oxygen insufflation is therefore recommended in cases of septic shock and in
some cases ventilation may be required. Sternal support is beneficial.
Nutritional Support
In the case of the collapsed foal enteral nutrition should be delayed until foals
are fully resuscitated. Glucose infusions of 4-8mg/kg/min glucose in
combination with plasma transfusion which supplies proteins are usually
sufficient for the first 48 hrs. If enteral nutrition cannot be initiated after this
period parenteral nutrition with amino acids and lipids may be necessary.
As a general guide glucose should be controlled at < 10 mmol/L and/or
significant spillage into urine should be prevented. Attempts to achieve tighter
glucose control have been associated with mortality in man; this is thought to
be due to hypoglycaemia.
Gradual re-introduction to enteral nutrition should be instituted as soon as
possible. If the foal is unable to stand and nurse regularly a nasogastric tube
can be left in situ and the mare’s milk administered via the tube.
Anti-inflammatory Therapy
Large numbers of anti-inflammatory-mediator drugs have been trialled in
human medicine and shown not to be successful. Flunixin, polymixin B and
pentoxifylline are sometimes used in foals. These are not widely
recommended for use in neonatal sepsis due to lack of evidence of efficacy
and a risk of renal damage with some of these drugs.
Corticosteroids
Critical illness-related corticosteroid insufficiency (CIRCI) describes an
inadequate cortisol response to the degree of illness and has been described
in foals. The current recommendation for children with catecholamineresistant, fluid-refractory septic shock with demonstration of CIRCI is to
provide hydrocortisone.[6] A suggested dose for foals is 1.3 mg/kg/day
divided into 4-hourly boluses IV for a 3-7 day tapering course – this has been
shown to decrease the endotoxin-induced proinflammatory cytokine response
without impairing the innate immune response. [15]
Nursing
• Regular turning e.g. every 2 hours to prevent decubital ulcers and
reduce atelectasis.
• Protect from urine/faecal scald by use of barrier creams and keeping
the bedding clean.
• Ocular protectant for recumbent foals to reduce corneal ulceration.
Monitoring
•
Repeat clinical examinations
15-‐18
February
2016
East
London
Convention
Centre,
East
London,
South
Africa
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