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EQUINE VETERINARY EDUCATION


Equine vet. Educ. (2018) 30 (2) 100-105 doi: 10.1111/eve.12564


Review Article Nutritional management of the foal with diarrhoea


B. Barr Rood and Riddle Equine Hospital, Lexington, Kentucky, USA. Corresponding author email: bbarr@roodandriddle.com


Keywords: horse; foal; diarrhoea; nutrition; enteral; parenteral


Summary Diarrhoea is a common problem in the neonatal and suckling foal. In certain circumstances supplemental nutrition is necessary depending on the age of foal, severity of diarrhoea and presence of other systemic manifestations. Nutritional supplementation can be provided either enterally or parenterally. Enteral nutrition is superior to parenteral nutrition because it is the most natural and physiologically sound means to provide nutritional support. Parenteral nutrition may be warranted if the foal is unable to receive or tolerate enteral nutrition. Dextrose alone or with amino acids and lipids can provide appropriate nutrition when enteral feeding is not tolerated. As soon as the foal stabilises enteral feeding can be reintroduced.


Introduction


Diarrhoea is a common problem in the foal. Important aspects of treatment included maintaining hydration, proper electrolyte balance and other supportive measures. In certain circumstances nutritional supplementation is necessary. A neonatal foal with diarrhoea that has stopped nursing or has secondary gastrointestinal problems such as ileus or abdominal distension will require nutritional supplementation. Suckling foals may not require supplementation as soon as the neonate. Nutritional supplementation can be provided by the enteral or parenteral route. Enteral nutrition is superior to parenteral nutrition because it is the most natural and physiologically sound means to provide nutritional support. Parenteral nutrition may be warranted if the foal is unable to receive or tolerate enteral nutrition. Carbohydrate solutions administered continuously or as an addition to bolus fluids is the simplest means of providing extra calories to a foal with diarrhoea. Amino acids and lipids can be added to provide a source of protein and additional calories. Mixtures of dextrose, amino acids and lipids must be administered at a constant rate infusion. The blood glucose must be closely monitored because many foals with diarrhoea are septic and intolerant of dextrose supplementation. As soon as the foal stabilises enteral feeding can be reintroduced. Mare’s milk is the preferred source of enteral nutrition because it is highly digestible and provides the correct balance of nutrients.


Foal diarrhoea


Diarrhoea is a common problem in the foal and a large majority of foals will have at least one episode of diarrhoea in the first 6 months of life (Urquhart 1981). There are numerous infectious and noninfectious causes of diarrhoea in the foal. Infectious causes include bacterial, viral, protozoal and parasitic organisms. Rotavirus, Clostridium perfringens types A


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and C, Clostridium difficile and Salmonella enterica are most commonly associated with infectious diarrhoea in the foal. Other less common infectious agents include coronavirus, Parascaris equorum, Strongylus spp., Cryptosporidium parvum and other anaerobic bacteria. Frederick et al. (2009) reported that foals less than 1 month of age are more likely to have diarrhoea due to Clostridium perfringens or undetermined aetiology, whereas foals greater than 1 month of age are more likely to have rotavirus, Salmonella sp. or parasites as causative agents (Frederick et al. 2009). Coinfection between infectious agents has recently been documented as being more prevalent than initially thought and may contribute to the severity of the gastrointestinal disorder. These observations were based on molecular-based testing comparing foals with diarrhoea to healthy foals. Coinfections with viral and protazoal organisms were more frequently identified in foals with diarrhea (Slovis et al. 2014). Possible noninfectious causes of diarrhoea include foal heat diarrhoea, dietary intolerance, ingestion of sand, asphyxia- associated gastroenteropathies and gastroduodenal ulceration. In the majority of cases diarrhoea is mild and medical


treatment may not be necessary. In other cases, the diarrhoea is severe with accompanying clinical signs of sepsis, septic shock and other systemic manifestations. The most important factor in the treatment of a foal with diarrhoea is maintaining hydration and electrolyte balance. In mild cases of diarrhoea, hydration may be maintained by nursing or administration of oral fluids. Severely affected foals and neonatal foals will often require administration of intravenous (i.v.) fluids and have severe electrolyte derangements which require additional i.v. or oral supplementation of bicarbonate, sodium or potassium. Plasma or synthetic colloids are useful for increasing oncotic pressure and maintaining circulatory volume in foals with hypoproteinaemia. Antimicrobial therapy is necessary in neonatal foals and foals with diarrhoea accompanied by signs of septicaemia. Commonly used antimicrobials include a combination of a beta-lactam and an aminoglycoside or a third generation cephalosporin. Any foal receiving an aminoglycoside should have its renal status closely monitored. If a Clostridial organism is suspected, metronidazole can be added to the treatment. There are many gastrointestinal protectants and absorbents that can be administered to a foal with diarrhoea. Activated charcoal and di-tri-octahedral smectite are absorbants that can bind endotoxin and reduce its absorption. Studies have shown that di-tri-octahedral smectite can bind the exotoxins of Clostridium difficile and Clostridium perfringens (Weese et al. 2003; Lawler et al. 2008). In foals with severe diarrhoea prophylactic use of antiulcer medications may be warranted. Since diarrhoea caused by rotavirus or Clostridium difficile


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