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ASPIRATION PNEUMONIA IN A HOLSTEIN COW FOLLOWING A LIQUID CALCIUM DRENCH Brett Gamble DVM (2012)
Outline Case Description Aspiration Pneumonia Oral calcium Alternatives to traditional calcium drenches Take-home messages
History 7 year old Holstein cow, sudden death the day previous Calved mid-day in June with twins Mild signs of milk fever received calcium IV, and drenched with liquid calcium (Calcium chloride and proprionate) owners reported no significant struggling during drenching
History Started deteriorating a few hours later laboured breathing, “puffing” Owners administered 2 nd bottle calcium IV Cow died 10 minutes later
Differentials & Diagnosis Differentials: Aspiration pneumonia Cardiotoxicity from 2 nd bottle of calcium Diagnosis Acute aspiration pneumonia from calcium drench causing diffuse bronchointerstitial pneumonia
Aspiration Pneumonia Can be caused by: Improper drenching Improper stomach tube placement Aspiration of ruminal contents during anesthesia or severe stage III milk fever Rebhun’s Diseases of Dairy Cattle: The cow’s muzzle should be held so that the head from pole to muzzle is horizontal to the ground or slightly higher. Holding the head too high or twisting the head to the side interferes with swallowing and risks inhalation of irritating chemicals.
Aspiration Pneumonia Disease course depends on: volume aspirated nature of contents aspirated Prognosis is guarded in all cases
Oral Calcium Preventative effects when given around calving when 3 -4 doses of calcium chloride or calcium proprionate are given prophylactically 12 -24 hours before calving to 24 hours after Reduced relapses when oral calcium is given to clinical cases following IV treatment Most preparations last around 6 hours Effects on subclinical hypocalcemia?
Calcium Chloride In most formulations absorbed quickly low volume required acidifying effect enhances calcium mobilization Caustic necrosis of upper respiratory tract and gastrointestinal tract Pictures Complements of Dr. Gregory Queen
Calcium Proprionate Less irritating Gluconeogenic Slower absorption, slightly lower efficacy Require higher volumes
Paste versus Liquid Literature commonly states paste is safer no actual studies Liquid is more likely to stimulate esophageal groove and by-pass rumen Pastes and boluses have proven to be effective Paste still has risks calcium chloride very caustic
Alternatives to Calcium Drenches
Alternatives- Bovikalc Calcium chloride and calcium sulfate fat encapsulated boluses Supports calcium levels for 12 hours No risk of aspiration Prevent subclinical hypocalcemia when given to targeted groups of cows 6. 8 lb more milk at first test when administered to high producing and lame cows at calving Not available in Canada
Alternatives- Subcutaneous Calcium borogluconate Only supports calcium levels for 4 -5 hours Can be irritating (even without dextrose) Ideally should limit to 75 ml/site
Alternatives- Subcutaneous Calcium Theracalcium Calcium gluconate & calcium glucoheptonate Smaller volumes required Glucoheptonate must be metabolized by livershould provide prolonged calcium support Only labeled for IV treatment of milk fever in Canada
Take-home Messages Liquids likely have a higher risk of aspiration than paste Review proper drenching/stomach tube placement techniques Never administer oral calcium if you suspect inhibited swallowing reflex Subcutaneous calcium is an alternative Prevention is BEST
References Braun U, et al. Aspirationspneumonie bei 40 Kühen nach peroraler Behandlung. Schweizer Archiv für Tierheilkunde 2007; 149: 363 -365. Goff JP. Treatment of calcium, phosphorus, and magnesium balance disorders. Vet Clinics Food Animal Practice 1999; 25: 619 -635. Goff JP, Horst RL. Oral administration of calcium salts for treatment of hypocalcemia in cattle. J Dairy Sci 1993; 76: 101 -108. Kümper H. Aspirationspneumonie und andere Komplikatio- nen infolge oraler Applikation von Kalziumschloridgel bei der Milchkuh. Prakt Tierarzt Coll Veter XXIII 1993; 74: 19– 23. Oetzel GR. Managing high risk fresh cows. AABP 2012 Conference Proceedings. Oetzel GR, Miller BE. Effect of Oral Calcium Bolus Supplementation on Early Lactation Health and Milk Yield in Commercial Dairy Herds. J Dairy Sci; Accepted 2012, In Press. Sampson JD, Spain JN, Jones C, and Carstensen L. Effects of calcium chloride and calcium sulfate in an oral bolus given as a supplement to postpartum dairy cows. Vet Ther 2009; 10: 131 -139. Smith B. Large Animal Internal Medicine, 4 th edition. Mosby Elsevier, 2009: 659. Thilsing-Hansen T, Jørgensen RJ, and Østergaard S. Milk fever control principles: a review. Acta Vet Scand 2002; 43: 1 -19. Wentink GH, van den Ingh TSGAM. Oral administration of calcium chloride-containing products: testing for deleterious side effects. Vet Quart 1992; 14: 76 -80.
Thanks! Oxford Bovine Veterinary Services OABP and Pfizer Dr. Garrett Oetzel Dr. Gregory Queen