Successful treatment of hyperkalaemic periodic paralysis in a horse during isoflurane anaesthesia.
Abstract: A 3-year-old, 400 kg, gelding Quarter Horse was presented for investigation of epistaxis. Methods: The horse was bright, alert and responsive with rectal temperature, heart rate and respiration rate within normal limits. Results: During a second general anaesthetic for surgical treatment of guttural pouch mycosis by balloon-tipped catheter occlusion of the right major palatine artery and ligation of the right external carotid artery, signs consistent with hyperkalaemic periodic paralysis (HYPP) were exhibited. These included concurrent hyperkalaemia, hypercapnoea, sinus tachycardia, and muscle fasciculations in the presence of normothermia. Stress associated with an acute haemorrhage pre-operatively, and intra-operative hypercapnoea may have precipitated the episode. There were no signs of HYPP during a general anaesthetic, 1 week earlier, when an initial attempt at surgical treatment of guttural pouch mycosis was performed. Treatment consisted of fluid therapy and administration of calcium gluconate (0.1-0.2 mg kg(-1) minute(-1)), dextrose 5% (5 mL kg(-1) hour(-1)) and insulin (0.05 IU kg(-1)). Treatment resulted in the resolution of clinical signs and an uneventful recovery. Results: The diagnosis of HYPP was confirmed by DNA analysis post-operatively. Conclusions: Clinical cases of intra-operative HYPP can present despite a previous history of uneventful general anaesthesia. Rapid diagnosis and treatment can result in the successful management of HYPP. This report documents an unusual presentation of HYPP, a disease that remains present in the Quarter Horse population.
© 2011 The Authors. Veterinary Anaesthesia and Analgesia © 2011 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesiologists.
Publication Date: 2011-02-10 PubMed ID: 21303442DOI: 10.1111/j.1467-2995.2010.00592.xGoogle Scholar: Lookup
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Summary
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The research details a case of a 3-year-old Quarter Horse, that showed symptoms of hyperkalaemic periodic paralysis (HYPP) during a surgical procedure under general anaesthesia, was successfully managed by administering fluid therapy and a combination of calcium gluconate, dextrose, and insulin.
Background Information
- The gelding Quarter Horse, weighing 400 kg, was brought for inspection due to a condition of nosebleed or epistaxis. The horse was deemed healthy based on its alertness and normal rectal temperature, heart rate, and respiration rate.
Observation and Diagnosis
- On its second general anaesthetic treatment, which was for the surgical remedy of guttural pouch mycosis, the horse showed symptoms consistent with hyperkalaemic periodic paralysis (HYPP). These included a simultaneous increase in potassium (hyperkalaemia) and carbon dioxide (hypercapnoea) in the blood, faster sinus rhythm (sinus tachycardia), and muscle twitching (muscle fasciculations), even as the body temperature stayed normal.
- Stress from acute haemorrhage before the surgery and elevated carbon dioxide during the operation might have triggered this episode.
- Interestingly, the horse displayed no signs of HYPP during an earlier general anaesthetic procedure a week before, where an initial attempt was made to treat its guttural pouch mycosis surgically.
- DNA analysis following the operation confirmed the diagnosis of HYPP.
Treatment and Conclusion
- The medical treatment included fluid therapy and the administration of calcium gluconate, dextrose 5%, and insulin. This resulted in the resolution of the clinical symptoms and the horse’s safe recovery.
- The research concludes that even if there is no previous history of general anaesthesia complications, clinical cases of HYPP can occur during surgery. This underlines the importance of a quick diagnosis and treatment which can lead to the successful management of HYPP. The study also highlights that HYPP is still a prevalent disease among the Quarter Horse population, and this is an unusual presentation of the disease.
Cite This Article
APA
Pang DS, Panizzi L, Paterson JM.
(2011).
Successful treatment of hyperkalaemic periodic paralysis in a horse during isoflurane anaesthesia.
Vet Anaesth Analg, 38(2), 113-120.
https://doi.org/10.1111/j.1467-2995.2010.00592.x Publication
Researcher Affiliations
- Department of Veterinary Clinical and Diagnostic Services, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada. dsjpang@ucalgary.ca
MeSH Terms
- Anesthetics, Inhalation / adverse effects
- Animals
- Calcium Gluconate / therapeutic use
- Fluid Therapy / veterinary
- Glucose / therapeutic use
- Horse Diseases / chemically induced
- Horse Diseases / therapy
- Horses
- Hypercapnia / chemically induced
- Hypercapnia / therapy
- Hypercapnia / veterinary
- Hyperkalemia / chemically induced
- Hyperkalemia / therapy
- Hyperkalemia / veterinary
- Insulin / therapeutic use
- Isoflurane / adverse effects
- Male
- Paralysis, Hyperkalemic Periodic / chemically induced
- Paralysis, Hyperkalemic Periodic / therapy
- Paralysis, Hyperkalemic Periodic / veterinary
- Tachycardia, Sinus / chemically induced
- Tachycardia, Sinus / therapy
- Tachycardia, Sinus / veterinary
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