title: A randomized controlled trial of dexamethasone as an adjunctive therapy to propylene glycol for treatment of hyperketonemia in postpartum dairy cattle.
abstract: Treatment of hyperketonemia with oral propylene glycol has proven efficacy but the cure rate remains moderate. Dexamethasone has long been suggested as a treatment for hyperketonemia, even though evidence of its efficacy is contradictory. The objective of this randomized controlled trial was to evaluate the effect of adding a single intramuscular injection of 20mg of dexamethasone to oral propylene glycol therapy for hyperketonemia [blood β-hydroxybutyrate (BHB) ≥1.2mmol/L]. All cows between 3 and 16d in milk on 4 dairy farms in New York State were tested once weekly for hyperketonemia using a handheld ketone meter. All enrolled animals received 312g (300mL) of propylene glycol orally once daily for 4d and either a single injection of dexamethasone or an equivalent volume of sterile saline. A total of 509 animals were enrolled, with 254 and 255 in the placebo and dexamethasone groups, respectively. Treatment with dexamethasone decreased the odds of being hyperketonemic in the second week posttreatment; however, the odds of hyperketonemia in the first week posttreatment only decreased in those animals that were treated at a BHB blood concentration between 1.2 and 1.5mmol/L. For the 8% of cows with blood BHB >3.2mmol/L at enrollment, receiving dexamethasone increased the odds of being hyperketonemic the following week. We detected no difference between treatment groups in the odds of postpartum disease or in milk production. For cows with initial BHB of 1.2 to 1.5mmol/L, treatment with dexamethasone tended to reduce the odds of pregnancy at first insemination. Based on the small and conditional benefits of dexamethasone and a lack of difference in milk yield or disease incidence, we do not recommend the use of dexamethasone to treat hyperketonemia.
authors.affiliation: Department of Population Medicine, University of Guelph, Guelph, ON, Canada, N1G 2W1.
authors.forename: Elise H
authors.initials: EH
authors.lastname: Tatone
authors.affiliation: Department of Population Medicine, University of Guelph, Guelph, ON, Canada, N1G 2W1. Electronic address: tduffiel@uoguelph.ca.
authors.forename: Todd F
authors.initials: TF
authors.lastname: Duffield
authors.affiliation: Perry Veterinary Clinic, Perry, NY 14530.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Capel
authors.affiliation: Department of Animal Biosciences, University of Guelph, Guelph, ON, Canada, N1G 2W1.
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: DeVries
authors.affiliation: Department of Population Medicine, University of Guelph, Guelph, ON, Canada, N1G 2W1.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: LeBlanc
authors.affiliation: Department of Population Medicine, University of Guelph, Guelph, ON, Canada, N1G 2W1.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Gordon
mesh_terms: D020155:3-Hydroxybutyric Acid / Q000097:blood; D000818:Animals; D002417:Cattle; D002418:Cattle Diseases / Q000097:blood / Q000188:drug therapy*; D003612:Dairying; D003907:Dexamethasone / Q000737:chemistry / Q000494:pharmacology*; D005260:Female; D007659:Ketones / Q000097:blood*; D007662:Ketosis / Q000097:blood / Q000188:drug therapy / Q000662:veterinary*; D007774:Lactation; D016015:Logistic Models; D008892:Milk / Q000737:chemistry; D009518:New York; D049590:Postpartum Period / Q000097:blood*; D011247:Pregnancy; D019946:Propylene Glycol / Q000737:chemistry / Q000494:pharmacology*
chemical_list: D007659:Ketones; D019946:Propylene Glycol; D003907:Dexamethasone; D020155:3-Hydroxybutyric Acid
keywords: dexamethasone; glucocorticoid; hyperketonemia; randomized controlled trial