The Causes and Implications of Subclinical Hypocalcemia
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Transcript of The Causes and Implications of Subclinical Hypocalcemia
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Hypocalcemia!
It’s Not Just Milk Fever Anymore!!!
Jesse Goff
Iowa State University
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Lactation #
Ca
(mg/
dl)
0
2
4
6
8
10
12
0 1 2 ≥3
Normal
Sub-clinical
Milk Fever
25%
0.7%
54%
2%
53%
5%
Incidence of hypocalcemia in USA confinement herds
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0.50
0.55
0.60
0.65
0.70
0.75
0.80
0.85
0.90
1st 2nd ≥3rdLactation
NE
FA
(m
M)
Ca < 8.0 mg/dl
Ca 8.0 mg/dl≥
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Mastitis
Retained FetalMembranes and Metritis
Ketosis/Fatty Liver
Milk Fever
Displaced Abomasum
Lameness
Decreasing DMIDecreasing DMI
Around Calving Calving
Insufficient Vitamins, Trace Minerals, or Anti-Oxidants
High DCAD or
Low Mg diets
Negative Energy + Protein Balance Increasing NEFA
Immune Suppression Hypocalcemia Lost Muscle Tone
Insufficient Dietary Effective Fiber
Rumen acidosis
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Normal Blood Calcium Concentration= 9-10 mg/100ml
Extracellular Ca Pool ~11 g
Serum Ca pool ~ 3.5 g
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Extracellular Ca Pool ~11 g
Serum Ca pool ~ 3.5 g
Urine Ca0.2 - 6 g *
Endogenous Fecal Loss
5-8 g Ca
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Extracellular Ca Pool ~11 g
Serum Ca pool ~ 3.5 g
Urine Ca0.2 - 6 g *
Lactation- 20-30 g Ca
Colostrum –2.3 g Ca/ LMilk – 1.1 g Ca / L
Endogenous Fecal Loss
5-8 g Ca
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Extracellular Ca Pool ~11 g
Serum Ca pool ~ 3.5 g
Bone ~ 8 Kg Ca
Bone Fluid ~ 9 -15 g Ca *
Osteoclast recruitment &
activation
Urine Ca0.2 - 6 g *
Lactation- 20-30 g Ca
Colostrum –2.3 g Ca/ LMilk – 1.1 g Ca / L
PTH Endogenous Fecal Loss
5-8 g Ca
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Parathyroid Hormone
Extracellular Ca Pool ~11 g
Serum Ca pool ~ 3.5 g
Bone ~ 8 Kg Ca
Bone Fluid ~ 9 -15 g Ca *
Osteoclast recruitment &
activation
Urine Ca0.2 - 6 g *
Lactation- 20-30 g Ca
Colostrum –2.3 g Ca/ LMilk – 1.1 g Ca / L
PTH Endogenous Fecal Loss
5-8 g Ca
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Trabecular
Co
mp
act
Co
mp
act
A B
Figure 50.5
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OCLOb
ObOcyte
Blood vessel
Marrow Cavity
H
Bone spicule Figure 50.4
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Parathyroid Hormone
Extracellular Ca Pool ~11 g
Serum Ca pool ~ 3.5 g
Bone ~ 8 Kg Ca
Bone Fluid ~ 9 -15 g Ca *
Osteoclast recruitment &
activation
Urine Ca0.2 - 6 g *
Lactation- 20-30 g Ca
Colostrum –2.3 g Ca/ LMilk – 1.1 g Ca / L
PTH Endogenous Fecal Loss
5-8 g Ca
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Section thru compact Bone
Ca++
Osteocytic Osteolysis Ca in bone fluid surrounding each cell pumped into blood
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Parathyroid Hormone
Extracellular Ca Pool ~11 g
Serum Ca pool ~ 3.5 g
Bone ~ 8 Kg Ca
Bone Fluid ~ 9 -15 g Ca *
Osteoclast recruitment &
activation
Urine Ca0.2 - 6 g *
Diet Ca = 45- 150 g**Passive Ca Transport
Lactation- 20-30 g Ca
Colostrum –2.3 g Ca/ LMilk – 1.1 g Ca / L
PTH Endogenous Fecal Loss
5-8 g Ca
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Ca++
Ca++
Passive Transport of Ca Across Intestine
Ca++Ca++
Ca++Ca++
Ca++Ca++
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Ca++
Ca++
Passive Transport of Ca
Ca++Ca++
Ca++Ca++
Ca++
Ca++
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Ca++
Ca++
Passive Transport of Ca
Ca++Ca++
Ca++
Ca++
Ca++
Ca++
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Ca++
Ca++
Passive Transport of Ca
Ca++Ca++
Ca++
Ca++
Ca++ Ca++
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Parathyroid Hormone
Extracellular Ca Pool ~11 g
Serum Ca pool ~ 3.5 g
Bone ~ 8 Kg Ca
Bone Fluid ~ 9 -15 g Ca *
Osteoclast recruitment &
activation
Urine Ca0.2 - 6 g *
Kidney 25-OH vit D
Diet Ca = 45- 150 g**
1,25(OH)2D
Active Ca Transport
Passive Ca Transport
Lactation- 20-30 g Ca
Colostrum –2.3 g Ca/ LMilk – 1.1 g Ca / L
PTH Endogenous Fecal Loss
5-8 g Ca
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Ca++
Ca++ 1,25-vitD
VDR
Vitamin D-dependent Active Transport of Ca
Ca++ Ca++
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Ca++
Ca++1,25-vitD
VDR-1,25-vitD
Vitamin D-dependent Active Transport of Ca
Ca++ Ca++
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Ca++
CaBP
Ca++
Vitamin D-dependent Active Transport of Ca
Ca-ATPase pump
Ca++ Ca++
VDR-1,25-vitD
TRPV-6
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Ca++
CaBP
Ca++
-CaBP
Vitamin D-dependent Active Transport of Ca
Ca++
Ca ATPase pump
Ca++ Ca++
Ca++
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Ca++-CaBP
Ca -ATPase Pump
Vitamin D-dependent Active Transport of Ca
Ca++
Ca++ Ca++
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Ca++
CaBP
Ca -ATPase Pump
Vitamin D-dependent Active Transport of Ca
Ca++
Ca++ Ca++
Ca++
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Parathyroid Hormone
Extracellular Ca Pool ~11 g
Serum Ca pool ~ 3.5 g
Bone ~ 8 Kg Ca
Bone Fluid ~ 9 -15 g Ca *
Osteoclast recruitment &
activation
Urine Ca0.2 - 6 g *
Kidney 25-OH vit D
Diet Ca = 45- 150 g**
1,25(OH)2D
Active Ca Transport
Passive Ca Transport
Lactation- 20-30 g Ca
Colostrum –2.3 g Ca/ LMilk – 1.1 g Ca / L
PTH Endogenous Fecal Loss
5-8 g Ca
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A. pH=7.35 Normal Mg
Cyclic AMP
PTH
Receptor
C. pH=7.35 Hypomagnesemia
PTH
Receptor
B. pH=7.45 Normal Mg
Receptor
PTH
Adenyl cyclase complex
Adenyl cyclase complex
Adenyl cyclase complex
Mg++
Cyclic AMP Cyclic AMP
Mg++
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2 Eq of each anion source fed
5.5
6.0
6.5
7.0
7.5
8.0
8.5
HC
lN
H4 c
hlor
ide
Ca
chlo
ride
Ca
sulf
ate
Mg
sulf
ate
Ele
men
tal S
ulfu
r
Uri
ne p
H
H2S
O4
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Minerals/DCAD for Close-up Diets
Phos at .30-.37%Mg at .4% to use passive absorption!!S between .22 and .4%Ca at .85-1.3% ??Na at .1-.15%K as close to 1% as possibleEnough Chloride to urine pH.
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Na, K, and Cl for the close-up dry cow.
Keep diet Na at .10-.15%
Keep diet K as close to 1.0% as you can get.
THIS IS ALL YOU NEED TO DO TO PREVENT MILK FEVER IN HOLSTEINS!!!!
TO REDUCE SUBCLINICAL HYPOCALCEMIA YOU WILL NEED TO ADD CHLORIDE TO COUNTERACT K.
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HOW MUCH Chloride do I add to the diet?
Enough to bring urine pH between 6.2 and 6.8 the week before calving. (Jersey target= 5.8-6.2)
When urine pH is below 5.3 in the cows you may have caused an uncompensated metabolic acidosis = trouble!!!!!
Thumbrule
% Chloride needed = % K - 0.5
Example -If diet K is 1.3% then bring diet to 0.8 % Cl and check urine pH to fine tune diet
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Interpreting urine pHCollect ten samplesScenario 1- average pH = 6.3 + .6
- good shape, compensated metabolic acidosisScenario 2-average pH= 7.4 + .5
Add more anion – 0.25 lb incrementsScenario 3 – average pH 5.2 + 0.5
-reduce anion by 0.5 lbScenario 4 – 4 cows at 5.2, 6 cows at 7.8
-reduce anion by 0.5 lbs and start increasing back in after 4-5 days by 0.25 lb increments
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150
200
250
300
350
400
DC
AD
0.0
0.5
1.0
1.5
2.0
2.5%
of
DM
Con
trol 50
100
150
Chloride (lbs/acre)
Potassium
Calcium
Chloride
DCAD
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A. pH=7.35 Normal Mg
Cyclic AMP
PTH
Receptor
C. pH=7.35 Hypomagnesemia
PTH
Receptor
B. pH=7.45 Normal Mg
Receptor
PTH
Adenyl cyclase complex
Adenyl cyclase complex
Adenyl cyclase complex
Mg++
Cyclic AMP Cyclic AMP
Mg++
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Hypomagnesemia
Blood Mg < 1.9 mg/dl within 12 hrs of calving indicates inadequate dietary absorption of Mg.
-secondary hypocalcemia
-Depressed feed intake, depressed rumen fermentation (Ammerman, et.al., 1971)
-Tetany in grazing dairy ( below 1.2 mg/dl).
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MagnesiumAdult Ruminants absorb Mg across rumen wall ! Mg insoluble at rumen pH is NOT available.
- Active transport process efficient with low diet Mg BUT EASILY POISONED BY DIET K AND NITROGEN
- Second passive transport system exists, but requires high concentration of ionized Mg in rumen fluid to work
Keep diet Mg at 0.4% prepartum and early post-partum to take advantage of passive transport of Mg across rumen wall
MAKE SURE Mg Source is AVAILABLE to the cow. Finely ground, not overly calcined!
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Magnesium sources
Pre-calving - using MgSO4 or MgCl2 as “anions” also supplies readily available, soluble Mg.
-The better anion supplements on the market include Mg in this form to remove Mg worries pre-calving.
Post-calvingMagnesium Oxide – supply Mg and act as rumen alkalinizer.
- my experience low Mg = primary cause of mid-lactation milk fevers
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Testing Magnesium Oxide Availability
Weigh out 3 g MgO into large vessel.
Add 40 ml of 5% acetic acid (white vinegar) slowly!!
Cap container and shake well and let sit 30 minutes. Check the pH.
Vinegar will be pH 2.6-2.8!
The best MgO will bring the pH up to 8.2.
The worst to just 3.8.
pH is a log scale so this represents >10,000 fold difference in buffering action.
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Milk Fever PreventionMilk Fever Prevention1. Avoid very high potassium forages for
close-up cows; practiced by most dairies in US.
2. Add anions (Cl or Sulfate) to diet to reduce blood and urine pH; various forms practiced.
3. Diet Mg = 0.4% and available
4. Reduce diet Ca to stimulate parathyroid hormone release well before calving.
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Milk Fever PreventionMilk Fever Prevention1. Avoid very high potassium forages for
close-up cows; practiced by most dairies in US.
2. Add anions (Cl or Sulfate) to diet to reduce blood and urine pH; various forms practiced.
3. Diet Mg = 0.4% and available
4. Reduce diet Ca to stimulate parathyroid hormone release well before calving.
-zeolite makes this possible!!??
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Milk Fever - UnknownsMilk Fever - Unknowns
1. Is it necessary to raise diet Ca when using ‘anionic” diets?
2. Is there any advantage to combining preventatives? Low K + Low Ca + Anions, + IV or oral Ca?
3. Is partial acidification better than no acidification?