Renal uraemic encephalopathy and unilateral uveitis associated with disseminated <i>Halicephalobus gingivalis</i> in a horse in the United Kingdom

A marked increased urine GGT: creatinine ratio was recorded from urine collected 12 h post admission (1739.33U/g; normal <25 u/g), indicative of renal tubular damage.Intravenous balanced isotonic Hartman's fluids were commenced @4 mL/kg/h, reduced to 3 mL/ kg/h after 36 h, then 2 mL/kg/h for 60 h.To act as a potential lipid trap (firocoxib has lipophilic properties) Intralipid 20% TM 2 was administered at 0.2 mL/kg/h for 84 h.Additional treatment included misoprostol 3 5 mg/kg q12 hours, omeprazole 4 1 tube once daily, a single dose of furosemide 5 at 50 mg/kg, N-acetyl cysteine 6 (10 g twice daily) started after 4 days and sucralfate 7 (6 g every 6 h) after 5 days.The horse developed profound jejunal dysmotility and consequent gastric reflux (6-10 L q2 hours from 12 to 20 h after firocoxib administration), ceasing abruptly.Initially quiet, the horse became brighter after 72 h.The horse was steadily reintroduced to feed after reflux stopped.Serial blood monitoring showed no further evidence of hepatic or renal injury, and urine GGT:creatinine ratio returned to acceptable levels by day 5.Main limitations: Single case.Conclusions: Initial profound intestinal stasis has not been reported with NSAID adverse drug events.In this case of marked accidental overdose, some evidence of renal tubular injury and hepatic injury was detected, but was reversible and the horse was discharged 10 days after admission.He made a full recovery, returning to previous athletic activities.