Pale Gums in Horses

Key Takeaways

Pale gums are gums that have less color than the healthy salmon pink color typically identified in a horse’s mouth. 

• Gums can be used as a sign of overall health

• Pale gums are a symptom of anemia (blood or iron loss), pain, shock, or infection

• Conditions associated with pale gums include toxicoses, anaplasmosis, equine infectious anemia, gastric ulcers, and leptospirosis

• Horses with pale gums require urgent veterinary care

In cases where pale gums are accompanied by fever, signs of pain, or a rapid heart rate, emergency veterinary attention is warranted

• Diagnostic tools include physical examination, blood work, urinalysis, and endoscopy

• Treatment depends on the underlying cause but may include antibiotics, IV fluids, activated charcoal, and blood transfusions

• Prognosis depends on the underlying cause

A Closer Look: What are Pale Gums in Horses?

The gums are a useful tool in caring for a horse because the membranes are thin and the blood is close to the surface. Horses with gums that are paler than usual require veterinary attention. If pale gums are accompanied by fever, signs of pain, or a rapid pulse, emergency veterinary attention is required.

Possible Causes

There are many potential causes for pale gums. In general, pale gums are the result of a low volume of red blood cells (anemia), infection, pain, or shock as well as other causes. 

Possible causes of anemia include:

Red maple poisoning

• Iron deficiency

• Equine infectious anemia

Possible causes of infection include:


• Leptospirosis

• Potomac horse fever

• Strongyles infection

Possible causes of shock include:

• External or internal bleeding

• Dehydration

• Bacterial infections, particularly intestinal infections

Possible other causes of pale gums include:

• Ionophore toxicosis

• Cancers

• Heart defects or illnesses

Gastric ulcers

Risk Factors

The severity of pale gums varies widely depending on the underlying cause. 

In some cases, onset is sudden as with internal or external injury. In other cases, onset is gradual, such as with an iron deficiency.

In some cases, the underlying cause is mild and resolves easily with treatment such as with strongyles. In other cases, such as with endotoxemic shock and ionophore toxicosis, the cause is sometimes fatal. 

The risk of pale gums is higher for horses that:

• Have a poor diet

• Are not drinking sufficient water

• Have been recently injured

• Have been grazing in areas where toxic plants grow

• Have poor immune systems

• Have eaten medicated feed that is intended for cattle

Testing and Diagnosis

Diagnosis aims to identify the underlying cause of pale gums. Diagnostic tools include:

• Physical examination

• Blood work

• Rectal palpation 

• Urinalysis

• Endoscopy (the use of a camera to see into the horse’s gastrointestinal system)

• Nasogastric intubation 

• Diagnostic imaging, such as x-ray and ultrasound

Note: nasogastric intubation should only be performed by a veterinarian. There is no safe way to intubate a horse at home.

Treatments depend on the underlying cause, but may include:

• Antibiotics

• IV fluids

• Blood transfusions

• Activated charcoal or mineral oil in the case of toxicoses

• Antacids and medications to protect the stomach lining in the case of gastric ulcers

• Pain relief

• Anti inflammatory medications

• Corticosteroids

• Surgery

Note: always consult a veterinarian before administering medications to horses, including activated charcoal.

Similar symptoms

Gums in healthy horses are usually a strong pink or salmon color. They are typically shiny and slick. Comparing the gum color between horses is less useful than being aware of the changes to an individual horse’s gums, since some healthy horses have naturally paler gums. Horses with yellow, brick red, or blue/purple gums also require veterinary attention.

Associated Symptoms

Other symptoms observed with pale gums vary depending on the underlying condition and may include:

• Signs of pain such as restlessness, panting, biting or kicking at the flanks, and sweating

• Lethargy

Lack of appetite

• Fever

• Cold or swollen limbs

• Sticky mucous membranes

Lack of coordination (ataxia)

• Shivering

• Agitation

• Confusion

Exercise intolerance

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