Practical Approaches and Clinical Management of

Periparturient Downer Cow

-Dr V.Rajesh B.V.Sc & A.H
“Learning is the continuous process”
Common Metabolic Diseases in Bovines

➢Acute Ruminal Acidosis

➢Hypocalcemia
➢Hypophosphatemia/PPH
➢Hypokalemia
➢Downer Cow Syndrome
➢Bovine Ketosis
➢Hypomagnesaemia
 At the end of this session

Differentially Diagnosing cases of

✓Prepartum Downer due to Subclinical Hypocalcemia
(SCH)
✓Prepartum Downer due to OG Diseases
✓Post partum Downer –
Hypophosphatemia+Hypokalemia
✓Downer due to Acidosis
✓Bovine Secondary Recumbency-Calving Paralysis
Terms to know for Better understanding

➢the term “Downer cow” was used to denote non-

ambulatory cattle recumbent for at least 24 hours
without obvious reason.
➢Alert downer cows
➢Creeper cows
➢Non-Alert downer cows
➢Periparturient diseases of cow
Pathophysiology of Downer
Ischemic Muscle Necrosis
 Clinical Examination of Downer

➢ Mental Status
➢ Temperature
➢ Heart Rate-Prognostic indicator
➢ Mucous Membrane
➢ Auscultation of Heart/lungs
➢ Rumination /Rumen Motility-Hypo/Hyper
 Classification of Downer

Alert Downer Non-Alert Downer

➢ Sternal Recumbency with ➢ Lateral or Sternal Recumbency
Feeding and Watering with Chin Placed on Ground
,Defaecation,Urination- Normal ➢ Temp,HR Elevated with
➢ Rumination Respiratory Distress
➢ Creeper ➢ Anorectic,
➢ Attempt to Stand on Stimulation ➢ Empty Rectum
➢ Extended Neck
 Approaching a case of Downer Cow postpartum-
Differentials

1.Acute Ruminal 2.Toxemic

Acidosis Conditions

3.MusculoSkeletal
4.Hypocalcemia
and Nervine
/Hypophosphatemia
Disorders postpartum
ACUTE RUMINAL ACIDOSIS
Physical Examination-Rumen Ballottement
Environmental Examination-Avoid Concrete floor
Physical Sling Support-Alert Downers
After Recovery using appropriate Treatment
Correction of Metabolic crisis of the animal is First MANDATORY (**Mild,Moderate and
Severe Are classified based upon its Base Deficit Score)
Mild Acidosis (5)
1) Oral Antacids
2) inj Antihistamines
3) inj Bcomplex with liver extract(esp Thiamine at 10-20mg per kg IV in NS)
4) Inj FPP
5) oral AB are not preferable.
6) oral Probiotics

Moderate Acidosis (10)

7) Parentral Antacids
2,3,4,5,6
8) Rumen Cud Transplantation/Transfaunation

Severe Acidosis(15)
9) Evacuation of Ruminal content in fluid filled severly distended Recumbent animal
7,2,3,4,5,6,8
10) optional oral AB treatment
11) inj NS/RL at 10-20ml per kg if dehydration or Anorexia after correcting it's acidosis
using parentral Antacids.
12) inj CBG on day 2..if Acidosis induced Hypocalcaemia.
13) NSAIDs..if needed.. Flunixin.
TOXEMIC/INFECTIOUS CONDITIONS
Clinical Examination-Mucous Membrane
Scapular pulsation—Indicative of Severe Anaemia
After Recovery using appropriate Treatment
Physical Examination-Mental Status
HPD
LIVER FLUKES—CIRRHOTIC LIVER
After Recovery using appropriate Treatment
Downer due to Septicaemia-Mastitis
Mastitis
After Recovery using appropriate Treatment
Downer due to Septicaemia-Metritis
After Recovery using appropriate Treatment
Schematic Representation of Anatomy of Nerves in Cattle
 Common Nerve injury in Cattle
Calving Paralysis-intrapelvic parturient trauma – large Sized fetus
➢ Obturator Nerve Paralysis-Adductor paralysis
➢ Sciatic Nerve Paralysis-Characteristic persistent Knuckling of
Fetlock
Distal Branches of Sciatic Nerve
➢ Peroneal Nerve Paralysis -passes superficially over the lateral femoral
condyle and the head of the fibula- Intermittent Knuckling of Fetlock
➢ Tibial Nerve Paralysis- rare due to its protection from Muscles-dropped
hock syndrome- Fetlock is partially flexed-Buckling of Fetlock
Radial Nerve paralysis-Pressure Ischemia over lateral aspect of Humerus-
Dropped Elbow & Dragging of Forelimb
Buckling and knuckling of the fetlock joint in a recovered
downer cow
MS & NERVINE DISORDERS-POSTPARTUM
Shoulder Luxation/Radial Nerve Injury
After Recovery using NSAIDS and Nervine tonics
After Recovery using NSAIDS and Nervine tonics
Sciatic Nerve Injury-Persistent Knuckling
Peroneal Nerve Injury-intermittent Knuckling
Treatment using NSAIDS , Nervine inj & Epidurals
After Recovery using NSAIDS and Nervine tonics
Bilateral Tibial Nerve Injury-Buckling of Fetlock
Unilateral Tibial Nerve Injury-Buckling of Fetlock
Obturator Nerve Injury/Hip Dislocation
A downer cow in the spread eagle position.
Unilateral Hip Dislocation/Luxation
MILK FEVER -COMPLICATIONS
Clinical Examination of Heart for low intensity of HR
Positive Response to CBG Treatment confirms MF
After Recovery using CBG IV & SC
CALCIUM HOMEOSTASIS
Downer due to Hypophosphatemia
After Recovery using Phosphate therapy
 Clinical Consideration in Hypophosphatemia
➢Etiology –Hypocalcemia-Ruminal Atony-Salivary Phosphorous, PTH induced Renal
Excretion ,Drains in Colostrum

➢Diagnosis- Relapsing /Recurrent Animal due to continuing

Hypophosphataemia/Creeper Cow

➢TWO TYPES OF AVAILABLE PHOSPHOROUS in the Market

➢In Bovines,The Blood phosphorous level is direct indicator of Dietary intake and
Bioavailabilty of Phosphates(Inorganic) and it is also a factor for Bovine Recumbency
(Recurrence/Persistant)

➢INJECTABLE/ORAL-ONLY PHOSPHATES(INORGANIC)

➢Dose of Inorganic Phosphate -60g of SAP in 200ml NS/Distilled water IV

-60g of SAP in 200ml NS/Distilled water SC 12hrs interval
-oral-120g of SAP bid for 3-5days
➢ It is undesirable to adm parentrally Sodium Acid Phosphate(SAP) along with Calcium and
Magnesium salts IV-Rapid infusion-precipitation of Ca and Mg salts

➢ IV adm of PHOSPHATES can be done after 2hrs where the animals not able to take oral
Medications

➢ Rapid Infusion of Phosphates –low bioavailabilty-after 2hrs-it will be excreted via Kidneys-so
little parentral usage only

➢ Phosphorus depletion may ALSO occur after oral or parenteral carbohydrate adm and after
parenteral insulin administration as a result of increased cellular phosphorus uptake in
combination with glucose.

➢ Parenteral adm of organic phosphorus (inj toldimphos, butaphsphan, phosphite, or

hypophosphite) as phosphite are unsuitable for increasing plasma phosphorus.

➢ PHOSPHITES- Metabolic Modifiers-can be used in other conditions like SI and Ketosis

Kits for Phosphorous supplementation
Downer due to Hypokalemia
After Recovery using Oral and IV Potassium
 Clinical Consideration in Hypokalemia
➢ Prolonged Recumbency—Increase in permeability of Sarcoplasmic
membrane-loss of K from intracellular to Extracellular –Excretion via
Kidneys—Hypokalemia (andrew et al, 1992)

➢ Muscle weakness –Lowers resting membrane potential –decreased

Excitability of NM tissues-Downer Cow syndrome (Radostits et
al,2000)

➢ Over dosage of Bicarbonate solutions in Acute Ruminal Acidosis-

Alkalosis-Renal Excretion

➢ Multiple dosing of Isofluperidone in Ketosis-Mineralocorticoid

activity-Renal Excretion

➢ Prolonged Anorexia/Low dietary Potassium Intake

➢ Enteritis/Severe Diarrhoea
➢ ABOMASAL STASIS/ Intestinal Obstruction
➢ Prolonged use of K free solution in fluid Therapy for Diarrhoea
➢ Unwarranted infusion of Hypertonic Dextrose solution

Dosage calculations-parentral Vs Oral

➢ Oral safe-0.4g per kg-bid ie 120g bid for 3-5 days only

➢ Injectable-unsafe-only after Lab investigations-cardiac arrhythmias-VF and

Death.

➢ Dose is 0.5meq/Kg Bt wt Very very Slow IV in Normal Saline under careful

Cardiac Monitoring

➢ Epidural Inj of Thiamine +Dexamethasone -Intracellular Potassium

Retension(IVJ 1970 by Rao)
Epidural Injection –To increase Intracellular K level
Epidural Injection –To increase Intracellular K level
 Available potassium kits

Lab Grade KCL 200ml has only 20g- Orcalyte Downer-MRP 120
500gms-MRP 300 MRP 80rps
Approaching a case of Downer Cow Prepartum-Differentials

2.Intestinal
1.Paralytic ileus
obstruction

4.Subclinical
3.OG disorders
Hypocalcemia
 Prepartum Downer Diseases
HYDROPS-Hydro-Allantois(90%)-Progressive Bilateral
ventral Abdominal Distension-Round shaped abdomen
Torsion
Macerated /Mummified Fetus
Paralytic ileus-Bilateral Abdominal Distension-Reduced
quantity of dung
Intussusception/Intestinal Obstruction-Rectal prolapse &
Raspberry Jam/Jelly like Faeces
Peritonitis-Reduced quantity of Dung-Abdominocentesis
Prepartum Downer -Hydrops
Prepartum Downer-Subclinical Hypocalcemia
 Diagnosing and Treating of Subclinical Hypocalcemia

➢ Most of the Prepartum diets are Alkaline(Legumes and grasses has

high Potassium which is alkaline)
➢ The urine pH of near-term prepartum cow is good indicator that the
animal is in SCH and for prevention of Milk Fever.
➢ By testing urine pH with pH paper,if it is acidic(6.8-7) it is safe..if it is
alkaline(>8),it is unsafe..
Cations-Na,K,Ca,Mg-Diet promotes More Alkaline Blood Ph—Metabolic Alkalosis--
-More Incidence of Milk Fever---DC
Anions-Cl,S,P-Diets promotes More Acidic Blood Ph--- Metabolic Acidosis

➢ Treating with DCAD PREPARATIONS POWDERS-

INTABOLYTE/HYPORID/METABOLITE
➢ Pain Management using NSAIDs
 Other common Downer Etiology—
Colic/Botulism/Hypomagnesemia/Poisoning
Sudden Downer –Colic and Impaction
After Recovery using Spasmolytics and Rumen Buffers
 Treatment in General
✓ Prognosis depends upon Early Treatment for its Primary Etiology
✓ Supportive Therapy-Anti Inflammatory and Antihistamines
✓ NSAIDS-Esp Tolfenamic Acid /Flunixin 24hrs IV once & CPM IM
✓ Inj Vitamic C IM
✓ Inj Ad3E IM
✓ Inj Methylated Cobalamin for Nervine Disorders.-IM
✓ Inj Calcium Levulinate –Serum Calcium Maintanence-IM
✓ Oral KCL-Hypokalemic Crisis(Prolonged Anorexia /Recumbency)
✓ Fluid Therapy in Non Alert Anorectic Downer –RL and NS
✓ STRICTLY NO HYPERTONIC DEXTROSE and ISOFLUPERIDONE
(Steroids having highest Mineralocorticoid Activity)
 Management –Downer Cows
Sand pit floor or Soft Bedding
Non Slippery ground Surface and not in concrete Floor
Assisted lifting with Slings/Commercially available Cow
lifters
Turn Side by Side Every 3 hrs once
Wound Care
Physiotherapy after Lifting-Muscle massage
Fomentations
 Prevention in General
Reducing the Chances of Milk Fever will Reduce incidence of
DC
✓ Dietary Feeding Anionic Powders-------reduces Blood pH---Excretion of Ca
via Urine---Low Serum Calcium---Activates PTH secretion---Resorption of
Ca from Bones.---Stimulates Vitamin D in Kidneys—More absorption of
Calcium from Intestines.
✓ Inj Vitamin D3 IM 2-8 days before parturition-Milk fever prone cow during
pregnancy to increase Intestinal absorption of Calcium-@dose of 1million units
per 45kg.,IM
ie., 13 amp per 350kg(77LACS UNITS)….rs 800(1 amp has 6lacs units)
✓ Administration of Oral Calcium gel at the time of Parturition
 Now in the end of this session

Differentially Diagnosing cases of

✓Prepartum Downer due to Subclinical Hypocalcemia
(SCH)
✓Prepartum Downer due to OG Diseases
✓Post partum Downer –
Hypophosphatemia+Hypokalemia
✓Downer due to Acidosis
✓Bovine Secondary Recumbency-Calving Paralysis
 End Discussion…..
Dr V.RAJESH B.V.Sc, & A.H
Veterinary Assistant Surgeon
Villupuram District
+919442583877

As Veterinary officer-KMF Karnataka-2007-2009

As VAS -DAH-TN -2009-Till date

Thank you
Spl Thanks to Respected Dr S.Sivaraman Sir