جامعة أسيوط

كلية الطب البيطري

Metabolic Diseases: Milk fever

Prepared byDr. Ali H. Sadiek

Prof. of Internal Veterinary Medicine and Clinical Laboratory Diagnosis

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

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

Metabolic disordersMetabolic 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 thantreatment

Causes of metabolic DiseasesCauses 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

3-Stress of milk

production

2-Decreased feed intake

Metabolic Disorders

Examples of Examples of MetabMetab. diseases. diseases

1. Milk Fever.2. Hypomagnesaemia.3. Downer Cow Syndrome.4. Post Parturient Hemoglobinurea.5. Azoturia6. Metritis, udder edema, retained

placenta.7. Ketosis.8. Pregnancy toxemia of ewes.9. Fat Cow Syndrome.

Diseases characterized by recumbency.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 What are the disease associtedassocitedwith with ketonuriaketonuria

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 feverMilk fever• It is an acute to peracute, afebrile, flaccid

paralysis of mature dairy cows thatoccurs 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.

EtiologyEtiology• 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 Pool: 3 g

Body reserve:Total: 6000 gMobilizable:15-20 g/d

•10 L colostr. need 23 gm Ca (9 folds serum Ca).

Ca intakeDry period: 50 g/dLactation: 100 g/d

Each cow need 30 gm ca daily, at parturition

CausesCauses• 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 parturitionSerum Ca level after parturition

2345678910

-8 -6 -4 -2 0 2 4 6 8 10

Days from Parturition

Seru

m C

a (m

g/dl

)

NormalHypocalcemiaMilk Fever

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

Time of occurrence relative to calving

% of cases

Before calving 3 After calving 6

1-25 h after calving 75 25-48 h after calving 12 > 48 h after calving 4

Signs of Milk FeverSigns of Milk Fever

Ch. by excitation, violence, nervousness.Decreased movement, convulsions, reluctant to move, may be falling.Increased rate and strength of heart rateBody temp:37 to 38.5°CSerum Ca: 5.5-7.5 mg/dl

Three clinical stages could be recognized:1- First stage: (Stage of anorexia, ataxia, & hind limb stiffness).

22--Second stage (Stage of Second stage (Stage of recumbencyrecumbency and Depression) 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” , mydriasisWeak , rapid heart rateRuminal atony and dry feces.Serum Ca:3-6.5 mg/dl

33--The Third stage: (Stage of The Third stage: (Stage of pariesispariesis and comatose)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 sheepMilk fever in sheep1. 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 proppygait, 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 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 Metritis4. 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 feverDiagnosis 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 therapy

Differential diagnosesDifferential diagnosesIt 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 obturatornerves), 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 feverTreatment 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 CaSigns of response to Ca--therapytherapy

• 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 24-

48 hr and require additional therapy.• Incomplete milking has been advised to reduce the

incidence of relapse.

Intravenous calcium therapyIntravenous calcium therapy

I/V & S/C calcium therapyI/V & S/C calcium therapy

Sucutaneous injection of ca gluconate

Prevention of Milk feverPrevention of Milk fever1. 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 feverPrevention of Milk fever4. The DCAD approach :Use the dietary cation-

anion 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

Thank You