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Food Animal Medicine > Neonatal Diarrhea > Flashcards

Neonatal Diarrhea Flashcards

1
Q

What agents produce diarrhea in neonatal ruminants?

A
  • E.coli (ETEC)
  • Rotavirus Serogroup A
  • Coronavirus Serotype 2
  • Cryptosporidium parum
  • Salmonella spp (serogroups B, C, D)
  • Clostridium perfringens A
  • Clostridium perfringens C
  • Eimeria spp
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2
Q

What is the MOA of E.coli in producing neonatal diarrhea?

A
  • STa hypersecretion crypts
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3
Q

How is E.coi diagnosed?

A
  • Age: 0-3 days
  • Test: K99 PCR of Feces
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4
Q

What is the MOA of Rotavirus Serogroup A in causing neonatal diarrhea?

A
  • Malabsorption (SI, vilous blunting)
  • Hypersecretion crypts by NSP4
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5
Q

How is Rotavirus Serogroup A diagnosed?

A
  • Age: 5-14 days
  • Test: RT-PCR on Feces
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6
Q

What is the MOC of Coronavirus Serotype 2 in producing neonatal diarrhea?

A
  • Malabsorption
  • Muco-hemorrhagic enterocolitis (SI & LI)
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7
Q

How is Coronavirus Serotype 2 diagnosed?

A
  • Age: 5-30 days (up to 5mo)
  • Test: RT-PCR on Feces
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8
Q

What is the MOA of Cryptosporidium parum in producing neonatal diarrhea?

A
  • Malabsorption (SI and LI) by villous atrophy
  • PG med hypersecretion in crypts
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9
Q

How is Cryptosporidium parum diagnosed?

A
  • Age: 7-30 days
  • Test: RT-PCR on feces
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10
Q

What is the MOA of Salmonella spp (serogroups B,C,D) in producing neonatal diarrhea?

A
  • Enteritis (Fibrinonecrotic ulcerative)
  • Endotoxemia
  • Pneumonia (S. dublin)
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11
Q

How is Salmonella spp diagnosed

A
  • Age: any
  • Test: Culture, PCR
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12
Q

What is the MOA of Clostridium perfringens A in causing neonatal diarrhea?

A
  • Abomasitis
  • Abomasal ulceration
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13
Q

How is Clostridium perfringens A diagnosed?

A
  • Age: 2-4 mo
  • Tests: Necropsy, PCR (alpha beta toxin)
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14
Q

What is the MOA of Clostridium perfringens C in causing neonatal diarrhea

A
  • Enteritis (hemorrhagic necrotic)
  • Enterotoxemia
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15
Q

How is Clostridium perfringens C diagnosed?

A
  • Age: < 10days
  • Test: Necropsy, PCR
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16
Q

What is the MOA of Eimeria spp in causing neonatal diarrhea?

A
  • Enteritis (SI & LI)
  • 95% infections subclinical
  • May become chronic
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17
Q

What other issues can Coronavirus Serotype 2 cause?

A
  • Respiratory disease in older calves
  • Lactose intolerance
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18
Q

What other issues can Cryptosporidium parum cause?

A
  • Zoonotic
  • Autoinfection
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19
Q

What other issues can Salmonella spp cause?

A
  • Systemic disease
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20
Q

What other issues can Clostridium perfringens A cause

A
  • Colic
  • Abdominal distention
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21
Q

What other issues can Clostridium perfringens C cause?

A
  • Colic
  • Tetany
  • Opisthotonos
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22
Q

How is Eimeria app diagnosed?

A
  • Age: >8days
  • Test: Fecal float (>5000 oocysts/g)
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23
Q

What is the source of Rotavirus Serogroup A?

A

Adult cows

24
Q

What is the source of Salmonella spp serogroups B,C,D

A

coostrum/milk

25
Q

What are the sources of Eimeria spp

A
  • Calves (3wks -6mo)
    • weaning = stress
26
Q

What is the pathophysiology of neonatal diarrhea?

A
  • Hyper-secretion (crypt) - Bacteria
    • Cl, Na, HCO3, K, H2O
  • Malabsorption - Viruses
    • Destruction of absorptive villous epithelial cells (decreased Na and water absorption)
    • Hyperplasia of crypt cells > secretion
    • Increased osmolarity and milk fermentation leading to bacterial overgrowth
    • Villi atrophy
  • Inflammation Salmonella, Clostridium, coccidia
    • Enteritis
    • Translocation of bacteria and endotoxins
27
Q

Why does metabolic acidosis occur in neonates with diarrhea?

A
  • Original theories:
    • Loss of bicarbonate via the intestines
    • Formation of L-lactate secondary to dehydration
  • Current:
    • D-lactate accumulation
      • primarily of GI origin - Rumen acidosis, Neonatal diarrhea
      • Age dependent
        • young calves with ETEC less academic than older calves with crypto or viral diarrhea
28
Q

Why does neonatal diarrhea present with paradoxical hyperkalemia?

A
  • Extracellular potassium concentration ~2% of total body potassium
  • Affected calves have negative potassium balance due to intestinal losses and decreased milk consumption
  • Depends on degree of dehydration and the cause of the metabolic acidosis, does not require the presence of acidemia
29
Q

Why does neonatal diarrhea present with Hyponatremia?

A
  • Loss of isotonic fluid through the GI tract is replaced by free water
  • Calves with compromised sodium absorption capacity due to severe pathologic changes or an inadequate level of agents that facilitate sodium cotransport
  • Hyponatremia results in a fluid shift from the extracellular space to the intracellular compartment and may result in neurologic disturbances, depression, disorientation, and convulsions
30
Q

What are the causes of Hypoglycemia in neonatal calves with diarrhea

A
  • Withdrawal from milk
  • septicemia
31
Q

What are the clinical effects of diarrhea?

A
  • Significant fluid & electrolyte losses
  • Cardiovascular collapse
  • Acidosis:
    • fecal loss of bicarbonate
    • Endogenous synthesis of L-lactate
    • GI bacterial fermentation and synthesis of D-lactate
  • Variable amounts of depression
32
Q

What are the risk factors for Neonatal Calf Diarrhea (NCD)

A
  • Dystocia
    • calves born from dystocia 2-4x more likely to get sick in first 45days of life
  • Dam parity
    • risk of diarrhea 3.9x ⇡ in calves born to heifers (1st parity)
  • Colostrum management
    • Failure transfer of passive immunity
    • Anti E. coli K99 antibodies in colostrum are low
  • Beef cow Management:
    • High stocking density in calving pasture
    • High pathogen load in environment
  • Intensive calf-rearing systems
    • 1x daily milk feeding
    • Damp bedding
    • Feeding mastitic milk
33
Q

How are NCD calves treated?

A
  • Correct dehydration
  • Correct metabolic acidosis
  • Correct electrolyte abnormalities
  • Provide adequate nutrition
34
Q

What is the most common cause of death in diarrheic calves?

A

Dehydration & metabolic acidosis

35
Q

How should fluids be administered in NCD cases?

A
  • Determined by:
    • Mentation-
      • alert = oral
      • Depressed = IV
    • Suckle reflex-
      • Strong = oral
      • Weak/absent = IV
36
Q

What fluids may be used in NCD cases?

A
  • Sodium bicarbonate
  • Polyionic crystalloid
  • Dextrose (5%)
37
Q

How is metabolic acidosis corrected?

A
  • mEq HCO3 needed = weight (kg) x base deficit (mEq/L) x 0.6
  • more consistent recovery if an alkalinizing agent is used
38
Q

How are electrolyte disturbances In NCD cases corrected?

A
  • Oral electrolyte solutions (OES)
    • only 60% absorbed in GI tract
  • Must satisfy 4 requirements:
    • Supply sufficient sodium to normalize extracellular fluid volume (ECF)
    • Provide agents that facilitate absorption of sodium and water from intestine (glucose, glycine, acetate, propionate, citrate
    • Provide an alkalinizing agent (acetate, propionate, bicarbonate)
      • >50 mmol/L and high SID ([Na+] + [K+]) - ([Cl-]) at least 60-80
    • Provide energy
39
Q

What are the results of neonatal calf diarrhea (NCD)?

A
  • Dehydration
  • Metabolic acidosis
  • Negative energy balance
  • Overgrowth of gram negative bacteria (E. coli)
40
Q

Why would calves die from NCD?

A
  • Acidemia
  • Septicemia
  • Hyperkalemia
  • Hypoglycemia
  • Hypothermia
41
Q

What are the advantages of OES?

A
  • Administration is easy
  • Catheterization (IV) not required
  • Correction of dehdration, and acidosis
  • Provision of nutrition support
42
Q

What are the requirements of an ideal OES

A
  • Adequate sodium concentration to replace deficit (90-130 mM/L
  • Contain agents to facilitate intestinal absorption of sodium and water (glycine, acetate, glucose)
  • Provide an alkalinizing agent (acetate, propionate, bicarbonate)
  • Provide sufficient energy
  • Facilitate healthy gastrointestinal microbiome
43
Q

What IV fluids are used for NCD?

A
  • Lactated Ringers (LRS)
    • Readily available
    • Corrects dehydration and electrolyte abnormalities
    • Weak alkalinizing ability. Requires hepatic metabolization which takes a long time
      • LRS considered poor alkalinizing agent for NDC
  • Isotonic sodium bicarbonate
    • No commercially available form, must be made (13g/L of baking soda or 155mEq/L bicarbonate)
    • Strong alkalinizing agent, does not require hepatic metabolization
    • Requires IV catheterization, restraint and monitoring
  • Hypertonic saline
    • Commercially available
    • Shifts fluid from GI tract into extracellular fluid space
    • Combined with OES results in rapid plasma volume expansion (corrects dehydration)
      • Increases:
        • Cardiac output
        • Mean arterial pressure
        • Glomerular filtration
    • IV catheter not required can be given off the needle
    • 4ml/kg given as rapid IV infusion
    • Does not correct academia
      • requires oral electrolyte with alkalinizing agent
  • Hypertonic sodium bicarbonate
    • Newer, not as cheap as hypertonic saline
    • Increases plasma volume and corrects acidosis
    • 5-10 ml/kg as an IV fluid bolus (over 5 min)
    • Should follow up with OES
44
Q

What factors are considered when selecting a fluid type for a neonate with diarrhea

A
  • Suckle strength
  • Standing/recumbent
  • Hydration status
45
Q

How is hydration status assessed in calves

A

Eyeball recession

1.6 x eyeball recession in mm = % dehydration

46
Q

When is just OES (oral electrolytes) used in neonates with diarrhea? (standing, suckle, dehydration)

A
  • Standing, Suckle Present, Minimal dehydration (<6%, eyeball recession ≤3mm)
  • OR
  • Standing, Suckle Absent, Minimal dehydration (<6%, eyeball recession ≤3mm)
47
Q

When is IV hypertonic saline and OES used for neonates with diarrhea (Standing, suckle, dehydration)

A
  • Standing, Suckle Absent, Dehydration ≥6%, eyeball recession >3mm
48
Q

When is IV Sodium Bicarbonate used in neonates with diarrhea

A
  • Calf Recumbent, Suckle Absent
  • Volume of fluids will be determined by hydration status, depression score, or laboratory data
49
Q

How is the Base deficit estimated in a neonate with diarrhea?

A
50
Q

How are losses restored and maintenance fluids calculated for IV fluids in a neonate with diarrhea?

A
51
Q

How is 1.3% Sodium bicarbonate made for IV?

A
  • 8.4% NaHCO3 solution (available commercially)
    • Add 156ml to 1L sterile water
      • Volume 1st solution (V1) x concentration 1st solution [C1] = V2x[C2]
      • (X)[8.4%] = (1000ml)[1.3%] ⇒ X = 156 ml
  • Laboratory Grade (USP) NaHCO3 powder
    • 156mEq/L = 13g powder/L
    • To 1L sterile water add 13g powder
    • To 1 gallon add 52g powder
52
Q

What common fluid therapy mistakes are made when treating NCD?

A
  • Diarrhea not ID early enough
  • Volume/duration of fluid therapy to low/short
  • Administering oral fluids when calf needs IV fluids
53
Q

How is nutritional support given to calves with NCD?

A
  • Milk/replacer should not be suspended 100%
    • smaller volumes (5-7% BW) at higher frequency (every 4-6hrs)
    • Provides energy
    • Intestinal healing
  • 2.5 - 5% dextrose solution within IV fluid therapy
54
Q

When should antibiotics be used for NCD?

A
  • There are increased coliform #s in the SI regardless of the diarrhea etiology
    • Leads to Bacteremia (~80% g(-) (E.coli)
  • Frequency of bacteremia is sufficiently high that treatment of severely ill calves should include antibiotics
55
Q

What antibiotics are ineffective at treating NCD?

A
  • Oral Antibiotic (penicillin, neomycin, ampicillin, tetracycline)
  • Increase Diarrhea
56
Q

What Antibiotics are effective for NCD?

A
  • Oral amoxicillin trihydrate 10mg/kg PO q12hr
    • Reduced mortality and duration of diarrhea
  • Parenteral antibiotics (ampicillin, ceftiofur)

Food Animal Medicine (43 decks)

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