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ketosis/pregancy toxemia by sue reith


Differentiating Hypocalcemia from Milk Fever,
Pregnancy Toxemia, Parturient Paresis and Ketosis

By Sue Reith

How can you tell early on that your goat has hypocalcemia?

Ask yourself: Have you been feeding your doe in the early months of pregnancy a regular, ample grain ration along with her hay? Especially, have you been feeding this grain ration along with grass hay instead of alfalfa? If so, watch for the following signs:

* The doe gradually or suddenly loses interest in her grain ration.
* After a short time she also loses interest in her hay ration, be it grass hay or alfalfa.
* She weakens fast. Acts depressed.
* Without intervention she goes down and won't get up.
* Body temperature is normal (102.3) when it first starts
* Body temperature is subnormal (below 102) later on in its progression
* Without quick and correct intervention she will die.

What steps can you take to correct this?

Before I continue, I want to point out that any dosages I mention are intended for full-sized dairy-type does, weighing ~120-150 lbs avg. If your doe is one of the smaller varieties you need to adjust recommended dose sizes accordingly. That having been said...

Immediately, with not a moment's delay, start her on Nutridrench or oral propylene glycol to provide her with the needed energy so that she will not become ketotic. Ketosis is a metabolic problem caused by the animal's living on its own body reserves because it has stopped eating food, and the result, if not corrected, will be coma and subsequent death.

I recommend giving the doe either the recommended dose of Nutridrench for her weight, or 60cc propylene glycol, 2x daily for 2 days to restore her, and 30cc daily thereafter until she is clearly eating properly again, to prevent/reverse ketosis.

Additionally, start her on calcium replacement therapy quickly. While calcium gluconate is the usually recommended calcium replacement, my preference is a product called CMPK, or a generic substitute thereof. This is because calcium gluconate contains only calcium, whereas the CMPK products contain magnesium, phosphorus, and potassium as well, all of which enhance the calcium and make it more readily available for the body to use. Logic tells us that calcium in combination with these other elements that make it work better will be able to correct the deficiency and restore the doe to health much more quickly than a product that contains calcium alone. Keep in mind that a single dose or only a few doses of this product will only fix her for the moment, but her babies will continue to grow and to drain her system of the needed calcium and phosphorus. You need to continue the doses daily until she freshens and is eating sufficient amounts of properly balanced nutrients to enable her to lactate properly.

I recommend that you give CMPK, 30cc (1oz) every 2 hours or so until she appears to be bright and alert and willing to eat once more. The reason for giving this specific amount every two hours, instead of giving a larger dose less often, is because calcium, necessary for muscle contractions, is essential for the heart to beat properly. To give a large dose all at once might, at the later stages of the treatment, actually be an overdose. This could cause the heart to beat too rapidly and create further difficulties to add to the ones the doe is already experiencing. This potential for overdose can be prevented by giving smaller amounts more often, as I have recommended. I always advise people to check the calcium's effect upon the doe by taking a moment to feel the heart rate of a normal doe. Compare her heart's number of beats per minute with those of your hypocalcemic doe. Initially, the hypocalcemic doe's heart rate will be considerably slower than that of the normal doe because she lacks the calcium to keep it beating at a normal rate. When your sick doe's heart rate is the same as, or a tiny bit faster than, your normal doe's heart rate, things are going well.

Then, give her a daily maintenance dose of ~ 30cc (1oz), increasing that amount accordingly if she starts to deteriorate, continuing until she freshens, at which point she will no longer need to provide calcium and other nutrients for the fast-growing fetuses within her.

BTW: When she resumes eating, forget the grain for a while. She will probably refuse it anyway. That should not cause you concern because her body is still trying to regulate her calcium-deficient condition. If she is not eager at first about eating hay (grass is OK if that's what you have, but alfalfa hay or alfalfa pellets would be really good now) you would be wise to bring her some of her favorite browse. I feed Salal up here in the Northwest, and the wild huckleberry, both of which stay green all winter. In your area there must be something yummy that, of course, is not toxic. If you don't know her favorite, give her a variety and let her choose.

Here is some insight gained from personal experience as well as working with others whose animals had hypocalcemia. The veterinarian, and perhaps others you ask for advice, will probably tell you that once a goat gets hypocalcemia (be prepared that they will probably call it milk fever or pregnancy toxemia), if the kids are not removed right away she will in all likelihood die. Please note that although they mean well, they may not have the practical experience to draw upon for dealing with this situation, and little is written about it in their resource material, so they may offer you a single dose, or 2 doses perhaps, of Calcium Gluconate or CMPK to fix her condition for that moment. Using my recommended regimen of continued calcium therapy throughout the pregnancy and until she is eating well after freshening, I have never experienced a case where the kids were lost or the mom died because they were not removed when she got hypocalcemia.

If possible, it would be better to use injectable CMPK instead of the oral form to treat your doe. My reason for this is: (a) I feel it is always risky to dose a seriously debilitated animal orally because of the potential for part of the fluids to end up in the lungs of the struggling animal, resulting in aspiration pneumonia, and (b) calcium is, in concentrated form, somewhat caustic, and it will often burn the tender membranes of your goat's throat. The problem with this recommendation is that in their infinite wisdom the powers that be have decreed that injectable CMPK, while relatively inexpensive (about $4/1000ml in the catalogs) should be a prescription item, available only under the guidance of a veterinarian. The danger with this is that in addition to an increased per-dose cost, many veterinarians, especially those that are not goat-oriented, will not understand about hypocalcemia, or why continued doses are necessary, and will generally prescribe and provide only a single dose or maybe two. This is tantamount to trying to stop the leaking dam from bursting by putting your finger in the hole.

An Important Note

There will be very serious consequences if you allow your very weak and debilitated doe to remain in a lying-down position for very long. Her legs will quickly lose their muscle tone, and they will soon be too weak to support the heavy weight of her body. At that point she will be unable to rise by herself. If she is allowed to remain 'down' for too long a period, her leg joints will begin to 'ankylose', or freeze permanently in the position they are in. This will be irreversible.

So, if the doe has been recumbent ('down') for 3 or more days, it is absolutely essential that she be gotten back up on her feet ASAP. This may require the creating of a makeshift 'sling', attached to a pulley that is fastened to an overhead beam in the barn. The sling should be raised up so that she can touch the ground comfortably with her feet and move around, and in 2 hours it should be lowered so she can rest for a while... The process should be repeated continuously, 2 hours up and 2 hours down, until she can once again support her body's weight with her own legs. This generally takes but a few days, though her pregnant condition may place an added burden upon her as she tries to get her strength back.

How does a pregnant goat get hypocalcemia? And how can it be prevented?

Actually, in a doe that's not lactating (which would mean having calcium drained from her system daily) extra calcium is not needed to support fetal growth for the first 3 months of gestation. At the 3-month stage the fetus is no bigger than a newborn baby kitten. It is at this point that the growth of the now completely formed fetus starts to take place rapidly, and it's an appropriate time to begin giving a small amount of alfalfa with the grass hay, increasing it gradually until at the time of freshening she is getting all alfalfa, which in my view should be continued for the length of time she remains in milk, tapering off as her milk production tapers off until she reaches the end of that lactation, at which time she would be getting all grass hay again.

At that same 3-month point when you start giving alfalfa, you should also start offering a very small amount of grain, no more than a small handful, increasing it slowly over the next 2 months until by the time the animal freshens it is getting maybe a cup in the morning and a cup at night. Then, depending on the amount of milk the doe is giving per milking, you should increase the grain so that she is getting enough to help produce the milk but not make her fat. The recommendation has always been a pound of grain for 8 lbs (~ a gallon) of milk This requires that you lace the grain with rocks or alfalfa pellets to keep her occupied while you milk out that whole gallon (a huge amount per milking, so don't be disappointed if you never achieve it!) so that you don't have to load her up with too much grain to occupy her time while accomplishing this task.

The whole thing that sets off this hypocalcemia problem in a doe any time in the last 6-8 weeks of pregnancy is that she needs a ratio of 2 parts calcium (alfalfa is rich in calcium) to 1 part phosphorus (grain is rich in phosphorus) to free up enough calcium for the onset of the rapid fetal development, and while she can survive on the hefty grain ration her managers foolishly give her in the first 3 months before the babies start growing, by that 3-month point her body is accustomed to and relying on it for nutrition. So you can't suddenly cut it back at that stage of the game to meet the 2 parts calcium/1 part phosphorus. And the goat cannot, for simple lack of room in her tummy while those babies are growing rapidly inside of her in those last 3 months, ingest enough alfalfa to provide the 2 parts calcium she needs to balance each 1 part phosphorus she gets in the grain ration she's become accustomed to. So the first thing the out-of-balance does will do is instinctively stop eating the grain that her body by now has become accustomed to, in a desperate effort to free up enough calcium from the hay to provide for the babies' growth. By now the babies' growth needs are draining all the available nutritional resources from the poor pregnant doe so, when she stops eating the grain that she shouldn't have been given those 1st 3 months, she becomes both nutritionally and calcium deficient all at once. She gets very weak and soon goes down, and vets stand around scratching their heads, not realizing what led up to this, and try to figure out what's wrong. They offer her Nutridrench or propylene glycol (maybe) for the ketotic situation she finds herself in, and wonder why she continues to get weaker and weaker, not realizing her problem is that the (mis) management process has deprived her of much needed calcium, which is essential not only for the babies' development but for her own muscle tone as well. No calcium, no muscle tone, no heart pumping, dead goat.
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