Ketosis Treatment. Outline. Subclinical and Clinical Ketosis 4/4/12. Systema<c Review Ketosis Treatment Study. Common.

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1 Ketosis Treatment Jessica Gordon, DVM DVSc Candidate Department of Popula<on Medicine University of Guelph Systema<c Review Outline 2011 Ketosis Treatment Study Ketosis Incidence Preliminary Results Subclinical and Clinical Ketosis Common Average lacta<onal incidence ~30% Costly As high as $350 per subclinical case (Duffield, unpublished) Treatment challenges No universally effec<ve treatment Leads to/exacerbated by other diseases 1

2 Systema<c Review Review available literature in methodical manner Decrease bias of reviewer Examine and explain differences between studies Analyze the body of literature to help make informed treatment/interven<on decisions Sargeant et al, 2006 Literature Search Searched ketosis treatment ca]le in 4 databases Naturally occurring ketosis in lacta<ng dairy ca]le Control group with ketosis Untreated or treated with a baseline treatment eg Dextrose versus dextrose + insulin Clearly defined diagnos<c test and outcome 1,395 journal articles, thesis, and abstracts 660 Other topic 360 Repeat cita<ons 186 Reviewed literature 179 No control group 10 journal articles 2

3 Results Large Minnesota study, 2010 Tested all fresh cows Treated ½ of posi<ve cows, other ½ untreated Dextrose, dexamethasone, & B12 IV once Propylene glycol PO for 3 days Treated cows: milk yield DA risk reproduc<ve performance culling risk Carrier et al, personal communica<on Results McArt study in New York & Wisconsin in 2010 All fresh cows tested ½ treated with propylene glycol, ½ untreated Treated cows had: Shorter <me to ketosis cure ketosis cure milk produc<on DA risk culling risk McArt et al, in press Results Steroids 2007 Guelph study Predef administered at calving (Seifi et al, 2007) ketosis cure, ketosis risk Other studies show adverse effects ketosis risk and infec<ous disease Dextrose Omen given in combina<on Never studied alone with proper controls 3

4 B Vitamins Necessary cofactor for gluconeogenesis Appe<te s<mulant Recent studies have shown benefits for: Preven<on (Rollin et al, 2010, Fürl et al, 2010) Treatment in cows with LDA (Lohr et al, 2006) 2011 Ketosis Treatment Study May- September farms enrolled in Ontario Tested all fresh cows and heifers 3-9 DIM DIM 680 tested 2011 Ketosis Treatment Study Posi<ve if > 1.2 mmol/l BHBA on Precision Xtra All treated with 300ml propylene glycol for 3 days Addi<onal treatments: 200 IU long- ac<ng insulin SQ once 25 ml B 12 - phosphorus product (Catosal ) SQ for 3 days Both insulin & Catosal Neither insulin or Catosal 295 treated in Ontario 4

5 Total Incidence 43% 57% Non- Keto<c Keto<c Ketosis Incidence by Farm % Affected 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Farm ID Non- Keto<c Keto<c Number of Cows Tested % Ketosis Incidence by Farm In Order of Incidence (Lowest to Highest) 19% 29.9% 31.3% 32.9% 46.2% 47.4% 50% 53.8% Farm ID 53.9% 55.6% 59.7% 60.4% 66.7% 66.7% 78.6% Non- Keto<c Keto<c 5

6 Cows Treated by Lacta<on 21% 50% Lacta<on 1 Lacta<on 2 Lacta<on 3+ 29% Cows Treated by Days in Milk 29% Week 1 (3-9 DIM) Week 2 (10-16 DIM) 71% Cure Rates Treatment Group Total Cure Rate (%) Referent 99 40/ % Insulin 95 32/ % Catosal 92 37/ % Insulin & Catosal 85 43/ % Maintain (% of cure) 11/ % 8/ % 14/ % 11/ % Relapse (% of cure) 29/ % 24/ % 23/ % 32/ % Spontaneous Cure (%) 18/ % 18/ % 20/ % 10/ % 6

7 Cure Rates Treatment Group Total Cure Rate (%) Referent 99 40/ % Insulin 95 32/ % Catosal 92 37/ % Insulin & Catosal 85 43/ % Maintain (% of cure) 11/ % 8/ % 14/ % 11/ % Relapse (% of cure) 29/ % 24/ % 23/ % 32/ % Spontaneous Cure (%) 18/ % 18/ % 20/ % 10/ % Cure Rates Independent Variable OR p-value Catosal Insulin Lactation 0.34 <0.001 Enrollment BHBA 0.08 <0.001 Herd was included as a random effect. Insulin X Catosal interaction was not significant. Conclusions Serious lack of well- designed ketosis treatment studies Bo]om line: Propylene glycol Insulin B vitamins Steroids Dextrose? 7

8 Conclusions In 1966, Robertson stated, Obviously, there is s<ll room for improvement before we reach the ideal of 1.0 visit per cow. In 2012, there is s<ll room for improvement. 8