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Exertional Rhabdomyolysis (Tie-Up)

NOTE:
Please call EVC with any questions or concerns. As with any medical problem,
complications can develop and early intervention can help return your horse to health
more rapidly.
Description

Exertional Rhabdomyolysis is a systemic disease of variable severity involving the rupture of muscle fibers primarily in the hindquarters. Without adequate treatment
and differentiation of causes, the disease can progress into a cyclical issue with decreased
performance as a result or more severe complications such as chronic myositis (muscle
inflammation) or renal (kidney) failure.

Causes
• Metabolic
o Electrolyte: Electrolyte imbalances involving molecules such as Potassium (K), Sodium (Na), Chloride (Cl), Calcium (Ca) or Magnesium. Diagnostic tool: Serum chemistry. o Endocrine: Hypothyroidism. Diagnostic Tool: Serum T4. o Systemic Disease: Diagnostic tool: Full physical examination and o Hormonal: Filly in estrus. Therapeutic option: Stimulate follicular ovulation with HCG or Deslorelin and control reproductive cycle with Regumate (Altrenogest) or Depo-Provera (Medroxyprogesterone) • Musculoskeletal
o Muscle: Abnormal Calcium cell membrane metabolism. Therapeutic o Unsoundness: Secondary musculoskeletal compensation in even the most mildly lame horse can cause undue stress. Diagnosis and treatment of a primary lameness is essential. • Psychologic
o Nervous or “high-strung” horses are more prone to Tie-Up. Therapeutic option: Daily tranquilization or long term management with Reserpine or Fluphenazine. o “Monday Morning Syndrome” a term taken from a similar disease in draft horses. Therapeutic option: Gradual increase and decrease in exercise intensity and duration is essential throughout the week for predisposed horses.
Treatment - Acute
• If patient is comfortable enough to allow it, continue walking slowly and cooling out normally… if not, allow patient to quietly cool out in stall. • Veterinary Examination
• Medications depending on severity:
o All based on approximately 1000-1100# patient 288 Training Center Drive • Elkton, Maryland 21921
Phone (410) 392-6646 • Fax (410) 392-7862 • [email protected]
o Please see veterinarian for current racing withdrawal times
o NSAIDs: Banamine 500mg (10 ml) IV ASAP
o Tranquilization/Vasodilation: Acepromazine 10-20mg (1-2ml) IV/ IM
o Sedation and Analgesia: Butorphanol 5-15mg (0.5 – 1.5ml) IV or IM
o Muscle Relaxation: Robaxin 1-5g (10-50ml) IV
o Muscle Relaxation: Valium 20-50mg (2-5ml) IV
• Bloodwork focusing on CK and AST enzyme levels 4-6 hours post episode
• Fluid Therapy:
o Oral – Nasogastric intubation with warm water and electrolyte powder o Intravenous – Catheterize and administer 10-60 Liters over 1-2 days
Treatment – Chronic
o High fat / protein and Low carbohydrate diet, i.e.: * Supplement up to one cup of Rice Bran, Corn or Vegetable oil
as top-dressing on feed (monitor for palatability)
* Remove Alfalfa from diet, add additional grass hay
* Consider switching grain ration to Re-Leve, or similar complete
pelleted low soluble carbohydrate / high fat feed specifically
designed for horses that Tie-Up
o VetraSel: Vitamin E and Selenium
o DMG: Dimethylglycine
o “Light Salt”: Potassium Chloride (KCl)
o Balanced Electrolytes: Powder in feed and/or water or as paste post-
o Thyro-L: use with diagnosed hypothyroidism
o Milk of Magnesia: Magnesium Hydroxide
o Acepromazine 1-2, 25mg tablets orally or up to 2ml IV 15 minutes
o Naproxen 10, 500mg tablets orally two times per day and taper
o Robaxin 5-10, 750mg tablets orally two times per day
o Phenytoin 10, 100mg tablets orally two times per day
o Dantrolene 3-4, 100 mg scoops 3 hours prior to exercise without food
o Banamine 500mg IV to breeze
o MgSO4 (Magnesium Sulfate) 20-100 ml to breeze
o RVI 2ml subcutaneously every other day for four treatments, then 48
o Avoid Furosemide (Salix) if electrolyte imbalance is a suspected cause o Monitor CK / AST levels post-breeze o Ensure proper hydration

Source: http://www.equinevetcare.com/PDF/ClientEducation/Rhabdomyolysis.pdf