Recumbent Murrah Buffalo Three Weeks After Calving: Calcium, Ketones, or Both?
A 5-year-old Murrah buffalo in her second lactation calved 20 days ago and is now recumbent. She produces 9 L of milk daily and receives wheat straw, 4 kg of concentrate, and limited green fodder. The owner reports sudden inability to rise 12 hours ago. Rectal temperature is 38.1°C, heart rate 76/min, rumen contractions 1 per 3 minutes, and feces are dry. The buffalo is alert but depressed; her ears are cold. The udder is not hot or painful and the milk appears normal. Serum biochemistry shows calcium 6.8 mg/dL (reference 8.5–10.5), inorganic phosphorus 2.2 mg/dL (4–8), magnesium 2.1 mg/dL (1.8–2.4), glucose 38 mg/dL (45–75), and BHBA 3.6 mmol/L (<1.2). Urine ketone test is trace positive. There is no history of trauma, and the animal can bear weight on the forelimbs when lifted.
1. Rank the likely causes of recumbency and explain how the laboratory values shift your ranking. What two bedside checks would you still perform before committing to treatment?
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The ranking should be: (1) hypocalcemia complicated by negative energy balance, (2) clinical ketosis, and (3) hypophosphatemia contributing to muscle weakness. Calcium at 6.8 mg/dL is low enough to impair neuromuscular function, but recumbency at 20 days postpartum is atypical for classic milk fever, so I would not stop at that diagnosis. Glucose of 38 mg/dL with BHBA of 3.6 mmol/L indicates excessive fat mobilization and inadequate gluconeogenesis; the trace urine ketone supports ketosis. Phosphorus at 2.2 mg/dL can worsen weakness and recumbency even when calcium is corrected. Magnesium is normal, making hypomagnesemic tetany less likely.
Before treating, I would perform two bedside checks: a strip-cup and California Mastitis Test on all quarters to exclude toxic mastitis, and a careful musculoskeletal and nerve examination after lifting the buffalo, looking for hip injury, femoral nerve damage, or long-bone fracture. I would also check rumen pH and hydration. These checks matter because giving calcium to a cow with a fracture or toxic mastitis will not restore standing and may delay the real intervention.
2. Outline your first six hours of treatment, including monitoring endpoints and one intervention you would avoid.
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I would start with slow intravenous calcium borogluconate 25%, diluted in 1–2 L of isotonic saline, giving roughly 300–500 mL over 20–30 minutes while auscultating the heart every few minutes. I would stop or slow the infusion if bradycardia, arrhythmia, or a shortened QT interval appears. Because the buffalo is hypoglycemic and ketotic, I would give oral propylene glycol 300 mL twice daily and, if she remains weak, a slow intravenous dextrose infusion. I would correct phosphorus with oral sodium acid phosphate or a balanced calcium-phosphorus preparation rather than relying on calcium alone.
Monitoring endpoints are restoration of standing or stronger limb withdrawal, heart rate and rhythm, rumen contractions, appetite, and normalization of glucose and BHBA over 24–48 hours. I would avoid repeated blind calcium injections and avoid forced lifting with ropes, which can cause further muscle and nerve injury. I would also avoid long-acting corticosteroids unless adrenal insufficiency is documented.
3. The buffalo stands after eight hours but milk yield falls. What herd-level prevention plan would you give for the next calving season?
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The fall in milk yield suggests that recovery is incomplete and that the transition ration is still inadequate. For the herd, I would focus on the dry period and the three weeks before calving. I would body-condition-score every animal, avoid overconditioning, and formulate a close-up ration with controlled energy and adequate but not excessive calcium, plus balanced phosphorus and magnesium. If the farm has a history of milk fever, I would discuss dietary cation-anion difference with a nutritionist and monitor urine pH rather than using anionic salts blindly. I would also ensure palatable forage, trace mineral supplementation, and a gradual increase in concentrate after calving.
For this buffalo, I would continue propylene glycol for 3–5 days, monitor BHBA, and recheck calcium and phosphorus. At herd level, I would record every calving, recumbency case, and milk drop so that the next case is detected earlier. Prevention is more cost-effective than repeated emergency treatment, especially in a 9 L/day buffalo where a prolonged milk drop quickly exceeds the cost of ration correction.