1. CASE 2 SIGNALMENT & HISTORY Slide 1 6 months-old Warmblood colt
Four day history of :
Fever (39.5°C)
Depression
Decreased appetite
Lying down more than usual
Treated by referring veterinarian with flunixin and trimethoprim sulfonamides for 4 days: no clinical improvement
Parasite status: dewormed with a single dose of fenbendazole at 2 and 5 months of age; new horse on premises with unknown parasite status
No other sick horses or other sick foals
Slide 1

2. CLINICAL FINDINGS ON ARRIVAL
Calm but alert
Slightly unthrifty, poor hair coat
HR 56 bpm / RR 30 bpm / T 38.6 ˚C
Moist and pink mucous membranes, capillary refill time 2sec
Mild to moderately enlarged submandibular lymph nodes
Mild bilateral mucous nasal discharge
Cardiac auscultation: normal
Respiratory auscultation: crackles diffusely over both lung fields
Abdominal auscultation - normal gut sounds
Eating and drinking normally
Soft feces
List the clinical problems using information obtained from the history and physical examination
Slide 2

3. Haematology results on arrival
Foal
Reference
PCV (l/l)
0.44
Haemoglobin (g/dL)
15.6
MCV (fl) 37
MCH (pg)
13.1
MCHC (g/dl)
35.4
WBC (x109/L)
7.9
Neutrophils (x109/L)
4.6
Lymphocytes (x109/L)
3.20
Monocytes (x109/L)
0.10
Eosinophils (x109/L)
0.8
Platelets (x109/L)
213
Blood smear cytology: No abnormal cells seen
Identify the major haematological abnormalities. What is your interpretation?

4. Biochemistry on arrival
Foal
Reference
SAA (mg/L)
3642
0-20
Fibrinogen (g/L)
5.22
Urea (mg/dL)) 25
Creatinine (umol/L)
1.1
Total bilirubin (mg/dL)
1.7
AST (IU/L)
182
GGT (IU/L) 5
1-40
Total Protein (g/L) 30
53-73
Albumin (g/L) 10
29-41
Creatine Kinase (IU/L)
531
Glucose (mg/dL)
113
Triglycerides (mmol/L)
0.79
Identify the major biochemical abnormalities, RANKING them in order of significance. What is your interpretation?

5. Blood gas analysis (venous) & electrolytes on arrival
Foal
Reference pH
7.362
pCO2 (mmHg)
40.4
38-48
HCO3 (mmol/L)
21.9
22-29
Base excess (mmol/L)
-2.2
pvO2
40.7
37-56
Lactate (mmol/L)
1.1
<2
Na (mmol/L)
122
K (mmol/L)
3.7
Cl (mmol/L) 95
95-103
Ca ionized (mmol/L)
1.45
Magnesium ionized (mmol/L)
0.42
Interpret the venous blood gas and electrolyte analysis

6. Free catch urine sample results
 Dipstick
Qualitative protein
Very mild +
Qualitative glucose -
Qualitative ketones
Qualitative blood pH
6.0
Specific Gravity
1.026
Cytology findings
WBC microscopy
Occasional cell
RBC microscopy
Epithelial cells
RBC casts
Negative
WBC casts
Bacteria
Crystals
Occasional
Interpret the urinary analysis

7. Abdominocentesis results
Result
Macroscopic
Clear and not coloured
Protein (g/dL)
Lactate (mmol/L)
Total cell count (x109/L)
0.28
Neutrophils (%)
73.5%
Interpret the abdominocentesis

8. What are your chief differential diagnosis in order of likelihood at this stage?
Comment on which complementary examinations you would chose to further differentiate between the main differential diagnoses

9. Thoracic US

10. Pulmonary investigation
Thoracic radiographs: mild broncho-interstitial pattern, no abscesses
Tracheal aspirate cytology:
52.5% neutrophils (toxic & degenerative changes)
41% macrophages (active)
6.5% lymphocytes
Intra- and extra cellular cocci are visible
Tracheal aspirate bacteriology : pending

11. Fecal analysis Fecal egg count MacMaster:
340 EPG Strongyles
0 EPG Parascaris equorum
Salmonella (culture) : negative
Clostridium (rapid membrane bound immunoassay):
Negative for Clostridial antigens
Negative for Clostridial toxins
Sand sedimentation test: no sand
Succeed fecal occult blood test:
Negative for hemoglobin
Positive for protein
Lawsonia PCR : positive

12. Abdominal ultrasonography (left ventro-caudal abdomen, 5 MHz probe)
small intestinal walls up to 0.8cm

13. Evolution Clinical deterioration after admission
More severe depression
Complete anorexia
Increased heart rate (80bpm)
Higher fever (39.6°C)

14. Evolution Following treatment gradual improvement Day 4:
acute, severe colic => exploratory laparotomy
Euthanasia