Emergency Care for Metabolic Laminitis

Research has shown about 90% of laminitis cases are metabolic (endocrinopathic) which means the key to successful treatment is controlling insulin.

Everyone's first instinct is to reach for phenylbutazone or some other NSAID medication to control pain but these are only minimally effective. The reason is endocrinopathic laminitis is not inflammatory and they do nothing to control insulin. They should not be used for longer than 5 days but horses often get caught in a prolonged course of NSAIDs because the insulin level and trim have not been adequately addressed.

A useful acronym to keep you focused on the comprehensive treatment is DDT:

  • D: Diagnosis
  • D: Diet and Drugs
  • T: Trim

If the horse has not been tested for metabolic syndrome and Cushing's with insulin and ACTH this can be done after the condition has stabilized. In the meantime, starting metformin at 30 mg/kg twice a day can help control insulin. If the horse also has PPID (Cushing's disease), pergolide will be necessary to lower insulin.

The emergency diet should be soaked grass hay only, fed at 1.5% of current body weight or 2% of ideal weight, whichever is larger. Plain beet pulp which has been well rinsed then soaked can be used to carry supplements and medications. No pasture, alfalfa or clover. No grains including those that claim to be safe, and no balancers since their base is often not safe. Safe means less than 10% sugar and starch combined.

A general vitamin and mineral supplement can be added but it is far better to have the hay analyzed so that one can be chosen which actually matches what the horse needs. Also analyze for sugar and starch to see if you need to continue soaking. Vitamin E 2000 IU for the average size horse and 4 to 6 oz of ground flax should be added as well as salt.

The feet should be radiographed as soon as possible. Remove shoes and trim the horse to have a short rounded toe and palmar angle no higher than 5 degrees to minimize stress to the laminae. Styrofoam blocks or boots and pads are best for comfort.

If you focus on diagnosis, diet and trim, not just pain control, outcome will be much improved. For more detailed information, visit https://www.ecirhorse.org/ .

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