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Severe phenylephrine-associated hemorrhage in five aged horses

Jeremy Frederick DVM1, Steeve Giguère DVM, PhD, DACVIM2, Kelly Butterworth DVM3, Alessandra Pellegrini-Masini DVM, PhD, DACVIM4, Raul Casas-Dolz VMD5, and Meg Miller Turpin DVM, DACVIM6
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  • 1 Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.
  • | 2 Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.
  • | 3 Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.
  • | 4 Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, Athens, GA 30602.
  • | 5 Byron Reid and Associates, 1630 F Rd, Loxahatchee, FL 33470.
  • | 6 Equine Hyperbaric Center of South Florida, 1630 F Rd, Loxahatchee, FL 33470.

Abstract

Case Description—5 aged (≥ 17 years old) horses developed life-threatening Internal hemorrhage following IV administration of phenylephrine at 3 hospitals.

Clinical Findings—All 5 horses developed severe hemothorax, hemoabdomen, or both within minutes to hours following administration of phenylephrine.

Treatment and Outcome—Four of 5 horses died of hemorrhagic shock, and 1 horse survived with a blood transfusion. The exact source of hemorrhage was Identified In only 1 horse. Medical records of all horses with nephrosplenic entrapment of the large colon and treated with phenylephrine at the University of Florida Veterinary Medical Center between 2000 and 2008 (n = 74) were reviewed. Three of these 74 (4%) horses developed fatal hemorrhage (horses 1 through 3 of this report). The risk of developing phenylephrine-associated hemorrhage was 64 times as high (95% confidence interval, 3.7 to 1,116) in horses ≥ 15 years old than in horses < 15 years old.

Clinical Relevance—The potential risks versus benefits of phenylephrine administration should be evaluated carefully, especially In old horses. (J Am Vet Med Assoc 2010;237:830–834)

Abstract

Case Description—5 aged (≥ 17 years old) horses developed life-threatening Internal hemorrhage following IV administration of phenylephrine at 3 hospitals.

Clinical Findings—All 5 horses developed severe hemothorax, hemoabdomen, or both within minutes to hours following administration of phenylephrine.

Treatment and Outcome—Four of 5 horses died of hemorrhagic shock, and 1 horse survived with a blood transfusion. The exact source of hemorrhage was Identified In only 1 horse. Medical records of all horses with nephrosplenic entrapment of the large colon and treated with phenylephrine at the University of Florida Veterinary Medical Center between 2000 and 2008 (n = 74) were reviewed. Three of these 74 (4%) horses developed fatal hemorrhage (horses 1 through 3 of this report). The risk of developing phenylephrine-associated hemorrhage was 64 times as high (95% confidence interval, 3.7 to 1,116) in horses ≥ 15 years old than in horses < 15 years old.

Clinical Relevance—The potential risks versus benefits of phenylephrine administration should be evaluated carefully, especially In old horses. (J Am Vet Med Assoc 2010;237:830–834)

Contributor Notes

Address correspondence to Dr. Giguère (gigueres@uga.edu).