Evaluation of peritoneal fluid lactate as a marker of intestinal ischaemia in equine colic

Reasons for performing study: The most common cause of death as a direct result of colic is acute circulatory failure secondary to intestinal ischaemia. Early and accurate recognition of ischaemic bowel is essential to decrease complications and increase survival. Blood to peritoneal lactate values have been evaluated as a prognostic indicator, but lactate values characterised by type of lesion have not been reported. Hypothesis: Plasma and peritoneal lactate values are higher in horses with intestinal ischaemia secondary to a strangulating obstruction (ISSO). Methods: Venous blood and peritoneal fluid were collected sequentially from 20 clinically healthy horses and 189 horses admitted for colic during a one-year period. Blood gas, pH, electrolyte (K+, Na+, Cal(++), Cl-), glucose and lactate values were determined for blood and peritoneal fluid samples; other values recorded for peritoneal fluid included gross appearance, total protein and nucleated cell count. Information regarding diagnosis, treatment and outcome was retrieved from the medical records. Results: Peritoneal and plasma levels of lactate were lower in control compared to clinical cases. Horses with ISSO had a higher peritoneal lactate value (8.45 mmol/l) than those with nonstrangulating obstruction (2.09 mmol/l). Factors with the strongest correlations with the presence of ISSO were changes in the gross appearance of the peritoneal fluid and values of peritoneal fluid chloride, pH and log(10) lactate. Conclusions: Analysis of peritoneal fluid gross appearance, pH, lactate and chloride can be used for diagnosis of ISSO. Potential relevance: Peritoneal fluid lactate is a better predictor of ISSO than blood lactate and may aid in early detection of catastrophic peritoneal lesions such as intestinal strangulation and rupture.