Plus-Hex CLINICAL plasma ( Hypermune , Veterinary Immunogenics ) was warmed to body temperature and administered at 2 ml / kg / hr . A nasogastric tube ( NGT ) was placed through the left nostril . The patient was checked for reflux and , as none was obtained , 3 litres of water with an electrolyte solution ( SELEKT horse electrolyte ) and di-tri-octahedral smectite ( Bio-sponge ) were administered . A constant-rate infusion ( CRI ) of lidocaine ( Lidocaine Hydrochloride Injection BP 2 % w / v , Bova ) was started , as the patient continued to display signs of colic ( pawing , flank watching and getting up and down into sternal recumbency ). Further medication was also administered , as detailed in Table 7 .
Case progression
Over the initial 48-hour period following admission , the patient displayed intermittent signs of discomfort , became pyrexic with a temperature of 40 ° C and continued to pass loose diarrhoea . The clinical parameters remained relatively stable . Despite intensive treatment , the albumin concentration continued to decrease . On Day 3 , the patient became increasingly dull , with minimal appetite ( Figure 2 ). The albumin concentration was 8 g / l and total protein was 20 g / l . A third plasma transfusion was administered , and the patient was started on total parenteral nutrition ( TPN ).
Table 7 . Treatment plan .
Medication Dose
Route and frequency
Oxytetracycline |
5 mg / kg |
IV , BID |
Metronidazole |
25 mg / kg |
PO , BID |
Misoprostol |
5 µ g / kg |
PO , BID |
Dalteparin |
50 iu / kg |
SC , SID |
Hyperimmune plasma
2 litres IV
Oral electrolytes ( SELEKT horse electrolyte )
3 litres water + 1 sachet
PO via NGT
Di-tri-octahedral smectite ( Bio-sponge )
1 g / kg PO via NGT
Sucralfate |
10 – 40 mg / kg |
PO , QID |
|
|
or BID |
Lidocaine Bolus ( ml ) = 0.065 mg / kg × BW ( kg )
Isotonic crystalloid solution ( Hartmann ' s ) + 500 ml glucose 50 %
CRI rate ( ml / hr ) = 0.15 × BW ( kg )
2 ml / kg / hr IV
IV , CRI
Meloxicam 0.6 mg / kg IV / PO , BID
NGT = nasogastric tube ; BW = body weight ; CRI = constant-rate infusion .
Venous blood samples were taken daily for the first 3 days to monitor hypoproteinaemia and electrolyte parameters in particular . Clinical examinations were performed on the patient every 3 hours , with hourly camera observations recorded . In addition to a medication treatment plan , a nursing care plan was created , as outlined in Table 8 on page 24 .
Figure 2 . The patient became increasingly dull with minimal appetite .
During the subsequent 48 hours , the patient began to stabilise and displayed an improvement in appetite and demeanour . This improvement continued over the following week of hospitalisation . The patient was taken out of the isolated medical ICU once it had been confirmed that the diarrhoea was not infectious . The albumin concentration remained stable at 15 g / l . Supportive care was slowly reduced , which was well tolerated .
On day 11 , a repeat ultrasound scan confirmed that the intestinal thickening had resolved . The patient was discharged from the hospital on day 14 to continue treatment on oral medications ( Table 9 , page 25 ) at home on the farm . It was recommended that a blood sample be obtained in 7 days to support a review of the patient ' s ongoing management .
Volume 39 ( 2 ) • April 2024
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