Intragastric pH of foals admitted to the intensive care unit.
Authors: Wise Jessica C, Raidal Sharanne L, Wilkes Edwina J A, Hughes Kristopher J
Journal: Journal of veterinary internal medicine
Summary
# Intragastric pH in critically ill foals: implications for gastric ulcer prophylaxis Gastric acid dynamics in neonatal foals requiring intensive care have received little scientific attention, despite widespread clinical concern about secondary ulceration in this population. Researchers measured intragastric pH continuously for 24 hours in 42 ICU-admitted foals with nasogastric tubes, correlating pH patterns with clinical history, presenting signs, and blood gas parameters. Mean gastric pH was 5.5 (±1.8), with the median foal spending only 6.3% of recording time below pH 4—a finding that challenges assumptions about severe gastric acidification in sick neonates. Notably, foals with placentitis showed paradoxically elevated pH (median 7.2 versus 5.3; P = .002), whilst those with diarrhoea demonstrated increased time spent at pH <4 (median 28.8% versus 4.6%; P = .02), suggesting that specific disease processes have distinct effects on gastric acid secretion. Counterintuitively, surviving foals exhibited lower mean pH values, and foals maintaining pH >4 for >50% of the time had significantly worse oxygenation and elevated carbon dioxide, raising questions about the physiological consequences of elevated gastric pH in critical illness. The predominantly non-acidic gastric environment documented here suggests that routine acid suppressive therapy for ICU foals may be unnecessary, particularly given that only 6% of recording time involved genuinely acidic conditions in most cases. Clinicians should consider disease-specific presentations when deciding on prophylactic treatment, reserving gastric acid suppression for identified risk factors rather than adopting blanket protocols.
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Practical Takeaways
- •ICU foals maintain relatively neutral intragastric pH for >80% of the time, suggesting routine acid suppression therapy may not be necessary for all neonates
- •Placentitis-exposed foals paradoxically show higher gastric pH and less acidic time, questioning common preventive acid-suppressive protocols in this group
- •Diarrheal foals show increased gastric acidity and may benefit more from targeted acid suppression, but pH management alone does not guarantee survival
Key Findings
- •Mean intragastric pH in ICU foals was 5.5±1.8, with median 6.3% time spent at pH <4
- •Foals with placentitis history had significantly higher mean pH (7.2 vs 5.3) and less time at pH <4 (0.1% vs 13%)
- •Foals with diarrhea spent significantly more time at pH <4 (28.8% vs 4.6%)
- •Foals with pH >4 for >50% of time had lower PaO2 and higher PaCO2, and surviving foals had lower median hourly pH