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Discussion on Effects of Long Term Bute?

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Steve P
New Member
Username: irhunter

Post Number: 1
Registered: 10-2011
Posted on Friday, Oct 28, 2011 - 11:33 am:   Edit PostPrint Post

Dr. O

I have a 9 year old OTTB Gelding that is a rescue horse. He came to me with torn platter hooves and bi-lateral Stringhalt (severity fluctuates between both hind legs). He has been on a 25% Fat diet since 4/1/11. Tested negative for EPM.
He's 16 hh and about 1000-1100lbs. He's been on Bute for the last 3 months, 1 gm oral, top dressed on beet pulp and veg oil, twice a day. For roughage, he gets about 14lbs of Alfalfa/Grass hay per day. With regular trimming, his hooves are growing in nice, and he is now growing back in concave soles that are not nearly as "ouchy" on rocks and hard surfaces as when I received him.

Abnormalities in his recent blood work are:

WBC - 5.4 K/ul
Glucose Serum - 22 mg/dl
Creatinine - 0.8 mg/dl
Potassium - 5.8 meq/l
Anion Gap - 19
Albumin - 4.2 g/dl
Globulin - 2.3 g/dl
Alb/Glob Ratio - 1.8
Bilirubin, Direct - 0.7 mg/dl

Everything else is within normal range. Liver and Kidney stress is indicated but does it appear severe? The Lab repeated the Glucose Serum test, with repeat results. Would that be dietary or another result of the Bute? With such a low Glucose Serum level, could that be affecting the high K level, throwing off the test results a bit? Any chance the high K level and Stringhalt could be related?

Thanks for you input.
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Steve P
New Member
Username: irhunter

Post Number: 2
Registered: 10-2011
Posted on Friday, Oct 28, 2011 - 8:52 pm:   Edit PostPrint Post

Dr. O

I just read another topic in which you addressed the norms for each specific lab. I have added in the norms for this lab...

WBC - 5.4 K/ul - Low - Norm 5.5 to 12.5
Glucose Serum - 22 mg/dl - L - Norm 60 to 120
Creatinine - 0.8 mg/dl - L - Norm 1.2 to 2.0
Potassium - 5.8 meq/l - H - Norm 2.4 to 4.7
Anion Gap - 19 - H - Norm 5 to 16
Albumin - 4.2 g/dl - H - Norm 2.5 to 4.0
Globulin - 2.3 g/dl - L - Norm 2.5 to 4.0
Alb/Glob Ratio - 1.8 - H - Norm .6 to 1.5
Bilirubin, Direct - 0.7 mg/dl - H - 0.0 to 0.4

My vet had me replace a pound of beet pulp with Oat Grain. She also had me discontinue Bute for now. I turned Coyote out in the large arena today to free exercise. He ran all out for about 10 minutes, without stop or being driven. On his sire's side he is out of the Nasrullah/Bold Ruler Lineage. On the Dam he is out of the War Admiral line. He's just amazing to watch run.... hard to believe he can barely walk due to the Stringhalt.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 26020
Registered: 1-1997
Posted on Sunday, Oct 30, 2011 - 11:13 am:   Edit PostPrint Post

Welcome Steven,
I don't see evidence of liver or kidney stress above. What in particular makes you think so?

As to the mild rise in potassium causing the stringhalt, it seems unlikely as hyperkalemia, when severe, induces muscular weakness and not a neuromuscular hyperreactivity as seen with stringhalt.
DrO
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Steve P
New Member
Username: irhunter

Post Number: 3
Registered: 10-2011
Posted on Sunday, Oct 30, 2011 - 12:15 pm:   Edit PostPrint Post

Hi Dr. O,

I was concerned with the high Bilirubin, Alb/Glob Ratio and Potassium. As a novice, seeing the elevated results, especially with the Bilirubin being almost twice the lab norm pointed towards the Kidneys and Liver.

I wanted to wean him off the Bute as his hooves tightened up. I forgot to mention, he had white line stretching/seperation which we've been trimming every three weeks. During his daily exercise, he wears Easyboot Trails, with the medium comfort pad inserts.

With 2 gm of Bute a day and his boots on, he can trot without signs of discomfort. His daily exercise includes 30 minutes of trotting in the round pen. I usually let him run, free choice, in the large arena. He typically goes for about 7 to 10 minutes at varying speeds from lope to all out gallop. Without the Bute, he only lopes for a lap or two and then stops.

I have not found any reference to Bute affecting Stringhalt, so I assume he is still either tender footed or another undiagnosed condition is being masked by the severe Stringhalt.

Thank you for your response.
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Robert N. Oglesby DVM
Moderator
Username: dro

Post Number: 26026
Registered: 1-1997
Posted on Sunday, Oct 30, 2011 - 11:45 pm:   Edit PostPrint Post

The high albumin (and concurrent high A/G) levels are not what is seen in either liver or kidney disease, indeed just the opposite is sometimes seen: diseased kidneys may loose albumin to the urine and a diseased liver will decrease albumin production.

The low glucose is almost certainly a commonly seen artifact due to the time between collection of the sample and the time of lab processing: the red blood cells use up the glucose in the tube. And yes the potassium could be related as the RBC's start to leak potassium out into the serum, artificially raising the serum levels in the sample tube with time.

While it is true that liver failure leads to increased bilirubin there are other possible causes including increased RBC breakdown and in the horse even inappetance can cause a rise in bilirubin levels. Without other signs of liver failure this would not be considered a reliable sign of liver failure. If liver failure is a concern see HorseAdvice.com » Diseases of Horses » Colic, Diarrhea, GI Tract » Mouth, Esophagus, and Liver » Liver Disease and Failure.
DrO
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Steve P
New Member
Username: irhunter

Post Number: 4
Registered: 10-2011
Posted on Monday, Oct 31, 2011 - 12:10 am:   Edit PostPrint Post

Thank you very much! Poor Coyote has enough against him without me inadvertently causing more!

I hadn't thought about the time delay from sample taking to lab analysis.

Steve
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