Endotoxemia in horses refers to the presence of endotoxins in the bloodstream, typically originating from the cell walls of Gram-negative bacteria. This condition can occur due to gastrointestinal disturbances, infections, or other systemic issues, leading to a cascade of inflammatory responses. Endotoxins stimulate the release of various cytokines and other mediators, which can result in clinical signs such as fever, depression, and colic. The physiological impact of endotoxemia can be significant, affecting multiple organ systems. This page compiles peer-reviewed research studies and scholarly articles that explore the pathophysiology, clinical manifestations, and management strategies of endotoxemia in equine patients.
Tukia E, Wagner B, Vainio K, Mönki J, Kareskoski M.Postpartum metritis in mares is a life-threatening condition associated with severe clinical signs due to endotoxemia, and it is often followed by complications such as laminitis. Repeated large-volume uterine lavages are commonly recommended as a part of the treatment protocol to remove endotoxin-laden contents from the uterus. It has, however, also been suggested that lavages may increase the uptake of endotoxin into the circulation, leading to a deterioration of clinical signs. Endotoxemia is associated with the release of a multitude of inflammatory mediators regulating the immune response...
Burden CA, Meijer M, Pozor MA, Macpherson ML.Retained fetal membranes are the most common postpartum condition in mares. Although the incidence of retained fetal membranes is low, the consequences for the health of the mare can be severe (metritis, endotoxemia, laminitis, death). Oxytocin administration is often the first line of therapy for management of retained fetal membranes. Removal of fetal membranes using umbilical vessel infusion and manual membrane removal are effective tools for reducing risks associated with abnormally heavy membranes, retained membranes, or for mares that are geographically limited for veterinary care.
McGovern KF, Lascola KM, Smith SA, Clark-Price SC, Wilkins PA, Schaeffer DJ, Foreman JH.Hyperglycemia and endotoxemia have been associated with coagulation abnormalities in horses. Studies in humans suggest greater disturbances in coagulation with hyperglycemia and concurrent endotoxemia. Objective: To compare coagulation parameters in horses administered with lipopolysaccharide (LPS) with and without concurrent hyperglycemia. Methods: Twelve healthy adult horses. Methods: Hyperglycemia (180-240 mg/dL) was maintained for 6 hours in 6 horses (GLU-LPS) using 140 mg/kg IV bolus of dextrose followed by a 20% dextrose constant rate infusion. A similar volume of saline was administe...
Johnson RJ, Rivard C, Lanaspa MA, Otabachian-Smith S, Ishimoto T, Cicerchi C, Cheeke PR, Macintosh B, Hess T.Fructose is a simple sugar present in honey and fruit, but can also exist as a polymer (fructans) in pasture grasses. Mammals are unable to metabolize fructans, but certain gram positive bacteria contain fructanases and can convert fructans to fructose in the gut. Recent studies suggest that fructose generated from bacteria, or directly obtained from the diet, can induce both increased intestinal permeability and features of metabolic syndrome, especially the development of insulin resistance. The development of insulin resistance is driven in part by the metabolism of fructose by fructokinase...
Stewart AJ.Magnesium (Mg) is an essential macroelement that is required for cellular energy-dependent reactions involving adenosine triphosphate and for the regulation of calcium channel function. Subclinical hypomagnesemia is common in critically ill humans and animals and increases the severity of the systemic inflammatory response syndrome; worsens the systemic response to endotoxins; and can lead to ileus, cardiac arrhythmias, refractory hypokalemia, and hypocalcemia. This article discusses the clinical signs, consequences, and treatment of hypomagnesemia in horses and describes the association of Mg...
Prange T, Holcombe SJ, Brown JA, Dechant JE, Fubini SL, Embertson RM, Peroni J, Rakestraw PC, Hauptman JG.To determine (1) the short- (to hospital discharge) and long- (>6 months) term survival, (2) factors associated with short-term survival, and (3) the perioperative course for horses with resection and anastomosis of the descending colon. Methods: Multicentered case series. Methods: Horses (n=43) that had descending colon resection and anastomosis. Methods: Medical records (January 1995-June 2009) of 7 equine referral hospitals were reviewed for horses that had descending colon resection and anastomosis and were recovered from anesthesia. Retrieved data included history, results of clinical and...
Doherty TJ.Surgical manipulation of the intestines activates intestinal macrophages that release cytokines and nitric oxide, which results in inhibition of intestinal motility. Subsequent infiltration of circulating leukocytes into the intestinal wall contributes to cytokine and nitric oxide release and exacerbates ileus. Other factors contributing to ileus are endotoxemia; edema of the intestine wall subsequent to excessive fluid therapy; hypocalcemia; and long abdominal incisions. Because treatment of ileus with prokinetic drugs has not proven to be very effective, efforts should be directed at reducin...
Mair TS, Smith LJ.Few studies have assessed short- and long-term complication rates of horses following surgical treatment of colic, a potentially fatal condition. Complications can lead to patient discomfort and increased costs; knowledge of predisposing factors may help to reduce complication rates. Objective: To document and analyse short-term complications in 300 horses undergoing colic surgery, and to assess some of the possible predisposing factors. Methods: History, clinical findings, surgical findings and procedures, and post operative treatments of 300 consecutive surgical colic cases (1994-2001) were ...
Eggleston RB, Mueller PO.As with many aspects of clinical medicine, there is yet to be a single or definitive cure for postoperative adhesion formation. Current methods of prevention target risk factors predisposing horses to adhesion formation. Systemic pharmacologic therapies, such as antimicrobials, nonsteroidal anti-inflammatory drugs, Salmonella antiserum, and hyperimmune plasma, help to reduce abdominal inflammation and minimize the effects of endotoxemia. Intra-abdominal or systemic heparin aids in enhancing peritoneal fibrinolysis. Prokinetic therapy promotes early postoperative return of intestinal motility, ...
Lalko CC, Deppe E, Ulatowski D, Lutgen A, Hart AP, Patton EA, Lunn DP, Suresh M, Darien BJ.Acute inflammatory diseases, such as colic, septicemia and endotoxemia are common in equines and have been shown to be correlated to vascular injury and thrombosis. In humans with similar thrombotic conditions, P-selectin and P-selectin glycoprotein ligand-1 (PSGL-1)-mediated platelet-leukocyte adhesion contributes to the pathogenesis of these disorders through the generation of inflammatory mediators and tissue factor. As such, we hypothesized that a P-selectin-PSGL-1 (platelet-leukocyte) interaction, similar to that in humans, may also exist in the horse. The objective of this study was to i...
Katz LM, Ragle CA.Horses with tears that involve all layers of the rectum except the mesocolon (grade IIIb) have a poor prognosis for survival because of the difficulty in treating these wounds and the propensity for them to progress to full perforations (grade IV). Most treatments for grade-IIIb rectal tears involve surgery of some kind, but not all grade-IIIb rectal tears require surgical intervention. We report on 4 horses with grade-IIIb rectal tears that were evaluated via palpation per rectum and endoscopy. Two of 4 horses were admitted with signs consistent with shock and endotoxemia, and evaluation of a...
Ingle-Fehr JE, Baxter GM.To measure blood flow in the palmar digital artery and laminae corium, using ultrasonic and laser Doppler flowmetry, respectively. Methods: 6 healthy horses. Methods: Digital blood flow and laminar perfusion, respectively, were measured by placing a flow probe around the palmar digital artery and a laser Doppler flow probe in a hole in the dorsal aspect of the hoof wall. All horses were given saline (0.9% NaCl) solution (1 L, IV, during a 30-minute period). Seven days later, each horse was given endotoxin (0.1 microgram/kg of body weight, IV, in 1 L of saline solution, during a 30-minute perio...
Moore BR, Hinchcliff KW.Heparin is used clinically in horses to treat hemostatic abnormalities associated with severe gastrointestinal disease, septicemia, and endotoxemia. The primary anticoagulant effect of heparin is through the suppression of thrombin-dependent amplification of the coagulation cascade, and inhibition of thrombin-mediated conversion of fibrinogen to fibrin. Heparin may be of benefit in preventing the complications associated with hypercoagulable states such as jugular vein thrombosis, laminitis, and organ failure. Heparin may also be beneficial in the prevention of intraabdominal adhesions after g...
Welles EG, Prasse KW, Moore JN.Protein C content and plasminogen activity were measured in plasma from 100 horses with signs of colic. Data were analyzed by grouping horses 4 ways. Each horse was allotted to 1 of 2 outcome groups (survivors and nonsurvivors), 1 of 3 broad-category diagnosis groups (inflammatory disorders, strangulating obstructions, and all other gastrointestinal disorders), and 1 of 2 clinical management groups (medical and surgical). In a fourth grouping, all horses (although numbers of horses included in each subgroup were small) were assigned either to specific diagnostic groups that had high expectatio...
Johnson RJ, Rivard C, Lanaspa MA, Otabachian-Smith S, Ishimoto T, Cicerchi C, Cheeke PR, Macintosh B, Hess T.Fructose is a simple sugar present in honey and fruit, but can also exist as a polymer (fructans) in pasture grasses. Mammals are unable to metabolize fructans, but certain gram positive bacteria contain fructanases and can convert fructans to fructose in the gut. Recent studies suggest that fructose generated from bacteria, or directly obtained from the diet, can induce both increased intestinal permeability and features of metabolic syndrome, especially the development of insulin resistance. The development of insulin resistance is driven in part by the metabolism of fructose by fructokinase...
Moore BR, Hinchcliff KW.Heparin is used clinically in horses to treat hemostatic abnormalities associated with severe gastrointestinal disease, septicemia, and endotoxemia. The primary anticoagulant effect of heparin is through the suppression of thrombin-dependent amplification of the coagulation cascade, and inhibition of thrombin-mediated conversion of fibrinogen to fibrin. Heparin may be of benefit in preventing the complications associated with hypercoagulable states such as jugular vein thrombosis, laminitis, and organ failure. Heparin may also be beneficial in the prevention of intraabdominal adhesions after g...
Stewart AJ.Magnesium (Mg) is an essential macroelement that is required for cellular energy-dependent reactions involving adenosine triphosphate and for the regulation of calcium channel function. Subclinical hypomagnesemia is common in critically ill humans and animals and increases the severity of the systemic inflammatory response syndrome; worsens the systemic response to endotoxins; and can lead to ileus, cardiac arrhythmias, refractory hypokalemia, and hypocalcemia. This article discusses the clinical signs, consequences, and treatment of hypomagnesemia in horses and describes the association of Mg...
Eggleston RB, Mueller PO.As with many aspects of clinical medicine, there is yet to be a single or definitive cure for postoperative adhesion formation. Current methods of prevention target risk factors predisposing horses to adhesion formation. Systemic pharmacologic therapies, such as antimicrobials, nonsteroidal anti-inflammatory drugs, Salmonella antiserum, and hyperimmune plasma, help to reduce abdominal inflammation and minimize the effects of endotoxemia. Intra-abdominal or systemic heparin aids in enhancing peritoneal fibrinolysis. Prokinetic therapy promotes early postoperative return of intestinal motility, ...
Doherty TJ.Surgical manipulation of the intestines activates intestinal macrophages that release cytokines and nitric oxide, which results in inhibition of intestinal motility. Subsequent infiltration of circulating leukocytes into the intestinal wall contributes to cytokine and nitric oxide release and exacerbates ileus. Other factors contributing to ileus are endotoxemia; edema of the intestine wall subsequent to excessive fluid therapy; hypocalcemia; and long abdominal incisions. Because treatment of ileus with prokinetic drugs has not proven to be very effective, efforts should be directed at reducin...
McGovern KF, Lascola KM, Smith SA, Clark-Price SC, Wilkins PA, Schaeffer DJ, Foreman JH.Hyperglycemia and endotoxemia have been associated with coagulation abnormalities in horses. Studies in humans suggest greater disturbances in coagulation with hyperglycemia and concurrent endotoxemia. Objective: To compare coagulation parameters in horses administered with lipopolysaccharide (LPS) with and without concurrent hyperglycemia. Methods: Twelve healthy adult horses. Methods: Hyperglycemia (180-240 mg/dL) was maintained for 6 hours in 6 horses (GLU-LPS) using 140 mg/kg IV bolus of dextrose followed by a 20% dextrose constant rate infusion. A similar volume of saline was administe...
Lalko CC, Deppe E, Ulatowski D, Lutgen A, Hart AP, Patton EA, Lunn DP, Suresh M, Darien BJ.Acute inflammatory diseases, such as colic, septicemia and endotoxemia are common in equines and have been shown to be correlated to vascular injury and thrombosis. In humans with similar thrombotic conditions, P-selectin and P-selectin glycoprotein ligand-1 (PSGL-1)-mediated platelet-leukocyte adhesion contributes to the pathogenesis of these disorders through the generation of inflammatory mediators and tissue factor. As such, we hypothesized that a P-selectin-PSGL-1 (platelet-leukocyte) interaction, similar to that in humans, may also exist in the horse. The objective of this study was to i...
Burden CA, Meijer M, Pozor MA, Macpherson ML.Retained fetal membranes are the most common postpartum condition in mares. Although the incidence of retained fetal membranes is low, the consequences for the health of the mare can be severe (metritis, endotoxemia, laminitis, death). Oxytocin administration is often the first line of therapy for management of retained fetal membranes. Removal of fetal membranes using umbilical vessel infusion and manual membrane removal are effective tools for reducing risks associated with abnormally heavy membranes, retained membranes, or for mares that are geographically limited for veterinary care.
Welles EG, Prasse KW, Moore JN.Protein C content and plasminogen activity were measured in plasma from 100 horses with signs of colic. Data were analyzed by grouping horses 4 ways. Each horse was allotted to 1 of 2 outcome groups (survivors and nonsurvivors), 1 of 3 broad-category diagnosis groups (inflammatory disorders, strangulating obstructions, and all other gastrointestinal disorders), and 1 of 2 clinical management groups (medical and surgical). In a fourth grouping, all horses (although numbers of horses included in each subgroup were small) were assigned either to specific diagnostic groups that had high expectatio...
Tukia E, Wagner B, Vainio K, Mönki J, Kareskoski M.Postpartum metritis in mares is a life-threatening condition associated with severe clinical signs due to endotoxemia, and it is often followed by complications such as laminitis. Repeated large-volume uterine lavages are commonly recommended as a part of the treatment protocol to remove endotoxin-laden contents from the uterus. It has, however, also been suggested that lavages may increase the uptake of endotoxin into the circulation, leading to a deterioration of clinical signs. Endotoxemia is associated with the release of a multitude of inflammatory mediators regulating the immune response...
Mair TS, Smith LJ.Few studies have assessed short- and long-term complication rates of horses following surgical treatment of colic, a potentially fatal condition. Complications can lead to patient discomfort and increased costs; knowledge of predisposing factors may help to reduce complication rates. Objective: To document and analyse short-term complications in 300 horses undergoing colic surgery, and to assess some of the possible predisposing factors. Methods: History, clinical findings, surgical findings and procedures, and post operative treatments of 300 consecutive surgical colic cases (1994-2001) were ...
Ingle-Fehr JE, Baxter GM.To measure blood flow in the palmar digital artery and laminae corium, using ultrasonic and laser Doppler flowmetry, respectively. Methods: 6 healthy horses. Methods: Digital blood flow and laminar perfusion, respectively, were measured by placing a flow probe around the palmar digital artery and a laser Doppler flow probe in a hole in the dorsal aspect of the hoof wall. All horses were given saline (0.9% NaCl) solution (1 L, IV, during a 30-minute period). Seven days later, each horse was given endotoxin (0.1 microgram/kg of body weight, IV, in 1 L of saline solution, during a 30-minute perio...
Prange T, Holcombe SJ, Brown JA, Dechant JE, Fubini SL, Embertson RM, Peroni J, Rakestraw PC, Hauptman JG.To determine (1) the short- (to hospital discharge) and long- (>6 months) term survival, (2) factors associated with short-term survival, and (3) the perioperative course for horses with resection and anastomosis of the descending colon. Methods: Multicentered case series. Methods: Horses (n=43) that had descending colon resection and anastomosis. Methods: Medical records (January 1995-June 2009) of 7 equine referral hospitals were reviewed for horses that had descending colon resection and anastomosis and were recovered from anesthesia. Retrieved data included history, results of clinical and...
Katz LM, Ragle CA.Horses with tears that involve all layers of the rectum except the mesocolon (grade IIIb) have a poor prognosis for survival because of the difficulty in treating these wounds and the propensity for them to progress to full perforations (grade IV). Most treatments for grade-IIIb rectal tears involve surgery of some kind, but not all grade-IIIb rectal tears require surgical intervention. We report on 4 horses with grade-IIIb rectal tears that were evaluated via palpation per rectum and endoscopy. Two of 4 horses were admitted with signs consistent with shock and endotoxemia, and evaluation of a...
