The FGF-23/klotho axis and its relationship with phosphorus, calcium, vitamin D, PTH, aldosterone, severity of disease, and outcome in hospitalised foals.

BACKGROUND: Fibroblast growth factor-23 (FGF-23) and klotho are key regulators of vitamin D and parathyroid hormone (PTH) synthesis as well as phosphorus and calcium homeostasis; however, information on the FGF-23/klotho axis in healthy and hospitalised foals is lacking. OBJECTIVES: The aims of this study were to measure serum FGF-23 and klotho concentrations and determine their association with serum phosphorus, total calcium (TCa), vitamin D metabolite [25(OH)D, 1,25(OH)2 D], PTH, and aldosterone concentrations, disease severity, and mortality in hospitalised foals. STUDY DESIGN: Prospective, multicentre, cross-sectional study. METHODS: A total of 91 foals ≤72 h old were classified as hospitalised (n = 81; 58 septic; 23 sick non-septic [SNS]) and healthy (n = 10). Blood samples were collected on admission. Hormone concentrations were determined by immunoassays. RESULTS: Serum FGF-23, PTH, phosphorus, and aldosterone concentrations were higher while klotho, 25(OH)D, 1,25(OH)2 D, and TCa concentrations were lower in septic and SNS compared to healthy foals (P<0.05). In hospitalised and septic foals, increased FGF-23 and aldosterone concentrations were associated with high phosphorus and PTH but not with TCa and vitamin D metabolite concentrations. Hospitalised foals with the highest FGF-23 and lowest klotho concentrations were more likely to die (odds ratio (OR): 3.3; 95% confidence interval (CI): 1.1-10.3 and OR: 3.1; CI: 1.1-8.0, respectively). MAIN LIMITATIONS: Blood gas, ionised calcium, blood culture information not being available for many foals, and use of the sepsis score to classify hospitalised foals. CONCLUSIONS: Imbalances in the FGF-23/klotho axis may contribute to mineral dyshomeostasis and disease progression in critically ill foals. Elevated FGF-23 and reduced klotho, together with high phosphorus and PTH concentrations suggests FGF-23 resistance. FGF-23 and klotho are good markers of disease severity and likelihood of mortality in hospitalised foals. Aldosterone may influence phosphorus and PTH dynamics in hospitalised foals. Routine measurement of phosphorus concentrations in sick foals is recommended.

Vitamin D Metabolites and Their Association with Calcium, Phosphorus, and PTH Concentrations, Severity of Illness, and Mortality in Hospitalized Equine Neonates.

BACKGROUND: Hypocalcemia is a frequent abnormality that has been associated with disease severity and outcome in hospitalized foals. However, the pathogenesis of equine neonatal hypocalcemia is poorly understood. Hypovitaminosis D in critically ill people has been linked to hypocalcemia and mortality; however, information on vitamin D metabolites and their association with clinical findings and outcome in critically ill foals is lacking. The goal of this study was to determine the prevalence of vitamin D deficiency (hypovitaminosis D) and its association with serum calcium, phosphorus, and parathyroid hormone (PTH) concentrations, disease severity, and mortality in hospitalized newborn foals. METHODS AND RESULTS: One hundred newborn foals ≤72 hours old divided into hospitalized (n = 83; 59 septic, 24 sick non-septic [SNS]) and healthy (n = 17) groups were included. Blood samples were collected on admission to measure serum 25-hydroxyvitamin D3 [25(OH)D3], 1,25-dihydroxyvitamin D3 [1,25(OH) 2D3], and PTH concentrations. Data were analyzed by nonparametric methods and univariate logistic regression. The prevalence of hypovitaminosis D [defined as 25(OH)D3 <9.51 ng/mL] was 63% for hospitalized, 64% for septic, and 63% for SNS foals. Serum 25(OH)D3 and 1,25(OH) 2D3 concentrations were significantly lower in septic and SNS compared to healthy foals (P<0.0001; P = 0.037). Septic foals had significantly lower calcium and higher phosphorus and PTH concentrations than healthy and SNS foals (P<0.05). In hospitalized and septic foals, low 1,25(OH)2D3 concentrations were associated with increased PTH but not with calcium or phosphorus concentrations. Septic foals with 25(OH)D3 <9.51 ng/mL and 1,25(OH) 2D3 <7.09 pmol/L were more likely to die (OR=3.62; 95% CI = 1.1-12.40; OR = 5.41; 95% CI = 1.19-24.52, respectively). CONCLUSIONS: Low 25(OH)D3 and 1,25(OH)2D3 concentrations are associated with disease severity and mortality in hospitalized foals. Vitamin D deficiency may contribute to a pro-inflammatory state in equine perinatal diseases. Hypocalcemia and hyperphosphatemia together with decreased 1,25(OH)2D3 but increased PTH concentrations in septic foals indicates that PTH resistance may be associated with the development of these abnormalities.

Oleander toxicosis in equids: 30 cases (1995-2010).

OBJECTIVE: To determine clinical, laboratory analysis, and necropsy findings for equids with oleander toxicosis and to identify factors associated with outcome. DESIGN: Retrospective case series. ANIMALS: 30 equids. PROCEDURES: Medical records of equids with detectable concentrations of oleandrin in serum, plasma, urine, or gastrointestinal fluid samples and equids that had not received cardiac glycoside drugs but had detectable concentrations of digoxin in serum were identified via a medical records database search. Descriptive statistics were calculated for medical history, physical examination, laboratory analysis, and necropsy variables. Logistic regression analysis was used to identify physical examination and laboratory analysis factors significantly associated with outcome. RESULTS: 3 of 30 (10.0%) equids died before or immediately after arrival at the hospital. Of the other 27 equids, 23 (85.2%) had gastrointestinal tract abnormalities, azotemia was detected for 19 (70.4%), and a cardiac arrhythmia was ausculted for 18 (66.7%). Mortality rate for all equids was 50.0%; mortality rate for hospitalized equids was 44.4%. The most common cause of death was cardiac dysfunction. Odds of survival to discharge from the hospital were lower for equids with cardiac arrhythmias versus those without arrhythmias and decreased with increasing Hct and serum glucose concentrations. Odds of survival increased with increasing serum chloride concentration and duration of hospitalization. CONCLUSIONS AND CLINICAL RELEVANCE: Equids with oleander toxicosis frequently had simultaneous gastrointestinal tract, cardiac, and renal problems. Oleander intoxication should be a differential diagnosis for equids with colic in geographic areas where oleander is found, especially when azotemia or cardiac arrhythmias are detected concurrently.

Factors associated with survival of neonatal foals with bacteremia and racing performance of surviving Thoroughbreds: 423 cases (1982-2007).

OBJECTIVE: To identify factors associated with short-term survival in bacteremic neonatal foals, evaluate the racing performance of Thoroughbred survivors, and evaluate changes in causative organisms and their antimicrobial susceptibility. DESIGN: Retrospective case series. ANIMALS: 423 bacteremic foals. PROCEDURES: Medical records of foals that were hospitalized in 1982 through 2007 were reviewed, and those with bacteremia were included in the study. Data retrieved included signalment, physical examination and clinicopathologic findings at admission, localized infections, concurrent illnesses, duration of hospitalization, and outcome (survival to discharge from the hospital vs nonsurvival). The number, identity, and antimicrobial susceptibility of organisms isolated from blood samples were also obtained. Racing records for surviving Thoroughbred foals and maternal siblings were examined. RESULTS: Of 423 bacteremic foals, 254 survived. Odds of survival were negatively associated with age at admission, septic arthritis, band neutrophil count, and serum creatinine concentration and positively associated with year of admission, diarrhea, rectal temperature, neutrophil count, and arterial blood pH. Overall, microbial culture of blood samples yielded 554 isolates; Escherichia coli was consistently isolated most frequently. Percentage of isolates susceptible to enrofloxacin, but no other antimicrobial, decreased over time. Surviving Thoroughbred foals did not differ from siblings with regard to percentage of starters, percentage of winners, or number of starts; however, surviving foals had significantly fewer wins and total earnings. CONCLUSIONS AND CLINICAL RELEVANCE: During the study period, microbial resistance to antimicrobials commonly used to treat bacteremic foals did not develop. Surviving bacteremic Thoroughbred foals were as likely to start races as their siblings but earned less money.

Randomized controlled trial of effects of Escherichia coli antiserum on serum immunoglobulin G concentrations and morbidity and mortality rates in foals.

OBJECTIVE: To determine whether administration of commercially available Escherichia coli antiserum to neonatal foals would affect serum IgG concentration or morbidity and mortality rates during the first 60 days of life. DESIGN: Randomized controlled trial. ANIMALS: 271 neonatal foals on 4 well-managed farms. PROCEDURE: Foals were randomly assigned to a treatment or control group. All foals were allowed to suckle colostrum normally. In addition, treatment-group foals were given E coli antiserum (10 micromilligrams) orally between 0 and 8 hours after birth. Serum samples were obtained between 18 and 36 hours after birth, and serum IgG concentration was determined. Foals were monitored for the first 60 days after birth, and causes of disease or death were recorded. RESULTS: Groups did not differ significantly in regard to breed, sex, month of birth, season of birth, age of dams, parity of dams, duration of gestation, or specific gravity of colostrum before suckling. In addition, groups did not differ significantly in regard to mean serum IgG concentration, prevalence of complete or partial failure of passive transfer of immunity, frequency or causes of disease, or frequency of death from infectious causes. CLINICAL IMPLICATIONS: In this group of foals on well-managed farms, administration of E coli antiserum did not alter serum IgG concentrations or morbidity and mortality rates during the first 60 days of life.

[Foal diseases and foal loss]. / Untersuchungen von Fohlenerkrankungen und Fohlenverlusten.

An investigation was carried out upon occurrence and course of infectious and non infectious diseases as well as the mortality in foals born and raised at the State Stud Marbach/Lauter between 1982 and 1991. The foals have been investigated from birth to weaning, they consisted of 177 Thoroughbred Arabians and 285 German Warmblood foals (total 462 foals). The diseases were divided into pre-, peri- and postnatal according to their known or assumed cause and onset. There was a preponderance of prenatal diseases (11.25%) whereas the perinatal rate was 1.30% and the postnatal rate of diseases was 8.66%. The rate of infectious diseases increased from the pre- to the postnatal period of life. A comparison between the two breeds showed that 9% of the Arabian foals suffered from infectious diseases whereas only 4.9% of the Warmblood foals were similarly affected. This is probably linked to the lower level of colostral immunoglobulins in the Arab herd, as previously shown by us. The measurement of mare colostral and foal serum IgG as well as the paramunisation of neonatal and weaned foals are important factors in the prevention of infectious diseases.

Surgical treatment of sand colic. Results in 40 horses.

A retrospective study of 40 horses that underwent surgical treatment for sand colic was performed. Three horses were euthanatized and one died during surgery. Of the 36 horses that recovered from anesthesia, five died before discharge from the hospital and seven died after discharge. Twenty-four horses survived at least 12 months. Sand impaction of the right dorsal colon was present in 26 horses. In addition to sand impaction, 10 horses also had colonic displacement or volvulus.