Parturient Paresis Flashcards by Madeleine Gauthier

what is a transition cow?

when a cow is in late gestation and is preparing to calve and “transitions” from being a dry cow to a fresh cow

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what are the 4 components of parturient paresis? which one is most important?

hypocalcemia
hypomagnesemia
Hypophosphatemia
Hypokalemia

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tell me the other names of parturient paresis

Clinical or subclinical hypocalcemia
milk fever

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tell me about normal calcium mobilization during calving/lactation.
how much Ca in colostrum per day?
when is [Ca] lowest in blood?

pre calving –> Ca leaves blood and is sequestered w/i mammary gland during colostrum formation

20-30g Ca per day

day 1 after calving

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what does hypocalcemia cause?

paresis
increase risk of metritis
increase risk for fatty liver development
increase risk of mastitis
reduce fertility
increase risk of DA
higher blood NEFA

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Why does hypocalcemia cause paresis?

Ca is required for muscle contractions, so low Ca = impaired muscle contractions

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why does hypocalcemia increase risk of metritis?

Hypocalcemia impairs immune cell response, including neutrophil function

lower Ca in mitochondria decreases its use as a secondary messenger and decreases release of cytokines and impaired neutrophil function

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Why does hypocalcemia increase risk for fatty liver development?

due to increased NEFAs bc body fat is being mobilized more

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why does hypocalcemia increase risk of mastitis?

Ca required for muscle contraction, so hypocalcemia reduces contraction of teat sphincter –> lil gremlins can get up in there more easily

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why does hypocalcemia reduce fertility?

because of the other diseases it causes/increases risk for

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why does hypocalcemia increase a risk for DA?

Ca required for muscle contraction, so it reduces rumen and abomasal contraction and reduces rumen and abomasum motiliy.

it also mobilizes more body fat causing increase NEFAs

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why does hypocalcemia increase NEFAs?

mobilizes more body fat

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tell me the relationship b/t Ca, parathyroid gland, PTH, and Vitamin D?

low Ca –> parathyroid detects –> PTH released –> renal reabsorption of Ca from proximal renal tubules & resorption of bone collagen to release Ca

Vit D absorbed in diet or synthesized by skin –> absorption of Ca from small intestine & resorption of bone collagen to release Ca

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what are the risk factors for parturient paresis?

fresh dairy cow >3 lactation
Jerseys & Guernseys
Hypomagnesemia

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why are fresh dairy cows >3 lactations more at risk for parturient paresis?

they have less osteoclasts, so they are less able to utilize the Ca from their bones

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why are Jerseys and Guernseys more at risk for parturient paresis?

they have fewer receptors for Vit D

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Why is hypomagnesemia a risk factor for parturient paresis?

interferes with PTH action on tissues

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what are the cut offs for clinical and subclinical hypocalcemia?

clinical: <5 mg/dL or < 1.25 mmol
subclinical: <8-8.4 mg/dL or <2.1 mmol

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is subclinical hypocalcemia more likely to occur in primiparous or multiparous cows?

multiparous (50% of them get subclinical hypocalcemia, 25% of primiparous)

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describe stage 1 of clinical hypocalcemia

standing and ambulatory
hypersensitivity and excitability
mildly ataxic, tremors

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describe stage 2 of clinical hypocalcemia

cannot stand, sternal recumency w/ s-shaped curve to neck, obtunded

cold body temp and extremities

decrease PLR & dilated pupils

tachycardia, weak pulse, anorectic

bloat

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describe stage 3 of clinical hypocalcemia

lose consciousness
unable to maintain sternal recumbency
extreme muscle flaccidity
severe bloat

how can you diagnose hypocalcemia?

total calcium (calcium split trehalase assay)
ionized calcium (ISTAT, HORIBA)

bench top in-clinic analyzers

compare and contrast using total Ca vs ionized Ca to diagnose hypocalcemia

tCa: less expensive, less affected by sampling conditions

iCa: more accurate measurement of available Ca, few thresholds est., affected by hydration and albumin status

how do you treat a cow with stage 1 hypocalcemia?

**oral Ca bolus** 1st bolus immediately after calving 2nd bolus 12-24 h later

tell me about postpartum Ca supplementation, like who to give it to, how to, etc

1 oral tx = 4g Ca IV tx of standing multiparous cows only! (not for blanket tx, not for primiparous cows) provides oral Ca absorption for immediate use to cover time b/t when cows can become normocalcemic after calving

how do you treat a cow with stage 2 or 3 hypocalcemia?

500 mL 23% Ca gluconate IV - 1g/45kg BW (0.022223g/kg) - 1 bottle = 10g Ca/500mL - give slowly! (10-20 mins) - do not use milk vein oral Ca bolus

when should you NOT give calcium gluconate to tx hypocalcemia?

when there is subclinical hypocalcemia or those w/o C/S

when should you NOT give oral Ca bolus to tx hypocalcemia?

when stage 2 or 3 cow does not response to IV Ca

what is hypocalcemic relapse, why does it happen, and how to prevent it?

12-24 h after IV Ca to subclinical hypocalcemic cows immediately postpartum rapid increase in [Ca] removes stimulation of PTH secretion and slows homeostatic response oral Ca bolus

why should you give IV Ca slowly?

fatal cardiac arrhythmia if given too fast

using Ca borogluconate sub q: 1. what does it require? 2. what is the pro? 3. how many mL per site? 4. what is the con?

1. adequate perfusion and hydration to absorb 2. blood Ca increased for at least 12 h after SQ admin 3. no more than 75mL per site 4. little effect on minimizing risk of subsequent dz development, milk prod., repro performance

DO NOT ADMIN CA PRODUCT WITH ______ UNDER THE SKIN!

glucose

how can you prevent hypocalcemia?

- DCAD diet - dietary Ca manipulation - Vit D supplementation

What is DCAD diet? how does it help prevent hypocalcemia? what is the recommended "dosage"?

dietary cation-anion difference diets high in alkalinity leads to clinical hypocalcemia, so DCAD creates metabolic acidosis by lowering alkalinizing cations (Na, K, Ca, Mg) and increasing anions (S, Cl, P) add anionic salts to diet to balance and create more acidic state 100-200 mEq/kg [ (Na + K) - (S + Cl) mEq/kg ]

how can you monitor cows on DCAD?

test "close up" cows' urine pH pH = 6.0-6.5 holsteins pH = 5.5-6.0 jerseys

how can you manipulate dietary Ca to prevent hypocalcemia? why does this work?

Low Ca diet prior to parturition High Ca diet after parturition Feed Ca binder in dry period Low Ca diet puts cow in negative Ca balance --> stimulating PTH secretion --> stimulate osteoclastic bone resorption & renal production feed less than 20g Ca per cow per day

tell me pros and cons of supplementing Vit D to prevent hypocalcemia what is the dose of Vit D supplementation and when?

30,000-50,000 IU added to prepartum diet pros: when fed with DCAD decreases subclinical hypocalcemia, doesn't affect postpartum Ca levels cons: injectable causes negative feedback loop that leads to down reg of Ca, doesn't affect postpartum Ca levels

why is phosphorus important during pregnancy?

required for fetal skeletal development in last trimester of pregnancy

what are the risk factors for hypophosphatemia?

hypocalcemia PTH increases renal and salivary excretion of P lost through colostrum and milk in fresh cows

what are the C/S of hypophosphatemia?

typical downer cow not as responsive to Ca plasma P <1 mg/dl

how do you tx hypophosphatemia?

6-23g monosodium phosphate dissolved in 1L of saline IV oral supplementation 50-500g monosodium phosphate Cal Mag Plus/Phos

what are the C/S of hypokalemia?

flaccid paralysis, recumbency, s-shaped neck, **cardiac arrhythmias (ventricular tachycardia)** serum K < 2.5 mmol/L

what are the causes of hypokalemia?

- parturient paresis syndrome - chronic anorexia or GI stasis - repeated admin of isoflupredone acetate

how do you tx hypokalemia?

nursing care for downer cows oral KCl 50g/100kg BW

Mg is absorbed from _____.

rumen

what causes hypomagnesemia?

- beef cows on lush pastures high in K & N, low in Mg & Na - inadequate Mg in forages (cool season grasses, green cereal crops) - bad weather

what are the risk factors for hypomagnesemia?

high producing cows mid-lactation dairy cows w/ milk fever C/S

what are the C/S of hypomagnesemia?

- Mg > 1.1 mg/dL - twitching of face - tetanic spasms of muscles - staggering - clonic convulsions - chomping of jaws/frothy salivation - paddling - tachycardia >120 - tachypnea >60 - high RT > 40

how do you dx hypomagnesemia?

serum??? PM: vitreous humor Mg >1mg/dL up to 48h after death, CSF Mg remains low up to 12 h after death

why should you not use blood to test for hypomagnesemia post mortem?

blood samples shortly after death may be normal Mg due to rupture of muscles and release of Mg

how to you tx hypomagnesemia?

1.5-2.25g Mg IV (milk fever supplements 1.5-4g) oral Mg salts 100g Mg oxide drench 200-400mL 50% Mg sulfate solution enema

what is important to know about using Mg IV to tx hypomagnesemia?

can take up to 1 h to recover and stand (CSF Mg to return to normal) many will relapse in 12 h

what are the top down cow ddx?

- parturient paresis - toxic mastitis - toxic metritis - MSK injury (stifle injury, pelvic fx) - coxofemoral luxation - calving paralysis