Arterial lactate concentration, hospital survival, sepsis and SIRS in critically ill neonatal foals

Abstract

Summary Reasons for performing study: Blood lactate concentration has been shown to be a useful clinical indicator in human patients, but has not been formally investigated in critically ill foals. Objective: To investigate the association of blood lactate with hospital survival, markers of cardiovascular status, metabolic acid base status, sepsis and systemic inflammatory response syndrome (SIRS). Methods: A database containing clinical, haematological, plasma biochemical and hospital outcome data on neonatal foals referred to an intensive care unit in 2000‐2001 was analysed. Seventy‐two foals for which arterial lactate was measured at admission were included in the study. Results: Sixty‐one foals had an admission lactate concentration >2.5 mmol/1. Admission lactate was statistically associated with hospital survival, mean arterial pressure, blood creatinine concentration, bacteraemia, anion gap, lactate concentration at 18‐36 h after admission and evidence of SIRS, but not with packed cell volume or heart rate. Lactate at 18‐36 h was also associated with survival and evidence of SIRS. Anion gap, base excess, base excess due to unidentified anions (BEua), simplified strong ion gap or bicarbonate correctly classified foals for presence of hyperlactaemia (>5 mmol/1) in 80% of animals. Conclusions: Admission blood lactate gives important prognostic information. Lactate should be measured rather than assumed from the anion gap, base excess, BEua, simplified strong ion gap or bicarbonate. Potential relevance: Blood lactate concentrations at admission are clinically relevant in neonatal foals and warrant further investigation. This should include the clinical value of measuring changes in lactate in response to treatment.

Hypothalamic‐Pituitary‐Adrenal Axis Dysfunction in Hospitalized Neonatal Foals

“…Shock was considered present in foals that had at least 2 of the following at admission: (1) mean arterial pressure o 60 mmHg; (2) cold extremities; (3) weak peripheral pulses; (4) capillary refill time 4 2 seconds; (5) altered mental status (eg, marked depression or inability to stand, nurse, or track the mare); (6) rectal temperature o 99.01F (o37.21C); or (7) plasma lactate concentration 4 5 mmol/L. 37 MODS was defined as at least 2 of the following criteria present at any time during hospitalization: (1) anuria, oliguria, or persistent azotemia (serum creatinine concentration 4 2.2 mg/dL for !72 hours) after initial fluid resuscitation and rehydration; (2) clinical diagnosis of perinatal encephalopathy; (3) respiratory dysfunction (hypoxemia, hypercapnia, or both) requiring either nasal insufflation of oxygen or ventilation; (4) persistent ileus necessitating withholding of enteral feeding for 424 hours; (5) 424 hours of vasopressor therapy; or (6) a clinical diagnosis of disseminated intravascular coagulation. Survival was defined as survival to hospital discharge; nonsurvival was defined as death or euthanasia during hospitalization.…”

Prognostic examinations of neonatal foals with perinatal asphyxia syndrome (PAS)

“…Bei neonatal erkrankten Fohlen wurden verschiedene Parameter untersucht, wobei sich eine Leukopenie oder eine Hyperlaktatämie als wertvolle prognostische Parameter herausgestellt haben (Castagnetti und Veronesi 2008, Corley et al 2005, Gayle et al 1998, Wotman et al 2009 …”

“…Hypo-oder Hyperglykämie (Hollis et al 2008) und Hyperlaktatämie (Corley et al 2005, Henderson et al 2008, Veronessi et al 2009, Wotman et al 2009) sowie eine gestörte Laktatclearance (Wotman et al 2009) wurden bei erkrankten Fohlen als Indikatoren einer ungünstigen Prognose beschrieben. Eine erhöhte Anionenlücke korrelierte bei Fohlen mit respiratorischen Erkrankungen und bei Fohlen in intensivmedizinischer Therapie mit schlechteren Überlebenschancen (Hoffman et al 1992, Bedenice et al 2003b).…”

Oral single dose of allopurinol in thoroughbred foals born from mares with placentitis

“…At birth, foals were submitted to clinical evaluation with assessment of neuromuscular reflexes and behavioral signs, as described by CURCIO & NOGUEIRA (2012). Venous blood was collected by puncturing the jugular vessel at birth (0h) and at 6, 12 and 24 hours of life.…”

“…Accumulation of hypoxanthine metabolites in the brain during the hypoxic period induces the additional production of superoxides and hydroxyl radicals (oxidative stress) (INDER & VOLPE, 2000). Experimental and clinical studies in human neonatology have proposed several drugs as alternative therapies to help block the progression of damage and/or improve the repair of injured tissue (GONZALES & FERRIERO, 2009). Based on studies in human neonatology, a component therapy approach was developed to treat at-risk foals that include antioxidants as Allopurinol and neuroprotective medications.…”