Approach to hyperlipaemia

Presenting signs

·    Obese

·    Reduced appetite/not eating

·    Dull mentation

Diagnosis

·    Suggestive clinical signs

·    Take blood sample

o  Gross appearance of blood sample – milky/white plasma/serum

o  Measure plasma triglycerides - >5mmol/L = hyperlipaemia, 1.5-5mmol/L = hyperlipidaemia

o  Liver enzymes – increased GGT, ALP, SDH, increased bile acids

o  Measure glucose level – hyperglycaemia (due to insulin resistance)

Management

·    Provide calories to reverse NEB – any way you can get them in

o  Enteral nutrition – try hand grazing, offering different feeds, NG tube

o  Parenterally – glucose infusion (only PPN, not TPN as don’t want to give fats)

·    Treatment of primary condition

·    Provide analgesia if in pain

Pathogenesis

·    Horse develops NEB ® mobilisation of fat stores ® release and accumulation of TAGs ® overwhelms the liver

·    Physiological causes:

o  Decreased intake

o  Increase requirements, e.g. lactation, pregnancy

·    Pathological causes:

o  Sepsis/SIRS (endotoxaemia)

Azotaemia

Presenting signs

·    Dull, lethargic, pyrexic

·    Abdominal discomfort

·    Obesity

·    Tachycardic, tachypnoeic

·    Slow CRT, congested MMs

·    Dry mucus-coated faeces

·    Head/muzzle oedema

·    Hepatic encephalopathy ® ataxia, neurological signs, recumbency

Risk factors 

·    Obesity

·    Weight loss

·    Pregnancy/lactation

·    Old age

·    Stress

·    Underlying primary disease

Investigations

·    Clinical exam

·    Blood sample – increased serum TAG, milky serum/plasma

Management

·    If mild – give sugary feeds and glucose drenches

·    If more severe ® NG tube 2-3L warm water, rehydration salts, glucose powder, ready brek

·    If very severe – intensive IVFT, prognosis is poorer