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CLINICAL CASE OF PREGNANCY TOXAEMIA IN A GOAT: A CASE REPORT ON

VETERINARY MEDICINE APPROACH

Article · July 2016

DOI: 10.5455/ijlr.20160613094613

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 Vol 6(6) June’16
International Journal of Livestock Research eISSN : 2277-1964

Clinical Case of Pregnancy Toxaemia in a Goat - A Case Report on

Veterinary Medicine Approach
Faez Firdaus Abdullah Jesse1*, Eric Lim Teik Chung1, Wan Nurhakimah Wan Zakaria1,
Yusuf Abba2, Muhammad Abubakar Sadiq1, Konto Mohammed1, Abdulnasir Tijjani1,
Lawan Adamu3, Idris Umar Hambali1, Asinamai Athliamai Bitrus2, Mohd Azmi Mohd
Lila2, Abdul Wahid Haron1 and Abdul Aziz Saharee1
1
Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, Universiti Putra Malaysia,
43400 Serdang, Selangor, Malaysia,
2
Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, Universiti Putra
Malaysia, 43400 Serdang, Selangor, Malaysia,
3
Department of Veterinary Medicine, Faculty of Veterinary Medicine, University of Maiduguri,
PMB1069, Borno State, Nigeria.

*Corresponding author: jesseariasamy@gmail.com

Rec. Date: May 15, 2016 23:38

Accept Date: Jun 13, 2016 09:46
Published Online: June 21, 2016
DOI 10.5455/ijlr.20160613094613

Abstract
A pregnant Jamnapari doe was presented with primary complaint of inappetance and recumbency for a
week. The most prominent abnormality during physical examination was weakness in both hind limbs
typified by difficulty in standing. Ultrasonography revealed that the doe were carrying three viable
foetuses that were about 4-months old. Hemato-biochemistry findings showed hypocalcaemia
(1.98mmol/L) and hypoglycaemia (2.2mmol/L). Besides that, ketone bodies were also detected from the
urine (3+ or 8mmol/L). The doe was treated vigorously for pregnancy toxaemia with 1L of Glucose 20%
(G-20) and 5L of 0.9% NaCl, administered intravenously BID for 3 days as glucose replacement and
rehydration respectively. 30mL of propylene glycol was also given orally BID for 7 days as glucose
precursor. Flunixin meglumine 2.2mg/kg was administered intramuscularly SID for 3 days as non-
steroidal anti-inflammatory. In addition, 20mL of theracalcium was given intramuscularly SID for two
days and 5mL of Catosal® was given intramuscularly SID for 6 days for calcium supplement and to
stimulate body metabolism respectively. One vial (2ml) of methylcobalt was administered intramuscularly
SID for 3 days as a nerve supplement and physiotherapy was performed after caesarean section for 10
minutes TID for 6 days in order to increase blood circulation and prevent muscle atrophy. However, the
does’ condition started to deteriorate on Day 7 and caesarean was performed on the same day where
three foetuses were saved. The doe’s condition improved tremendously and was discharged after a week
of caesarean section. This clinical case reports the clinical management of pregnancy toxaemia in a goat,
which is a common problem in small holder farms in Malaysia.

Key words: Doe, Pregnancy Toxaemia, Clinical Management, Treatment

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How to cite: Jesse, F. F. A., Chung, E. L. T., Zakaria, W. N. W., Abba, Y., Sadiq, M. A., Mohammed, K.,
Tijjani, A., Adamu, L., Hambali, I. U., Bitrus, A. A., Lila, M. A. M., Haron, A. W. & Saharee, A. A. (2016)
Clinical Case of Pregnancy Toxaemia in a Goat - A Case Report on Veterinary Medicine
Approach. International Journal of Livestock Research, 6 (6), 76-81.doi:10.5455/ijlr.20160613094613

Introduction

Pregnancy toxaemia in small ruminant occurs during late gestation and is characterized by feed rejection
and neurological signs leading to comatose and death (Kahn and Line 2005). This disease happens due to
lack of glucose as an energy source either due to poor nutrition or excessive demand from multiple
foetuses or combination of the two (Tinkler 2014). The body of the doe that has multiple foetuses and
being fed with low energy feed will utilise alternative sources of energy by producing glucose from other
non-carbohydrate substances such as fat to facilitate glucose to the foetuses (Brozoz et al., 2011). When
the body mobilizes more fatty tissue, ketone bodies are produced and are released into the blood causing
an increase in hepatic fat accumulation leading to hepatic lipidosis. Obese does carrying multiple foetuses
are at higher risk because of the limited rumen space for adequate intake of feed (Jones and Navarre
2014). In severe outbreaks, morbidity can reach up to 20% with a mortality rate of 80% of affected
animals (Ismail et al., 2008). Early clinical signs of pregnancy toxaemia in ewes and does include
inappetance, listlessness, aimless walking, muscle twitching, fine muscle tremor, opisthotonos, and
grinding of teeth. As the condition progresses, blindness, ataxia and finally recumbency, coma and death
will occur in animals that are not diagnosed and treated with the condition (Kahn and Line 2005; Abba et
al., 2015). The main objective of treatments in pregnancy toxaemia is to increase the formation of glucose
for utilization at tissue level, and increase the usage of ketone bodies to prevent acidosis and electrolytes
disorder. However, treatments with drugs are only effective in an early disease diagnosis where prognosis
is always grave if the animals start showing irreversible neurological injuries (Cal-Pereyra et al., 2015).
Euthanasia or removal of foetuses should be considered in advance stages of the disease or in heavily
pregnant doe that does not response well to treatment due to the high glucose demand (Lima et al., 2012).
According to Olfati et al (2013), treatment of pregnancy toxaemia is usually unsuccessful and prevention
is the key in reducing the occurrence of this disease. This manuscript describes the clinical approach in
management of pregnancy toxaemia in a doe. This clinical case management highlighted that institution
of correct treatment at the right time was able to give better prognosis and success.

Case Report
Patient Signalment
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A Jamnapari doe weighing 50kg during last trimester of pregnancy was presented with primary complain
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of inappetance and recumbency for a week. The doe was managed intensively and was fed with cut

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shrubs, pellets, brewer’s grains and supplemented with calcium powder. The vaccination and deworming
status were not up-to-date.

Physical Examination
The doe was presented on sternal recumbency with body score of 2 out of 5. Physical examination
findings of the doe were having pyrexia at 39.8°C, congested mucous membrane with capillary refill time
of more than 2 seconds and weakness of both hind limbs.

Laboratory Investigation and Results

Ultrasonography revealed that the doe was carrying three viable foetuses that were about 4-months old.
Hemato-biochemistry findings showed hypocalcaemia at 1.98mmol/L (Ref: 2.2-3.2) and hypoglycaemia
at 2.2mmol/L (Ref: 3.5-7.1) due to increased demand in calcium for foetal bone development and glucose
for foetuses development, respectively. Besides that, ketone bodies were also detected in the urine (3+ or
8mmol/L). Based on the history, clinical signs and diagnostic work-ups, the doe was diagnosed with
pregnancy toxaemia.

Treatment
The doe was treated promptly and vigorously for pregnancy toxaemia. 1L of Glucose 20% (G-20) and 5L
of 0.9% NaCl were administered intravenously BID for 3 days as glucose replacement and rehydration,
respectively. 30mL of propylene glycol was also given orally BID for 7 days as glucose precursor.
Flunixin meglumine (2.2mg/kg) was administered intramuscularly SID for 3 days as non-steroidal anti-
inflammatory. Besides that, 20mL of theracalcium was given intramuscularly SID for two days and 5ml
of Catosal was given intramuscularly SID for 6 days for calcium supplement and to stimulate body
metabolism respectively. In addition, 1 vial (2mL) of methylcobalt was administered intramuscularly SID
for 3 days as nerve supplement and physiotherapy was performed on the doe 10 minutes TID for 6 days to
increase blood circulation and to prevent muscle atrophy.

Progression
The doe was bright, alert and responsive with increase in appetite after 2 days of hospitalization.
However, the does’ condition starts to deteriorate again on Day 7, and caesarean section was performed
on the same day. Three foetuses were saved from the surgery, but one died a day after the surgery. The
doe’s condition improved tremendously and was discharged home a week after the surgery.
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Discussion
According to Edmondson et al (2012), pregnancy toxaemia can be divided into four categories.
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1) The first category is primary pregnancy toxaemia where inadequate nutrition such as poor quality
feed or period of fasting that occurs in a doe.
2) The second category is fat doe pregnancy toxemia which is due to over-conditioned during early
gestation then the animal suffer a nutritional decline during late gestation.
3) Third is severely under-conditioned does due to lack of feed after drought or after heavy flood.
4) Lastly is secondary pregnancy toxemia due to concurrent disease such as parasites, poor dentition, or
lameness.
In this present case, the doe may be suffering from category (1) and (4) pregnancy toxaemia where poor
quality of feed was fed throughout the gestation period and the doe was having lameness during the late
gestation period. Based on Tinkler (2014), clinical signs such as anorexia, depression and separation from
the herd are the first step in diagnosis of pregnancy toxaemia in a pregnant doe which were the primary
complaint in the present case. As the disease progressed, animal will start showing neurological signs
include depression, tremors, star-gazing, ataxia, circling, teeth grinding and blindness due to
encephalopathy that result from hypoglycaemia (Andrews 1997). In the final stage without proper
diagnosis and treatment, affected animal will be in recumbency and coma where the prognosis at this
stage is very poor with low survivality rate (Tinkler 2014). Next, laboratory diagnosis of serum beta-
hydroxybutyrate (BHB), glucose, calcium, potassium parameter and urine ketone level can be performed
to further diagnose pregnancy toxaemia (Ramin et al 2007). BHB is one of the ketone bodies found from
metabolism of fat but was not measured in this case because urine ketone concentrations are more
sensitive and specific compared to serum BHB (Edmondson et al 2012). In cases of pregnancy toxemia,
there will be hypoglycemia where the glucose level is less than 2mmol/L and urine ketone level will be
elevated more than 0.7mmol/L which was both observed in the present case.
The main therapeutic plan in pregnancy toxaemia is to restore the glucose metabolism and dehydration
status, which were the main focus in this case (Ermilio and Smith 2011). In the present case, the doe was
promptly administered dextrose and fluid therapy to replace the glucose and electrolyte loss, as well as to
rehydrate and at the same time to flush out the ketone bodies. Oral replacement of glucose with 30 to 60
mL of propylene glycol twice a day as glucose precursor also must be given (Andrews 1997; Pugh 2002).
In addition, propylene glycol also inhibits rumen bacteria to prevent production of volatile fatty acid
(Olfati et al., 2013). Similarly, as it was in this case, caesarean is highly recommended in advanced stages
of the disease or in heavily pregnant doe that do not respond well to treatment due to the high glucose
demand (Brounts et al., 2004; Lima et al., 2012; Abba et al., 2015).
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There are few important points to be noted in the control and prevention of pregnancy toxaemia; high-
energy supplement feed such as 0.5-1 kg of cereal grain such as corn, oats, barley or combination should
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be given during the final months of gestation (Edmondson et al., 2012). Besides that, free choice of trace

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mineral salt and clean water should always be provided ad-libitum to the animal (Tinkler 2014). Animals
need to be regrouped based on the stage of pregnancy and evaluation body condition scores (BCS). BCS
of 2.5 to 3.5 should be achieved one month before kidding and 2.0 to 2.5 at kidding (Cannas and Pulina
2008). Addition of high-energy feeding to thin does with BCS of less than 2 should be performed and
revaluation of the condition can be done every 2 weeks (Fthenakis et al., 2012). All these can be achieved
with good herd health management emphasising on the nutrition, reproduction, housing, and welfare of
the animals which will eventually help prevent disease development and outbreaks in order to reduce
economic losses (Abdullah et al., 2015). In summary, this present case reports the clinical approach in the
management of a clinical case of pregnancy toxaemia in a doe, where prompt treatment at the right time
was able to give better prognosis to the dam and the foetuses.

Conclusion
Glucose is the major source of energy to the foetuses in pregnant animal. Pregnancy toxaemia results
from disruption of the glucose homeostatic mechanism in response to increased nutritional demands of
rapidly developing foetuses. Early treatment is very crucial to save the life of the dam and the foetuses.
Treatment is benefited from early investigation, which includes timely diagnosis and immediate
administration of energy sources to affected animals.

Acknowledgement
The authors wish to acknowledge the supporting staff of University Veterinary Hospital, University Putra
Malaysia in particular Mr. Mohd Jefri Norsidin and Mr. Nazim Razali Kanani for their technical help and
support.

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