title: Construction and validation of a decision tree for treating metabolic acidosis in calves with neonatal diarrhea.
abstract: BACKGROUND
  The aim of the present prospective study was to investigate whether a decision tree based on basic clinical signs could be used to determine the treatment of metabolic acidosis in calves successfully without expensive laboratory equipment. A total of 121 calves with a diagnosis of neonatal diarrhea admitted to a veterinary teaching hospital were included in the study. The dosages of sodium bicarbonate administered followed simple guidelines based on the results of a previous retrospective analysis. Calves that were neither dehydrated nor assumed to be acidemic received an oral electrolyte solution. In cases in which intravenous correction of acidosis and/or dehydration was deemed necessary, the provided amount of sodium bicarbonate ranged from 250 to 750 mmol (depending on alterations in posture) and infusion volumes from 1 to 6.25 liters (depending on the degree of dehydration). Individual body weights of calves were disregarded. During the 24 hour study period the investigator was blinded to all laboratory findings.
  
  
  RESULTS
  After being lifted, many calves were able to stand despite base excess levels below -20 mmol/l. Especially in those calves, metabolic acidosis was undercorrected with the provided amount of 500 mmol sodium bicarbonate, which was intended for calves standing insecurely. In 13 calves metabolic acidosis was not treated successfully as defined by an expected treatment failure or a measured base excess value below -5 mmol/l. By contrast, 24 hours after the initiation of therapy, a metabolic alkalosis was present in 55 calves (base excess levels above +5 mmol/l). However, the clinical status was not affected significantly by the metabolic alkalosis.
  
  
  CONCLUSIONS
  Assuming re-evaluation of the calf after 24 hours, the tested decision tree can be recommended for the use in field practice with minor modifications. Calves that stand insecurely and are not able to correct their position if pushed require higher doses of sodium bicarbonate, if there is clinical evidence of a marked D-lactic acidosis. In those calves, determining the degree of loss of the palpebral reflex was identified as a useful decision criterion to provide an additional amount of 250 mmol sodium bicarbonate. This work demonstrates the clinical relevance of the discovery that D-lactate is responsible for most of the clinical signs expressed in neonatal diarrheic calves suffering from metabolic acidosis.
authors.affiliation: Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, LMU Munich, Sonnenstrasse 16, 85764, Oberschleissheim, Germany. florian.trefz@campus.lmu.de
authors.forename: Florian M
authors.initials: FM
authors.lastname: Trefz
authors.forename: Annette
authors.initials: A
authors.lastname: Lorch
authors.forename: Melanie
authors.initials: M
authors.lastname: Feist
authors.forename: Carola
authors.initials: C
authors.lastname: Sauter-Louis
authors.forename: Ingrid
authors.initials: I
authors.lastname: Lorenz
mesh_terms: D000138:Acidosis / Q000097:blood / Q000188:drug therapy / Q000378:metabolism / Q000662:veterinary*; D000818:Animals; D000831:Animals, Newborn; D002417:Cattle; D002418:Cattle Diseases / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D003663:Decision Trees; D003967:Diarrhea / Q000097:blood / Q000188:drug therapy / Q000378:metabolism / Q000662:veterinary*; D004573:Electrolytes / Q000097:blood; D019344:Lactic Acid / Q000097:blood; D011446:Prospective Studies; D015203:Reproducibility of Results; D017693:Sodium Bicarbonate / Q000008:administration & dosage*; D018709:Statistics, Nonparametric
chemical_list: D004573:Electrolytes; D019344:Lactic Acid; D017693:Sodium Bicarbonate