Hypoglycemia in Neonatal Ruminants.pptx

5/12/2023
Kabul University
Faculty of Veterinary Science
Department of Clinic
Internal Medicine
1
‫په‬
‫زېږېدلو‬ ‫نوؤ‬
‫کې‬ ‫شخوندوهونکو‬
‫کموالې‬ ‫ګلوکوز‬ ‫د‬ ‫وینې‬ ‫د‬
Hypoglycemia in Neonatal Ruminants
Lecturer: Prof. M. Monir
Tawfeeq
Prepared by: Muhammad Ajmal

5/12/2023 2
Objectives
 Introduction
 Hypoglycemia in Neonatal Ruminants
 Diarrhea & Hypoglycemia in Neonatal Ruminants
 Hypothermia & Hypoglycemia in Neonatal Ruminants
 Conclusion

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Introduction
 Glucose is the primary source of energy for
all mammalian cells.
 Hypoglycemia: Low Level of blood
glucose or low blood Glucose concentration.
 NBGC in calves at birth are lower than
juvenile reference values (80-120 mg/dL),
but rise to >100 mg/dL within the first 24
hours. (WAGNER, 2019) (Kristie et al, 2002)

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Introduction
Cont…
 Hypoglycemia in neonatal elk as a blood glucose concentration 4.2 mmol/L.
(Kristie et al, 2002)
 hypoglycemia has the potential to cause irreversible brain damage and death.
 Hypoglycemia has traditionally been associated with neonatal diarrhea and
endotoxaemia in calves.
 Hypoglycemia has also been consistently observed in septic neonatal diarrheic
calves. (Trefz et al, 2016)

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 Hypoglycemia has two types:
 Severe hypoglycemia was defined as plasma glucose concentration
(< 79 mg/dl) or (< 2 mmol/L).
 Normoglycemia was defined as plasma glucose concentration of
(79-124 mg/dl) or (4.4-6.9 mmol/L).
 Severe hypoglycemia was associated with a survival rate of
20.6%, compared with 74.0% discharged animals in calves with
plasma glucose concentration in the reference range.(Trefz et al, 2016)
(Karapinar et al, 2020)
Cont…

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C/Signs in Calves
 Weakness
 Lethargy ‫حالي‬ ‫بې‬
 Severe Depression ‫خپګان‬ ‫شدید‬
 Recumbency ‫حالت‬ ‫پریوتې‬
 Loss of the suckling reflex
 Hypothermia
 Convulsions ‫تکان‬
 Seizures or Opisthotonus
 Coma & Death (Trefz et al, 2016)(Tsukano et al, 2018).
https://www.google.com/search?q=Hypoglycemia+in+calves+images&ie=utf-8

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Diagnosis
Severe hypoglycemia was not easily diagnosed based on clinical
signs, but should be suspected in calves:
 Clinical evidence of septicemia,
 Hypothermia
 Acute abdominal emergencies
 Evidence of malnutrition.
(Trefz et al, 2016)

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 “Cow-Side-Test (CST)”, is advantageous for the diagnosis and treatment of
hypoglycemic and hyperglycemic cows.
 Point-of-Care (POC) analyzers that require minimal blood samples and that can
measure a wide range of other variables including glucose concentration rapidly,
also categorized as CST in bovine practice. (Karapinar et al, 2020)
 Automated Chemistry Analyzers (ACA) measure the glucose concentration by
means of a hexokinase or glucose oxidase method as the gold standard.
 These hand-held glucose meters are used in veterinary practice as Portable Blood
Glucose Meter (PBGM). (Nishi et al, 2019)
Diagnosis
Cont…

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Clinical and Post mortem
 Evidence of Septicemia
• Severe Hypoglycemic calves 61%
• Normoglycemic calves 21% (Trefz et al, 2016)

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 Generalized Peritonitis
• Normoglycemic calves 2%
Cont…
(Trefz et al, 2016)

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 Evidence of malnutrition
 Neonatal Diarrhea
(Trefz et al, 2016)

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(Kristie et al, 2002)

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 Diarrhea is one of the most common diseases in the clinical setting, and it can
cause hypoglycemia in calves.
 Diarrheic calves with hypoglycemia have Severe Malnutrition that usually occurs
in the terminal stages of the disease.
 Malnourished animals respond poorly to treatment because of marked
physiological and metabolic changes.
 As hypoglycemia has a higher risk of death in diarrheic calves.
 It is important to immediately evaluate the blood glucose concentration to detect
hypoglycemia requiring treatment. (Nishi et al, 2019)
Diarrhea & Hypoglycemia in Neonatal Ruminants

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Treatment of Neonatal Calves
 Polyelectrolyte isotonic solutions with 2.5 to 5.0% dextrose are widely used in
fluid therapy for cattle. especially for hypoglycemic calves with diarrhea.
 However, the large volume of glucose supplemented during fluid replacement
increases the risk of developing hyperglycemia. (Nishi et al, 2019)
 Additional supportive therapy consisted of the parenteral administration of
Nonsteroidal drugs and the supplementation of Vitamin E and selenium.
 Antimicrobial therapy was initiated in cases of a concurrent bacterial infections.
(Trefz et al, 2017)

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 Lamb survival rates in New Zealand are highest.
 Singles (90%)
 Twins (88%)
 Triplets surviving 54%-77%
 Lamb survival is affected by both maternal ewe factors including:
 Genotype
 Nutrition
 Stress,
 Uterine environment,
 Litter size
 Dystocia,
 Maternal bonding
 Behaviour,
 And colostrum and milk production. (Hegarty et al, 2017)
Hypoglycemia lambs

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 And lamb factors including:
• Birthweight
• And ability to withstand hypothermia.
 Most lamb death occurs within the first 3 days after birth.
 Starvation (Hypoglycemia) is the most frequent cause of death in
multiples and increases with decreasing birth-weight. (Hegarty et al,
2017)
Hypoglycemia lambs

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 Hypoglycemia is defined as the level of blood glucose below 80 mg/dL
in newborn lambs.
 New born lambs lose their body temperature quickly particularly if
they are Not well fed and when the environment is cold and humid.
 Consequently, Hypothermia-hypoglycemia complex (HHC), which is
a metabolic disorder characterized by the decrease in body temperature
and blood glucose level that leads to significant neonatal lamb losses,
emerges. (GÖK & GÜL, 2018)
Hypoglycemia in Lambs

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(GÖK & GÜL, 2018)

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 Mild Hypothermia - Any Age
 Temperature between 37 - 39 °C
 Lamb is weak,
 Depressed,
 Appears empty
 but can stand.
TREATING HYPOTHERMIA(CHILLING) AND HYPOGLYCEMIA
(STARVATION) IN VERY YOUNG LAMBS & KIDS
https://www.google.com/search?q=Hypoglycemia+in+lambs+%26+kids+images&ie=utf-8
https://www.amstewardship.ca/faast-reviews/neonatal-
management/kid-lamb-management/

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 In addition to colostrum, feed these small lambs an extra 50
mL/kg of a 20% dextrose solution by stomach tube 1 hour after
the colostrum feeding.
 For small lambs (under 2 kg), wool pullovers worn for 2 to 4
days, helps to maintain body temperature. These very small lambs
may do better in the orphan lamb pen.
 Small lambs < 1.5 kg (3 lbs) at birth, may not have sufficient fat reserves to
initiate heat production, even with colostrum.
ACTIONS:

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 Moderate to Severe Hypothermia Temperature ≤ 37 °C
 Lambs over 5 hours old should be considered hypoglycemic
(starved) as well as hypothermic.
 Do not warm before administering colostrum or glucose.
 If ≤ 37 °C; < 5 Hrs Old and Suckle Reflex (Unable to Swallow)
 Lamb is weak,
 Empty, depressed
 and may be unable to stand.
https://www.amstewardship.ca/faast-reviews/neonatal-management/kid-lamb-management/

5/12/2023 22
The lamb must first be injected with a sterile solution of warm 20%
dextrose at a dose rate of 10 mL/kg body weight into the abdominal
cavity (intraperitoneal).
Place in warming box until rectal temperature is > 37°C.
Once revived and with a suckle reflex, administer warm colostrum by
stomach tube. Feed 50 mL/kg bodyweight.
Additionally feed 200 mL/kg bodyweight spread over three more
feedings within the first 24 hours.
ACTIONS:

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 Move to hospital pen with heat source (e.g. box in warm
environment) and feed until strong and maintaining normal
temperature (39°C).
 Once strong, return to dam but make sure lamb is nursing (identify
using livestock paint or marker)
https://ontariogoat.ca/wp-content/uploads/2015/11/hypothermia-poster-final-approved.pdf

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Administering Dextrose Solution Using an
Intraperitoneal (IP) Injection
 Sterile 60 mL syringe, draw up 20 mL of sterile 50% dextrose.
 Boil clean water and draw up 30 mL of this water into the same syringe.
 This will provide 50 mL of warm (38 - 40°C) 20% dextrose solution.
 The dose is 10 mL per kg bodyweight; 50 mL is sufficient for a 5 kg lamb.
 The lamb is suspended vertically by the forelimbs.
 The injection site is 2.5 cm (1 in.) below and to the side of the navel.

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 Use a 20 gauge (pink) 1 inch needle.
 The needle is inserted at a 45 degree angle to the body wall (the
needle is pointed in the direction of the lamb’s pelvis).
 Ask your veterinarian to show you how to do it.
 The internal organs will be pushed away by the needle and not
damaged.
 Both the conscious and comatose lamb can be injected in this
manner.
Cont… Administering Dextrose Solution Using an
Intraperitoneal (IP) Injection

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https://www.google.com/search?q=Hypoglycemia+in+lambs+%26+kids+images&ie=utf-8

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Hypothermia and hypoglycemia can be Prevented through:
• Proper nutrition in late gestation.
• Prevention of dystocia.
• Ensuring a warm, dry and draft free
environment after birth.
• Preventing a lack of maternal bonding.
management/kid-lamb-management/ https://www.amstewardship.ca/wp-
content/uploads/2020/09/Tube-Feeding-Lamb.jpg

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Conclusion
 Hypoglycemia: Low Level of blood glucose.
 Severe hypoglycemia in calves < 2mmol/L.
 Normoglycemia in calves 4.4-6.9mmol/L.
 Hypoglycemia in neonatal elk as a blood glucose concentration 4.2 mmol/L.
 Hypoglycemia is defined as the level of blood glucose below 80 mg/dL in
newborn lambs.
 Hypoglycemia is associated with Diarrhea and Hypothermia in neonatal
Ruminants.

5/12/2023 29
References
1. NISHI, Y. MURAKAMI, Y. OTSUKA, M. TSUKANO, K. AJITO T. and SUZUKI K. (2019). Accuracy
of the point-of-care glucose meter for use in calves. J. Vet. Med. Sci. 81 (9): 1301-1304. doi:
10.1292/jvms.19-0272
2. Trefz, F. M. Feist, M. and Lorenz, I. (2016). Hypoglycaemia in hospitalised neonatal calves: prevalence,
associated conditions and impact on prognosis. The Veterinary Journal. http://dx.doi.org/doi:
10.1016/j.tvjl.2016.10.001
3. Jones, M. and Navarre, C. (2014). Fluid Therapy in Small Ruminants and Camelids. Vet Clin Food Anim
30 441-453 http://dx.doi.org/10.1016/j.cvfa.2014.04.006
4. Hegarty, J. E. Harding, J. E. Oliver, M. H. Gamble, G. Dickson, J. L. Chase G.
& Jaquiery A. L. (2017). Oral dextrose gel to improve survival in less vigorous newborn triplet lambs: a
randomised controlled trial, New Zealand Journal of Agricultural Research, 60:1, 54-69, DOI:
10.1080/00288233.2016.1240091
5. Mair, B. Drillich, M. Klein-Jöbstl, D. Kanz, P. Borchardt, S. Meyer, L. Schwendenwein I. and Iwersen
M. (2016). Glucose concentration in capillary blood of dairy cows obtained by a minimally invasive
lancet technique and determined with three different hand-held devices. BMC Veterinary Research
(2016) 12:34 DOI 10.1186/s12917-016-0662-3
6. Tsukano, K., Sarashina, S. and Suzuki, K. (2018). Hypoglycemia and failure of respiratory compensation
are risk factors for mortality in diarrheic calves in Hokkaido, northern Japan. J. Vet. Med. Sci. 80: 1159-
1164. [Medline] [CrossRef]

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References
7. WAGNER, L. F. (2019). CHARACTERIZATION OF SHORT-TERM AND LONG- TERMMORBIDITY
AND MORTALITY OF GOAT KIDS BORN TO DOES WITH PREGNANCY TOXEMIA.
VETERINARY BIOMEDICAL SCIENCES. Pp:1-42
8. GÖK T. & GÜL Y. (2018). Investigation of Hypothermia and Hypoglycemia Complex in Newborn Lambs.
University of Fırat, Faculty of Veterinary, Department of Internal Medicine, Elazığ, TURKEY. F.U. Vet. J.
Health Sci.
9. Dahl M. O. (2020). LABORATORY EVALUATION OF HYPOGLYCEMIA IN CATTLE. Department of
Internal and Preventive Medicine, College of Veterinary Medicine University of
Mosul,Mosul,IRAQ41002.VeterinaryPractitionerVol.21No.2
https://www.researchgate.net/publication/350177033
10. Ortolani , E. L. Maruta , C. A. Júnior , R. A. B. Mori , C. S. Antonelli , A. C. Sucupira M. C. A. and
Minervino A. H. H. (2020). Metabolic Profile of Steers Subjected to Normal
Feeding, Fasting, and Re-Feeding Conditions. Vet. Sci. 2020, 7, 95; doi:10.3390/vetsci7030095
11. Grongnet, J. F. Laurence Couette, J. Lareynie Lesage, M. METABOLIC CONSEQUENCES OF
INDUCED HYPOXIA IN NEWBORN LAMBS. Annales de Recherches Vétérinaires, INRA Editions,
1984,15 (1), Pp.17-28. hal-00901474

Thank You For Your Attention
Any Questions?
5/12/2023 31
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