Use of Alprazolam to Facilitate Mare‐Foal Bonding in an Aggressive Postparturient Mare

A healthy 11-year old, 577 kg maiden Quarter Horse mare was examined at the Lloyd Veterinary Medical Center with a 4-day old colt because the mare would bite or kick the foal when the foal attempted to suckle. The owner bottle fed the foal small amounts of mare’s milk over the first 4 days of life, but the foal became progressively weaker over time and was recumbent and nonresponsive at presentation. Furthermore, although gestational length and parturition were reportedly normal, the mare had apparently not been producing adequate amounts of milk since the foal was born. Upon presentation (Day 1), the foal weighed 36.8 kg and was severely dehydrated, undernourished, unresponsive, hypothermic (32.2°C; reference range [RR], 37.2–38.6°C), bradycardic (40 beats/min; RR, 96–108 beats/min), hypoglycemic (28 mg/dL; RR, 101–226 mg/dL), hyperlactatemic (4.2 mmol/L; RR, <2.5 mmol/L), and had a low serum immunoglobulin G (IgG: 400–800 mg/dL ; RR, >800 mg/dL). A CBC revealed leucopenia (3.41 9 10/lL; RR, 5.1–10.1 9 10/lL) characterized by neutropenia (2.15 9 10/lL; RR, 3.21–8.58 9 10/lL) and relevant serum biochemistry derangements included hypoproteinemia (3.5 g/ dL; RR, 5.3–7.9 g/dL), hypoalbuminemia (1.9 g/dL; RR, 2.8–3.7 g/dL), and hyperbilirubinemia (4.61 mg/ dL; RR, 0.5–3.9 mg/dL). The foal was treated for failure of transfer of passive immunity and polymicrobial sepsis confirmed via blood culture yielding E. coli and Citrobacter sp. Treatment included administration of 2 L of equine plasma, which increased the serum IgG to >800 mg/ dL, fluid resuscitation and treatment, antimicrobial treatment consisting of ceftiofur (Naxel ) (5 mg/kg IV q12h) and gentamicin (10 mg/kg IV q24h) for 10 days followed by sulfamethoxazole-trimethoprim (30 mg/ kg PO q12h) for 7 days, nasoesophageal tube feedings and supportive and nursing care. The mare was treated with domperidone (1.1 mg/kg PO q24h) to increase milk production. The foal was able to ambulate by Day 4 and by Day 6, was bright and alert and attempted to suckle from the mare frequently. However, the mare consistently demonstrated aggressive behavior toward the foal; therefore the mare’s head was tied in a stationary position and periodic sedation (detomidine, Dormosedan, 0.011 mg/kg IM q6h) was administered while the hindlimbs were hobbled to allow the foal to suckle under strict supervision. Although the foal was able to suckle voluntarily, the mare continued to display violent behavior and attempted to bite and kick the foal, but was constrained by the applied restraints. In an attempt to facilitate mare-foal bonding and provide a means for the foal to suckle unsupervised without maternal sedation or restraint, the mare was administered alprazolam (0.035 mg/kg PO q8h) on Day 7. On Day 8, 24 hours after the initial dose of alprazolam, the mare had a quieter demeanor and demonstrated less aggression toward the foal. The next day (Day 9) the mare was not aggressive toward the foal and allowed the foal to suckle regularly. Over the next 2 days, the mare was untied, the hobbles were removed and the foal was allowed to suckle without incident. On Day 11, the mare’s physical examination was within acceptable parameters, but the mare appeared mildly sedate; therefore the frequency of alprazolam administration was decreased to twice daily (0.035 mg/kg PO q12h). On Day 14, the foal weighed 44 kg and was suckling regularly without threat from the mare. The mare and foal were subsequently discharged with instructions to administer alprazolam (0.035 mg/kg PO q12h for 3 days, then 0.018 mg/kg PO q12h for 5 days). One week after discharge the owner reported that the mare demonstrated no aggression toward the foal when suckling, and 6 months after presentation the mare and foal were reportedly healthy. From the Lloyd Veterinary Medical Center, Department of Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA (Wong, Alcott, Hepworth); the Department of Clinical Sciences, North Carolina State University, Raleigh, NC (Davis); and the Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA (Wulf, Coetzee). Corresponding author: D.M. Wong, Lloyd Veterinary Medical Center, Department of Clinical Sciences, Iowa State University, Ames, IA 50011; e-mail: [email protected]. Submitted August 4, 2014; Revised October 1, 2014; Accepted October 28, 2014. Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of American College of Veterinary Internal Medicine. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. DOI: 10.1111/jvim.12510 Abbreviations: