Initial Evaluation and Minimum Data Base

Foals with severe illness always look their best shortly after birth. Early clinical signs of depression or slow to start nursing, etc., may be significant and if economically feasible should be worked up with the same database as an obviously ill foal.
Any foal that is collapsed, hypothermic, hypotensive and unresponsive needs immediate resuscitation to avoid irreversible cardiopulmonary failure (See Resuscitation Part 1, Resuscitation Part 2 - Evaluation of Cardiovascular Status and Shock (SIRS)).

I. Evaluation of Foals Not Requiring Initial Resuscitation [1-3]

1. Observe the foal from a distance and note the level of alertness, rate and pattern of respiration, degree of effort, gait, etc.
2. Place the foal in a suitable, warm, protected environment, close to the mare for initial evaluation.
3. Check mucous membranes and use oxygen during evaluation if indicated.
4. Perform brief overview exam noting any obvious problems such as trauma (cracked ribs, congenital anomalies, hernias, swellings, etc.)
5. Check rectal temperature: If < 100°F (37.8°C) and if foal is recumbent, place on insulating pad, wrap in blankets, raise environmental temperature, apply heat lamps.
6. Obtain blood culture (use good technique to preserve vein).
7. Place IV catheter.
8. Draw EDTA, heparin and clotted tubes from IV catheter or jugular or peripheral vein.

1. Complete blood count STAT (perform differential and determine immature neutrophil count (bands, etc.) and examine cells for signs of toxicity)
2. Venous blood gas and Na+, K, Cl-, and creatinine STAT
3. Submit chemistry panel
4. Lactate determination stat
5. Colloid oncotic pressure determination

9. STAT blood glucose; spin heparinized blood and use dextrose strip, or glucometer on plasma. Minimum dextrose requirement is 4-5 mg/kg/min (250 cc 5% dextrose/hour for 50 kg foal) [1,2]

1. If glucose is < 60 mg/dl (3 mmol/l) start 1-2% dextrose (make 1% dextrose by adding 20 cc of 50% dextrose to 1 liter replacement fluids and administer it in 30-60 minutes).
2. Some foals may require additional dextrose after fluid replacement. If maintenance 2.5% or 5% dextrose fluid rates does not meet the needs, up to 10% dextrose can be administered, although it is hyperosmotic and requires careful titration with a fluid pump.
3. One may switch to parenteral nutrition in foals that remain hypoglycemic for extended periods of time (>6 hours) (See Parenteral Nutrition).
4. Start prewarmed IV replacement fluids with 1% dextrose in (LRS, Normosol-R, Plasmalyte-148) in foals that are normoglycemic.

10. Assess serum IgG STAT: If obtain a high value and foal's serum protein is < 4.5 g/dl repeat test with control sample.
11. Measure blood pressure in recumbent foals (Doppler on tail).
12. Obtain blood gas or determine oxygen saturation with pulse oximetry (see Assessment of Oxygen Needs).
13. Assess maturity - Radiograph carpus and tarsus if suspect premature of dysmature.
14. Weigh foal.
15. Perform standard post foaling care (chlorhexidine 0.5% to navel, tetanus prophylaxis, enema if indicated).
16. Obtain a thoracic radiograph.
17. Ultrasound umbilicus and check size of bladder
    Editor's Comment - A lot of sick foals don't "feel" a big bladder and will rupture; monitor for this frequently
18. Complete comprehensive physical exam and record findings.
19. Evaluate physical findings and laboratory data, compute sepsis score2, and initiate therapy. (See Infections for sepsis score).

1. If your history, examination and instinct suggest sepsis is a possibility, repeat blood culture if 1 hour has passed and start foal on IV antibiotics and consider plasma administration.