Use of plasma ionized calcium levels and Ca2+ substitution response patterns as prognostic parameters for ileus and survival in colic horses.
Abstract: Hypocalcaemia is a common finding in horses with enterocolitis and severe gastrointestinal disorders. The aims of this study were to investigate in colic horses 1)the parameters related to hypocalcaemia, 2)the influence of hypocalcaemia on outcome and 3)the possible beneficial effect of Ca2+ substitution. Methods: Randomized controlled trial. Methods: Intensive care unit. Methods: One hundred forty-four horses that were admitted with an acute abdomen during a 1.5 year period were enrolled and daily evaluated for clinical criteria and whole blood ionized Ca2+ levels. Colic horses with hypocalcaemia were randomly assigned to receive Ca2+. Methods: Analysis of heparinised whole blood samples. Horses that were assigned to be treated received 400 mEq Ca2+ diluted in 10L of Ringer's lactate solution every 24 h until low reference range limits were obtained or until death. Results: 88% of all colic patients showed blood ionized Ca2+ levels below the reference range at the time of admission. Multivariable analysis revealed that the presence of reflux, signs of endotoxaemia, increased Packed Cell Volume (PCV), alkalinization of pH and the interaction PCV/pH all predispose colic horses to low ionized Ca2+ levels at the time of admission. The Odds for developing ileus during hospitalization are +/- 11.94 times larger for horses in the "very low" calcaemia interval, in comparison with normocalcaemic horses. The Odds for fatal outcome are respectively +/- 9.82 and 8.33 times larger for horses in the "very low" and "low" calcaemia interval. Ca2+ substitution increased the probability of survival, provided that Ca2+ levels could be normalized. The lack of an upward calcaemia response, despite repetitive Ca2+ substitutions, can be guarded as a poor ominous sign. Conclusions: Hypocalcaemia in colic horses is of prognostic relevance both with regard to survival as to the probability of development of ileus during hospitalization. This study shows the importance of routine measurement of ionized calcium levels in colic horses. Moreover, correction of hypocalcaemia seems to improve clinical outcome.
Publication Date: 2006-01-13 PubMed ID: 16402513
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- Journal Article
- Randomized Controlled Trial
Summary
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The research article explores the effect of hypocalcaemia (low levels of calcium in the blood) on the survival and occurrence of ileus in horses with colic. The study demonstrates the significance of measuring ionized calcium levels and the potential beneficial impact of calcium supplementation in improving the medical outcomes.
Objectives and Methodology
- The aim of the study was threefold: to examine parameters associated with hypocalcaemia in colic horses, to understand the impact of hypocalcaemia on the outcomes, and to investigate the possible benefits of calcium substitution (Ca2+ substitution).
- The method approach can be summarized as a randomized controlled trial carried out in an intensive care unit.
- The study sample comprised 144 horses with acute abdominal pain (colic) over a period of 1.5 years. These horses were routinely evaluated based on clinical criteria and whole blood ionized calcium levels.
- Horses suffering from hypocalcaemia were randomly assigned to receive calcium supplementation whereby 400 mEq Ca2+ was diluted in 10L of Ringer’s lactate solution and administered every 24 hours until minimum reference range limits were attained or until the horse’s demise.
Results and Findings
- At the time of admission, 88% of all colic patients were found to have blood ionized calcium levels below the standard range.
- Multivariable analysis disclosed several factors predisposing colic horses to low ionized calcium levels, including the presence of reflux, signs of endotoxaemia, elevation in the Packed Cell Volume (PCV), pH alkalinization, and the combined effect of PCV/pH.
- Horses with “very low” calcium levels had nearly twelve times higher odds of developing ileus during hospitalization compared to normocalcaemic horses.
- The odds of fatal outcomes were around ten and eight times higher for horses in the “very low” and “low” calcium ranges respectively.
- Calcium substitution increased the chances of survival, given that calcium levels could be normalized. Additionally, the lack of an increase in calcium levels, despite repeated substitutions, was considered a bad sign.
Conclusions
- Hypocalcaemia in colic horses is a critical factor concerning survival rates and the likelihood of developing ileus. Thus, routine measurement of ionized calcium levels is emphasized.
- The research also suggests that correcting hypocalcaemia (through calcium supplementation) could potentially enhance clinical outcomes for colic horses.
Cite This Article
APA
Delesalle C, Dewulf J, Lefebvre RA, Schuurkes JA, Van Vlierbergen B, Deprez P.
(2006).
Use of plasma ionized calcium levels and Ca2+ substitution response patterns as prognostic parameters for ileus and survival in colic horses.
Vet Q, 27(4), 157-172.
Publication
Researcher Affiliations
- Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium. Catherine.Delesalle@UGent.be
MeSH Terms
- Abdomen, Acute / blood
- Abdomen, Acute / drug therapy
- Abdomen, Acute / veterinary
- Animals
- Calcium / blood
- Calcium / therapeutic use
- Colic / blood
- Colic / complications
- Colic / drug therapy
- Colic / veterinary
- Female
- Gastroesophageal Reflux / blood
- Gastroesophageal Reflux / complications
- Gastroesophageal Reflux / veterinary
- Hematocrit / veterinary
- Horse Diseases / blood
- Horse Diseases / drug therapy
- Horse Diseases / epidemiology
- Horse Diseases / etiology
- Horses
- Hydrogen-Ion Concentration
- Hypocalcemia / blood
- Hypocalcemia / complications
- Hypocalcemia / drug therapy
- Hypocalcemia / veterinary
- Ileus / epidemiology
- Ileus / etiology
- Ileus / veterinary
- Male
- Multivariate Analysis
- Prognosis
- Survival Analysis
Citations
This article has been cited 3 times.- Bishop RC, Gutierrez-Nibeyro SD, Stewart MC, McCoy AM. Performance of predictive models of survival in horses undergoing emergency exploratory laparotomy for colic.. Vet Surg 2022 Aug;51(6):891-902.
- Farrell A, Kersh K, Liepman R, Dembek KA. Development of a Colic Scoring System to Predict Outcome in Horses.. Front Vet Sci 2021;8:697589.
- Chakravarty A, Anand S, Sapra H, Mehta Y. Undetected hypoparathyroidism: An unusual cause of perioperative morbidity.. Indian J Anaesth 2014 Jul;58(4):470-2.
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