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BACK TO BASICS: THE ACUTE ABDOMEN IN THE FIELD


specificity of lactate for the detection of strangulat- ing obstructions and thus the acute need for surgery. Always keep in mind that blood lactate values in ponies presenting with a primary complaint of gastro- intestinal disease have higher admission lactate con- centrations (2.8 mmol/L vs 1.6 mmol/L) than adult horses, to avoid overestimating the severity of disease in that population.11


4. Point-of-Care Lab Data: Glucometer


Hyperglycemia is common in horses with colic and can be easily and affordably measured using a hand- held glucometer, providing additional evidence to- ward severity of a disease process. Approximately 50% of horses with colic admitted to referral hospi- tals have blood glucose concentrations 135 mg/dL, and extreme hyperglycemia (180 mg/dL) has been associated with surgical colic, strangulating obstruc- tions, and decreased short- and longer-term sur- vival.12,13 Hyperglycemia may occur acutely as part of the stress response to a severe gastrointesti- nal obstruction, but also occurs secondary to glucose dysregulation and insulin resistance that develops with progressive disease.14 Glucose can be a valu- able adjunct to peritoneal fluid analyses when a septic peritonitis is suspected such as with presence of cloudy peritoneal fluid. Peritoneal fluid glucose concentrations less than 30 mg/dL have been shown to be highly specific for septic peritonitis as well as a peritoneal fluid glucose to blood glucose difference of greater than 50 mg/dL.15 It also should be noted that the correlation between hand held glucometers to plasma chemistry analyzers can vary, and it is important to ensure calibration for each new re- agent lot is performed, and that test strips are prop- erly stored with regard to temperature and humidity recommendations.16 Although less widely utilized, point-of-care tri- glyceride analyzers have also been validated for use in horses, ponies, and donkeys,17 and may provide valuable adjunctive data in horses with more chronic or insidious conditions, as hypertriglyceride- mia is a relatively common complication in anorectic equids.


5. Summary


Abdominocentesis is valuable in horses managed in the field with acute colic where a decision for eutha- nasia must be made either when surgical interven- tion is not a financially viable option for the owners, or if gastrointestinal rupture is suspected and should be confirmed. Other scenarios where ab- dominocentesis may be helpful include recurrent colic, suspected peritonitis, and for serial assess- ment in horses with persistent nonstrangulating obstructions not amenable to referral, particularly if peritoneal fluid can be identified on ultrasono- graphic examination. A brief ultrasonographic examination at the site of abdominocentesis is highly recommended to recognize presence of peri- toneal fluid and to avoid injury to viscera or en-


terocentesis. Interpretation of peritoneal fluid findings can be readily performed in the field by visual inspection and use of a refractometer and lactate meter. Field assessment of horses with colic using a portable lactate meter and glucometer can provide valuable insight into severity of the disease pro- cess to guide therapy or the need for referral or euthanasia.


Acknowledgments


Declaration of Ethics The Author has adhered to the Principles of Veteri- nary Medical Ethics of the AVMA.


Conflict of Interest The Author has no conflicts of interest.


References and Footnotes


1. Desrochers AM, White NA. Diagnostic approach to colic. In: Blikslager AT, White NA, Moore JN, Mair TS, eds. The equine acute abdomen. 3rd ed. Hoboken, NJ: John Wiley& Sons, Inc; 2017;223–262.


2. Tulleners EP. Complications of abdominocentesis in the horse. J Am Vet Med Assoc 1983;182:232–234.


3. Weimann CD, Thoefner MB, Jensen AL. Spectrophotomet- ric assessment of peritoneal fluid haemoglobin in colic horses: An aid to selecting medical vs. surgical treatment. Equine Vet J 2002;34:523–527.


4. Brownlow MA, Hutchins DR, Johnston KG. Reference val- ues for equine peritoneal fluid. Equine Vet J 1981;13:127– 130.


5. Estepa JC, Lopez I, Mayer-Valor R, et al. The influence of anticoagulants on the measurement of total protein concen- tration in equine peritoneal fluid. Res Vet Sci 2006;80:5–10.


6. Peloso JG, Cohen ND. Use of serial measurements of peri- toneal fluid lactate concentration to identify strangulating intestinal lesions in referred horses with signs of colic. JAm Vet Med A 2012;240(10):1208–1217.


7. Shearer TR, Norby B, Carr EA. Peritoneal fluid lactate evaluation in horses with nonstrangulating versus stran- gulating small intestinal disease. J Equine Vet Science 2018;61:18–21.


8. Fielding CL, Magdesian KG. How to use venous blood lac- tate concentration to guide fluid therapy in adult horses, in Proceedings. Am Assoc Equine Pract 2015;51:2005.


9. Lumsden JH, Rowe R, Mullen K. Hematology and biochem- istry reference values for the light horse. Can J Comp Med 1980;44:32–42.


10. Johnston K, Holcombe SJ, Hauptman JG. Plasma lactate as a predictor of colonic viability and survival after 360 degrees volvulus of the ascending colon in horses. Vet Surg 2007;36: 563–567.


11. Dunkel B, Kapff JE, Naylor RJ, et al. Blood lactate concen- trations in ponies and miniature horses with gastrointestinal disease. Equine Vet J 2013;45:666–670.


12. Hassel DM, Hill AE, Rorabeck RA. Association between hyperglycemia and survival in 228 horses with acute gastro- intestinal disease. J Vet Intern Med 2009;23:1261–1265.


13. Hollis AR, Boston RC, Corley KT. Blood glucose in horses with acute abdominal disease. J Vet Intern Med 2007;21: 1099–1103.


14. Toth F, Frank N, Chameroy KA, et al. Effects of endotox- aemia and carbohydrate overload on glucose and insulin dynamics and the development of laminitis in horses. Equine Vet J 2009;41:852–858.


15. Van Hoogmoed L, Rodger LD, Spier SJ, et al. Evaluation of peritoneal fluid pH, glucose concentration, and lactate dehy-


AAEP PROCEEDINGS  Vol. 66  2020 113


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