What is milk fever
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milk fever hypocalcemia postpartum definition symptoms treatment
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I now have enough information to give a thorough answer. "Milk fever" is primarily a veterinary term but also has a human medicine usage. Let me compile the complete response.
Milk Fever
"Milk fever" is a term used in two distinct contexts - one in veterinary medicine (the primary and most common usage) and one in human medicine (historical/alternative term for postpartum/puerperal fever).
1. Veterinary Medicine: Milk Fever (Periparturient Hypocalcemia)
This is the predominant modern meaning of the term.
Definition
Milk fever is a metabolic disease caused by a sudden, severe drop in blood calcium (hypocalcemia) occurring in dairy cows (and occasionally goats, sheep, and dogs) around the time of calving/parturition. It is also called parturient paresis or periparturient hypocalcemia.
Why Does It Happen?
When a cow begins producing milk at calving, there is a massive demand for calcium to produce colostrum and milk. If the cow's body cannot rapidly mobilize enough calcium from bone or absorb it from the intestine, blood calcium levels fall. This is most common in:
- High-yielding dairy cows (2nd-5th lactation)
- Jersey and Guernsey breeds
- Older cows (the calcium mobilization response weakens with age)
Pathophysiology
- Normal blood calcium: ~2.1-2.5 mmol/L
- At calving, up to 30 grams of calcium may be secreted into colostrum daily
- The parathyroid hormone (PTH) / vitamin D axis is overwhelmed
- Flaccid muscle paralysis results from impaired neuromuscular transmission
Clinical Signs (Three Stages)
| Stage | Signs |
|---|---|
| Stage 1 (early) | Excitability, hypersensitivity, tetany, muscle tremors, loss of appetite |
| Stage 2 (classic) | Sternal recumbency, cold extremities, dry muzzle, tucked head, weak pulse, subnormal temperature |
| Stage 3 (late) | Lateral recumbency, bloat, inability to rise, coma, death if untreated |
Treatment
- Intravenous calcium borogluconate (400-800 mL of 23% solution given slowly) - the mainstay of treatment
- May be followed by subcutaneous calcium supplements
- Response is usually rapid (cow stands within 30-60 minutes)
- Monitoring for cardiac arrhythmias during IV administration is essential
Prevention
- Pre-calving low-calcium (anionic) diets
- Oral calcium supplements at calving
- Vitamin D and DCAD (dietary cation-anion difference) management
- Avoidance of pre-calving high-calcium diets
2. Human Medicine: Milk Fever / Puerperal Fever
Historically, "milk fever" in humans referred to a fever that appeared around day 2-3 postpartum, coinciding with milk "coming in." It was once believed that fever was caused by the milk itself. This is now understood to be puerperal (postpartum) infection - most commonly endometritis.
Puerperal Fever (Modern Understanding)
- Definition: Fever ≥38.0°C occurring on any 2 of the first 10 days postpartum (excluding the first 24 hours)
- Most common cause: Endometritis - infection of the uterine lining
- Affects ~5% of vaginal deliveries and ~10% of cesarean deliveries - Rosen's Emergency Medicine
Predisposing factors include:
- Operative delivery (C-section, forceps, vacuum)
- Prolonged rupture of membranes
- Prolonged 2nd-stage labor
- Frequent vaginal examinations
- Lack of prenatal care
Causative organisms: Gram-positive cocci, gram-negative coliforms, and anaerobes; less commonly Chlamydia and Mycoplasma spp.
Clinical features:
- Foul-smelling lochia
- Uterine tenderness
- Fever and abdominal pain (indicating greater severity)
- Elevated white blood cell count
Differential diagnosis of postpartum fever also includes:
- Perineal/wound infection
- Urinary tract infection
- Atelectasis
- Septic pelvic thrombophlebitis
- Deep venous thrombosis
- Mastitis
Treatment of endometritis:
- Clindamycin 900 mg IV every 8 hours + Gentamicin 5 mg/kg IV every 24 hours (covers gram-positive, gram-negative, and anaerobic organisms)
- Most patients require inpatient admission
Sepsis from puerperal infections accounts for up to 15% of maternal deaths worldwide - Rosen's Emergency Medicine.
3. Milk Fever in Dogs (Canine Eclampsia)
In dogs, "milk fever" (eclampsia or lactational hypocalcemia) is a life-threatening drop in blood calcium that typically occurs 1-3 weeks after whelping, when lactational demand is highest. Signs include muscle tremors, stiffness, hyperthermia, and seizures. Treatment is IV calcium gluconate.
Summary
| Context | Cause | Key Feature |
|---|---|---|
| Dairy cows (main usage) | Hypocalcemia at calving | Flaccid paresis, treats with IV calcium |
| Historical human use | Postpartum uterine infection | Fever, endometritis, treats with antibiotics |
| Dogs | Lactational hypocalcemia | Muscle tremors/seizures post-whelping |
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