hyperketonemia treatment at the individual cow and herd level
TRANSCRIPT
Overview ▪ Physiology
▪ BHB cut-points
▪ Individual animal treatment
▪ Herd-level testing and treatment
Negative Energy Balance (NEB)
• Dairy cows enter a state of NEB during the transition period
• Increased energy demand in early lactation
Energy (NEL) Requirements2 days before versus 2 days after
calving 1,600-lb Cow 1,250-lb Heifer
Function Pre Post Pre Post
Maintenance 11.2 10.1 9.3 8.5Pregnancy 3.3 --- 2.8 ---Growth --- --- 1.9 1.7Milk production --- 18.7 ---
14.9
Total (Mcal) 14.5 28.8 14.0 25.1Calculated from NRC (2001). Assumes milk production of 55 lb/d for cow
and 44 lb/d for heifer, each containing 4% fat.Courtesy of J. K. Drackley
Dry Matter Intake
kg
Ospina et al., 2013, VCNA
Ketosis▪ Ketosis is the elevation of ketone bodies:▪ Acetone▪ Acetoacetate▪ β-hydroxybutyrate (BHB)
▪ Clinical manifestation:▪ Decrease in appetite▪ Weight loss▪ Decrease in milk production
Subclinical disease>80% of cases
Nomenclature ▪ Ketosis
▪ Subclinical ketosis▪ Blood BHB 1.2 – 2.9 mmol/L
▪ Clinical ketosis▪ Blood BHB ≥ 3.0 mmol/L
▪ Hyperketonemia (HYK)▪ Blood BHB ≥ 1.2 mmol/L
Types of Hyperketonemia▪ Type I and Type II: human-based distinction
▪ Inability to adapt to early lactation NEB▪ Early in lactation, 3-21 DIM▪ Excessive NEB just before or after calving
▪ Energy intake limited▪ 3 to 6 weeks in milk▪ Lack of energy substrates for level of milk
production
Periparturient Blood BHB Concentration
-21 -18 -15 -12 -9 -6 -3 0 3 6 9 12 15 18 210.0
0.2
0.4
0.6
0.8
1.0
1.2
Day relative to calving
BHB,
mm
oL/L
Adapted from McCarthy et al., 2015, JDS
How much is “normal”?▪ Incidence:
▪ Follow a group of animal through time▪ Number of new cases/number of animals
tested▪ 25% - 85%, average ~ 45%
▪ Prevalence:▪ Snapshot in time▪ Number of new and existing cases/number of
animals tested▪ 0% - 70%, average ~ 20%
Incidence ~2-2.2 x prevalence
Additional Info on Blood BHB Testing
▪ Time of sampling▪ Not important in ad lib TMR fed herds ▪ Otherwise highest ~ 4 to 5 hours after
feeding
▪ Location of sampling▪ Tail vessels = jugular vein▪ Milk vein ~ 0.3 mmol/L lower
Blood BHB Cut-Points▪ ≥ 1.2 to 1.4 mmol/L
▪ Based on health and production outcomes
▪ ≥ 3.0 mmol/L = more severe hyperketonemia
▪ Remember:▪ If you your cut-point, sensitivity and
specificity▪ You correctly identify more ketotic cows but
treat more non-ketotic cows
Applications of Hyperketonemia Testing
▪ Identifying individual hyperketonemic cows▪ Cow-side test for treatment decisions▪ How intensive should we be?
▪ Identifying herds with hyperketonemia problems▪ Herd-level testing for management decisions
Individual Consequences of HYK
▪ Higher risk for adverse health events▪ Metritis▪ Displaced abomasum▪ Mastitis▪ Culling
▪ Decrease milk yield in early lactation
▪ Poorer reproduction
When do we test?
3 4 5 6 7 8 9 10 11 12 13 14 15 160
5
10
15
20
25
30
35
Days in Milk
Bloo
d BH
B ≥
1.2
mm
ol/L
(%) Prevalence
Adapted from McArt et al., 2012, JDS
▪ Hyperketonemia▪ BHB ≥ 1.2 mmol/L
▪ Severe hyperketonemia▪ BHB ≥ 3.0 mmol/L
Hyperketonemia Treatment
HYK Treatment (BHB ≥1.2 mmol/L)
▪ Propylene glycol
▪ Vitamin B12
▪ Glucocorticoids - ?
Gordon et al., 2013, VCNA
Propylene Glycol▪ Two modes of action:
▪ Increased supply of propionate = glucogenic
▪ Reduced insulin sensitivity = decreased glucose demand by peripheral tissues
▪ Oral drenching preferred over mixing in feed
▪ No benefit with additional glycerol
Propylene Glycol▪ Speeds resolution of ketosis▪ Prevents progression to severe ketosis
▪ Increases early lactation milk yield
▪ Reduces risk of DA and culling
▪ 300 mL, orally once a day for 5 days
~$1/dose
Administration of Propylene Glycol
▪ The stuff tastes horrible …
Dosing gunHomemade
pump
20 oz. soda bottle & speculum
Vitamin B12 ▪ Synthesized in rumen
▪ Methylmalonyl-CoA mutase▪ Coverts propionate to
succinyl-CoA▪ Vitamin B12 dependent
▪ Some supporting evidence▪ 1 dose 25 mL Catosal (0.05
mg B12 and 100 mg butaphosphan/mL)
PropionateVitamin
B12
Glucocorticoids
▪ Examples:▪ Dexamethasone (Azium)▪ Isoflupredone (Predef)
▪ Lack of efficacy▪ Possible adverse side effects
HYK Treatment (BHB ≥3.0 mmol/L)
▪ Dextrose▪ ½ - 1 bottle IV▪ No randomized, controlled trials ever done
on efficacy of dextrose!
▪ Propylene glycol▪ Vitamin B12
▪ Corticosteroids - ?▪ Resent study shows 20mg dexamethasone
may be detrimental to cows with BHB >2.0 mmol/L
Gordon et al., 2013, VCNA
▪ BHB ≥1.2 mmol/L▪ Excellent
▪ BHB ≥3.0 mmol/L▪ Fair to good▪ Monitor for subsequent
diseases
▪ Severe fatty liver▪ Poor – intensive therapy
and $$$
Prognosis ofHyperketonemia
Applications of Hyperketonemia Testing
▪ Identifying individual hyperketonemic cows▪ Cow-side test for treatment decisions▪ How intensive should we be?
▪ Identifying herds with hyperketonemia problems▪ Herd-level testing for management decisions
Incidence vs. Prevalence Testing
▪ Incidence = new cases▪ Difficult to measure
▪ Prevalence = new and existing cases▪ Easier to measure
▪ First take a prevalence sample▪ Sample at least 20 cows between 3 to 14
DIM▪ A larger sample size will result in a more
precise estimate
Sample Size▪ The more cows you test, the more precise the prevalence estimate.
▪ 35 animals between 3-14 DIM:▪ Bleed 14 cows, 3 ketotic
▪ 75% confident the prevalence is between 11-31%
▪ Bleed 25 cows, 5 ketotic ▪ 75% confident the prevalence is between 15-
25%▪ Bleed 33 cows, 7 ketotic
▪ 95% confident the prevalence is between 15-25%
Test Accuracy▪ Ketone tests with poor sensitivity falsely decrease prevalence estimate.
▪ Use cow-side blood BHB meters!
Which cows to sample?▪ All cows in DIM range are eligible▪ Most really sick cows will not be hyperketonemic
▪ Random sample▪ Systematic sample – every kth animal
≤ 15%
(e.g. ≤ 3/20, + cows)
Estimate Herd Level Prevalence:Sample ~20 cows that are 3 to 14 DIM Positive cows have BHB ≥ 1.2 mmol/L
> 15% to 40%
(e.g. 4 to 8/20, + cows)
≥ 40%
(e.g. ≥ 9/20, + cows)
≤ 15%
Monitor herd level prevalence monthly.
Sample ~20 cows once monthly. More frequently when there are changes,
e.g. diet formulation.
Monitor
≥ 40% Give 300 mL of propylene
glycol once daily for 5 days starting at 3 DIM to
all cows.
Recheck prevalence in one month.
Treat all cows
Monitoring and Action Recommendations
Ospina et al., 2013, VCNA
>15% to 40%Monitor incidence of SCK.
Sample cows 3 to 9 DIM twice a week, e.g.,
Tuesday and Friday.
Test and treat
Relevance?
Adapted from Ospina et al., 2010, JDS
Postpartum BHBA
40% of herds above herd alarm level
Summary ▪ High prevalence of HYK
▪ Use an accurate test
▪ Treatment is cost-effective
▪ Regular herd monitoring is important
