Changes

Also known as: '''''Parturient hypocalcaemia — Milk Fever — Puerperal tetany — Lactation tetany — Periparturient hypocalcaemia — Eclampsia'''''

Also known as: '''''Parturient Hypocalcaemia — Milk Fever — Puerperal Tetany — Lactation Tetany — Periparturient Hypocalcaemia — Eclampsia'''''

==Introduction==

==Introduction==

It is most common in '''high-producing dairy cows over the age of 5''', and also more common in '''Channel Island breeds'''.

It is most common in '''high-producing dairy cows over the age of 5''', and also more common in '''Channel Island breeds'''.

The disease can contribute to '''dystocia, uterine prolapse, retained fetal membranes, metritis, abomasal displacement, and mastitis'''.

The disease can contribute to '''[[Dystocia - Cattle|dystocia]], [[Uterine Prolapse|uterine prolapse]], retained fetal membranes, [[metritis]], [[Abomasal Displacement|abomasal displacement]], and [[:Category:Mastitis|mastitis]]'''.

===Clinical Signs===

===Clinical Signs===

===Treatment===

===Treatment===

Treatment involves restoring serum calcium levels back to normal as soon as possible, to avoid complications such as nerve and muscle damage.

Treatment involves restoring serum calcium levels back to normal as soon as possible, to avoid complications such as nerve and muscle damage. '''Calcium borogluconate''' is given intravenously (i/v), and sometimes also '''suncutaneous (s/c)''' to provide a more sustained release. Many solutions also contain '''magnesium and phosphorus''', which can sometimes be helpful and is not contraindicated. Calcium solutions should be administered slowly over 10-20 minutes and the heart auscultated for [[:Category:Arrhythmia|arrhythmias]].

 

'''Calcium borogluconate''' is given intravenously, and sometimes also '''s/c''' to provide a more sustained release.

 

Many solutions also contain '''magnesium and phosphorus''', which can sometimes be helpful and is not contraindicated.

 

Calcium solutions should be administered slowly over 10-20 minutes and the heart ausculted for arrhythmias.

The animal will respond quickly to calcium supplementation, and '''eructation, defecation and urination''' should occur once the cow rises.

The animal will respond quickly to calcium supplementation, and '''eructation, defecation and urination''' should occur once the cow rises.

===Prevention===

===Prevention===

Prevention of hypocalcaemia is implemented during the dry period.

Prevention of hypocalcaemia is implemented during the dry period. Dry cows '''should not receive''' feeds high in calcium such as lush spring grass, kale, sugar beet pulp. However feeding low-calcium diets prior to parturition to stimulate intestinal absorption and enhance skeletal reabsorption is not as effective as once thought.

 

Dry cows '''should not receive''' feeds high in calcium such as lush spring grass, kale, sugar beet pulp.

 

However feeding low-calcium diets prior to parturition to stimulate intestinal absorption and enhance skeletal reabsorption is not as effective as once thought.

'''Prophylactic treatment''' of susceptible cows is possible, using s/c or oral calcium supplementation.

'''Prophylactic treatment''' of susceptible cows is possible, using s/c or oral calcium supplementation.

'''DCAD (dietary cation-anion difference) diets''' are the new method of prevention. They involve decreasing the blood pH of cows in the late pre-partum and early post-partum periods by providing an excess of anions over cations. This is believed to enhance calcium absorption from the intestine and reabsorption from bone.

'''DCAD (dietary cation-anion difference) diets''' are the new method of prevention. They involve decreasing the blood pH of cows in the late pre-partum and early post-partum periods by providing an excess of anions over cations. This is believed to enhance calcium absorption from the intestine and reabsorption from bone. This diet should only be fed to dry cows, and involves supplementation with anionic salts such as magnesium chloride, magnesium sulphate, calcium chloride, ammonium chloride. These salts are not palatable and reduce dry matter intake and can lead to a negative energy balance and '''problems''' such as [[Fatty Liver|fatty liver]]. DCAD diets must be '''used with great care''' and urine pH should be monitored closely.

 

This diet should only be fed to dry cows, and involves supplementation with anionic salts such as magnesium chloride, magnesium sulphate, calcium chloride, ammonium chloride.

 

These salts are not palatable and reduce dry matter intake and can lead to a negative energy balance and '''problems''' such as fatty liver.

 

DCAD diets must be '''used with great care''' and urine pH should be monitored closely.

'''Other methods of prevention''' include:

'''Other methods of prevention''' include:

===Eclampsia===

===Eclampsia===

This is a hypocalcaemic tetany associated with '''pregnancy in bitches and queens'''.

This is a hypocalcaemic tetany associated with '''pregnancy in bitches and queens'''. Calcium is lost to foetuses during gestation and through milk during lactation. '''Improper perinatal nutrition or the stress of lactation''' may result in limited calcium intake. Excessive supplementation of calcium during pregnancy causes downregulation of the calcium regulatory system and subsequent clinical hypocalcemia when calcium demand is high.

 

Calcium is lost to foetuses during gestation and through milk during lactation. '''Improper perinatal nutrition or the stress of lactation''' may result in limited calcium intake. Excessive supplementation of calcium during pregnancy causes downregulation of the calcium regulatory system and subsequent clinical hypocalcemia when calcium demand is high.

'''Tetany''' occurs as a result of spontaneous repetitive firing of motor nerve fibers. As a result of the loss of stabilizing membrane-bound calcium, nerve membranes become more permeable to ions and require a stimulus of lesser magnitude to depolarize. '''Hypoglycemia''' can occur concurrently.

'''Tetany''' occurs as a result of spontaneous repetitive firing of motor nerve fibers. As a result of the loss of stabilizing membrane-bound calcium, nerve membranes become more permeable to ions and require a stimulus of lesser magnitude to depolarize. '''Hypoglycemia''' can occur concurrently.

A '''slow intravenous infusion of 10% calcium gluconate''' is indicated immediately.

A '''slow intravenous infusion of 10% calcium gluconate''' is indicated immediately.

'''ECG monitoring''' can be put in place to check for arrhythmias. A portion of the calcium can also be diluted with saline and injected subcutaneously for prolonged release.

'''ECG monitoring''' can be put in place to check for [[:Category:Arrhythmia|arrhythmias]]. A portion of the calcium can also be diluted with saline and injected subcutaneously for prolonged release.

The response should be immediate following treatment. Diazepam may have to be used if the seizuring does not stop.

The response should be immediate following treatment. Diazepam may have to be used if the seizuring does not stop.

If the animal is not in a periparturient period, other causes of hypocalcaemia should be considered:

If the animal is not in a periparturient period, other causes of hypocalcaemia should be considered:

'''Renal failure'''

:[[:Category:Renal Failure|'''Renal failure''']]

 

:'''Primary [[hypoparathyroidism]]'''

'''Primary hypoparathyroidism'''

:'''Acute [[pancreatitis]]'''

 

:[[Ethylene Glycol Toxicity|'''Ethylene glycol toxicity''']]

'''Acute pancreatitis'''

:'''Iatrogenic''': following parathyroid surgery, post-transfusion, phosphate enemas

 

:'''Severe malabsorption/starvation'''

'''Ethylene glycol toxicity'''

:'''Hypovitaminosis D'''

 

:'''[[Hypoalbuminaemia]]'''

'''Iatrogenic''': following parathyroid surgery, psot-transfusion, phosphate enemas

:'''Laboratory error'''

 

'''Severe malabsorption/starvation'''

 

'''Hypovitaminosis D'''

 

'''Hypoalbuminaemia'''

 

'''Laboratory error'''

====Clinial Signs====

====Clinial Signs====

'''Acute treatment''' involves slow intravenous injection of 10% calcium borogluconate. Concurrent monitoring for bradycardia and arrhythmias.

'''Acute treatment''' involves slow intravenous injection of 10% calcium borogluconate. Concurrent monitoring for bradycardia and arrhythmias.

'''Chronic treatment''' of hypocalcaemia involves treating the underlying cause.

'''Chronic treatment''' of hypocalcaemia involves treating the underlying cause. It can involve an '''oral vitamin D metabolite''' such as calcitriol, or an '''oral calcium supplement''' such as calcium carbonate. Calcium levels should be kept slightly low to normal.

 

It can involve an '''oral vitamin D metabolite''' such as calcitriol, or an '''oral calcium supplement''' such as calcium carbonate.

 

Calcium levels should be kept slightly low to normal.

For treatment of '''primary hypoparathyroidism''', vitamin D treatment has to be continued lifelong but oral calcium can usually be stopped.

For treatment of '''primary hypoparathyroidism''', vitamin D treatment has to be continued lifelong but oral calcium can usually be stopped.

Root, M. (2009) '''Clinical canine and feline reproduction: evidence-based answers''' ''John Wiley and Sons''

Root, M. (2009) '''Clinical canine and feline reproduction: evidence-based answers''' ''John Wiley and Sons''

[[Category:Parathyroid Glands - Pathology]]

[[Category:Parathyroid Glands - Pathology]]

[[Category:Vascular Fluid]]

[[Category:Vascular Fluid]]