Plus-Hex CLINICAL
Table 9 . Medication prescribed to the patient on discharge .
Medications
Medication |
Dose |
Route and frequency |
Details of the medications prescribed to the patient by the veterinary surgeon are outlined in Table 10 . |
Doxycycline 10 mg / kg PO , BID Sucralfate 10 – 40 mg / kg PO , BID Misoprostol 5 µ g / kg PO , BID
Table 10 . Types of medication prescribed .
Medication Type / indication
Discussion
This case report details the intensive treatment and nursing care of a 6-month-old foal with a severe case of EPE caused by L . intracellularis .
The treatment of EPE consists of intensive supportive care combined with the administration of specific antimicrobials directed against L . intracellularis . The supportive care includes intravenous fluid therapy , plasma transfusions , enteral and parenteral nutrition , and a variety of medications .
Blood panels
Initial blood evaluation revealed a marked hypoproteinaemia with hypoalbuminaemia and hypoglobulinaemia , which is most commonly associated with a protein-losing enteropathy and is a consistent clinicopathological finding in EPE . This hypoproteinaemia causes the clinical signs of peripheral oedema . The elevated SAA and electrolyte abnormalities could be attributed to the diarrhoea , which causes gastrointestinal damage and inflammation .
Oxytetracycline Metronidazole Misoprostol Dalteparin
Hyperimmune plasma
Oral electrolytes ( SELEKT horse electrolyte )
Di-tri-octahedral smectite ( Bio-sponge )
Sucralfate Lidocaine Meloxicam
Antimicrobial agent Antimicrobial agent Anti-gastric ulceration Anticoagulant
To support low albumin ( hypoproteinaemia )
To correct electrolyte abnormalities
Gastrointestinal protectant , to absorb and neutralise endotoxins
Gastrointestinal protectant Analgesia Analgesia
Intravenous catheterisation
A single-lumen long-stay over-the-wire polyurethane IVC was placed , as the patient was very compromised and likely to need intensive supportive care over a long period . Polyurethane IVCs are less thrombogenic and can remain in place for up to 2 weeks . This patient was at risk of developing thrombophlebitis , so excellent catheter care was required to reduce the risk . The IVC and the surrounding site should be checked a minimum of four times a day for signs of heat , pain , swelling and patency . IVCs should be flushed regularly , every 4 – 6 hours .
If signs of phlebitis are identified , the IVC should be removed immediately and , if needed , a fresh IVC placed in an alternative site . The tip of the IVC could be sent for culture . A light covering should be placed over the IVC , for example , Tubigrip or an elastic adhesive bandage ( Bandesive ), with a dressing to protect the insertion point . This covering should be changed once daily and when soiled . It is reported that catheterrelated complications , such as thrombophlebitis , occur more frequently in patients that receive TPN , due to the components of the TPN [ 6 ] .
Intravenous fluid therapy
The patient was given a plasma transfusion soon after admission , with the aim of correcting the hypoproteinaemia in the short term . Hyperimmune plasma is a source of immunoglobulins ; it is used as a colloid and will help improve oncotic pressure in the short term . As this is a blood product , it needs to be administered slowly at first , with vital parameters recorded every 5 minutes for the first 30 minutes , and the patient monitored closely for signs of anaphylaxis . Adverse reactions may include tachycardia , tachypnoea , pyrexia , oedema and urticaria . It is good practice to have a standard operating procedure for administering transfusions .
On completion of the plasma transfusion , the patient was placed on an isotonic crystalloid solution ( Hartmann ' s ), to which an additional 500 ml of glucose 50 % was added , at a starting dose of 2 ml / kg / hr . Glucose was added to the fluids as the patient was anorexic . The maintenance fluid rate delivered was lower than normal , due to the patient ' s hypoproteinaemia . The intravenous fluids corrected the patient ' s dehydration after 24 hours . The administration of both crystalloids and colloids at
Volume 39 ( 2 ) • April 2024
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