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Metabolic Diseases: Milk fever
Prepared by

Dr. Ali H. Sadiek
Prof. of Internal Veterinary Medicine and Clinical Laboratory Diagnosis

Faculty of Veterinary Medicine, Assiut University
E-mail: Sadiek59@yahoo.com

Metabolic diseases
Metabolic disease or diseases of Intensive production occurs in highly lactating cows and preg. ewes. It occurs usually around parturition. It could be defined as disturb. of Internal homeostasis as a result of sudden change in one or more of intermediate metabolites.

Metabolic disorders
• Metab. disorders occur primarily in early lactation – Period of great stress and drastic changes in nutritional requirement – Energy metabolism disorders (ketosis, pregnancy toxemia, fatty liver, rumen acidosis) – Minerals and vitamin metabolism disorders (milk fever, metritis, udder edema, retained placenta) • Metab. disorders are correlated with each other: – A cow with milk fever is 4 x more likely to also suffer from retained placenta and 16 x more likely to develop ketosis than a cow with no milk fever. • Early detection and prevention is far better than treatment

Causes of metabolic Diseases
• Severe, sudden change in fluids, electrolytes, soluble organic elements during early lactation. • Animal become unable to withstand such changes led to change in the concentration of these elements in blood e.g. Na, K, Ca, P, Mg, Glucose, as a result of their secretion in Milk. • Stress of pregnancy, parturition, decreased feed intake, increased M. production.

1-Stress of pregnancy & parturition

Metabolic Disorders 2-Decreased feed intake 3-Stress of milk production

Examples of Metab. diseases
1. 2. 3. 4. 5. 6. 7. 8. 9. Milk Fever. Hypomagnesaemia. Downer Cow Syndrome. Post Parturient Hemoglobinurea. Azoturia Metritis, udder edema, retained placenta. Ketosis. Pregnancy toxemia of ewes. Fat Cow Syndrome.

Diseases characterized by recumbency.
1- Milk Fever. 2- Hypomagnesemia. 3- Downer cow syndrome. 4- Hypophosphatemia. 5- Ketosis. 6- Pregnancy toxemia. 7- Fatty liver syndrome. 8- Azoturia of equines.

What are the disease associted with ketonuria
1. Bovine Ketosis. 2. Pregnant toxemia of ewes. 3. Downer cow syndrome. 4. Fatty Liver in cows. 5. Displacement of Abomasum. 6. Ruminal acidosis. 7. Azoturia of equine.

Milk fever
• It is an acute to peracute, afebrile, flaccid paralysis of mature dairy cows that occurs most commonly at or soon after parturition. • It is manifest by changes in mentation, generalized paresis, and circulatory collapse. • In ewes it occurs before or after parturition. • It is called pregnancy toxemia in mares.

• At or near the time of parturition, the onset of lactation results in the sudden loss of calcium into milk. • Serum calcium levels decline from a normal of 10-12 mg/dL to 2-7 mg/dL. • Commonly, serum magnesium is increased, serum phosphorus is decreased, and cows are hyperglycemic.

Blood Ca: 10 mg/ 100 ml Ca intake Dry period: 50 g/d Lactation: 100 g/d Ca Pool: 3 g Body reserve: Total: 6000 g Mobilizable:15-20 g/d

Each cow need 30 gm ca daily, at parturition •10 L colostr. need 23 gm Ca (9 folds serum Ca).

• Drop of Ionized Ca in blood and tissues beyond the capability of PTH to withstand such drop. • PTH increased to mobilize ca from bone to the blood to withstand such dramatic needs. • In 5-20 % of cows PTH unable to mobilize sufficient ca leading to its sharp drop in blood. • Role of anaerobes in udder. • Role of adrenal gland. • Brain ischemia and anemia may have a role after parturition

Serum Ca level after parturition
10 9 8 7 6 5 4 3 2
-8 -6 -4 -2 0 2 4 6 8 10

Seru m Ca (m g/dl)

Normal Hypocalcemia Milk Fever

Days from Parturition

Occurrence of the disease
• Mainly in adult high lactating cows. • Gersy cows is the more affected ones. • Complete milking just after parturition may help occurrence of the dis. • It may occurs at late days of pregnancy or during parturition. • Most cases occurs just after parturition and extending to 10 days after. • 28 % of cases occurs afer the 1st week of parution extending to 2 Months after.

•Parturient paresis usually occurs within 72 hr of parturition. The disease may be seen in cows of any age but is most common in high-producing dairy cows >5 yr old. Incidence is higher in the Jersey breed.

% of cases 3 6 75 12 4

Time of occurrence relative to calving

Before calving After calving 1-25 h after calving 25-48 h after calving > 48 h after calving

Signs of Milk Fever
Three clinical stages could be recognized: 1- First stage: (Stage of anorexia, ataxia, & hind limb stiffness).
Ch. by excitation, violence, nervousness. Decreased movement, convulsions, reluctant to move, may be falling. Increased rate and strength of heart rate Body temp:37 to 38.5°C

Serum Ca: 5.5-7.5 mg/dl

2-Second stage (Stage of recumbency and Depression)

• Cow became calm, weak. • Lay down on sternum in a deep sleep, complete muscular relaxation. • Exhausted, dehydrated, dryness of nose and muzzle. • Mild hypothermia “35 to 37°C” , mydriasis Weak , rapid heart rate Ruminal atony and dry feces.

Serum Ca:3-6.5 mg/dl

3-The Third stage: (Stage of pariesis and comatose)

• Signs of circulatory failure. • Lateral recumbency with loss of consciousness. • Loss of muscle tone and paresis and inability to stand. • Weak rapid pulse and heart sound may be difficulty audible • Body temp: < 35 C • Serum ca: < 2.0 mg/dl

Milk fever in sheep
1. It is not common. 2. It occurs after parturition in ewes exposed for forceful exhaustion, long transport, deprivation of food and water. 3. Signs: Stilted and proppy gait, alert and struggling when approached, muscle tremors, staggers and Lay down, often with legs stretched out behind the body 4. It is misdiagnosed as pregnancy toxemia
A ewe showing signs of milk fever.

Problems that closely related to milk fever
1. Dystocia due to muscular weakness that prevents proper labor. 2. Retained placentas and Uterine prolapse. 3. Mastitis and Metritis 4. Decreased reproductive performance. 5. Bloat due to rumen atony. 6. Abomasal displacements and Ketosis. 7. Greater risk of other infectious disease. 8. Decreased milk production. 9. Reduced total productive life in the herd.

Diagnosis of Milk fever
•Case history:
Just after parturit. in a high lactat. cows.

•Signs: Recumbency, paresis, coma,
hypothermia •Lab.: Serum Ca < 7 mg/dl
• serum Mg is increased, serum P is decreased, and cows are hyperglycemic.

•Rapid response for IV Calcium

Differential diagnoses
It includes:

1. Acute coliform Toxic mastitis. 2. Toxic metritis. 3. Traumatic injury (eg, stifle injury, coxofemoral luxation, fractured pelvis, spinal compression), 4. Calving paralysis syndrome (damage to the L6 lumbar roots of sciatic and obturator nerves), or compartment syndrome. • Some of these diseases, in addition to aspiration pneumonia, may also occur concurrently with parturient paresis or as complications.

Treatment of Milk fever
Restoring normal serum calcium levels:
– Ca gluconate 20-25 % (400-800 ml IV and repeated after 6 hrs. I.V./I.M & /S.C – Ca carbonate or Ca chloride orally (2-4 gm daily for 3-5 days. – Ca, P, Mg preparation may be injected to maintain their equilibrium. – Calcium propionate (0.5 kg dissolved in 8-16 L water administered as a drench. – Calcium is cardiotoxic; therefore, it should be given slowly (10-20 min) with cardiac auscultation – Cases which not treated with sufficient doses may relapse again with complications ending in downer cows.

Signs of response to Ca-therapy
• Tremors are seen as neuromuscular function returns, • Stronger heart sounds and decreased heart rate • Return of smooth muscle function results in eructation, defecation, and urination once the cow rises • Approximately 75% of cows stand within 2 hr of treatment. • Animals not responding by 4-8 hr should be reevaluated and re-treated if necessary. • Of cows that respond initially, 25-30% relapse within 2448 hr and require additional therapy. • Incomplete milking has been advised to reduce the incidence of relapse.

Intravenous calcium therapy

I/V & S/C calcium therapy

Sucutaneous injection of ca gluconate

Prevention of Milk fever
1. Feeding low-calcium diets during the dry period to stimulate intestinal absorption and enhance skeletal resorption prior to the sudden onset of lactation. Total calcium requirement for a 500 kg dry cow is approx. 40 gm/day. Try not to feed in excess of 0.40 % Ca (% of ration DM) to dry cows 2. Delayed or incomplete milking after calving, which maintains pressure within the udder and decreases milk production. 3. Prophylactic treatment of susceptible cows at calving may help reduce parturient paresis. Cows are administered either SC calcium on the day of calving or oral calcium gels at calving and 12 hr later

Prevention of Milk fever
4. The DCAD approach :Use the dietary cationanion difference (DCAD), which decreases the blood pH of cows prior and just afetr calving. - Adding excess anions to the diet is believed to enhance calcium resorption from bone and absorption from the GI tract - Reducing the K content of the diet: by feeding corn silage as a major portion of the dry cow’s diet to decrease bl. pH 5. Administration of vitamin D3 and its metabolites is effective in preventing parturient paresis (20-30 million U, sid), given in the feed for 5-7 days before parturition, reduces the incidence

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