Case Study: Ketosis

in a dairy cowEmily Douglas-Osborn

Farm Background:

170 Holstein Friesian herd. Giving on average 9000L/cow/year.

All year-round calving but more in the summer.

Own Aberdeen Angus bull and buy in some Belgian Blue semen for AI.

Cows are turned out over the summer and housed during the winter.

Farm lameness, mastitis and fertility are all good, but infectious disease status is entirely unknown.

All milking cows are fed the same TMR and receive 3kg cake in the parlour twice daily. Dry cows in the far off group are fed ad lib hay, and transition dry cows (2-3 weeks pre calving) are fed ad lib maize silage. Everything is fed once daily and pushed up twice daily.

Presenting complaint:

No 170, off colour, not interested in cake and picking at silage. Has lost a large amount of weight since calving.

Calving was normal.

5th parity adult Holstein Friesian female, 3-4 weeks in milk.

Had been giving 35L/day but now has dropped to 10L/day.

Cows currently kept indoors 24/7.

Signalment:

History:

Off colour and food.

Farmer reports noticing off colour for one day, and just

hasn’t improved.

No previous treatment.

Dry cows and milking cows are fed the same silage and

TMR. In a group of 8 dry cows 5 were BCS 3.5 and over. Lameness, mastitis are well controlled within the herd and

the calving index was 440 in 2013, aiming for 400 in 2014.

Infectious disease status of the farm is completely

unknown. Ketosis rumbles in the herd at a rate of around

5%. (3.5% Jan 2014-Jan 2015)

Since 22nd January 2014, Ketosis has been diagnosed 6

times, and twice in 2 animals (92 and 170) DAs have been diagnosed 6 times, but a DA was only identified in a ketotic

animal once (RX Works).

Ketosis vs DAs

0

0.5

1

1.5

2

2.5

3

3.5

January February March April May June July August September October November December

Incidence of Ketosis and DAs Jan 2014-Jan 2015

Ketotic cows DAs

Mont

h

No

cases

Initial Differentials:

Milk Fever

DA

Ketosis

Traumatic reticulitis

Mastitis

Metritis

Toxicity

Pyelonephritis

RFM?

BVD?

Physical Exam:

T-38.1°C, P-60, R-24.

Reduced rumen turnover

Rumen relatively empty.

Otherwise NAD.

Dull and listless

Reduced rumen turnover

Rumen relatively empty

Problem List:

Differentials:

Ketosis

DA – not auscultated but can be there anyway.

Milk Fever – less likely as PR and faecal consistency normal, not ruled out.

BVD – immunosuppressor, may predispose to other disease.

Toxicity – very very unlikely given lack of access but not impossible

Traumatic reticulitis –, HR and RR normal, not pyrexic, withers test negative.

Mastitis – TPR normal, udder normal.

Metritis – TPR normal, uterus normal on rectal exam.

Pyelonephritis – TPR normal

RFM –Seen cleansing – intact.

Diagnostic Tests:

Blood ketones would be useful, but secondary problems ie DA arecommon. There is also a certain degree of ketosis in all fresh cows. Itcan be run cow side and is cheap.

Blood calcium would also be useful to detect hypocalcaemia, buttakes longer to get results.

Haematology and Biochemistry – For liver enzymes, won’tdifferentiate fatty liver from toxicity. May indicate inflammationpathology elsewhere but more expensive and takes longer.

BVD serology – probably not indicated until other causes ruled out but may be useful to screen herd to determine status.

Blood ketones were 5.1mmol/L

Should be under 1mmol/L

Diagnostic Test Results:

Adjusted Differentials:

Ketosis – confirmed

DA – not ruled out, maybe more likely as can occur secondary to

ketosis.

Hypocalcaemia – not ruled out but much less likely given high

ketones.

BVD – not ruled out, less likely given high ketones.

Toxins – unlikely to have accessed, and less likely given high ketones.

Final Diagnosis:

Ketosis.

Treatment Plan:

Ketosaid bottle, BID on day one and SID for three days after, contains

99.96% propylene glycol, glucose precursor.

1x Selekt Fresh Cow, contains 500g calcium proprionate

(oxaloacetate precursor) magnesium, and dry yeast.

5ml VitBee (vitamin B12) IM required in Krebs Cycle

5ml Dexadreson (dexamethasone) IM – change glucose distribution /

glucogenic effect?

Management: greater care feeding dry cows so they calve down at

a BCS of 2.5-3.

Treatment Plan:

This plan is a good one, covering all the suitable evidence based options.

Alternative options:

Glucose 40% 400ml IV – doesn’t last long. There may be a reduced insulin response in ketotic cows, so this isn’t a great option.

Insulin – reduced blood glucose, powerful antiketogenic, but poor response in cattle and not available/licensed.

Niacin – antipolytic, increases blood glucose and insulin, but uncertain mechanism and clinical value.

Bovine Somatotrophin – modifies IGF-1 levels? Evidence sparse.

Prognosis:

The prognosis is good

Fatty liver less likely as short duration of

ketosis

Not recumbent when attended = better

prognosis.

Welfare:

While ketosis is not painful, it has been shown that cattle with ketosis are less inclined to spend time eating and may experience increased hunger. They have decreased lying bouts but lie for longer. It has also been shown that the onset of ketosis is faster in lamer animals. What came first? Etc...

The prognosis in no 170 is good, and the treatment is not fairly non-invasive – ie two intramuscular injections and stomach tubing for three days.

Hence treating this animal is appropriate and indicated.

However, ketosis predisposes them to other diseases such as metabolic disorders, metritis, mastitis, and DAs, which may be painful and have other implications, ie DAs require surgery. Hence it is important to monitor animals for these conditions.

Economics

• Dexadreson = 72hr milk withhold.

• 35L/day lost for 3 days = 105L lost.

• 105 x 28.40 = 2982p = £29.82 lost in milk drop.

• Vet called out alone twice, other cases were seen as a part of another visit.

• So (2 x 71.25)+(4 x 41.25) = 142.5 + 165 = £307.50/year.

• One concurrent DA = 325.74 = £633.24 for year Jan 2014-Jan 2015.

• HHP = £355.19/month + VAT = £402.23/month, = £4826.75/year vets fees.

• In Jan 2014-Jan 2015 13% of vet costs are due to 6 cases of ketosis.

• A decrease in calving index of 45 days resulted in savings of £192/cow/year on

a sample farm milking 150 cows at 8000L/cow/year (Dairy Co). If fat cows

don’t conceive as well then losses are being incurred here.

Costs of ketosis:

Milk drop + vet + fertility

= (29.82 x 6) + 633.34 + (192 x 6) = approx. £1964.16/year.

Cost for vet callout to sick cow + tx ~£71.25

Tx only = 41.25

Average milk price = 28.40ppl

Economics - feeding TMR 55kg/head/day ad lib, fed once, pushed up twice daily.

Contains grass silage (60%), maize silage (40%), whole crop, soya, soya wholes, rape, and blend – urea + minerals.

Cake: 3kg BID.

Feed % DM Fresh

(kg)

DM

(kg)

MJ/kg

DM

Total MJ Cost/

tonne

Cost/

head/d

Cake 86 6.0 5.16 13.0 67.1 274 1.64

Maize silage 30 22 6.6 11.25 74.25 40 0.88

Grass silage 40 33 13.2 10.8 142.56 30 0.99

Total: 19.8 283.91 MJ £3.51

•Dry cows – hay ad lib, then maize silage 2-3 weeks pre-calving.

Feed %DM Fresh

(kg)

DM

(kg)

MJ/kg

DM

Total MJ Cost/

tonne

Cost/

head/d

Hay 85 13.5 11.5 9.5 109.25 38 0.51

Maize silage 30 38.3 11.5 11.25 129.4 40 1.53

Energy requirements:

Maintenance = BW/10 = 60MJ

Milking cow needs 5MJ/L produced = 5x35 = 175MJ

60 + 175 = 235MJ/day

Dry cows need 45MJ at 40 weeks gestation.

60 + 45 = 105MJ/day

Milking cows are being overfed by 48.9MJ/day when giving 35L/day, at

drying off (~10L/day) they are being overfed by 173.91MJ/day.

Far-off dry cows are being overfed by 9MJ/day

Transition dry cows are being overfed by 24.4MJ/day

Weight gain:

During lactation 1kg gain requires 35MJ

During dry period 1kg gain requires 60MJ

Hence dry cows should be gaining 0.4kg/day on maize silage and 0.15kg/day on hay.

Farm calving index is 400 days, = approx 60 days dry, on average 17.5days on maize, 42.5 on hay.

(42.5 x 0.15) + (17.5 x 0.4) = 13.4kg weight gain over a dry period in. But outdoors over summer, cows in since November, No 170 spent 39d dry in, 17.5 of those in the transition group.

(21.5 x 0.15) + (17.5 x 0.4) =10.2kg gained whilst in.

Lactating cows should be gaining 1.4kg/day increasing to 5kg/day over 305d lactation.

Turned out in April, so 66 days of early lactation before turnout indoors. 66 x 1.4 = 92.4kg.

= 102.6kg total theoretical weight gain whilst housed. May not be accurate, i did she always eat her 55kg TMR, did she lose or gain weight at pasture? Milk yield isn’t the same throughout the lactation, so they may well be gaining weight late in lactation.

Grass is 10-12MJ/kg DM, and 16-22% DM.

For 235MJ/day, - cake = 167.9MJ to get from grass.

= need 15.3kg DM/day. = 80.5kg freshweight/day.

But, we cannot know exactly how much this cow did or didn’t eat. Her requirements may also have changed for being outside, ie increased movement, heat generation, etc...

Body Condition Score:

Body condition score

Number of cows

Of those cows scored at 3.5 or above: 3 remained at the same BCS from Nov 2011 to Jan

2012. one went up in BCS by 0.5, and one went down by 1. Four appeared in the higher BCS

bracket twice, eleven didn’t, but seven new animals are at BCS 4 in Jan 2012. So weight gain

and loss is very dynamic, especially as the first two scores show changes over the fist month

of housing. Good doers outside don’t seem to be good doers inside. So it’s hard to say if they

are mostly gaining weight indoors or outdoors. Individual cow numbers weren’t acquired on

4th Feb 2015 but more scored higher in Feb 2015 than in Oct 2014.

No 170 scored at 4 in Nov 2011, but scored at 3 in Jan 2012. This fits with her losing condition

after calving and during early lactation.

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20

30

40

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60

70

80

1.5 1.75 2 2.25 2.5 2.75 3 3.25 3.5 3.75 4 4.5

04/02/2015

07/10/2014

25/01/2012

28/11/2011

Body Condition Score

This graph compares the percentage of milking and dry cows at

each body score on 4th February 2015.

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5

10

15

20

25

30

35

40

45

50

1.75 2 2.5 3 3.5 4 4.5

Milking cows

Dry cows

Body condition score

% of

cows

But...

By these calculations, all the cows should be overweight on the

current TMR, when they aren’t. So why not?

Bear in mind those scored were those presented at TB tests, they

aren’t the best representative sample of the herd.

And we don’t know exactly how much weight is being gained or lost

at grass.

If each cow eats all of her 55kg TMR/day, she eats 19.8% DM, for a

cow to eat 17-18% a day is ambitious, not all cows may be eating all

of their intended ration.

Some may be overeating

Some may be bullying others

Some may be lame

Some may have disease – gross health good but infectious disease status

is unknown

TMR Reformulation:

As the cows aren’t being overfed in the dry period, but 10/12 in the far off group are BCS >3.5, it is likely they are gaining weight at the end of the lactation as their milk yield drops.

High yielders ie >25L/day need 235MJ/day. A 2:1 DM grass silage:maize diet (30kg:20kg freshweight) = 197.1MJ/day, plus 1.7kg cake twice daily = 235MJ/day. Plus 10% freshweightoverfeed/day = 55kg total. This is £0.71/cow/day cheaper, = £216.55/cow/year

Low yielders ie <25L/day need 185MJ/day. A 1:1 DM grass silage:straw diet (22.5kg:10.6Kg freshweight) = 155.7MJ/day + 1.3kg cake in the parlour twice daily = 185MJ/day. Plus 10% overfeed = 36.41kg total. This is £1.60/cow/day cheaper = £488/cow/year.

Dry cows: require 10-13kgDM/day, a 2:1 DM grass silage:straw diet (20kg: 4.65kg) would be better. = total 112MJ/day. Plus 10% overfeed = 27.1kg total. This is £0.15/cow/day cheaper = £9/cow/year.

Cost benefit analysis:

Costs of ketosis Jan 2014-Jan 2015 is £1,964.16

To feed the current diets costs the farmer £89,043.00/year, £44,314.50

as they are outdoors for half the year.

To feed the diet as suggested in slide 23 would cost the farmer

£88,629/year, £44,521.50 as they are indoors for half the year.

This is £207/year cheaper.

So to address feeding and reducing ketosis cases, there is

potentially £2,171/year to be saved.

However this may depend on whether or not the farmer can

produce enough grass silage for these diets, and whether he will

lose income from using grass silage that he might have otherwise

sold.

Owner Communication:

Ketosis is a condition that occurs in conjunction with high BCS pre-

calving. When they calve down, their appetites are poor, as they are

fat, so they don’t eat well, causing energy deficits. The body makes

ketones as an energy source. Due to energy deficits, cows appear

dull and the milk yield drops.

The treatment plan is concerned with restoring energy intake,

allowing the cow to make and use glucose as opposed to ketones.

The prognosis provided there are no secondary complications is

good. Cows that are recumbent or have DAs have a more guarded

prognosis.

Monitoring of cattle, their general demeanour and ideally the month

temperatures in the week after diagnosis should be recorded so that

diseases such as mastitis, metritis and DAs are spotted early.

Herd Impact:

Ketosis can affect as many as 30-50% cows in a herd, and will mostly

be subclinical.

Fat cows are more likely to have problems calving.

Fat cows have reduced fertility.

Fat cows are more prone to metabolic disease.

There is a considerable drop in milk yield in early lactation.

Cows with ketosis are more likely to develop mastitis, metritis, and

displaced abomasums, which require surgery.

Non-responsive ketosis with liver compromise may require

euthanasia.

Herd Management:

Immediate changes:

BCS all cows every month.

Flag up those dry cows with BCS >3.5 which are likely to develop ketosis and give Kexxtone boluses 3 weeks prior to calving if necessary.

Mid term changes:

Group the milking cows into high and low yielders, and feed appropiately.

Compare BCS with fertility and health records.

Animals not in calf by day 150 should be considered for cull, or monitored closely for increasing BCS and dried off early, or given Kexxtone boluses 3 weeks prior to calving if necessary.

Repeat offenders, such as 170, should be closely monitored in future years or culled, as there may be some genetic predisposition to ketosis.

Long term changes:

Change the feed for all cows as per slide 23, or as per BCS of herd indicates is necessary.