Refeeding a Malnourished Horse to Excellent Health

Care : Health Issues

Kelly Vineyard, M.S., Ph.D.

Senior Nutritionist, Equine Technical Solutions

With quality veterinary care and a proper nutrition plan, you can successfully bring malnourished horses back to good health, allowing them to enjoy a promising future. Use these tips to avoid refeeding complications and to create the best nutrition plan for underweight horses.

Malnourished horses need proper care

Woman brushing buckskin horse.Starved horses can be a product of owner ignorance or economic hardship, but regardless of the reason, the horse may end up in a debilitated state. The new caretaker’s goal is to help the horse return to good health and appropriate body weight as quickly and safely as possible.
The first, and most important step, is to have an equine veterinarian perform a complete physical exam. Next, create a nutrition plan to facilitate the horse’s weight gain while avoiding potential complications that can occur when reintroducing feed to a chronically starved horse.
Appropriate nutrition and exemplary veterinary care can successfully bring malnourished horses back to good health, allowing them to enjoy a promising future. Depending on the horse’s initial condition, rehabilitation may take from three to 10 months or more. However, taking a slow and steady approach to refeeding will minimize the occurrence of potential complications.

How to feed a starved horse

Refeeding a severely malnourished, debilitated horse should commence slowly to avoid overwhelming the digestive and metabolic systems that have been significantly impaired by starvation. Consult your veterinarian to:
  • Develop a nutrition program.
  • Perform a complete physical examination.
  • Check for underlying conditions or diseases.
  • Assess organ function to identify proper medical treatment.
Be sure to record the horse’s initial body weight and take photographs to document its current condition.

Addressing dehydration

Often, malnutrition occurs at the same time as dehydration in horses. When appropriate, treatment should begin with rehydration.
If the horse is severely dehydrated but willing to drink, offer 2 to 4 liters of diluted saltwater (0.5 – 1% NaCl) every 30 minutes until the horse is no longer thirsty. Once the horse has satisfied its thirst, it is safe to offer free-choice water at all times. However, in severe cases, when the horse does not drink voluntarily, parenteral or enteral administration of fluids may be necessary.

Refeeding protocol – the first 10 days

The first 10 days of refeeding are the most important in rehabilitating a severely starved horse. These tips can assist with a smooth transition for your malnourished horse:
  • Days 1 – 3: Offer approximately 1.2 lbs. of leafy alfalfa for the average 1,000-pound horse every four hours.
  • Days 4 – 6: Slowly increase the amount of alfalfa while decreasing the number of feedings.
  • By day six: offer three meals per day, every 8 hours, for a total of 16.5 lbs. of alfalfa.
After 10 days, re-evaluate the horse to determine if weight gain has occurred. If the horse has positively responded to the refeeding protocol, then begin twice-daily feedings, and free-choice access to alfalfa hay may be allowed. After this, introduce concentrates gradually and address any deworming and dental problems. If the horse remains in a guarded state, continue to provide three meals of alfalfa hay a day until the horse becomes stabilized.
Sometimes a malnourished horse is unable to chew or ingest the food necessary for rehabilitation. In these cases, there are a few methods to entice feeding. If the horse is unable to chew alfalfa hay, substitute alfalfa cubes or pellets soaked in water during the initial refeeding period. When a horse refuses alfalfa hay products completely, then substituting other types of hay or soaked beet pulp without molasses with small amounts of Purina® Equine Senior® may entice the horse to eat more feed.

Refeeding syndrome in horses 

The first 10 days of refeeding are the time when a horse is most susceptible to a condition known as “refeeding syndrome.”
Refeeding syndrome is more likely to occur in severely underweight horses with a body condition score of less than 3. Refeeding syndrome is a potentially fatal condition that can lead to heart, kidney and respiratory system failure.
Closely monitor the horse for the first 10 days of refeeding for signs of refeeding syndrome, including:
  • Increased muscle weakness
  • Neurologic dysfunction
  • Irritability
  • Aggression
If any of these symptoms are observed, contact your veterinarian immediately.

Long-term feeding plan

Once the initial refeeding period has proven successful, a long-term plan may be put into place. The refeeding protocol should be dictated by the digestible energy (DE) requirement of the horse and the amount of weight that needs to be gained. Table 1 shows the daily DE requirements for mature horses at different levels of metabolism.

The DE requirements of growing, pregnant or lactating horses can be found in the 2007 NRC. It takes approximately 9 megacalories (Mcal) DE above the horse’s maintenance requirement to induce 1 pound of weight gain, and approximately 35 to 44 pounds of gain is required for an increase of one body condition score (BCS).

For example, if a 1,200-pound horse (ideal body weight) is currently a 3 BCS with a desired BCS of 5.5, then 110 pounds of gain would be required over 110 days at a desired rate of gain of 1 lb/day. Therefore, the horse must be fed a ration that provides 9 Mcal/day above the daily maintenance requirement (a total of 27.1 Mcal/day) for 110 days to gain 110 pounds and increase from a 3 BCS to a 5.5 BCS.
Table 1. Daily maintenance DE requirements* of mature horses (NRC 2007)
Desired bodyweight (lbs.) Minimum (Mcal) Average (Mcal) Elevated (Mcal)
800 11.0 12.0 13.2
1,000 13.8 15.1 16.5
1,200 16.6 18.1 19.8
1,400 19.3 21.1 23.1
*Minimum maintenance applies to sedentary horses due to confinement or limited voluntary activity, average refers to alert horses with moderate voluntary activity and elevated applies to nervous horses or those with high levels of voluntary activity.
Once the target daily DE intake has been established, deciding which feeds to utilize depends on several factors. The use of high-quality forages should be maximized whenever possible. Still, pasture should be introduced slowly and conservatively, similar to the way a horse would be introduced to lush spring pasture for the first time. For horses with poor dentition or digestive complications, a highly digestible and well-fortified complete feed like Purina® Equine Senior® should be utilized. Complete pelleted feeds are easier to chew than long-stemmed forage and facilitate digestion, absorption and maximize the horse’s ability to extract nutrients from the feed.
Use calorie-dense, fat-added concentrates to meet daily energy requirements if there are no underlying medical conditions that would require an alternative approach. Depending on the horse’s preference and the current forage program, Purina® Strategy® GX, Purina® Omolene® 500 and Purina® Ultium® Competition and Ultium® Gastric Care formulas are highly fortified, fat-added feeds that work well to facilitate weight gain. When introducing concentrate feeds, start by feeding minimal amounts in multiple meals per day. Increase the daily quantity of concentrate feed by no more than a total of 0.5 – 1 lb. per day, until you reach the desired feeding level.
If refeeding a young, growing horse, a conservative approach should be taken when bringing the youngster back to a full ration to prevent the occurrence of developmental orthopedic disease that can sometimes be induced by a compensatory growth spurt. Purina® Strategy® GX, Purina® Omolene® 300 and Purina® Ultium® Growth are all appropriate feeds to rehabilitate the growing horse.
It is important to remember that rehabilitation of a malnourished horse will vary and largely depends on the horse’s initial condition. Fortunately, quality veterinary care, combined with a proper nutritional approach, can successfully return a malnourished horse to good health.
Looking for the right feed to help refeed a malnourished horse? Use the Feed Finder to try a Purina® horse feed.