second day of the 3-day moderate intensity equestrian competition does not cause arterial hypoxemia in Thoroughbred horses

Dehydration and the associated impairment of cardiovascular and thermoregulatory function comprise major veterinary problems in horses performing prolonged exercise, particularly under hot and humid conditions. For these reasons, there is considerable interest in using pre-exercise hyperhydration to help maintain blood volume in the face of the excessive fluid loss associated with sweat production during prolonged exertion. However, recently it was reported that pre-exercise hyperhydration causes arterial hypoxemia in horses performing moderate intensity exercise simulating the second day of an equestrian 3-day event competition (E3DEC) which may adversely affect performance (Sosa Leon et al. in Equine Vet J Suppl 34:425-429, 2002). These findings are contrary to data from horses performing short-term maximal exertion, wherein hyperhydration did not affect arterial O2 tension/saturation. Thus, our objective in the present study was to examine the impact of pre-exercise hyperhydration on arterial oxygenation of Thoroughbred horses performing an exercise test simulating the second day of an E3DEC. Control and hyperhydration studies were carried out on seven healthy Thoroughbred horses in random order, 7 days apart. In the control study, horses received no medications. In the hyperhydration experiments, nasogastric administration of NaCl (0.425 g/kg) 5 h pre-exercise induced a plasma volume expansion of 10.9% at the initiation of exercise. This methodology for inducing hypervolemia was different from that of Sosa Leon et al. (2002). Blood-gas tensions/pH as well as plasma protein, hemoglobin and blood lactate concentrations were measured pre-exercise and during the exercise test. Our data revealed that pre-exercise hyperhydration neither adversely affected arterial O2 tension nor hemoglobin-O2 saturation at any time during the exercise test simulating the second day of an E3DEC. Further, it was observed that arterial blood CO2 tension, pH, and blood lactate concentrations also were not affected by pre-exercise hyperhydration. However, hemodilution in hyperhydrated horses caused an attenuation of the expansion in the arterial to mixed-venous blood O2 content gradient during phases B and D of the exercise protocol, which was likely offset by an increase in cardiac output. It is concluded that pre-exercise hyperhydration of horses induced in the manner described above is not detrimental to arterial oxygenation of horses performing an exercise test simulating the second day of an E3DEC.

Prevalence ofNeosporaantibodies in beef cattle in New Zealand

AIM

To estimate the prevalence of Neospora infection in a sample of New Zealand beef cattle.

METHODS

The prevalence of Neospora caninum infection in New Zealand beef cattle was estimated by collecting blood at slaughter from 499 beef cattle from 40 different farms at 2 slaughter plants in the North Island and 1 in the lower South Island . Sera were tested using an ELISA against Neospora tachyzoite antigen.

RESULTS

The prevalence of seropositive cattle was 2.5% (n=120), 3.6% (n=166) and 2.3% (n=213) at the plants surveyed, the overall prevalence being 2.8%. The serologically positive cattle came from 9 farms, 3 of which had more than 1 positive animal. The highest prevalence recorded amongst animals from 1 farm was 4/13 (31%), in a group of young steers.

CONCLUSION

Neosporosis appears to be present at a lower level in the New Zealand beef cattle population than in the New Zealand dairy cattle population. Nevertheless, from the high seroprevalence evident amongst young cattle on 1 farm, we suggest that Neospora may be a cause of infertility in beef cattle in this country.