Case 3:  "Meg"

     History:  “Meg” freshened two weeks ago with twins.  The first calf had to be pulled with a calf-jack.  Two days ago, she was observed to be weak in her hind end and then down on the following day.  There is also an unclear history of the owner giving several doses of isoflupredone acetate (Predef) in the past couple days.  Isoflupredone is a glucocorticoid with some mineralocorticoid effects.  At this time, the owners called their veterinarian.
     The referring veterinarian found “Meg” to be down for the past 1 or 2 hours but bright, alert, chewing her cud, eating, and drinking.  The producer had started antibiotic therapy with Naxcel the day before.  The referring veterinarian gave a 50% dextrose combination (with isoflupredone and B-12), 500 mL calcium gluconate, and 500 mL cal-dex.  “Meg” attempted to stand but was unable to raise her hindquarters. 
Later that evening, bloodwork was drawn and “Meg” was given additional calcium gluconate, 500 mL CMPK, and intravenous banamine.  She was referred to NBC for further treatment.  Bloodwork from the referring veterinarian revealed hypophosphatemia (2.4, ref 4.1-9.2), elevated AST (340), and slightly elevated calcium (9.8).  Mg, BUN, TP, GGT and Albumin were all normal.  K+ was not done.

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