Introduction • Hypomagnesaemia is a common feature of a group of syndromes chareterized by hyperaesthesia, incoordination, tetany and convulsions that can occur in all ruminants of all ages. • Name given to the syndrome affecting lactating cattle (beef or dairy cows) when grazing grass in the spring or autumn. • Also known as grass staggers, wheat-pasture poisoning, lactation tetany and hypomagnesemia, is a metabolic disorder of livestock. Introduction • Sub clinically occurs in lactating or dry usually not accompanied by clinical signs. • It usually affects the whole herd with slight nervous disposition, e.g. reluctance to enter the milking parlour. • Dry cows will be more prone to milk fever at parturition Introduction • Absorption of magnesium is influenced by factors including: – High levels of potassium, nitrogen and moisture content and low levels of sodium. – Mobilization of 70% magnesium which is found in bone and this portion is more labile in young animals making older cows more susceptible to developing the disease Introduction • The low availablity of Mg in forage may be from either low Mg concentrations or to factors in the forage that reduce availability of Mg to the animal • The winter type affects cattle fed winter rations in confinement. The out-winter type affects cattle in late winter that have been maintained thoughout the winter on sparse pasture plus some supplemental hay Classification • Classification by clinical types . • Tetanic syndrome type, which is characterized by nervousness, muscle twitching, ataxia, convulsions, recumbency with spasms, and opisthotonos. • The paretic type is characterized by listlessness, staggering, paresis, recumbency, and coma without spasms. • Subclinical types occur that are associated with depression of appetite and milk yield, slight nervousness,anemia, and udder edema. Classification by clinical sign cont.. • correlated with concentrations of Ca and Mg in blood • Disorders were classified into "milk fever" types and "grass tetany" types of syndromes. Combinations of changes in blood were: – a) hypocalcemia combined with hypermagnesemia; – b) hypocalcemia combined with normal magnesemia; – c) hypocalcemia combined with hypomagnesemia; and – d) normal calcemia combined with hypomagnesemia. • The first two types (milk fever) were characterized by gut stasis, paresis, coma, and low body temperature; • the last two types (grass tetany) were characterized by excitement, tetany, and convulsion Aetiology • The reduction of the amount of magnesium available in the food, and hence available for absorption from the gut, accompanied by a high physiological demand for magnesium. • Magnesium is lost from the body in milk, urine and faeces. • The endogenous 1.8g/day . Milk contains 0.12 g/l of magnesium so a cow producing 30 kg of milk would lose 3.6 g daily in the milk. • Any excess magnesium absorbed will be excreted via the urine, this being the mechanism for stabilizing plasma magnesium levels. Aetiology • If the plasma magnesium levels rise much above 0.8 mmol/l (2.0mg/100ml) the excess will be excreted. • If magnesium intake levels are excessive, up to 5.0 g/day may be excreted in the urine. • To maintain magnesium homeostasis the absorption of magnesium must be continuous so a constant supply is necessary in the diet. • Feeds vary considerably in both the content and the availability of magnesium so the choice of pasture is important. • Clovers have higher magnesium content than grasses and grasses themselves vary. Cause • Rapidly-growing and lactating animals have a higher requirement than non-lactating slow-growing animals. • Cows in their third to fifth lactation have an increased risk of developing hypomagnesaemia due to increased production and reduced age-related mobilization of magnesium from bone. • Low magnesium in soil pastures grown on soils that are low in available magnesium and high in available potassium. • Lush pasture • High levels of potassium from fertilisers. • High levels of ammonia (from nitrogenous fertilisers) inhibit magnesium absorption. Cause • The energy intake of the animals. Calcium, potassium and ammonium (nitrogen) ions are all thought to interfere with body uptake of magnesium. • Magnesium seems to be absorbed from most areas of the gastrointestinal tract; however, net absorption is thought to be greatest in the tureen, reticulum, and possibly omasum and colon. The amount of Mg absorbed at a particular site does not seem to be related specifically to metabolic requirements for Mg but to intraluminal concentration of available Mg at a given site. The percentage of Mg absorbed from the gut is relatively small as compared with the amount of Mg ingested; however, when dietary Mg is adequate, the amount of Mg absorbed is large as compared with metabolic needs for Mg. Individual cows most prone to hypomagnesemia have a reduced ability to absorb Mg from the gut Economic implications • Annual incidence of acute hypomagnesaemia around 0.5 per cent. • Many cows found dead. Types of Grass Tetany • The spring type affects lactating cows a few days after they are put out on grass. • The winter type affects cattle fed winter rations in confinement. • The out-winter type affects cattle in late winter that have been maintained thoughout the winter on sparse pasture plus some supplemental hay Classification of GT, • Cinical types: most common type is the tetanic syndrome type, which is characterized by nervousness, muscle twitching, ataxia, convulsions, recumbency with spasms, and opisthotonos. • The paretic type is characterized by listlessness, staggering, paresis, recumbency, and coma without spasms. • Subclinical types occur that are associated with depression of appetite and milk yield, slight nervousness, anemia, and udder edema. • clinical signs associated with ataxic and recumbent cases of "metabolic disorders" have been correlated with concentrations of Ca and Mg in blood . CLASSIFICATION OF GT • Milk fever" types and "grass tetany" types of syndromes. • Combinations of changes in blood were: • a) hypocalcemia combined with hypermagnesemia; milk fever were characterized by gut stasis, paresis, coma, and low body temperature; Concentration of blood Ca seems to be the distinguishing feature, and concentration of blood Mg seems to be the distinguishing feature in the GT type of disease • b) hypocalcemia combined with normal magnesemia; characterized by excitement, tetany, and convulsions. • c) hypocalcemia combined with hypomagnesemia • d) normal calcemia combined with hypomagnesemia, hypomagnesemic and normocalcemic • An intermediate type of disease cows developed low blood Ca and Mg and violent tetany near parturition. The cows responded to treatment with calcium gluconate. Factors Influence Development of GT. • Decreases in blood Mg concentrations seem to be the primary predisposing factor for GT. • Magnesium seems to be absorbed from most areas of the gastrointestinal tract; however, net absorption is thought to be greatest in the tureen, reticulum, and possibly omasum and colon. • when dietary Mg is adequate, the amount of Mg absorbed is large as compared with metabolic needs for Mg Factors Influence Development of GT. • Reduced ability to absorb Mg from the gut . • Small intestine have net secretion of Mg. • Potassium ions have a marked inhibition on Mg transport across the rumen wall. Thus, a forage high in K and low in Na (and the decrease of the Na/K ratio in the saliva that results profound effects on Mg transport in fore stomachs of ruminants and contribute greatly to the pathogenesis of GT. Factors Influence Development of GT • Binding of Mg and Ca by organic material in digesta may have significant effects on Mg and Ca absorption. • high ruminal ammonia concentrations decreased availability • Drastically reduced ultrafilterable Mg concentrations were found in the small intestine of sheep when the ration was changed from hay and concentrate to cut grass rich in crude protein. • Marked reduction in food intake decreases the ability of cows to maintain Mg and Ca homeostasis , especially in lactating animals . • Kidneys contribute to conservation of Mg under conditions of hypomagnesemia and, thus, play an important role in Mg homeostasis. urinary Mg concentrations of less than 1 mg/100 ml were typical of cows with GT decreased urinary Mg concentrations before serum Mg had decreased below 1.8 mg/100 ml Factors Influence Development of GT • Biochemical Changes, changes in blood Ca seem to be of pivotal pathophysiologic importance in development of GT. • endocrine changes in cows parathyroid hormone (PTH) increases in blood may not be sustained as the hypomagnesemic-hypocalcemic type of grass tetany develops. However, blood PTH concentrations appropriately increase in cows developing wheat pasture poisoning (WPP), in which hypocalcemia is the predominant change, and blood Mg concentrations decrease only moderately. Plasma concentrations of the active metabolite of vitamin D, 1,25-(OH)2D, seem to increase appropriately in cows affected with both GT and WPP Factors Influence Development of GT • Availability of Ca from bone reserves of animals with either GT or WPP may markedly decrease, as indicated by a progressive decrease in blood hydroxyproline concentrations in animals . • Deficiency of Mg or inappropriately low PTH, or both, may lead to a refractory condition of bones such that they cannot function as an effective source of Ca even when severe hypocalcemia develops. • If both dietary and bone sources of Ca and Mg are reduced in the face of a relatively large lactational demand for Ca and Mg, it is not surprising that there is an acute disruption of normal Ca and Mg homeostasis. • Thus marginal supply of dietary Ca and Mg of animals grazing tetany-prone forage may be reduced . • Rapid growth of forage, inappetance, or interruption in supply of supplemented Ca or Mg. Factors Influence Development of GT • Decreases concentrations in cerebrospinal fluid (CSF) • Decreases in CSF Mg in cows and sheep with GT reflect inadequate maintenance of animals leads to the proper ionic concentrations (Mg) in the interstitial fluid of the central nervous system (CSN), which leads to abnormal CSN function • Four principal types of lesions • a) hemorrhagic, Widespread vascular lesions, hemorrhagic edema, and calcification in cows with GT may alter transport of Mg into the CNS and other functions also and may explain some of the clinical signs and pathogenesis of GT • b) vascular, • c) deposition of Ca salts, and • d) degeneration of parenchymatous organs.. Neuromuscular Pathogenesis • Potassium ions have a marked inhibition on Mg transport across the rumen wall. Thus, a forage high in K and low in Na (and the decrease of the Na/K ratio in the saliva that results from consumption of these types of forage) could have profound effects on Mg transport in forestomachs of ruminants and contribute greatly to the pathogenesis of GT Pathogenesis • Binding of Mg and Ca by organic material in digesta may have significant effects on Mg and Ca absorption. • One factor influencing Mg availability for absorption that has not been investigated in detail is the incorporation of Mg into rumen microbes • High ruminal ammonia concentrations decreased availability of Mg in forage. Pathogenesis • availability of ingested Mg decreased when rumen ammonia concentrations were increased in a cow fed hay and concentrate. Drastically reduced ultrafilterable • Marked reduction in food intake decreases the ability of cows to maintain Mg and Ca homeostasis • especially in lactating animals Kidneys contribute to conservation of Mg under conditions of hypomagnesemia and, thus, play an important role in Mg homeostasis. Pathogenesis • urinary Mg concentrations of less than 1 mg/100 ml were typical of cows with GT • decreased urinary Mg concentrations before serum Mg had decreased below 1.8 mg/100 ml, which is thought to be the renal threshold for Mg Pathogenesis Pathogenesis Pathogenesis • endocrine changes. Apprently, appropriate parathyroid hormone (PTH) increases in blood may not be sustained as the hypomagnesemic-hypocalcemic type of grass tetany develops. • Blood PTH concentrations appropriately increase in cows developing wheat pasture poisoning (WPP), in which hypocalcemia is the predominant change, and blood Mg concentrations decrease only moderatly. • Plasma concentrations of the active metabolite of vitamin D, 1,25-(OH)2D, seem to increase appropriately in cows affected with both GT and WPP Pathogenesis • Gross, Histologic, and Subcellular Changes in Cattle with GT. Gross, histologic, and subcellular pathology of the various forms of GT • . Four principal types of lesions were described: – a) hemorrhagic, – b) vascular, – c) deposition of Ca salts, and – d) degeneration of parenchymatous organs. Widespread vascular lesions, hemorrhagic edema, and calcification in cows with GT may alter transport of Mg into the CNS and other functions also and may explain some of the clinical signs and pathogenesis of GT. SUBACUTE SIGNS • SUBACUTE,: apprehensive and hyperaesthetic. The head will be held high and tremors may be seen around the head (particularly the eyelids), over the shoulder and on the flank. These tremors will be exaggerated if the animal is touched or the skin pinched. The legs may become stiff and a staggering gait may be evident. • in the subacute phase for several hours or progress to the acute or peracute form, particularly in response to noise or some other stimulus such as attempting to herd them. The cows may be slightly nervous, reluctant to enter the milking parlour or be unwilling to be herded. The milk yield will be depressed slightly. The signs of milk tetany in calves are much the same as for cows with subacute, acute and peracute cases occurring ACUTE SIGNS • ACUTE last for up to an hour or more. In these cases a period of convulsions will be followed by a quiescent period in which the cow may attempt to rise, only to walk a few steps and fall over again followed by convulsions. The rectal temperature, elevated by 1 or 2°C (2–4°F). Cows are often found dead with obvious signs that the limbs had been paddling prior to death, thus disturbing the soil around the feet • PERACUTE. stagger for a few steps and fall over with tetanic spasms of the head, neck and legs followed by clonic convulsions. The legs will paddle furiously, the eyes roll and there is frothing at the mouth. The heart will pound fast and furious and death can occur at any time. Cows have been known to be grazing one minute and, in response to noise from a vehicle or other stimulus, to stagger, fall over in convulsions and die in two or three minutes. Often in peracute cases the animals are found dead Clinical pathology • Healthy normal cows should possess plasma magnesium levels over 0.85 mmol/l (2.0mg/100ml). • Acute cases the plasma levels will generally be below 0.4mmol/l (1.0mg/100ml). • Magnesium levels in the CSF in acute tetany will generally be below 0.6mmol/l (1.4mg/ 100ml). Hypocalcaemia is present in at least 80 per cent of acute tetany cases and hyperkalaemia is common. • Following tetany or in recovered cases aspartate aminotransferase (AST) and creatine kinase (CK) levels will rise to relatively high levels but return to normal quite soon after recovery Clinical pathology • At post mortem there are no pathognomonic signs. Haemorrhages may be present on the heart muscle and occasionally along the aorta. Regurgitation and aspiration of rumen contents may sometimes be seen. • The CSF levels of magnesium will be low and magnesium will be absent from the urine, although the bladder is nearly always empty at post mortem. Diagnosis • By clinical sign and symptoms • Blood biochemistry, • If animals are found dead then diagnosis must be differentiated from other causes of death. • Quantities of soil have been gouged out of the ground by each of the four feet during the paddling phase this is strongly indicative of acute grass staggers • . Diagnosis • Urine test strips are available in some countries. problems in getting a number of cows to micturate on demand. • Rib or coccygeal bone is usually used for this purpose. • A calcium/magnesium ratio in bone of 70 :1 is considered normal and 90:1 considered an indication of severe magnesium depletion Differential diagnosis • Acute lead poisoning: excitement and occasional convulsions. Hyperaesthesia, as measured by observing muscle tremors in response to pinching the skin, will be absent and blindness is usually a feature of lead poisoning. • Milk fever The history of being close to parturition • Acetonaemia licking the walls and floor or biting at gates, will usually distinguish this disease Differential diagnosis • Listeriosis :high rectal temperature and absence of true hyperaesthesia in listeriosis cases should be enough to distinguish this disease. • Bovine spongiform encephalopathy test the Mg level • Lightning strike Treatment • Discard 100ml of fluid from a 400ml bottle of 40 per cent CBG, which also contains magnesium 0.2 per cent and phosphorus 0.5 per cent, and replace this with 100ml of 25 per cent magnesium sulphate solution. • The mixture, which then contains 9g of calcium and approximately 6g of magnesium, is infused intravenously very slowly, taking 8–10 minutes. • The remaining 300ml of the original 400 ml 25 per cent magnesium sulphate is injected subcutaneously Prevention • Add calcined magnesite (magnesium oxide) to cattle concentrate that is being fed to the cows. • Dusting the pastures with magnesium oxide has been attempted using 50g/cow per day of magnesium oxide,or 0.5 kg/week applied in the early morning when the dew is on the grass. • Magnesium acetate via a water proportioner is effective • Magnesium chloride crystals to the drinking water