Low Albumin (Hypoalbuminaemia)

Horses Alpacas Guides Advice

Causes

The most common cause of low blood albumin in horses is intestinal disease. If there is diarrhoea then the loss is likely from the large intestine, if there is no diarrhoea then the loss is most likely from the small intestine. The causes of intestinal disease include worms particularly encysted redworm, sand, inflammatory bowel disease, some medications, infection, or neoplasia. It may also be caused by kidney or liver disease in rarer cases.

Symptoms

Weight loss
Fluid swelling under belly and/or lower legs
Lethargy
Not quite right
Diarrhoea
No outward symptoms in mild cases

Diagnosis

The low albumin is shown on a blood test. The cause can be investigated with:

an ultrasound scan on the abdomen to assess the small intestine, large intestine, kidneys and liver.
Faecal testing for worm burden, sand and infections.
Further blood testing looking for concurrent disease or inflammation.
Biopsy of the small intestine or rectum.
Gastroscopy.

Treatment

The specific treatment depends on the underlying cause but may include:

Wormer – encysted red worm is a common cause of low albumin so an equest wormer is usually recommended.
Steroids – the albumin is leaked through inflamed intestine walls therefore steroids are often indicated to treat the inflammation.
Misoprostal – a medication which improves the blood supply to the intestine to aid healing.
Psyllium – if sand is suspected and for large intestine support.
Probiotic supplement.
Fluids – if dehydrated.
Stopping any medications which could be the cause.
Treating any concurrent disease.
Plasma transfusion may be required in severely affected horses.

Prognosis

Mild cases which respond well to treatment quickly have a good prognosis, particularly if the underlying cause is identified and treated. However, some cases may require long-term treatment such as inflammatory bowel disease. Severely affected hypoalbuminaemic horses particularly with a heavy encysted redworm burden can have a poor prognosis and the condition may lead to euthanasia.

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Equine Metabolic Syndrome (EMS)

Horses Common Treatments Advice

EMS is a syndrome involving insulin resistance and unusual fat distribution around the body causing an increased risk of laminitis. Although it is not technically the same it is often likened to diabetes in humans, and this can be helpful when thinking about the condition. Some horses will be temporarily affected by EMS due to management and circumstances. This is because insulin resistance can be caused by obesity and lack of exercise (for example a horse who is out of work and on increased grass would be at risk), in these cases adjustments to the management system with or without short term medications can result in a resolution of both the clinical aspects of the disease and evidence on blood tests. Some horses however are genetically predisposed to EMS and these horses require lifelong management changes with or without medication and they may not ever test negative on blood tests despite best efforts.

Symptoms

Regional Adiposity

This refers to fat pad development typically on the crest of the neck, behind the shoulders and at the top of the tail. The horse may not have any excess fat in the abdomen region and can even have good rib exposure and so may not typically be thought of as overweight but still holds a cresty neck for example.

General obesity which is difficult to manage

In some cases the horse is just generally overweight all over.

Laminitis

Horses with EMS are significantly at risk of laminitis.

Exercise intolerance or mild demeanour alterations such as lethargy

Some horses with EMS feel groggy and be less keen for exercise.

Diagnosis

A clinical assessment is likely to cause high suspicion. Confirmation of the condition is obtained via blood tests, either resting or dynamic.

Resting blood test

This will measure (one or all of the following): insulin, glucose, triglycerides and adiponectin at rest. The most significant measurement is insulin as this is the driver of laminitis. A high level of insulin at rest is very significant. Glucose measures the free sugar in the blood and triglycerides is a measure of fat in the blood. Adiponectin is a hormone which is suppressed by metabolically unhealthy fat (bad fat), if the level is low then the horse has too much bad fat in the body.

Dynamic blood test

This measures the response of insulin to a sugar challenge (usually karolyte syrup) and is the most accurate insulin function test. The sugar syrup represents normal grass, hay or hard feed and so is a way for us to see how the body copes with a challenge which it should normally cope fine with. A horse with insulin dysregulation would have an overly high insulin result on this test.

Treatment

Management

Diet

A high fibre low sugar and starch diet is essential. This is because the body has insulin which is not working therefore it cannot process sugar normally, therefore keeping triggers low helps the body out. This usually means no grass, soaked hay and a high fibre, low starch and sugar hard feed.

Exercise

As long as the horse is sound, they should be exercised every day for at least 20 minutes. This has been shown to reduce insulin levels significantly and can be as simple as walking or lunging in-hand. If physical exercise is not an option then clever turnout solutions can be helpful such as track systems.

Don’t over-rug in winter

Allowing horses to regulate their own body temperature gives them the opportunity to use their fat supplies and increase their own insulin sensitivity.

Medication

‘Flozin’ drugs are highly effective. Examples are canagliflozin and ertugliflozin. These work by encouraging glucose to be excreted via urine and this causes weight loss and increased insulin sensitivity very quickly – insulin levels are regularly seen to drop dramatically within 7 days of starting this medication. These drugs can be used short term to rescue a case if for example the horse has laminitis (insulin directly damages the laminae so getting it down quickly helps get the horse better quicker) and then management can continue to manage the horse long term or can be used in an ongoing fashion for genetically affected horses. Side effects include urinary tract infections due to the sugar in the urine and high fat mobilisation in the blood which can be monitored with regular blood tests.

Prevention

Maintaining a healthy weight, providing regular exercise and keeping sugar and starch intake low are all vital parts of prevention of this condition.

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Choke

Horses Advice

Fortunately choke in horses refers to an obstruction of their food pipe (oeseophagus), as opposed to the windpipe and therefore is very rarely life threatening. It is quite a common condition and occurs when food blocks the oesophagus, which is the pipe that connects the back of the mouth with the stomach.

Causes

Most commonly choke occurs because some food gets stuck in the oesophagus. This can be hay/haylage, hard feed, a solid item like apple or carrot or a foreign body (i.e. not food material). A horse can have a random single choke episode or can be prone to it recurrently. Issues which predispose to choke include dental disease reducing the chewing ability and physical abnormalities of the throat or oesophagus.

Symptoms

Refusing food
Lip curling
Head down, tensing neck muscles, looking as though they are trying to be sick
Possibly making a noise – squeak or grunt
Saliva and food coming from nostrils/mouth
Distress with possible sweating
Gulping and repeated swallowing
Coughing and gagging

These symptoms are the result of the blockage causing a backflow of food and saliva back up the oesophagus, discomfort, panic and the horse trying to clear it themselves.

What to do?

Remove all food and water. Most cases of choke resolve uneventfully when the horse relaxes. This will be associated with the discharge from the nose stopping and the horse will become more settled and relaxed. Massaging the left side of the neck may help to ease the discomfort and help to reduce spasm of the oesophagus. A gentle walk around can help too.

If the symptoms persist for over fifteen minutes then contact the practice on 01562 701334 to arrange a visit.

Treatment

In the first instance we will examine the horse and establish whether the choke has self-resolved prior to our arrival. If it has then the vet may choose to give a muscle relaxant and anti-inflammatory to help resolve the oesophageal spasms and reduce the risk of recurrence. All feed and hay should be soaked for 24 hours so as not to irritate the already inflamed oesophagus. If it sounds as though the horse inhaled any food material and saliva on checking the trachea and chest then antibiotics may be discussed although this is less likely in a self-resolving choke.

If the choke has not self-resolved by the time the vet arrives then initial treatment consists of sedation, muscle relaxants and anti-inflammatories to resolve the spasm and obstruction. If this fails to resolve the obstruction, we will sedate the horse more heavily and a stomach tube will be passed up the nose and down the oesophagus to the level of the obstruction. At this point water will be used to lavage the obstruction clear. Again an examination afterwards will prompt a discussion regarding risk of inhalation in this case and the use of antibiotics.

If this fails to resolve, then often the horse is given some time for its own saliva to continue softening the obstruction and a repeat visit in a couple of hours will be arranged to repeat the tubing process. Sometimes we will use the gastroscope (camera) to visualise the obstruction) to help assist in resolving it.

Following clearance of a larger obstruction we will often recommend starving the horse for a period of up to 12 hours, then continue with sloppy feeds or grass for several days to reduce any stress or pressure on the oesophagus.

Complications

Although the vast majority of cases of choke resolve either without treatment or with some simple help at home a small number of cases can result in complications. The most common complication being inhalation of foodstuff and saliva which can result in a respiratory tract infection or more seriously pneumonia. Much more rare and serious would-be damage to the oesophagus itself from tears up to rupture. In very rare cases the obstruction is not resolved with repeated treatments at home and referral to an equine hospital will be discussed for more intensive management or even surgery to prevent the above-mentioned complications.

Prevention

Ensure that all dried feed is soaked thoroughly as per the manufacturer’s instructions to ensure they are fully swollen before eating.
Regular dental care to ensure chewing is thorough and complete.
The placing of a large brick or rocks in a food bowl may slow rapid, greedy feeders from taking in large mouthfuls of feed.
Ensure continuous access to fresh water.