Iatrogenic lipoid pneumonia in an adult horse
By Jenni Varjonmaa VM1
Outline
Keywords
Introduction
Patient's history
Clinical findings
Further investigation and therapy
Post-mortem findings
Discussion
Conclusions
References
Keywords
Lipoid pneumonia
Mineral oil
Nasogastric intupation
Introduction
Mineral oil is commonly used in equine practice
A lubricant in cases of gastrointestinal impaction
A purgative in cases of potential toxicosis
Administration of mineral oil via nasogastric intubation carries a risk of causing lipoid pneumonia
Lipoid pneumonia: A severe inflammatory reaction to the presence of oil in the lungs
NB! Usually fatal to horses
Patient's history
A 20-year-old gelding presented with a history of acute respiratory distress
Had begun after administration of a mineral oil and water mix, via nasogastric intubation, for treatment of suspected gastrointestinal dysfunction
Signs of acute respiratory distress:coughing, increased respiratory effort and rate, profound nostril flare, anxiety
After the initial tratment there were no signs of improvementfor further evaluation
Clinical findings
The gelding was in a good body condition but sweating
Tachycardic (88 beats/min)
tachypnoeic (26 breaths/min)
Bloody discharge from both nostrils
Bilateral inspiratory and expiratory wheezes in the caudodorsal lung fields
Reduced vesicular sounds bilaterally in the ventral lung fields
Further investigation and therapy
An arterial blood gas analysis revealed:
Arterial hypoxaemia (64mmHg, reference range rr. 90-115 mmHg)
Mild oxygen desaturation (92.3%, rr. > 95%)An intra-nasal cannula and oxygen insufflation initiated (15L/min) A long-term catheter and treatment with intravenous fluids
The arterial blood gas values deteriorated
Thoracic radiographs revealed aspiration pneumonia
[Picture]: Lateral radiograph of the caudodorsal lung field. A mixedbronchoalveolar-interstital pattern (typical of aspiration pneumonia) is present (arrows).Further investigation and therapy
Physical examination, diagnoctic findings and continued decline in the horse's conditioneuthanasia
Post-mortem findings
Marked congestion of the trachea, particularly in the distal half, with a large quantity of oil globlets present in the lumen
Pulmonary emphysema
A large amount of oil globules were apparent in the pulmonary parenchyma
Lipid droplets are grossly visible withinthe lumen of the trachea (arrows).
Discussion
Respiratory distress with a history of nasogastric intubation The majority of cases of lipoid pneumonia
Equine lipoid pneumonia are chronic rather than acute in nature
Horses with potential lipoid pneumonia
Thoracic auscultation reveals abnormal lung sounds
Thoracic ultrasonography reveals an increased number of comet tails
Discussion
Ante-mortem diagnosis of lipoid pneumonia can be made by confirming the precence of lipid within the lower highway by examiniting fluid obtained
From a bronchoalveolar lavage (BAL)
From trans-tracheal wash/aspiration
To identify the specific type of lipid compound in the lung tissue; chemical analysis, spectroscopy and chromatography
Treatment of exogenous lipoid pneumonia:
consisting of supportive care and antibiotics if secondary complications arise
Conclusions
Veterinarians should be aware that aspiration of fluids during nasogastric intubation is a serious risk of lipoid pneumonia and restrain properly the horse and carefully check that the tube is still in place if any movement occurs
Sick, sedated or refluxing animals may have a reduced swallowing reflex which makes it difficult to properly place the tube
The stomach tube may be in the oesophagus resulting in regurgitation and aspiration
References
Iatrogenic lipoid pneumonia in an adult horse (Irish Veterinary Journal Volume 63 Number 5 20)
Carolyn Cummins, Lisa Katz, Eva Maischberger and Lucy Metcalfe
Section of Veterinary Clinical Studies, University Veterinary Hospital, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin
http://www.irishvetjournal.org/content/pdf/2046-0481-63-5-303.pdf
Thank you for your attention!
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