Hyperlipemia in Equids

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Presentation for VMC 979 (Equine Medicine, senior clinical rotation) discussing basic details of hyperlipemia in equids. Includes signalment, risk factors, pathogenesis, clinical signs, diagnosis, treatment, and prognosis.

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Hyperlipemia in Equids

  1. 1. HYPERLIPEMIA IN EQUIDS Omega Cantrell VMC 979
  2. 2. THE BASICS  Clinical manifestation of a severe imbalance between energy intake and demand  Similar to ketosis in dairy cattle, but with triglycerides (TGs) rather than ketones as a consequence of this negative energy balance  Definitions  Hyperlipidemia  Serum [TG] increased but <500ng/dL  Hyperlipemia  Serum [TG] >500ng/dL
  3. 3. SIGNALMENT, HISTORY, RISK FACTORS  Breed predilection  Ponies, pony crosses, mini horses, donkeys, mini donkeys  Body condition  Obese animals (greater fat stores)  Risk factors  Obesity, lactation/pregnancy, stress/transportation  Concurrent disease/state of increased demand with decreased intake (especially in high risk breeds)  Chronic internal parasitism, colitis, colic, poor nutrition, etc.   Anything that would cause an animal to go off -feed, thus resulting in decreased energy intake compared to increased metabolic demands
  4. 4. PATHOPHYSIOLOGY  Negative energy balance = fatty acids (FAs) mobilized from adipose tissue  Most animals = production of ketones from FAs  Equids ≠ ketones  large amounts of mobilized lipids in circulation  Problem is TG overproduction, not catabolic failure  Hyperlipemic ponies = lipoprotein lipase (LPL) activity is 2x that of healthy animals of the same breed  May be precipitated by insulin resistance  Insulin inhibits hormone sensitive lipase (HSL, responsible for mobilization of fatty acids from adipose tissue)  Resistance = increased HSL activity = more FA mobilization, increased TGs  Exacerbated by risk factors (obesity, pregnancy, stress)  High serum [TG] may prolong/complicate recovery
  5. 5. CLINICAL SIGNS  Often referable to the primary disease  Hyperlipemia is typically a secondary problem  Can see severe depression, anorexia  Non-specific signs  measure serum [TG] in depressed, inappetant animals of at-risk breeds
  6. 6. DIAGNOSIS  Serum [TG]  May also diagnose with PCV/TS – will see cloudy/white (lipemic) serum once hemocrit tube is centrifuged  Hepatic/renal function, chemistry profile  Assessing for an underlying cause; can also help prognostically  Any diagnostics need for evaluation of the primary condition  YOU MUST TREAT THE UNDERLYING DISEASE!
  7. 7. COMPLICATIONS  Hepatic failure  Renal failure  Death  If it can be identified, YOU MUST TREAT THE PRIMARY DISEASE!  = often ends up being an expensive treatment, due to need for diagnostics and aggressive treatment in most cases
  8. 8. TREATMENT  Nutritional support  Reverses negative energy balance, increases serum [GLUC], promotes endogenous insulin release, inhibits lipid mobilization from peripheral stores  “Smorgasbord” approach, enteral, parenteral (rarely)  Resolve the primary disease!  Insulin therapy  May not be effective if insulin resistance is present  Heparin therapy  Enhances lipogenesis via stimulation of LPL, but no longer recommended (LPL high in affected individuals)  Contraindicated if coagulopathic due to liver dysfunction  No longer recommended as a mainstay of therapy
  9. 9. PROGNOSIS  Poor to grave  Mortality 43-80%  Survival in mini horses and donkeys (78%) vs. ponies (20 57%)  Prognosis worsens if renal involvement is present  Development or worsening of azotemia  Renal failure can cause further anorexia, which will exacerbate hyperlipemia; also results in build up of toxins in the body  Death is more often from failure to treat the primary disease  These animals are typically presented when signs are advanced, thus rapid, aggressive treatment is often required  Can become very expensive very quickly  combination of poor prognosis with a large estimate for care often results in euthanasia
  10. 10. REFERENCES  Boyce, M. (1999). Hyperlipemia in Ponies and Miniature Horses. Available: http://wwwchem.csustan.edu/chem4400/sjbr/99boyce.htm. Last accessed 24 October 2013.  Semrad, SD. (2012). Hyperlipemia and Hepatic Lipidosis in Large Animals. In: Aiello, SE et al. The Merck Veterinar y Manual. Whitehouse Station, NJ: Merck Sharp & Dome Corp.  Watson, T et al. (2013). Hyperlipemia Syndrome. Available: http://www.vetstream.com/equis/Content/Disease/dis0032 9. Last accessed 24 October 2013.

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