Hypoproteinemia in horses refers to a condition characterized by abnormally low levels of plasma proteins, particularly albumin and globulins, in the blood. These proteins are essential for maintaining osmotic pressure, transporting substances, and supporting immune function. Hypoproteinemia can result from various causes, including malnutrition, gastrointestinal disorders, liver disease, and protein-losing conditions. Clinical signs in horses may include edema, weight loss, and poor coat condition. Diagnostic evaluation typically involves blood tests to measure protein levels and identify underlying causes. This page compiles peer-reviewed research studies and scholarly articles that explore the etiology, diagnosis, and management of hypoproteinemia in equine patients.
Gomez DE, Leclere M, Arroyo LG, Li L, John E, Afonso T, Payette F, Darby S.This study describes the clinicopathological findings, diagnostic approach, treatment, and factors associated with non-survival of diarrheic horses admitted to 4 Canadian university teaching hospitals between 2015 and 2019. A total of 300 horses, ≥1-year-old, with acute diarrhea were included and represented 1.6% (300/18 481; range: 0.7 to 3%) of admissions during that period, 70% of the horses survived to discharge. Testing for enteropathogens was limited to a single fecal culture for Salmonella spp. in most cases. An enteropathogen was identified in 14% (42/300) of the horses, but in the h...
Pusterla N, Barnum S, Hall JA, Marshall-Lund L, Gebhart C.The objective of this study was to determine if serum amyloid A (SAA), a major acute-phase protein, could help support the diagnosis of equine proliferative enteropathy (EPE) caused by Lawsonia intracellularis infection in foals. Archived serum samples from 101 foals with enteric signs and hypoproteinemia were available for SAA testing. Based on immunodiagnostics for L. intracellularis, the foals were divided into EPE-suspect (67) and non-EPE-suspect cases (34). Serum amyloid A values ranged from 0 to 2,761 μg/mL (median 466 μg/mL) and from 0 to 2,555 μg/mL (median 192 μg/mL) for the ...
Page AE, Slovis NM, Horohov DW.Lawsonia intracellularis is the etiologic agent for equine proliferative enteropathy (EPE), which typically affects weanling and yearling horses. In North America, EPE cases often occur between August and January, although cases outside of this time frame have been reported. Clinical signs of EPE are usually nonspecific and include lethargy, pyrexia, anorexia, peripheral edema, weight loss, colic, and diarrhea. Diagnosis is based on the presence of hypoproteinemia and hypoalbuminemia along with clinical signs and positive commercial serologic and/or molecular testing. Treatment requires the us...
Bellezzo F, Kuhnmuench T, Hackett ES.Naturally occurring gastrointestinal disease is an important cause of acute hypoproteinemia in adult horses and hydroxyethyl starch colloid fluid treatment is a component of supportive care in these cases to improve plasma volume and maintain colloid osmotic pressure (COP). The objectives of the present study were to compare 2 formulations of high molecular weight hydroxyethyl starch and their relative effect on COP, acid-base status, and survival of horses with acute hypoproteinemia secondary to gastrointestinal disease. Methods: Twenty adult horses, ≥ 1 year of age, were prospectively enro...
Lane JK, Cohen JM, Zedler ST, Hollis AR, Southwood LL.To describe a novel surgical technique for management of right dorsal colitis in the horse. Methods: Clinical report. Methods: 14-year-old Warmblood gelding. Methods: The horse was referred for treatment of a stromal abscess and signs of right dorsal colitis. Plasma chemistry revealed marked hypoproteinemia. Abdominal ultrasonographic examination showed a thickened right dorsal colon (RDC). Medical treatment was unsuccessful. With the horse in left lateral recumbency under general anesthesia, an approach to the right side of the abdomen through a 16th rib resection was made. The thoracic cavit...
McClintock SA, Collins AM.A 6-month-old Quarter Horse weanling filly was presented with lethargy, weight loss, inappetance, mild diarrhoea, marked ventral oedema and severe panhypoproteinaemia. Serum antibody titres for Lawsonia intracellularis were very high but PCR to detect faecal shedding of the organism was negative. Proliferative enteropathy due to L. intracellularis infection was diagnosed. After treatment for 4 weeks with oral erythromycin and rifampicin the filly made a complete recovery.
Southwood LL.Horses with large colon volvulus (LCV) often require intensive postoperative medical management. Although early referral and surgical intervention are critical for minimal postoperative complications and a successful outcome, this is often not possible for many reasons. Endotoxemia, extensive mucosal damage with subsequent severe hypoproteinemia, and focal ischemic necrosis are the major causes of postoperative morbidity and mortality. Although fluid therapy, flunixin meglumine, and antimicrobials are still the mainstay of perioperative management, synthetic colloids are being used to maintain...
Magdesian KG, Hirsh DC, Jang SS, Hansen LM, Madigan JE.To determine molecular characteristics of Clostridium difficile isolates from foals with diarrhea and identify clinical abnormalities in affected foals. Methods: Retrospective study. Methods: 28 foals with C difficile-associated diarrhea. Methods: Toxigenicity, molecular fingerprinting, and antibiotic susceptibility patterns were determined. Information on signalment, clinical findings, results of clinicopathologic testing, whether antimicrobials had been administered prior to development of diarrhea, and outcome was obtained from the medical records. Results: Twenty-three (82%) foals survived...
Bihr TP.A 5-month-old Morgan filly was presented to the Atlantic Veterinary College with a history of lethargy, fever, depression, anorexia, and dependent ventral edema. Diagnostic tests revealed severe inflammation, hypoproteinemia, and thickened small intestinal loops. Protein-losing enteropathy caused by Lawsonia intracellularis was diagnosed and treated successfully with erythromycin-rifampin.
Jones PA, Bain FT, Byars TD, David JB, Boston RC.To determine the effect of hydroxyethyl starch (HES) on colloid oncotic pressure (pi) during fluid resuscitation of hypoproteinemic horses and to evaluate the clinical usefulness of direct and indirect methods for determination of pi before and after infusion of a synthetic colloid. Methods: Prospective clinical study. Methods: 11 hypoproteinemic horses. Methods: Horses received IV infusions of 8 to 10 ml of a 6% solution of HES/kg (3.6 to 4.5 ml/lb) of body weight during fluid resuscitation. Blood samples were obtained for determination of plasma measured colloid oncotic pressure (pi meas) an...
Cohen ND, Carter GK, Mealey RH, Taylor TS.Right dorsal colitis in horses has been associated with administration of phenylbutazone. Although reports of right dorsal colitis in this species have described surgical treatment associated with a poor prognosis, we have had success treating this condition medically. This report describes 5 horses with right dorsal colitis confirmed during celiotomy that were initially managed medically. All horses had a history of intermittent abdominal pain; weight loss was noted in only 1 horse. The doses (2.0 to 4.6 mg/kg PO bid) and duration (5 to 30 days) of administration of phenylbutazone were not un...
Parraga ME, Carlson GP, Thurmond M.The present retrospective study was undertaken to determine the frequency of hypoproteinemia and hypoalbuminemia in horses with natural occurring severe liver disease. The study represents a review of case records and laboratory data of 84 horses presented with acute or chronic liver disease to the University of California Veterinary Medical Teaching Hospital between 1973 and 1991. Forty horses (48%) had serum protein concentrations above the maximum reference value (7.7 g/dL). The increase in serum protein concentration was associated with hyperglobulinemia (P = .00005, R2 = .80). Only 13% (1...
Simmons TR, Gaughan EM, Ducharme NG, Dill SG, King JM, Anderson WI.Excessive administration of phenylbutazone was associated with development of right dorsal ulcerative colitis. The clinical signs of right dorsal colitis include chronic colic and weight loss. The laboratory abnormalities include panhypoproteinemia and a high WBC count in the abdominal fluid. Medical management of the chronic colic and protein-losing enteropathy associated with the ulcerative lesions in the right dorsal colon and surgical bypass of the right dorsal colon did not result in long-term resolution of clinical signs. Resection of the ulcerated right dorsal colon through a right late...
Sweeney RW, Sweeney CR, Saik J, Lichtensteiger CA.Chronic granulomatous bowel disease was diagnosed in 3 sibling Standardbred horses. Clinical signs included weight loss, loose feces, and decreased appetite in the terminal stage of the disease. Abnormal laboratory findings included hypoproteinemia and low xylose absorption. Necropsy revealed granulomatous inflammation of the intestines, mesenteric lymph nodes, and liver. Eosinophilic infiltration of the granulomatous lesions was a prominent finding in one horse. A causative agent was not detected by special histochemical staining or bacteriologic culturing.
Collins LG, Tyler DE.In a retrospective study of 269 horses that had been treated with phenylbutazone, horses receiving less than or equal to 8.8 mg/kg of body weight/day for less than or equal to 4 days or 2 to 4 mg/kg of body weight/day for up to 50 days remained clinically normal. Anorexia, depression, colic, hypoproteinemia, diarrhea, melena, weight loss, ventral edema, petechial hemorrhages of mucous membranes, oral and gastrointestinal tract erosions and ulcers, renal papillary necrosis, and death were among the complications seen in horses that had received greater than 8.8 mg/kg of body weight/day. In 2 ca...
Snow DH, Douglas TA, Thompson H, Parkins JJ, Holmes PH.Toxic effects of phenylbutazone (PBZ) in ponies and horses were studied, using a variety of biochemical, pathophysiologic, and pathologic methods. At dosage levels of 10 to 12 mg/kg of body weight/day for 8 to 10 days, ponies frequently developed clinical signs of toxicosis characterized by hypoproteinemia. Studies using 51CrCl3 demonstrated that PBZ caused a protein-losing gastroenteropathy. The plasma loss was usually associated with gastrointestinal ulceration, but sometimes occurred without obvious lesions in mildly affected animals. Similar studies (8.2 mg/kg/day for 13 days) in Thoroughb...
Meuten DJ, Butler DG, Thomson GW, Lumsden JH.Chronic granulomatous enteritis associated with weight loss and hypoproteinemia was identified in 2 horses. Both horses continued to have normally formed feces. Malabsorption of carbohydrate and lipid, with concomitant gastrointestinal protein loss was demonstrated in 1 case. One horse was treated symptomatically and gained 108 kg. In both cases, principal gastrointestinal lesions were partial to total villus atrophy and transmural mononuclear leukocytosis, with lymphocytes and histiocytes predominating. The cause of the condition was not identified in either case.
Magdesian KG, Hirsh DC, Jang SS, Hansen LM, Madigan JE.To determine molecular characteristics of Clostridium difficile isolates from foals with diarrhea and identify clinical abnormalities in affected foals. Methods: Retrospective study. Methods: 28 foals with C difficile-associated diarrhea. Methods: Toxigenicity, molecular fingerprinting, and antibiotic susceptibility patterns were determined. Information on signalment, clinical findings, results of clinicopathologic testing, whether antimicrobials had been administered prior to development of diarrhea, and outcome was obtained from the medical records. Results: Twenty-three (82%) foals survived...
Collins LG, Tyler DE.In a retrospective study of 269 horses that had been treated with phenylbutazone, horses receiving less than or equal to 8.8 mg/kg of body weight/day for less than or equal to 4 days or 2 to 4 mg/kg of body weight/day for up to 50 days remained clinically normal. Anorexia, depression, colic, hypoproteinemia, diarrhea, melena, weight loss, ventral edema, petechial hemorrhages of mucous membranes, oral and gastrointestinal tract erosions and ulcers, renal papillary necrosis, and death were among the complications seen in horses that had received greater than 8.8 mg/kg of body weight/day. In 2 ca...
Cohen ND, Carter GK, Mealey RH, Taylor TS.Right dorsal colitis in horses has been associated with administration of phenylbutazone. Although reports of right dorsal colitis in this species have described surgical treatment associated with a poor prognosis, we have had success treating this condition medically. This report describes 5 horses with right dorsal colitis confirmed during celiotomy that were initially managed medically. All horses had a history of intermittent abdominal pain; weight loss was noted in only 1 horse. The doses (2.0 to 4.6 mg/kg PO bid) and duration (5 to 30 days) of administration of phenylbutazone were not un...
Snow DH, Douglas TA, Thompson H, Parkins JJ, Holmes PH.Toxic effects of phenylbutazone (PBZ) in ponies and horses were studied, using a variety of biochemical, pathophysiologic, and pathologic methods. At dosage levels of 10 to 12 mg/kg of body weight/day for 8 to 10 days, ponies frequently developed clinical signs of toxicosis characterized by hypoproteinemia. Studies using 51CrCl3 demonstrated that PBZ caused a protein-losing gastroenteropathy. The plasma loss was usually associated with gastrointestinal ulceration, but sometimes occurred without obvious lesions in mildly affected animals. Similar studies (8.2 mg/kg/day for 13 days) in Thoroughb...
Page AE, Slovis NM, Horohov DW.Lawsonia intracellularis is the etiologic agent for equine proliferative enteropathy (EPE), which typically affects weanling and yearling horses. In North America, EPE cases often occur between August and January, although cases outside of this time frame have been reported. Clinical signs of EPE are usually nonspecific and include lethargy, pyrexia, anorexia, peripheral edema, weight loss, colic, and diarrhea. Diagnosis is based on the presence of hypoproteinemia and hypoalbuminemia along with clinical signs and positive commercial serologic and/or molecular testing. Treatment requires the us...
Gomez DE, Leclere M, Arroyo LG, Li L, John E, Afonso T, Payette F, Darby S.This study describes the clinicopathological findings, diagnostic approach, treatment, and factors associated with non-survival of diarrheic horses admitted to 4 Canadian university teaching hospitals between 2015 and 2019. A total of 300 horses, ≥1-year-old, with acute diarrhea were included and represented 1.6% (300/18 481; range: 0.7 to 3%) of admissions during that period, 70% of the horses survived to discharge. Testing for enteropathogens was limited to a single fecal culture for Salmonella spp. in most cases. An enteropathogen was identified in 14% (42/300) of the horses, but in the h...
Parraga ME, Carlson GP, Thurmond M.The present retrospective study was undertaken to determine the frequency of hypoproteinemia and hypoalbuminemia in horses with natural occurring severe liver disease. The study represents a review of case records and laboratory data of 84 horses presented with acute or chronic liver disease to the University of California Veterinary Medical Teaching Hospital between 1973 and 1991. Forty horses (48%) had serum protein concentrations above the maximum reference value (7.7 g/dL). The increase in serum protein concentration was associated with hyperglobulinemia (P = .00005, R2 = .80). Only 13% (1...
Bihr TP.A 5-month-old Morgan filly was presented to the Atlantic Veterinary College with a history of lethargy, fever, depression, anorexia, and dependent ventral edema. Diagnostic tests revealed severe inflammation, hypoproteinemia, and thickened small intestinal loops. Protein-losing enteropathy caused by Lawsonia intracellularis was diagnosed and treated successfully with erythromycin-rifampin.
Jones PA, Bain FT, Byars TD, David JB, Boston RC.To determine the effect of hydroxyethyl starch (HES) on colloid oncotic pressure (pi) during fluid resuscitation of hypoproteinemic horses and to evaluate the clinical usefulness of direct and indirect methods for determination of pi before and after infusion of a synthetic colloid. Methods: Prospective clinical study. Methods: 11 hypoproteinemic horses. Methods: Horses received IV infusions of 8 to 10 ml of a 6% solution of HES/kg (3.6 to 4.5 ml/lb) of body weight during fluid resuscitation. Blood samples were obtained for determination of plasma measured colloid oncotic pressure (pi meas) an...
Bellezzo F, Kuhnmuench T, Hackett ES.Naturally occurring gastrointestinal disease is an important cause of acute hypoproteinemia in adult horses and hydroxyethyl starch colloid fluid treatment is a component of supportive care in these cases to improve plasma volume and maintain colloid osmotic pressure (COP). The objectives of the present study were to compare 2 formulations of high molecular weight hydroxyethyl starch and their relative effect on COP, acid-base status, and survival of horses with acute hypoproteinemia secondary to gastrointestinal disease. Methods: Twenty adult horses, ≥ 1 year of age, were prospectively enro...
Meuten DJ, Butler DG, Thomson GW, Lumsden JH.Chronic granulomatous enteritis associated with weight loss and hypoproteinemia was identified in 2 horses. Both horses continued to have normally formed feces. Malabsorption of carbohydrate and lipid, with concomitant gastrointestinal protein loss was demonstrated in 1 case. One horse was treated symptomatically and gained 108 kg. In both cases, principal gastrointestinal lesions were partial to total villus atrophy and transmural mononuclear leukocytosis, with lymphocytes and histiocytes predominating. The cause of the condition was not identified in either case.
Simmons TR, Gaughan EM, Ducharme NG, Dill SG, King JM, Anderson WI.Excessive administration of phenylbutazone was associated with development of right dorsal ulcerative colitis. The clinical signs of right dorsal colitis include chronic colic and weight loss. The laboratory abnormalities include panhypoproteinemia and a high WBC count in the abdominal fluid. Medical management of the chronic colic and protein-losing enteropathy associated with the ulcerative lesions in the right dorsal colon and surgical bypass of the right dorsal colon did not result in long-term resolution of clinical signs. Resection of the ulcerated right dorsal colon through a right late...
Lane JK, Cohen JM, Zedler ST, Hollis AR, Southwood LL.To describe a novel surgical technique for management of right dorsal colitis in the horse. Methods: Clinical report. Methods: 14-year-old Warmblood gelding. Methods: The horse was referred for treatment of a stromal abscess and signs of right dorsal colitis. Plasma chemistry revealed marked hypoproteinemia. Abdominal ultrasonographic examination showed a thickened right dorsal colon (RDC). Medical treatment was unsuccessful. With the horse in left lateral recumbency under general anesthesia, an approach to the right side of the abdomen through a 16th rib resection was made. The thoracic cavit...
McClintock SA, Collins AM.A 6-month-old Quarter Horse weanling filly was presented with lethargy, weight loss, inappetance, mild diarrhoea, marked ventral oedema and severe panhypoproteinaemia. Serum antibody titres for Lawsonia intracellularis were very high but PCR to detect faecal shedding of the organism was negative. Proliferative enteropathy due to L. intracellularis infection was diagnosed. After treatment for 4 weeks with oral erythromycin and rifampicin the filly made a complete recovery.
Southwood LL.Horses with large colon volvulus (LCV) often require intensive postoperative medical management. Although early referral and surgical intervention are critical for minimal postoperative complications and a successful outcome, this is often not possible for many reasons. Endotoxemia, extensive mucosal damage with subsequent severe hypoproteinemia, and focal ischemic necrosis are the major causes of postoperative morbidity and mortality. Although fluid therapy, flunixin meglumine, and antimicrobials are still the mainstay of perioperative management, synthetic colloids are being used to maintain...
Pusterla N, Barnum S, Hall JA, Marshall-Lund L, Gebhart C.The objective of this study was to determine if serum amyloid A (SAA), a major acute-phase protein, could help support the diagnosis of equine proliferative enteropathy (EPE) caused by Lawsonia intracellularis infection in foals. Archived serum samples from 101 foals with enteric signs and hypoproteinemia were available for SAA testing. Based on immunodiagnostics for L. intracellularis, the foals were divided into EPE-suspect (67) and non-EPE-suspect cases (34). Serum amyloid A values ranged from 0 to 2,761 μg/mL (median 466 μg/mL) and from 0 to 2,555 μg/mL (median 192 μg/mL) for the ...
Sweeney RW, Sweeney CR, Saik J, Lichtensteiger CA.Chronic granulomatous bowel disease was diagnosed in 3 sibling Standardbred horses. Clinical signs included weight loss, loose feces, and decreased appetite in the terminal stage of the disease. Abnormal laboratory findings included hypoproteinemia and low xylose absorption. Necropsy revealed granulomatous inflammation of the intestines, mesenteric lymph nodes, and liver. Eosinophilic infiltration of the granulomatous lesions was a prominent finding in one horse. A causative agent was not detected by special histochemical staining or bacteriologic culturing.
