ANIMAL HEALTH CASE

KETOSIS
BY : ARVIANA ZULFA
061313143047
WHAT IS KETOSIS ?
Ketosis occurs when cows are in negative energy
balance.
This most commonly happens in the last 2 weeks of
pregnancy or in early lactation
WHAT IS KETOSIS ?
Keton bodies
Urine
Milk
Blood
Ketonuria
Ketonemia
Ketosis
Early
lactation
In the last 2
weeks of
pregnancy
-Growing calf
- Calving
- Forming
milk lactose
- forming
fatty milk
Need
glucose
If carbohydrate low
Gluconeogenesis
Keton bodies
acetoacetate, BHB, acetone
Primary ketosis
Secondary
ketosis
-Milk production
- Carbohydrate fed
-Because of another disorders
(LDA, Metritis, Peritonitis,
Mastitis)
Etiology
Type of Ketosis
Based on
Garrett R. Oetzel, DVM, MS
Tipe ketosis
Tipe 1 Tipe 2 Silase Asam Butirat
Deskripsi Spontaneous underfeeding Fat Cows Fatty Liver Wet Silages
BHBA darah Sangat tinggi Tinggi Tinggi
NEFA darah Tinggi Tinggi Normal atau tinggi
Glukosa darah Rendah Tinggi Bervariasi
Insulin darah Rendah Tinggi Bervariasi
Status insulin Insulin-dependent
(Diabetes mellitus tipe I)
Insulin-resistant
(Diabetes mellitus tipe II)
Bervariasi
BCS Kurus Gemuk Bervariasi
Benda keton Trigliserida hepar Bervariasi
Glukoneogenesis hepar Tinggi Rendah Bervariasi
Patologi hepar Tidak ada Fatty liver Bervariasi
Periode paling berisiko 3-6 minggu 1-2 minggu Bervariasi
Prognosis Sangat baik Jelek (infausta) Baik
Kunci uji diagnostik BHBA pasca partus NEFA pasca partus Analisis VFA silase
Kunci intervensi Pakan pasca partus Pakan pasca partus Silage dihancurkan atau
dihaluskan
Normal Glucose
Ketosis type 1
Ketosis type 2
Ketosis Silage
Type of Ketosis
Based on
Thomas J. Divers, DVM, Dipl ACVIM, ACVECC
Simon F. Peek, BVSc, MRCVS, PhD, Dipl ACVIM
Pregnancy
Ketosis
Subclinical
Ketosis
Primary
Ketosis
Secondary
Ketosis
Nervous
Ketosis
Many categories of ketosis in cattle, but most involve
a similar pathophysiology:
Lipolysis
excessive release of nonesterifi ed free fatty acids
(NEFAs)
increased fatty acid storage as triacylglycerols in the liver
in some cows, decreased hepatic secretion of very low-
density lipids (VLDLs)
Certain cows with primary ketosis may be genetically
predisposed to hepatic lipidosis because of their inability
to properly remove triglycerides from the liver.
Pregnancy Ketosis
Heifers
Have
illness or
external
event that
restricts
access to
feed
Pregnant
twin
fetuses
Need more
energy
Ketosis

Early signs are identical to lactational ketosis.
Without prompt treatment, the signs progress to
extreme constipation followed by recumbency, renal
failure, and death.
Subclinical Ketosis

Subclinical ketosis refers to clinically normal
in the first weeks of lactation that have BHB values
greater than 1400 mol/L or 14.4 mg/dl.
Clinical effects can be seen as excessive weight loss,
decreased appetite and production, and diminished
reproductive performance.
Subclinical ketosis may be present in 30% to 50% of early
lactation cows in some herds.
Primary Clinical Ketosis
early lactation cows (usually between 1 and 3 weeks in milk,
and most commonly in cows in their second to fourth lactation)
seemingly well fed
in proper body condition before calving
have no other medical illness
BHB levels >3000 mol/L or 26 mg/dl
Fat cow/fatty liver syndrome refers to the overly conditioned
cow
Primary ketosis hepatic lipidosis (because of their inability
to properly remove triglycerides from the liver)
Hepatic lipidosis
Reduced feed
intake of total mixed
rations (TMRs)
Temperature, pulse,
and respiration are
normal or
occasionally
subnormal
Ketones may be
detected in the
breath, urine, or
milk
Urine test (Urine
ketostrips)
Milk Ketone Test
Clinical Signs and Diagnoses
Persistent Ketosis

Cows with chronic ketosis/fat mobilization and hepatic
lipidosis:
lose considerable amounts of weight
have a poor appetite
but continue to produce moderate amounts of milk considering
their poor feed intake
appear weak (hypoglycemia, muscle weakness, and/or
hypokalemia)
may die, be sold, or have complications caused by frequent
treatment
serum concentrations of hepatic-derived enzymes (AST, GGT,
SDH) are often elevated
serum cholesterol is frequently low, but it returns toward normal
value as the cow begins to eat better
Cows with persistent ketosis for 1 to 7 weeks usually have
hepatic lipidosis (Dx. Ultrasound examination or biopsy of the
liver)
Periparturient Ketosis
Cows that are overconditioned before parturition and have
periparturient ketosis (although a urine ketone test may be only
weakly positive) rapidly develop hepatic lipidosis and have life-
threatening illness.
Hypocalcemia
and Recumbency
Heavy weight
Fatal
myopathy
Excessive fat
deposition in the
liver
Diminished hepatic
macrophag (Kupffer
cells) function
Septic
metritis
Die
Septic mastitis with repeated
episodes of recumbency
Secondary Ketosis
Another
disorders
(ex. LDA)
Decline in
feed intake
directly
Increase in
plasma BHB
Ketosis

Clinical signs : related to the primary disease (most
often displaced abomasum)
Diagnoses : Urine ketostrips light purple
- -> dark purple (dehydrated)
Therapy : correct the primary problem, and the ketosis
should then resolve
If the ketosis persists primary ketosis (BHB >1400
mol/L)
Nervous Ketosis
Primary Ketosis
Hyperketonemia Hypoglycemia
Isopropyl alkohol Nervous signs
Acetoacetat
and BHB
levels
Clinical Signs
Hypomotile rumen
Ketotic breath odor
Head pressing
Apparent blindness
Excessive licking and chewing

Therapy
500 ml Dextrose 50% IV (1-2 kali)
Glucocorticoid (10-20 mg Dexamethasone) 1x
300 ml Propylene glycol orally (1 or 2 daily for 5
days)

Therapy for Pregnancy Ketosis
Rapid intervention to prevent irreversible hepatic
lipidosis and multiorgan failure
Induction of parturition or surgical delivery of the
calves may be required.
Intensive support of the cow with dextrose and force
feeding is necessary.
If therapy is discontinued in the first few days after
parturition, these cows often have serious,
sometimes fatal, relapses of ketosis within 48 hours.
Therapy Ketosis with Hepatic Lipidosis
5% glucose administration in balanced electrolyte
solutions with 40 mEq of KCl added per liter of fluid
Insulin (200 IU of zinc protamine) (SC) every 24 to
36 hours if a continuous glucose infusion is used
Niacin (12 g orally daily)
Multi B vitamin (2x per days)
Therapy Ketosis with Periparturient
Overweight and Hepatic Lipidosis
IV fluids glucose and calcium
Insulin
Flunixin
Lipotropic no significant
Prevent
Avoid overweight in the last pregnant
Nutrional management
Over-crowding and/or lack of bunk space can be
another cause of insufficient energy intake in early
lactation cows
Maximize energy intake in early lactation

Thanks