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Pregnancy Care & Concerns

Pregnancy Toxemia and ketosis
By Robin Walters
Oct 28, 2002, 10:07am

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Robin Walters

Pregnancy toxemia and ketosis are the result of the high carbohydrate
(energy) demand of multiple fetuses in late pregnancy. The kids require an
increasing amount of carbohydrates the last trimester. Does bearing twins
have a 180% higher energy requirement than those with just a single fetus.
Does carrying triplets have a 240% greater energy requirement. When this
demand exceeds the supply, fat is metabolized into glucose. The metabolic
needs of the kids are met at the expense of the dam; this is what causes the
ketotic condition. To complicate matters, multiple fetuses produce more
waste products, which leads to the doe becoming toxic if she does not flush
them from her system.

Risk Factors for Pregnancy Toxemia
Multiple fetuses
Poor quality of ingested energy
Dietary energy level
Environment
Genetic factors
Obesity
Lack of good body condition or high parasite load
Confinement - lack of exercise

Toxemia and ketosis are typically seen in does that are overweight and get
little exercise. Under weight animals that are fed a poor quality feed are
also candidates for toxemia. Look for does at the bottom and top of the
pecking order. These does may be getting to much or not enough feed. Does
should be in good body condition, and not overly fat when bred. They can be
maintained on good roughage or forage during the first 100 days of
pregnancy. During the last trimester the doe should gain approximately 1/2
lb. per day. The doe must intake enough carbohydrates to supply the demand
of the growing fetuses and to keep her alive and functioning also.

I also believe that you see an increase in toxemia during extended drought
or rainy conditions. Severe weather conditions cause the quality of the feed
change, limits and changes the available browse, and the animals do not
receive the vitamins and minerals that they get naturally from high quality
feeds and browse. Extremely wet conditions, especially if following a
prolonged drought can also cause a dramatic and quick increase in the worm
load, and cause the doe to drop enough body condition to become a candidate
for toxemia.

When there is a decrease of glucose levels in the doe's brain, they tend to
lie down, become sluggish, and show a loss of appetite. They may get stiff,
and walk with a staggering gait. Swelling (edema) of the lower limbs is not
uncommon. Some does may also grind their teeth. Keto-acidosis is also common
during toxemia and needs to be treated daily. As the disease progresses, the
neurological systems become compromised due to lack of glucose. Blindness,
stargazing, tremors, aimless walking, ataxia (uncoordinated staggering
gait), are seen and eventually the doe becomes comatose. At this stage the
fetuses succumb and release toxins that send the doe into endotoxic shock,
and death. Does that survive toxemia need to be watched for dystocia, and
lactational ketosis.

Diet should include high quality roughage and increased concentrates. At
first sign of decreased appetite, or unwillingness to rise, managers need to
be wary. Exercise should be offered and forced if necessary. Some type of
high-energy supplement needs to be given to keep the doe from coming
ketotic. The carbohydrate (energy) level of the diet needs to be increased.
This can be accomplished by adding corn, fresh alfalfa hay, or a soybean
supplement to the diet. Increasing the protein does not necessarily increase
the energy level.

High Energy Supplements
Propylene Glycol
Nutri-drench
Dextrose
TKM Solution
Magic (1 part Molasses, 2 parts Kayro, 1 part Corn Oil)
Glucose IV
If the kids are within 7 days of due date, and the doe does not respond
immediately to treatment, giving 20-25mg dexamethasone can induce labor.
Labor will begin within 48 hours. Dexamethasone is preferred over hormonal
induction of parturition because of its beneficial stimulus to appetite.
Also, dexamethasone may also prepare the lungs of marginally immature kids
increasing their chances of survival during labor or cesarean. Valuable does
that fail to respond within 24 hours should have a cesarean immediately.
Even with surgery and fluids, prognosis is poor for the survival of both the
doe and kids. If valuable does don't respond to treatment early termination
of the pregnancy should be considered.

The key to treating toxemia is catching the subtle symptoms promptly. Fist
concern is to hydrate the doe and get enough sugars to the brain to get if
functioning properly. We have been successful treating does with the
following mixture:

TKM Solution
3- 500ml bottles Dextrose
3- 500ml bottles of Amino Acid Solution (not concentrate)
1 - 500ml bottle Calcium Glutenate 23%
(This can be mixed up ahead of time & stored in a cool dry place)
The goat also needs to receive the following - they need to be added when
you get ready to administer the dose:
Fortified B Complex - 5ml daily
Thiamine - daily
Vitamin C & E Supplements - daily
Probiotics - I give a double calf dose every time I treat. If this doesn't
stimulate their appetite, add 1 teaspoon of baking soda daily (add after you
have mixed everything together!)
I prefer the Loveland Industries Calf Pak for probiotics. When choosing
probiotics make sure you purchase one that contains viable (live)
probiotics. Be careful in handling probiotics; don't leave out in extreme
heat or cold. The refrigerator is a good place to store them. For the
Vitamins I have had a lot of success using Capra Products Capra-Tech 100 to
provide the C & E, and the Capra Cool for the thiamin & additional
probiotics. This seems like a remarkable amount of probiotics, but you are
fighting a metabolic disorder that is on going. You will not cure it, but
you can add support to enable the doe to live through pregnancy and
hopefully deliver live kids. We give 20-60cc magic twice daily at first
signs of toxemia. If the doe is completely off feed or becoming lethargic we
give a loading dose of 4-8oz. of the TK Solution. It is then repeated every
hour (2-4oz.) until the doe is standing, drinking, and urinating. We have
also found it helpful to give an equal amount of water (drench if necessary)
at every treatment. Once these does quit moving, they don't get up and
drink, as they should.

Be cautious given electrolytes or products that are high in sodium or
potassium. Although in a pinch they will work to hydrate the animal, you
don't want to give long term anything that has a lot of potassium in it.
That is why we use the dextrose instead of oral electrolytes. You need to
make sure that the doe urinates, giving a mild diuretic such as cranberry
juice may also be helpful. The does need to flush the toxins from their
system.

When the doe starts to respond we start decreasing the treatment intervals.
Treatment is dropped to 3-4 times a day, and if the doe is back on her feed
and eating well, we just give the magic mixture two to three times daily. We
have treated does successfully with 100-500ml of the TKM solution given
daily. Amount needed varies with each individual doe. The doe may scour the
first couple of days & Pepto-Bismol or Kaopectate can be given to relieve
the dietary scours. Don't be terribly concerned if the doe scours it is
caused by the drastic dietary changes and will clear up as the doe continues
to eat.

Propylene glycol can be given orally at the rate of 4 ounces, 4 times daily.
Nutri-drench can be substituted for propylene glycol, and is easier to dose
orally - it doesn't taste quite as offensive to the doe. Intravenous glucose
(25-50 grams - in a 5 or 10% solution), and B Vitamins, can also be given.
If probiotics are not available give baking soda orally to prevent acidosis
these need to be given at least once a day. Dextrose (50%) can be given IV
in a single 60-100ml dose, followed by a 5% dextrose solution in an
electrolyte drip.

Keto-acidocis is precipitated by metabolism of fat. When the doe is not
consuming an adequate amount of carbohydrate, that she metabolizes fat to
make glucose. The byproduct of this is ketones, which must be secreted by
the kidneys. The doe must have a fluid intake to allow this to happen. That
is why plain water is given, drenched, or tubed, along with the 50% glucose,
and other support therapy. When enough glucose is present, fat is not
metabolized, and the body has time to get rid of it. As this happens, the
doe will become more alert, and start to eat and drink on her own. This is a
vicious cycle, and difficult to break. If caught early, and treated
conscientiously, the cycle can be broken. The doe must be monitored
carefully until the kids are born, condition can change quickly and needs to
be responded in a timely fashion.

Does that have prolonged battles with toxemia and/or ketosis sometimes have
difficulty kidding. Dystocia is common due to the lack of exercise. The
uterus tends to loose muscle tone and often the kids must be pulled. The
does lack condition or energy to birth them unassisted. After kidding I feel
it is very important to leave the kids with the doe, even if you have to
supplement them. The kids will stimulate the doe's will to live. Continue
treatment three to four days after kidding to prevent a relapse.

Sources:
8th Edition Merck Veterinary Manual
Goat Medicine (Dr. Smith & Sherman)


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