Salem’s Story – Saving a very special horse
By Dr. Janet Han.

The veterinary profession lends itself to many challenging cases that often require intense medical management, diligent care, close client relationships, and cooperative patients. Despite these efforts, sometimes the prognosis for the condition remains guarded. However, with recent medical advancements, the outcomes of these cases are becoming more and more favorable. Occasionally there are cases that epitomize the importance of each of these components resulting in a successful outcome: this is the story of Salem.

Salem came to the Great Lakes Equine Wellness Center after an approximately one week history of being depressed and not having a good appetite. Salem received veterinary treatment at home consisting of intravenous fluids but remained depressed and was brought to our clinic. One of the first things done following an initial physical exam was a complete set of bloodwork. This had also been done on the farm and had shown a very high creatinine level. Creatinine can become increased due to dehydration but can also increase due to renal (kidney) disease. Salem’s creatinine was decreased from before, but still remained significantly elevated at 4.5 mg/dL (<2.0 mg/dL is normal). Calcium was also increased on the bloodwork, which can be another sign of renal disease. A sample of urine from Salem was also analyzed, and the specific gravity, which is a measure of the kidneys’ concentrating ability, was abnormal. This indicated that his kidneys were not concentrating the urine like they should, and further supported the diagnosis of acute renal failure.

Treatment for acute renal failure was initiated, which included constant intravenous fluids and a furosemide and dopamine infusion. Furosemide is a diuretic and is also thought to reduce the workload on the kidneys. Dopamine is believed to improve blood flow to the kidneys at certain rates. Anti-ulcer medication was also added to the treatment regimen. Ultrasound of the kidneys was performed and no abnormalities visualized. Salem’s attitude and appetite improved on therapy, and creatinine decreased to 3.7 mg/dL over the next several days. However, this improvement was not as pronounced as desired, and it was decided to start peritoneal dialysis.

Peritoneal dialysis is a therapy that has been used for a long time in human medicine for renal failure. It has also been used fairly extensively in small animal medicine, particularly in cases of renal failure that are refractory to conventional medical therapy. However, it is still a relatively new therapeutic option in equine veterinary medicine for treating renal failure. To perform peritoneal dialysis in horses, a dialysis catheter (a chest tube) is placed into the abdomen. Peritoneal dialysis utilizes the peritoneum, a thin membrane that lines the abdominal cavity. The peritoneum acts as a membrane across which fluid and certain substances flow and are filtered and cleared from the blood, thereby taking up part of the workload of the kidneys. Fluid (in this case a balanced electrolyte solution known as Lactated Ringers) is infused into the abdominal cavity via the dialysis catheter. It is then allowed to sit in the abdomen for a certain amount of time and then drained.

Peritoneal dialysis was performed for several days on Salem. He was also placed on broad spectrum antibiotics to prevent any infections that might occur from the catheter being in his abdomen. Creatinine eventually decreased to 2.8 mg/dL at its lowest point. At this time, it was decided by the owner that Salem should go home, as he could not remain on peritoneal dialysis and intravenous fluids indefinitely. As Salem had received over a week of intensive medical therapy for renal disease, it was hoped that this had allowed his kidneys enough time to heal and that he could complete the remainder of the recovery process at home. Although his creatinine increased somewhat after discontinuing medical therapy, Salem continued to remain very bright with a great appetite and was discharged into the care of his owner.

Recommendations for Salem included changes in diet and management to prevent worsening of renal disease. It was recommended that alfalfa hay and feeds high in protein be avoided, as these would increase the workload on the kidneys. Also, it was very important to ensure Salem drank well, for example by supplementing him with electrolytes to stimulate thirst. Regular recheck exams along with repeat bloodwork to be performed by the owner’s regular veterinarian were also recommended. 

To everyone’s delight, Salem did well at home and his creatinine eventually returned to normal over the course of several weeks; due to his promising recovery, he will be able to return to competition this year.  Overall, this case is a prime example of how client commitment and applied medical advancements saved the life of one very special horse.

###

Janet Han, DVM, MS, DACVIM, of Great Lakes Equine Wellness Center, completed an equine internship at the Rochester Equine Clinic in Rochester, NH followed by a residency in equine internal medicine at the Marion duPont Scott Equine Medical Center in Leesburg, VA. She has a master's degree in Biomedical and Veterinary Sciences at Virginia Polytechnic Institute and State University. Dr. Han is a Diplomate of the American College of Veterinary Internal Medicine.