References

Asplin K, Sillence M, Pollitt C Induction of laminitis by prolonged hyper-insulinaemia in clinically normal ponies. Vet J. 2007; 174:530-535 https://doi.org/10.1016/j.tvjl.2007.07.003

Bamford NJ. Clinical insights: Treatment of laminitis. Equine Vet J. 2019; 51:145-146 https://doi.org/10.1111/evj.13055

Bertin F, Forsythe LE, Kritchevsky J. Effects of high doses of levothyroxine sodium on serum concentrations of triiodothyronine and thyroxine in horses. Am J Vet Res. 2019; 80 https://doi.org/10.2460/ajvr.80.6.565

de Laat MA, McGowan CM, Sillence MN Equine laminitis: Induced by 48h hyperinsulinaemia in Standardbred horses. Equine Vet J. 2010; 42:129-135 https://doi.org/10.2746/042516409x475779

Donaldson M, Jorgensen A, Beech J. Evaluation of suspected pituitary pars intermedia dysfunction in horses with laminitis. J Am Vet Med Assoc. 2004; 224:1123-1127 https://doi.org/10.2460/javma.2004.224.1123

Durham AE. Endocrine disease in aged horses. Vet Clin North Am Equine Pract. 2016; 32:301-315 https://doi.org/10.1016/j.cveq.2016.04.007

Durham AE, Rendle DI, Newton JR. The effect of metformin on measurements of insulin sensitivity and β cell response in 18 horses and ponies with insulin resistance. Equine Vet J. 2008; 40:493-500 https://doi.org/10.2746/042516408x273648

Durham A, Frank N, McGowan C ECEIM consensus statement on equine metabolic syndrome. J Vet Intern Med. 2019; 33:(2)335-349 https://doi.org/10.1111/jvim.15423

Eps A van, Collins SN, Pollitt CC. Supporting limb laminitis. Vet Clin North Am Equine Pract. 2010; 26:(2)287-302 https://doi.org/10.1016/j.cveq.2010.06.007

Eps AW van, Burns TA. Are there shared mechanisms in the pathophysiology of different clinical forms of laminitis and what are the implications for prevention and treatment?. Vet Clin North Am Equine Pract. 2019; 35:379-398 https://doi.org/10.1016/j.cveq.2019.04.001

Frank N, Elliott SB, Boston RC. Effects of long-term oral administration of levothyroxine sodium on glucose dynamics in healthy adult horses. Am J Vet Res. 2008a; 69:76-81 https://doi.org/10.2460/ajvr.69.1.76

Frank N, Buchanan BR, Elliott SB. Effects of long-term oral administration of levothyroxine sodium on serum thyroid hormone concentrations, clinicopathologic variables, and echocardiographic measurements in healthy adult horses. Am J Vet Res. 2008b; 69 https://doi.org/10.2460/ajvr.69.1.68

Frank N. Safety and efficacy of canagliflozin and octreotide for managing insulin dysregulation in horses. JVIM. 2018; 32:2123-2143

Hague N, Durham A, Menzies-Gow N. Pergolide dosing compliance and factors affecting the laboratory control of equine pituitary pars intermedia dysfunction. Vet Rec. 2021; 189:(1) https://doi.org/10.1002/vetr.142

Hopster K, van Eps A. Pain management for laminitis in the horse. Equine Vet Educ. 2019; 31:384-392 https://doi.org/10.1111/eve.12910

Horn R, Bamford NJ, Afonso T Factors associated with survival, laminitis and insulin dysregulation in horses diagnosed with equine pituitary pars intermedia dysfunction. Equine Vet J. 2019; 51:440-445 https://doi.org/10.1111/evj.13041

Hustace JL, Firshman AM, Mata JE. Pharmacokinetics and bioavailability of metformin in horses. Am J Vet Res. 2009; 70:(5)665-668 https://doi.org/10.2460/ajvr.70.5.665

Johnson PJ, Slight SH, Wiedmeyer CE Equine laminitis. Clin Tech Equine Pract. 2004; 3:(1)45-56 https://doi.org/10.1053/j.ctep.2004.07.004

Kalra S, Singh V, Nagrale D. Sodium-glucose cotransporter-2 inhibition and the glomerulus: a review. Adv Ther. 2016; 33:1502-1518 https://doi.org/10.1007/s12325-016-0379-5

Katz LM, Bailey SR. A review of recent advances and current hypotheses on the pathogenesis of acute laminitis. Equine Vet J. 2012; 44:(6)752-761 https://doi.org/10.1111/j.2042-3306.2012.00664.x

Martinez R, Reval M, Campos M Involvement of peripheral cyclooxygenase-1 and cyclooxygenase-2 in inflammatory pain. J Pharm Pharmacol. 2002; 54:(3)405-12 https://doi.org/10.1211/0022357021778475

McFarlane D, Johnson PJ, Schott HC. Pituitary Pars Intermedia Dysfunction Equine Laminitis. 2016; 334-340

McFarlane D. Equine pituitary pars intermedia dysfunction. Vet Clin North Am Equine Pract. 2011; 27:93-113 https://doi.org/10.1016/j.cveq.2010.12.007

Meier A, Reiche D, Laat M de The sodium-glucose co-transporter 2 inhibitor velagliflozin reduces hyperinsulinemia and prevents laminitis in insulin-dysregulated ponies. Plos One. 2018; 13 https://doi.org/10.1371/journal.pone.0203655

Meier A, Laat M de, Reiche D The efficacy and safety of velagliflozin over 16 weeks as a treatment for insulin dysregulation in ponies. BMC Vet Res. 2019; 15:1-10 https://doi.org/10.1186/s12917-019-1811-2

Mercer MA, McKenzie HC, Byron CR Pharmacokinetics and clinical efficacy of acetaminophen (paracetamol) in adult horses with mechanically induced lameness. Equine Vet J. 2022; https://doi.org/10.1111/evj.13601

Nauck M. Update on developments with SGLT2 inhibitors in the management of type 2 diabetes - ProQuest. Drug Design, Development and Therapy. 2014; 8:1335-1380 https://doi.org/10.2147/dddt.s50773

Patterson-Kane JC, Karikoski NP, McGowan CM. Paradigm shifts in understanding equine laminitis. Vet J. 2018; 231:33-40 https://doi.org/10.1016/j.tvjl.2017.11.011

Pollitt C. Equine laminitis. Clin Techniques Equine Pract. 2004; 3:(1)34-44 https://doi.org/10.1053/j.ctep.2004.07.003

Potter S, Bamford N, Harris P Prevalence of obesity and owners' perceptions of body condition in pleasure horses and ponies in south-eastern Australia. Aust Vet J. 2016; 94:427-432 https://doi.org/10.1111/avj.12506

Price J, Marques J, Welsh E Pilot epidemiological study of attitudes towards pain in horses. Vet Rec. 2002; 151:(19)570-575 https://doi.org/10.1136/vr.151.19.570

Redden R. Preventing laminitis in the contralateral limb of horses with nonweight-bearing lameness. Clin Tech Equine Pract. 2004; 3:57-63 https://doi.org/10.1053/j.ctep.2004.07.005

Reilly P, Dean E, Orsini J. First aid for the laminitic foot: therapeutic and mechanical support. 2010; 26:(2)451-458 https://doi.org/10.1016/j.cveq.2010.06.004

Skrzypczak H, Reed R, Brainard B The pharmacokinetics of a fentanyl matrix patch applied at three different anatomical locations in horses. Equine Vet J. 2022; 54:153-158 https://doi.org/10.1111/evj.13424

Sommardahl CS, Frank N, Elliott SB Effects of oral administration of levothyroxine sodium on serum concentrations of thyroid gland hormones and responses to injections of thyrotropin-releasing hormone in healthy adult mares. Am J Vet Res. 2005; 66:1025-1031 https://doi.org/10.2460/ajvr.2005.66.1025

Sundra T, Kelty E, Rendle D. Preliminary observations on the use of ertugliflozin in the management of hyperinsulinemia and laminitis in 51 horses: a case series. 2022;

Tinworth KD, Boston RC, Harris PA The effect of oral metformin on insulin sensitivity in insulin-resistant ponies. Vet J. 2012; 191:79-84 https://doi.org/10.1016/j.tvjl.2011.01.015

Tóth F, Frank N, Geor R Effects of pretreatment with dexamethasone or levothyroxine sodium on endotoxin-induced alterations in glucose and insulin dynamics in horses. Am J Vet Res. 2010; 71:60-68 https://doi.org/10.2460/ajvr.71.1.60

Valencia NA, Jr DLT, Oberhaus EL. Long-term and short-term dopaminergic (Cabergoline) and antidopaminergic (Sulpiride) effects on insulin response to glucose, glucose response to insulin, or both in horses. J Equine Vet Sci. 2017; 59:95-103 https://doi.org/10.1016/j.jevs.2017.10.008

van Eps AW. Acute laminitis: medical and supportive therapy. Vet Clin North Am Equine Pract. 2010a; 26:(1)103-114 https://doi.org/10.1016/j.cveq.2009.12.011

van Eps AW. Therapeutic hypothermia (cryotherapy) to prevent and treat acute laminitis. Vet Clin North Am Equine Pract. 2010b; 26:(1)125-133 https://doi.org/10.1016/j.cveq.2010.01.002

West E, Bardell D, Morgan R Use of acetaminophen (paracetamol) as a short-term adjunctive analgesic in a laminitic pony. Veterinary Anaesthesia and Analgesia. 2011; 38:(5)521-522 https://doi.org/10.1111/j.1467-2995.2011.00639

Medical management of acute laminitis

02 September 2022
10 mins read
Volume 6 · Issue 5
Figure 1. 10-year-old Welsh pony, shifting weight caudally in the typical laminitic stance.
Figure 1. 10-year-old Welsh pony, shifting weight caudally in the typical laminitic stance.

Abstract

Laminitis is a medical emergency. It encompasses three distinct forms: sepsis-related laminitis, supporting limb laminitis and endocrinopathic laminitis. The latter is most commonly encountered in equine practice and is associated with hyperinsulinaemia. Regardless of the underlying cause, management of acute laminitis involves treatment of the underlying cause, and providision of analgesia and biomechanical support of the foot.

Laminitis is a painful and severely debilitating condition commonly encountered in equine practice (Figure 1). Three distinct forms of laminitis have been identified; inflammatory or sepsis-related laminitis, supporting limb laminitis and ‘endocrinopathic’ laminitis (van Eps and Burns, 2019), but endocrinopathic laminitis accounts for the vast majority of cases seen in practice and likely parallels the rise of obesity in equids (Donaldson et al, 2004; Potter et al, 2016; Patterson-Kane et al, 2018). The acute phase of laminitis begins at the onset of clinical signs which may include varying degrees of lameness, increased digital pulses, stiff gait, weight shifting, reluctance to move or sensitivity to hoof testers over the sole, particularly towards the toe (van Eps, 2010a). Laminitis should always be considered a medical emergency and treatment should be instituted immediately at the onset of clinical signs. Irrespective of the primary mechanism, medical management of acute laminitis focuses on treating the underlying cause, providing analgesia and supporting the foot. Regular assessment of the patient is imperative to gauge clinical response, adjust treatment and minimise suffering.

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