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Background: This study aimed to describe and compare therapeutic approaches for horses with acute diarrhea in different geographic regions worldwide. Methods: Clinical information was retrospectively collected from diarrheic horses presented to participating institutions between 2016 and 2020, including fluid therapy on admission, antimicrobial drugs, probiotics, anti-endotoxic medications, anti-inflammatory drugs, gastroprotectants, digital cryotherapy, and toxin-binding agents. Seasonal and geographic differences were investigated. Results: 1438 horses from 26 participating hospitals from 5 continents were included. On admission, 65% (926/1419) of horses were administered a fluid bolus. Antimicrobial drugs were administered to 55% (792/1419) within the first 24 hours of admission, with penicillin and gentamicin being the most used combination (25%, 198/792). Horses with leukopenia (OR: 2.264, 95%CI: 1.754 to 2.921; P<0.001) or meeting systemic inflammatory response syndrome criteria (OR: 2.542, 95%CI: 1.919 to 3.368; P<0.001) had higher odds of being administered antimicrobial drugs. Other treatments administered included probiotics (15%, 215/1438), polymyxin B (13%; 187/1438), pentoxifylline (8%; 118/1438), gastroprotectants (44%; 626/1419), digital cryotherapy (34%; 489/1435), plasma transfusion (13%; 182/1410) and toxin-binding agents (36%; 515/1438). Limitations: Due to the retrospective nature of the study, the rationale for treatment decisions was unavailable, and associations with survival could not be evaluated. Conclusions: Treatments varied between hospitals from different geographic regions. Prospective clinical trials are required to evaluate the effects of various treatments on survival. [ABSTRACT FROM AUTHOR]

Objective: To compare glucose measurements from capillary and venous blood samples using a point‐of‐care (POC) glucometer with a standard laboratory (colorimetric, glucose oxidase) assay (LABGLU) in a population of hospitalized, neonatal foals. Design: Multicenter, prospective, experimental study, conducted between March 2019 and June 2020. Setting: Four university teaching hospitals and 1 private referral hospital. Animals: Fifty‐four hospitalized neonatal (≤30 days of age) foals. Interventions: Simultaneous capillary (muzzle, POCMUZ) and venous (jugular, POCJUG) blood samples were obtained to determine POC glucose concentrations. Venous samples were also analyzed by LABGLU. Each foal was sampled at the time of enrollment or admission to the hospital and at 1 subsequent point during hospitalization. Indirect mean arterial pressure and hematocrit were concurrently recorded. Measurements and Main Results: Bland–Altman analysis showed a mean bias (95% limits of agreement) of −28.0 (−88.6 to 32.6) mg/dL for comparison of POCJUG with LABGLU, −8.2 (−94.3 to 78.0) mg/dL for POCMUZ and LABGLU, and 18.8 (−44.4 to 82.0) mg/dL for POCMUZ and POCJUG. A total of 63.5% of the POCJUG and 45.2% of the POCMUZ samples exceeded the reference value by ±15 mg/dL (for LABGLU samples <75 mg/dL) or ±15% (for LABGLU samples ≥75mg/dL). Concordance correlation coefficient (95% confidence interval [CI]) indicated a fair agreement between POCJUG and LABGLU (0.75, 95% CI: 0.66–0.82) and between POCMUZ and LABGLU (0.71, 95% CI: 0.58–0.80). Fifty percent (14/28) of hypoglycemic foals on the reference method were incorrectly classified as euglycemic by POCJUG, and 5 of 28 were incorrectly classified by POCMUZ. Conclusions: In the sampled population, the chosen POC glucometer lacked agreement with the standard laboratory measurement. Limits of agreement were wide for both POCJUG and POCMUZ. Inaccuracies in POC results could impact decision‐making in the clinical management of glycemic control in hospitalized neonatal foals and, importantly, increase the risk of hypoglycemic events being underdiagnosed in critical patients. [ABSTRACT FROM AUTHOR]

Background: Endothelial glycocalyx (EG) degradation occurs in septic humans and EG products can be used as biomarkers of endothelial injury. Information about EG biomarkers and their association with disease severity is lacking in hospitalized foals. Objectives: Measure serum syndecan‐1 (SDC‐1), heparan sulfate (HS), angiopoietin‐2 (ANG‐2), aldosterone (ALD), and plasma atrial natriuretic peptide (ANP) concentrations and to determine their association with disease severity and death in hospitalized foals. Animals: Ninety foals ≤3 days old. Methods: Prospective, multicenter, longitudinal study. Foals were categorized into hospitalized (n = 74; 55 septic; 19 sick nonseptic) and 16 healthy foals. Serum ([SDC‐1], [HS], [ANG‐2], [ALD]) and plasma (ANP) were measured over 72 hours using immunoassays. Results: Serum ([SDC‐1], [HS], [ANG‐2], [ALD]) and plasma (ANP) were significantly higher in hospitalized and septic than healthy foals (P <.05). Serum (ANG‐2) and plasma (ANP) were significantly higher in hospitalized nonsurvivors than in survivors (P <.05). On admission, hospitalized foals with serum (HS) > 58.7 ng/mL had higher odds of nonsurvival (odds ratio [OR] = 6.1; 95% confidence interval [CI] = 1.02‐36.7). Plasma (ANP) >11.5 pg/mL was associated with the likelihood of nonsurvival in hospitalized foals (OR = 7.2; 95% CI = 1.4‐37.4; P <.05). Septic foals with serum (ANG‐2) >1018 pg/mL on admission had higher odds of nonsurvival (OR = 6.5; 95% CI =1.2‐36.6; P <.05). Conclusion and Clinical Importance: Critical illness in newborn foals is associated with EG degradation and injury, and these biomarkers are related to the severity of disease on admission and the outcome of sick foals. [ABSTRACT FROM AUTHOR]

Background: The neutrophil‐lymphocyte ratio (NLR) in human medicine is an objective biomarker that reflects prognosis. The NLR as an independent biomarker to help predict nonsurvival in hospitalized neonatal foals has not been thoroughly interrogated. Objectives/Hypothesis: Retrospectively evaluate if the NLR at admission is associated with nonsurvival in sick hospitalized foals <4 days old. We hypothesized that a lower NLR will be associated with nonsurvival. Animals: One thousand one hundred ninety‐six client‐owned foals <4 days old of any breed and sex: 993 hospitalized foals and 203 healthy foals. Methods: Retrospective multicenter study. Medical records of foals presenting to 3 equine referral hospitals were reviewed. Foals were included if they had complete CBCs, sepsis scores, and outcome data. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Data were analyzed by nonparametric methods and univariate analysis. Results: Of the 993 sick hospitalized foals, 686 were sick nonseptic and 307 were septic. The median NLR was lower in sick hospitalized foals (median [95% confidence interval], 3.55 [0.5‐13.9]) compared with healthy foals (6.61 [3.06‐18.1]). Septic foals had the lowest NLR (2.00 [0.20‐9.71]). The NLR was lower in nonsurviving (1.97 [1.67‐2.45]) compared with surviving foals (4.10 [3.76‐4.33]). Nonsurviving septic foals had the lowest NLR (1.47 [1.70‐3.01]). Foals with a NLR of <3.06 or <1.6 at admission had odds ratio of 3.21 (2.24‐4.29) and 4.03 (2.86‐5.67) for nonsurvival, respectively. Conclusions and Clinical Importance: A NLR < 3.06 at admission in sick hospitalized foals is readily available and clinically useful variable to provide prognostic information. [ABSTRACT FROM AUTHOR]

Background: 5′‐adenosine monophosphate‐activated protein kinase (AMPK) agonists, particularly resveratrol (RES), have not been extensively evaluated for their effect on insulin dysregulation (ID) in horses. Objectives: Evaluate the effects of treatment with RES (10 mg/kg PO q12h), metformin (MET; 30 mg/kg PO q12h), and aspirin (ASP; 20 mg/kg PO q24h) on experimentally induced ID. Animals: Thirty‐three healthy, adult, light‐breed horses. Methods: Unblinded, placebo‐controlled, experimental trial evaluating effects of AMPK agonists (RES, MET, and ASP) on experimentally induced ID. Horses were randomly assigned to a treatment group (RES, MET/ASP, RES/ASP, RES/MET/ASP, or placebo [CON]) after induction of ID with dexamethasone (0.08 mg/kg PO q24h for 7 days). Frequently sampled insulin‐modified IV glucose tolerance tests (FSIGTT) and oral sugar tests (OST) were performed at baseline, 7 days after ID, and ID plus 7 days of treatment. Minimal model and OST variables were compared between (1‐way ANOVA) and within (1‐way ANOVA for repeated measures) groups over time to determine effects of treatment on ID. Results: Administration of dexamethasone for 14 days resulted in significantly altered insulin and glucose dynamics (SI, DI, basal [glucose], and [insulin]) and produced clinical signs of laminitis in 5 out of 33 (15%) of horses included in the study. Combination therapy with RES, MET, and ASP did not significantly improve insulin and glucose dynamics in horses with experimentally induced ID. Conclusions and Clinical Importance: Metabolic testing before glucocorticoid administration should be considered in horses with clinical signs of metabolic syndrome. [ABSTRACT FROM AUTHOR]

Objective: Insulin dysregulation is a hallmark of equine metabolic syndrome (EMS) and increases the risk for development of laminitis. Accurate diagnosis of insulin dysregulation is crucial for implementation of preventative strategies in this population. The objective was to assess the effects of dexamethasone administration on insulin and glucose dynamics in light-breed horses and assess the agreement of various diagnostic tests for insulin dysregulation [basal [insulin] (BI), oral sugar test (OST), and combined glucose-insulin test (CGIT)]., Animal: Fourteen adult light-breed horses., Procedure: Prospective, experimental study to assess insulin and glucose dynamics by performing basal insulin, OST, and CGIT before (baseline) and post-dexamethasone administration (0.08 mg/kg, PO, q24h) for 7 d. Insulin and glucose dynamics were assessed by the BI, OST, CGIT, and insulin sensitivity proxy measurements (RISQI, QUICKI, FGIR, HOMA-IR, IG) at the baseline and post-dexamethasone time points., Results: The OST area under the insulin and glucose curves were increased following dexamethasone treatment ( P < 0.001 and P < 0.01, respectively). Basal insulin, OST [insulin] at 60 min and CGIT [insulin] at 45 min were increased at the post-dexamethasone time point ( P < 0.001, < 0.001, and < 0.01). Similarly, time spent in the positive glucose phase during the CGIT was longer at the post-dexamethasone time point ( P < 0.001). The proxy measurements for insulin sensitivity (RISQI, QUICKI, FGIR) were decreased ( P < 0.01) and the proxy measurements for insulin resistance (HOMA-IR) and β-cell function (IG) were increased after dexamethasone administration ( P < 0.01). More horses were classified with following dexamethasone administration, based on the diagnostic criteria for basal insulin ( P = 0.03), OST ( P = 0.01), and CGIT ( P < 0.01). Kappa coefficients, measuring agreement between basal insulin, OST, and CGIT, showed none to moderate agreement at the baseline time point., Conclusion: Dexamethasone administration at 0.08 mg/kg, PO, q24h for 7 d worsened insulin dysregulation in adult light-breed horses based on findings of a basal insulin, OST, CGIT, and insulin sensitivity proxy measurements. There was none to moderate agreement between the basal insulin, OST, CGIT for the diagnosis of insulin dysregulation., Clinical Relevance: Horses administered dexamethasone at a dose of 0.08 mg/kg, PO, q24h for 7 d should be considered insulin dysregulation and appropriate preventative strategies should be implemented. The variability of diagnostic performance of common tests for insulin dysregulation (basal insulin, OST, CGIT) may affect clinical decisions; therefore, performing multiple tests, including proxy measurements, may improve diagnostic accuracy of insulin dysregulation., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)