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Horses that survive a serious illness or come through a tough winter will often lose weight and appear thin and ribby. As soon as they recover their health and have access to good pasture, these horses usually regain the weight they have lost. A different situation is found with horses that have been neglected to the point of starvation. These equines are often hundreds of pounds below their optimal body weight, having used up every bit of their stored fat and carbohydrates for survival. When protein is the only source of energy, a starving horse begins to break down its own muscles, connective tissue, and internal organs. Horses in this situation are at high risk of dying, and refeeding must be done very carefully if the horse is to survive.

Bringing a starved horse back to a healthy body condition must be done gradually.For a person who rescues a starved horse, the immediate thought is to give the horse anything and everything it will eat. If this idea is carried out, the horse is likely to die within a few days from a phenomenon known as refeeding syndrome. Because all body systems have been stressed by starvation, they are unable to break down large amounts of food, circulate nutrients to body tissues, and remove waste products efficiently. The strain of these formerly normal processes can quickly lead to circulatory and respiratory system collapse, kidney failure, and death.

Bringing a starved horse back to a healthy body condition must be done gradually. A suggested feeding schedule developed by the University of California, Davis, recommends beginning with tiny meals offered every four hours through the day. Each meal should consist of a measured pound of good-quality alfalfa (lucerne) hay, which will supply protein and important electrolytes. Water should always be available.

This schedule should be followed for the first three days, and no grain should be given during this period. On the fourth through tenth day, the horse should be given gradually increasing amounts of alfalfa in fewer feedings. The goal is to be feeding a total of about 13 lb (6 kg) of hay on the tenth day. This amount of hay should be split into three feedings scheduled eight hours apart.

After day 10, the amount of alfalfa hay can be increased until the horse has access to as much as he wants to eat. Grass hay can be added gradually after the first two weeks. No grain, supplements, apples, carrots, or other treats should be given for several months.

Though the horse may show a bit more energy and interest in its surroundings after a few weeks, complete rehabilitation can take as long as six months to a year. Frequent checks by a veterinarian are recommended, as starved horses may have other health problems that emerge as refeeding continues. Dental work, vaccinations, hoof care, and deworming can be scheduled when the horse becomes strong enough to tolerate them.

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