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jaundice from anorexia

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  • jaundice from anorexia

    I have a 5 year old TB who severely injured a hoof 50 days ago and has been on strict stall rest. He only comes out to get his bandage changed every couple days, and this will continue for a few months. Because of this, he's gone crazy, so I started him on reserpine on Thursday morning (a single 1cc IM injection).

    Friday, the farrier was out to re-shoe him, so he got an extra 2cc of ace IM to keep him extra quiet for this tricky process. While trying to keep his head entertained so the farrier could do his work, I noticed his membranes were jaundiced.
    I rushed blood to work for CBC and chem panel, and his bilirubin was very high (obviously), an 8, however nothing else was elevated or decreased significantly compared to his normal.

    Based on this, the vet thinks it is simply anorexia caused by his drugged state. A boarded internist said that reserpine has no history of causing liver damage, so while they haven't ruled out the drugs completely, they're not high on the list of differentials. However, no one has been able to tell me how rapidly this jaundice can occur in relation to anorexia, or how "anorexic" the horse has to get. The horse has been finishing all of his meals by the time I feed him his next meal. He is still jaundiced today, though he seems a little lighter in sedation and he's still finishing all his meals.

    I will say I don't normally check his membranes, so I have no idea how long the jaundice has been present. However he was admitted to the hospital for two weeks immediately following his injury, so I can be reasonably certain it was not present a month ago. We recently (three months ago) made a big move from IL to Louisiana, so he's had a rather big change in climate and feed (timothy hay to coastal bermuda).

    I watched him eat his hay yesterday for about half an hour and he is eating it more slowly than normal. But as I said, he still finishes it.

    Does anyone have any experience or knowledge in this? I have been told to watch for fever and colic symptoms for emergency problems. I was planning to bring him in for a surgery recheck on his hoof the week of the 12th, but I'm going see if I can bump that up to this week if the jaundice doesn't resolve.

  • #2
    Fasting hyperbilirubinemia is not uncommon in the horse.
    (In other words, an anorexic horse is often yellow.)
    IIRC, it takes about 48 hours to develop, and should resolve in about the same time period once the appetite is back to normal.
    "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

    ...just settin' on the Group W bench.

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    • #3
      I have never experienced jaundice due to sedation/anorexia. But for other reasons yes... and I see you are in IL now and came from Louisiana. Either or both locations wetlands?

      Comment

      • Original Poster

        #4
        What about prolonged fasting hyperbilirubinemia? He's still jaundiced. Will it eventually even out once his liver gets used to a lower normal amount of food?

        We actually moved from IL to LA. LA is kind of one giant wetland, from what I can tell, but the horse is on stall board, no turn out, and up to date on vaccinations.

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        • #5
          I am going to send you a link via PM.

          From what I have been told about "the fasting yellows" from my vets is you should not be seeing it with an appropriate feed reduction like in a stall rest situation. You mentioned the horse does eat all his feed correct? By the next meal correct? And is his wt good and he is not getting thin? Correct.

          But that you see it when a horse is not eating well. Either reducing its own feed intake for some reason. Or not being fed enough due to neglect.

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          • #6
            Based on this, the vet thinks it is simply anorexia caused by his drugged state. A boarded internist said that reserpine has no history of causing liver damage, so while they haven't ruled out the drugs completely, they're not high on the list of differentials. However, no one has been able to tell me how rapidly this jaundice can occur in relation to anorexia, or how "anorexic" the horse has to get. The horse has been finishing all of his meals by the time I feed him his next meal. He is still jaundiced today, though he seems a little lighter in sedation and he's still finishing all his meals.
            Have you discussed the horse's feeding regime with the vet - if it's adquate, this "diagnosis" does not make sense: I'd want his bloodwork checked again (would not wait until the 12th for this).


            reserpine has no history of causing liver damage
            unfortunatly this does not rule out the possibility that it may be occurring with your horse (only the probability).

            We used this with a couple of very stressed horses, it definitely has a sedating/relaxing effect so you might give it a go (did not seem to affect ability to learn).
            Now that your horse has shown liver involvement, I'd continue to monitor this even if you choose alternate remedies.

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            • #7
              I agree with the above posters--if he's eating, it shouldn't be fasting hyperbilirubinemia.
              "It's like a Russian nesting doll of train wrecks."--CaitlinandTheBay

              ...just settin' on the Group W bench.

              Comment


              • #8
                What other drugs has the horse been receiving? Sometimes it's not one or another individual meds, but the cocktails that cause problems.
                Click here before you buy.

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                • Original Poster

                  #9
                  Originally posted by alto View Post
                  Have you discussed the horse's feeding regime with the vet - if it's adquate, this "diagnosis" does not make sense: I'd want his bloodwork checked again (would not wait until the 12th for this).

                  unfortunatly this does not rule out the possibility that it may be occurring with your horse (only the probability).
                  Oh, I fully realize that it still could be the reserpine. I have brought him in to the hospital today for an early surgery re-check appointment so he can see one of the internists too for the jaundice. I plan to have them re-run bloodwork today to ensure that none of his other liver enzymes have crept up and to corner one of the internal medicine attendings to discuss his apparent lack of anorexia.

                  Originally posted by deltawave View Post
                  What other drugs has the horse been receiving? Sometimes it's not one or another individual meds, but the cocktails that cause problems.
                  The surgeon and I actually discussed this. He's received a few doses of tranquilizers in the last couple weeks, which was why I switched to reserpine. 9 days ago he received 3cc ace IM, then two 1.5cc IV doses of xylazine for a farrier appointment; he was dangerously out of control, which was why I finally caved for the reserpine. 4 days later he received his 1cc IM dose of reserpine, then the following day received 2cc ace IM.

                  However, this is in full disclosure that I do not know if the jaundice occurred BEFORE all of these drugs were given. As I said, I rarely check membranes unless I suspect a problem, and I had no reason to suspect any problems. I can feel quite comfortable that he was not jaundiced a month ago, when he was in the hospital for his injury and was quite anemic from the blood loss he sustained.

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                  • #10
                    Yikes I hope your horse is okay. I would wonder if a small stall sized paddock outside with a buddy would be a consideration. I hope horsey is okay.

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                    • Original Poster

                      #11
                      Unfortunately, that type of set up isn't available at my barn. But his stall is 14X14, which is more than enough for him to move around.

                      An update; I brought him in to the hospital and they drew more blood on Tuesday. Bilirubin was down from Friday, but still above normal. I pulled blood yesterday and today, and will do so again on Monday to get an idea of a trend. His PCV is lower than they'd like to see, so they're still not sure what (if anything) is going on. They agreed that the horse is not anorexic enough to cause a spike in the bilirubin.

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                      • #12
                        When more blood was pulled, did they run a liver panel to check AST, ALT, GGT and also SDH? Did they give any sort of recommendation on anything supportive for the liver? Ie milk thistle or SAMe?

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                        • #13
                          any updates

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                          • Original Poster

                            #14
                            I haven't received the bilirubin levels from today. The hospital gave me the wrong tubes last week (red top instead of green tiger) so they were not confident in his bilirubin levels on Wed/Thurs. He is still mildly jaundiced to the eye, but not as much as he was when this whole mess started.

                            He's still eating normally and there are no signs of colic or temp or anything like that.

                            AST at the original draw (most significant bilirubin of 7.8mg/dL) was 191 U/L. They did not do a liver-specific panel including the ALT/GGT/SDH.
                            I have asked if they have done a blood smear, but I haven't heard back.

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