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AZOTURIA

The signs of an ERS attack range from mild stiffness to complete immobility and even death

Trigger factors vary from one horse to another, but often involve exercise and high starch diets

High fibre, low starch diets should be fed, with amounts cut down on rest days, and horses should always be warmed up thoroughly

Introduction
This is a short review highlighting the major features of this syndrome, and giving guidelines for the management of cases. It is based on information provided by the Animal Heath Trust, from work by Pat Harris who now works for Pedigree Petfoods.

Equine rhabdomyolosis syndrome (also known as Tying up, Setfast, Monday morning disease, Azoturia, Exertional Myoglobinuria, etc.) has occurred in some form in most breeds of horse and pony, and can appear at any stage in the life of the animal. There seems to be an increased incidence in mares and fillies in training, and this could be related to hormonal changes during the oestrus cycle, as these have influences in electrolyte metabolism.

Due to its many manifestations, the signs of an attack can vary from mild stiffness and shortened stride in mild cases, to, in the worst scenario, complete stiffness and death.

Typically is often recurs following the initial attack, but it is difficult to predict when this will be as recurrences are intermittent. The severity of the attack also varies and between episodes most sufferers are apparently normal.

At tissue level, Equine Rhabdomolysis Syndrome primarily effects a small proportion of the type II fibres. These are the fast contracting muscle fibres that are more susceptible to fatigue.

Given the various forms by which it is known, however, what triggers and predisposes a horse to an attack varies from one individual to another. Exercise is one of the more common triggering factors. Nutrition is also important in its development - historically, Monday morning disease occurred when working horses were rested on a Sunday without any reduction in feed then exercised on Monday. This suggests that high carbohydrate diets may have a predisposing effect. High carbohydrate diets may cause increased acidity in the blood, which in turn can cause altered muscle metabolism and increased urinary excretion of calcium and phosphorus.

All these points make it difficult to have one theory to explain the syndrome and makes it very difficult to advise just one treatment or system of management to prevent it occurring.

Management that may help prevent Tying up

A. Feeding

i. Maintain fibre intakes - hay and/or grazing should be provided as usual.

ii. A complete concentrate mix or cube should also be fed. This should have as high a fibre content and low starch content as possible - e.g. Spillers Horse & Pony Cubes for maintenance to light work and Spillers HDF Sports Cubes for moderate to hard work.

iii. For horses in light work, the energy level of the particular mix or cube used should initially be one level lower than normally considered appropriate for the exercise level. Again, keep the diet as high in fibre as possible - look for feeds that derive their energy from fibre and not starch.

iv. Use apples, carrots and molassed chaffs and small amount of soaked sugar beet to make feed more palatable if necessary.

v. Minimise the consumption of starchy feeds such as mixes and straights (use straights such as oats and barley with care as they have poor mineral balance).

vi. Additional salts and minerals should only be fed if laboratory investigations suggest that they would be useful or if you are feeding below the manufacturers recommended level of concentrate feed. In these cases a general purpose vitamin and mineral supplement can be used. The exception is hard working horses which should always be fed salt at up to two ounces for a 500kg horse.

vii. When increasing the exercise level, do not increase the feed in anticipation - wait until after the workload has increased, and only then if required by the individual animal.

B. Exercise

i. Carry out a long warm-up before intense exercise followed by warm down after exercise.

ii. When the weather is good, turn the horse out as much as possible. Do not allow susceptible horses to stand out for long in the cold.

iii. Exercise daily, at a consistent level - if this is not possible aim to turn out on days off.

iv. If the horse has a day off, the amount of concentrate feed given should be significantly reduced from the evening before until the lunchtime feed of the next working day.

v. If there is a longer period of rest, decrease the amount of feed and if necessary change to one with a lower energy level.

vi. In a yard, if a virus or other disease is going round then reduce the feed levels of suspected horses and reduce the work load until several days after all signs of any infection have passed.

C. If Tying Up Occurs................

i. When an attack occurs walking home should be avoided if at all possible; and the horse should be transported home. Strict stable rest for the following few days is advisable and the horse should be kept warm, and away form draughts and given plenty of bedding. During this time feed only water and hay.

ii. Check that the horse urinates following an attack. If it does not urinate within 7 hours, call your vet.

iii. Keep the horse stabled until he is moving freely around the box, showing no signs of pain when the muscles are palpated and the urine is no longer discoloured.

iv. Before the horse returns to work you should aim for a period of turn out into a small paddock or indoor school. If the horse is turned out, to avoid getting a chill encourage them to move by putting hay in different places.

v. Mild attacks may only require a few day of this, but if the attack was quite severe, or if it was a recurrence, a further blood test should be taken before resuming exercise. As a guide, you should wait until the muscle enzyme CK has dropped to within double the upper limit of the range of the lab you use. Exercise should commence gradually and only straight line work should be carried out initially.

vi. When turning out the horse start feeding small amounts a balanced diet as previously described.

vii. If time off cannot be given, rest initially and then start exercise very gradually after at least four days on the diet described above and two or three days loose in an indoor school or field.

viii. Initial work should allow plenty of warm-up time and hills should be avoided. If the horse misbehaves on its own or in company, it should be exercised with others or alone as appropriate.

Laboratory Tests

i. Your vet will advise you on the necessary frequency of tests, but as a guide you should arrange for a blood sample to be taken on the third or fourth day after the return to exercise. This should be done before exercise with a second sample two to six hours after exercise. For the test to be a true indication of the extent of the recovery, the exercise undertaken should be fair and typical of the current exercise level but should not be over strenuous.

ii. If these initial samples are within acceptable limits, exercise can be continued, although you may want to monitor the situation via further blood and urine tests.

iii. Blood and urine should not be samples within 5 days of an attack.

Conclusion

The reasons for an attack of ERS in one of its guises are unfortunately many and varied. The recommendations above are designed to minimise the risk of an attack happening, and to help in the management of susceptible horses, but do not, sadly, guarantee freedom from the syndrome in all horses.

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