Texas Equine Veterinary Association

SUPPORTIVE CARE OF THE CRITICALLY ILL FOAL AN EXCERPT FROM THE LECTURE TO BE DELIVERED IN TECH #202 ON FRIDAY MORNING 72 INTRODUCTION - THE VULNERABLE NEONATE Critically ill foals pose a significant challenge in equine veterinary medicine. They have high mortality rates if not managed aggressively and appropriately. Supportive care is paramount, often as crucial as specific disease treatment. The focus of supportive care is on maintaining homeostasis, preventing complications, and optimizing recovery. COMMON COMPLICATIONS TO ANTICIPATE • Sepsis • Hypoglycemia • Hypoxemia/Respiratory distress syndrome • Neonatal encephalopathy (dummy foal syndrome) • Renal failure • Gastric ulcers • Diarrhea • Joint ill • Decubitus ulcers • Thrombophlebitis (from catheters) KEY PRINCIPLES OF SUPPORTIVE CARE • Continuous Monitoring: This includes vital signs, attitude, hydration, and urine output. • Thermoregulation: Preventing hypo/ hyperthermia is crucial. • Nutritional Support: This is critical for energy, healing, and immune function. • Fluid Therapy: Used for correcting dehydration and maintaining perfusion. • Pain Management: Ensures comfort and reduces stress. • Respiratory Support: Maintains adequate oxygenation and ventilation. • Cardiovascular Support: Addresses shock and maintains blood pressure. • Gastrointestinal Management: Focuses on preventing ileus and promoting gut health. • Infection Control: Minimizes nosocomial infections. • Nursing Care: Includes hygiene, bedding, turning, and decubitus ulcer prevention. THERMOREGULATION • Hypothermia (common in neonates): o Causes: Sepsis, poor perfusion, wet environment, low birth weight. o Effects: Decreased metabolic rate, poor suckle reflex,increased susceptibility to infection. o Management: Warm blankets, heat lamps (with caution), incubators, warm IV fluids, warm bags or socks with rice or oats. • Hyperthermia: o Causes: Over-warming, severe infection/sepsis. o Management: Remove heat sources, cool IV fluids, fanning, alcohol bath. NUTRITIONAL SUPPORT - THE CORNERSTONE • Why it's critical: High metabolic rate, limited energy reserves, prevents catabolism, supports immune system, promotes gut integrity. • Methods: o Enteral (preferred): • Dam's milk (if available and foal can suckle/tube feed). • Commercial milk replacers. • Frequency: Every 1-2 hours initially. • Route: Bottle feeding (if strong suckle), nasogastric tube (most common). o Parenteral (Total Parenteral Nutrition - TPN): • Indications: Ileus, severe malabsorption, inability to tolerate enteral feeding. • Components: Dextrose, amino acids, lipids. • Requirements: Central venous catheter, strict aseptic technique. FLUID THERAPY • Goals: Correct dehydration, maintain hydration, support perfusion, deliver medications. • Types of Fluids: o Crystalloids: Lactated Ringer's Solution (LRS), 0.9% Saline. • Initial boluses for shock (10-20 ml/ kg over 15-30 min). • Maintenance fluids (40-60 ml/kg day). o Colloids: Plasma, synthetic colloids (e.g., hydroxyethyl starch). • Indications: Hypoproteinemia, severe hypovolemic shock, sepsis. • Plasma provides immunoglobulins ( IgG) and clotting factors. SUPPORTIVE CARE OF THE CRITICALLY ILL FOAL AN EXCERPT FROM THE LECTURE TO BE DELIVERED IN TECH #202 ON FRIDAY MORNING • Monitoring: Urine output, PCV/TS, central venous pressure (CVP), clinical signs. PAIN MANAGEMENT • Analgesics: o NSAIDs (Non-Steroidal Anti- Inflammatory Drugs): Flunixin meglumine (caution with renal function/GI ulcers). o Opioids: Butorphanol, Fentanyl (effective, but can cause respiratory depression). o Alpha-2 Agonists: Xylazine, Detomidine (sedation and analgesia, short-acting). • Multimodal approach: Combining different classes of drugs for synergistic effects and reduced side effects. • Assessment: Subtle signs include grinding teeth, reluctance to move, abnormal posture, increased heart rate/ respiratory rate. RESPIRATORY SUPPORT • Assessment: Respiratory rate, effort, mucous membrane color, auscultation. • Oxygen Supplementation: o Indications: Hypoxemia (PaO2 < 60 mmHg), respiratory distress. o Methods: Nasal insufflation, oxygen cage, face mask, hyperbaric oxygen chamber. • Ventilatory Support: o Indications: Severe respiratory f ailure, apnea. o Mechanical ventilation (requires specialized equipment and expertise). • Airway Management: Clear secretions, elevate head. CARDIOVASCULAR SUPPORT • Assessment: Heart rate, pulse quality, capillary refill time (CRT), mucous membrane color, blood pressure. • Addressing Shock: o Fluid boluses (as discussed). o Vasopressors: Dopamine, Dobutamine, Norepinephrine (if fluids alone are insufficient to maintain blood pressure). • Monitoring: ECG, blood pressure (direct arterial preferred, but not applicable on awake foal). BY LISA M. UPSHAW, LVT

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