Hypomagnesaemia (Grass

Staggers, Grass Tetany)

 Introduction
• Hypomagnesaemia is a common feature of a
group of syndromes chareterized by
hyperaesthesia, incoordination, tetany and
convulsions that can occur in all ruminants of all
ages.
• Name given to the syndrome affecting lactating
cattle (beef or dairy cows) when grazing grass in
the spring or autumn.
• Also known as grass staggers, wheat-pasture
poisoning, lactation tetany and hypomagnesemia,
is a metabolic disorder of livestock.
 Introduction
• Sub clinically occurs in lactating or dry usually
not accompanied by clinical signs.
• It usually affects the whole herd with slight
nervous disposition, e.g. reluctance to enter
the milking parlour.
• Dry cows will be more prone to milk fever at
parturition
 Introduction
• Absorption of magnesium is influenced by
factors including:
– High levels of potassium, nitrogen and moisture
content and low levels of sodium.
– Mobilization of 70% magnesium which is found in
bone and this portion is more labile in young
animals making older cows more susceptible to
developing the disease
 Introduction
• The low availablity of Mg in forage may be
from either low Mg concentrations or to
factors in the forage that reduce availability of
Mg to the animal
• The winter type affects cattle fed winter
rations in confinement. The out-winter type
affects cattle in late winter that have been
maintained thoughout the winter on sparse
pasture plus some supplemental hay
 Classification
• Classification by clinical types .
• Tetanic syndrome type, which is characterized by
nervousness, muscle twitching, ataxia,
convulsions, recumbency with spasms, and
opisthotonos.
• The paretic type is characterized by listlessness,
staggering, paresis, recumbency, and coma
without spasms.
• Subclinical types occur that are associated with
depression of appetite and milk yield, slight
nervousness,anemia, and udder edema.
 Classification by clinical sign cont..
• correlated with concentrations of Ca and Mg in blood
• Disorders were classified into "milk fever" types and
"grass tetany" types of syndromes. Combinations of
changes in blood were:
– a) hypocalcemia combined with hypermagnesemia;
– b) hypocalcemia combined with normal magnesemia;
– c) hypocalcemia combined with hypomagnesemia; and
– d) normal calcemia combined with hypomagnesemia.
• The first two types (milk fever) were characterized by
gut stasis, paresis, coma, and low body temperature;
• the last two types (grass tetany) were characterized by
excitement, tetany, and convulsion
 Aetiology
• The reduction of the amount of magnesium available in
the food, and hence available for absorption from the
gut, accompanied by a high physiological demand for
magnesium.
• Magnesium is lost from the body in milk, urine and
faeces.
• The endogenous 1.8g/day . Milk contains 0.12 g/l of
magnesium so a cow producing 30 kg of milk would
lose 3.6 g daily in the milk.
• Any excess magnesium absorbed will be excreted via
the urine, this being the mechanism for stabilizing
plasma magnesium levels.
 Aetiology
• If the plasma magnesium levels rise much above 0.8
mmol/l (2.0mg/100ml) the excess will be excreted.
• If magnesium intake levels are excessive, up to 5.0
g/day may be excreted in the urine.
• To maintain magnesium homeostasis the absorption of
magnesium must be continuous so a constant supply is
necessary in the diet.
• Feeds vary considerably in both the content and the
availability of magnesium so the choice of pasture is
important.
• Clovers have higher magnesium content than grasses
and grasses themselves vary.
 Cause
• Rapidly-growing and lactating animals have a higher
requirement than non-lactating slow-growing animals.
• Cows in their third to fifth lactation have an increased risk
of developing hypomagnesaemia due to increased
production and reduced age-related mobilization of
magnesium from bone.
• Low magnesium in soil pastures grown on soils that are low
in available magnesium and high in available potassium.
• Lush pasture
• High levels of potassium from fertilisers.
• High levels of ammonia (from nitrogenous fertilisers) inhibit
magnesium absorption.
 Cause
• The energy intake of the animals. Calcium, potassium and
ammonium (nitrogen) ions are all thought to interfere with body
uptake of magnesium.
• Magnesium seems to be absorbed from most areas of the
gastrointestinal tract; however, net absorption is thought to be
greatest in the tureen, reticulum, and possibly omasum and colon.
The amount of Mg absorbed at a particular site does not seem to
be related specifically to metabolic requirements for Mg but to
intraluminal concentration of available Mg at a given site. The
percentage of Mg absorbed from the gut is relatively small as
compared with the amount of Mg ingested; however, when dietary
Mg is adequate, the amount of Mg absorbed is large as compared
with metabolic needs for Mg. Individual cows most prone to
hypomagnesemia have a reduced ability to absorb Mg from the gut
 Economic implications
• Annual incidence of acute hypomagnesaemia
around 0.5 per cent.
• Many cows found dead.
 Types of Grass Tetany
• The spring type affects lactating cows a few
days after they are put out on grass.
• The winter type affects cattle fed winter
rations in confinement.
• The out-winter type affects cattle in late
winter that have been maintained thoughout
the winter on sparse pasture plus some
supplemental hay
 Classification of GT,
• Cinical types: most common type is the tetanic syndrome
type, which is characterized by nervousness, muscle
twitching, ataxia, convulsions, recumbency with spasms,
and opisthotonos.
• The paretic type is characterized by listlessness, staggering,
paresis, recumbency, and coma without spasms.
• Subclinical types occur that are associated with depression
of appetite and milk yield, slight nervousness, anemia, and
udder edema.
• clinical signs associated with ataxic and recumbent cases of
"metabolic disorders" have been correlated with
concentrations of Ca and Mg in blood .
 CLASSIFICATION OF GT
• Milk fever" types and "grass tetany" types of syndromes.
• Combinations of changes in blood were:
• a) hypocalcemia combined with hypermagnesemia; milk fever were
characterized by gut stasis, paresis, coma, and low body
temperature; Concentration of blood Ca seems to be the
distinguishing feature, and concentration of blood Mg seems to be
the distinguishing feature in the GT type of disease
• b) hypocalcemia combined with normal magnesemia; characterized
by excitement, tetany, and convulsions.
• c) hypocalcemia combined with hypomagnesemia
• d) normal calcemia combined with hypomagnesemia,
hypomagnesemic and normocalcemic
• An intermediate type of disease cows developed low blood Ca and
Mg and violent tetany near parturition. The cows responded to
treatment with calcium gluconate.
Factors Influence Development of GT.
• Decreases in blood Mg concentrations seem
to be the primary predisposing factor for GT.
• Magnesium seems to be absorbed from most
areas of the gastrointestinal tract; however,
net absorption is thought to be greatest in the
tureen, reticulum, and possibly omasum and
colon.
• when dietary Mg is adequate, the amount of
Mg absorbed is large as compared with
metabolic needs for Mg
Factors Influence Development of GT.
• Reduced ability to absorb Mg from the gut .
• Small intestine have net secretion of Mg.
• Potassium ions have a marked inhibition on
Mg transport across the rumen wall. Thus, a
forage high in K and low in Na (and the
decrease of the Na/K ratio in the saliva that
results profound effects on Mg transport in
fore stomachs of ruminants and contribute
greatly to the pathogenesis of GT.
 Factors Influence Development of GT
• Binding of Mg and Ca by organic material in digesta may have
significant effects on Mg and Ca absorption.
• high ruminal ammonia concentrations decreased availability
• Drastically reduced ultrafilterable Mg concentrations were found in
the small intestine of sheep when the ration was changed from hay
and concentrate to cut grass rich in crude protein.
• Marked reduction in food intake decreases the ability of cows to
maintain Mg and Ca homeostasis , especially in lactating animals .
• Kidneys contribute to conservation of Mg under conditions of
hypomagnesemia and, thus, play an important role in Mg
homeostasis. urinary Mg concentrations of less than 1 mg/100 ml
were typical of cows with GT decreased urinary Mg concentrations
before serum Mg had decreased below 1.8 mg/100 ml
 Factors Influence Development of GT
• Biochemical Changes, changes in blood Ca seem to be
of pivotal pathophysiologic importance in development
of GT.
• endocrine changes in cows parathyroid hormone (PTH)
increases in blood may not be sustained as the
hypomagnesemic-hypocalcemic type of grass tetany
develops. However, blood PTH concentrations
appropriately increase in cows developing wheat
pasture poisoning (WPP), in which hypocalcemia is the
predominant change, and blood Mg concentrations
decrease only moderately. Plasma concentrations of
the active metabolite of vitamin D, 1,25-(OH)2D, seem
to increase appropriately in cows affected with both GT
and WPP
 Factors Influence Development of GT
• Availability of Ca from bone reserves of animals with either GT or
WPP may markedly decrease, as indicated by a progressive
decrease in blood hydroxyproline concentrations in animals .
• Deficiency of Mg or inappropriately low PTH, or both, may lead to a
refractory condition of bones such that they cannot function as an
effective source of Ca even when severe hypocalcemia develops.
• If both dietary and bone sources of Ca and Mg are reduced in the
face of a relatively large lactational demand for Ca and Mg, it is not
surprising that there is an acute disruption of normal Ca and Mg
homeostasis.
• Thus marginal supply of dietary Ca and Mg of animals grazing
tetany-prone forage may be reduced .
• Rapid growth of forage, inappetance, or interruption in supply of
supplemented Ca or Mg.
 Factors Influence Development of GT
• Decreases concentrations in cerebrospinal fluid (CSF)
• Decreases in CSF Mg in cows and sheep with GT reflect inadequate
maintenance of animals leads to the proper ionic concentrations
(Mg) in the interstitial fluid of the central nervous system (CSN),
which leads to abnormal CSN function
• Four principal types of lesions
• a) hemorrhagic, Widespread vascular lesions, hemorrhagic edema,
and calcification in cows with GT may alter transport of Mg into the
CNS and other functions also and may explain some of the clinical
signs and pathogenesis of GT
• b) vascular,
• c) deposition of Ca salts, and
• d) degeneration of parenchymatous organs.. Neuromuscular
 Pathogenesis
• Potassium ions have a marked inhibition on
Mg transport across the rumen wall. Thus, a
forage high in K and low in Na (and the
decrease of the Na/K ratio in the saliva that
results from consumption of these types of
forage) could have profound effects on Mg
transport in forestomachs of ruminants and
contribute greatly to the pathogenesis of GT
 Pathogenesis
• Binding of Mg and Ca by organic material in
digesta may have significant effects on Mg and
Ca absorption.
• One factor influencing Mg availability for
absorption that has not been investigated in
detail is the incorporation of Mg into rumen
microbes
• High ruminal ammonia concentrations
decreased availability of Mg in forage.
 Pathogenesis
• availability of ingested Mg decreased when
rumen ammonia concentrations were increased
in a cow fed hay and concentrate. Drastically
reduced ultrafilterable
• Marked reduction in food intake decreases the
ability of cows to maintain Mg and Ca
homeostasis
• especially in lactating animals Kidneys contribute
to conservation of Mg under conditions of
hypomagnesemia and, thus, play an important
role in Mg homeostasis.
 Pathogenesis
• urinary Mg concentrations of less than 1
mg/100 ml were typical of cows with GT
• decreased urinary Mg concentrations before
serum Mg had decreased below 1.8 mg/100
ml, which is thought to be the renal threshold
for Mg
Pathogenesis
Pathogenesis
 Pathogenesis
• endocrine changes. Apprently, appropriate parathyroid
hormone (PTH) increases in blood may not be
sustained as the hypomagnesemic-hypocalcemic type
of grass tetany develops.
• Blood PTH concentrations appropriately increase in
cows developing wheat pasture poisoning (WPP), in
which hypocalcemia is the predominant change, and
blood Mg concentrations decrease only moderatly.
• Plasma concentrations of the active metabolite of
vitamin D, 1,25-(OH)2D, seem to increase appropriately
in cows affected with both GT and WPP
 Pathogenesis
• Gross, Histologic, and Subcellular Changes in Cattle
with GT. Gross, histologic, and subcellular pathology of
the various forms of GT
• . Four principal types of lesions were described:
– a) hemorrhagic,
– b) vascular,
– c) deposition of Ca salts, and
– d) degeneration of parenchymatous organs. Widespread
vascular lesions, hemorrhagic edema, and calcification in
cows with GT may alter transport of Mg into the CNS and
other functions also and may explain some of the clinical
signs and pathogenesis of GT.
 SUBACUTE SIGNS
• SUBACUTE,: apprehensive and hyperaesthetic. The head
will be held high and tremors may be seen around the head
(particularly the eyelids), over the shoulder and on the
flank. These tremors will be exaggerated if the animal is
touched or the skin pinched. The legs may become stiff and
a staggering gait may be evident.
• in the subacute phase for several hours or progress to the
acute or peracute form, particularly in response to noise or
some other stimulus such as attempting to herd them. The
cows may be slightly nervous, reluctant to enter the milking
parlour or be unwilling to be herded. The milk yield will be
depressed slightly. The signs of milk tetany in calves are
much the same as for cows with subacute, acute and
peracute cases occurring
 ACUTE SIGNS
• ACUTE last for up to an hour or more. In these cases a period of
convulsions will be followed by a quiescent period in which the cow
may attempt to rise, only to walk a few steps and fall over again
followed by convulsions. The rectal temperature, elevated by 1 or
2°C (2–4°F). Cows are often found dead with obvious signs that the
limbs had been paddling prior to death, thus disturbing the soil
around the feet
• PERACUTE. stagger for a few steps and fall over with tetanic spasms
of the head, neck and legs followed by clonic convulsions. The legs
will paddle furiously, the eyes roll and there is frothing at the
mouth. The heart will pound fast and furious and death can occur
at any time. Cows have been known to be grazing one minute and,
in response to noise from a vehicle or other stimulus, to stagger,
fall over in convulsions and die in two or three minutes. Often in
peracute cases the animals are found dead
 Clinical pathology
• Healthy normal cows should possess plasma
magnesium levels over 0.85 mmol/l (2.0mg/100ml).
• Acute cases the plasma levels will generally be below
0.4mmol/l (1.0mg/100ml).
• Magnesium levels in the CSF in acute tetany will
generally be below 0.6mmol/l (1.4mg/ 100ml).
Hypocalcaemia is present in at least 80 per cent of
acute tetany cases and hyperkalaemia is common.
• Following tetany or in recovered cases aspartate
aminotransferase (AST) and creatine kinase (CK) levels
will rise to relatively high levels but return to normal
quite soon after recovery
 Clinical pathology
• At post mortem there are no pathognomonic
signs. Haemorrhages may be present on the
heart muscle and occasionally along the aorta.
Regurgitation and aspiration of rumen
contents may sometimes be seen.
• The CSF levels of magnesium will be low and
magnesium will be absent from the urine,
although the bladder is nearly always empty
at post mortem.
 Diagnosis
• By clinical sign and symptoms
• Blood biochemistry,
• If animals are found dead then diagnosis must be
differentiated from other causes of death.
• Quantities of soil have been gouged out of the
ground by each of the four feet during the
paddling phase this is strongly indicative of acute
grass staggers
• .
 Diagnosis
• Urine test strips are available in some
countries. problems in getting a number of
cows to micturate on demand.
• Rib or coccygeal bone is usually used for this
purpose.
• A calcium/magnesium ratio in bone of 70 :1 is
considered normal and 90:1 considered an
indication of severe magnesium depletion
 Differential diagnosis
• Acute lead poisoning: excitement and occasional
convulsions. Hyperaesthesia, as measured by
observing muscle tremors in response to pinching
the skin, will be absent and blindness is usually a
feature of lead poisoning.
• Milk fever The history of being close to
parturition
• Acetonaemia licking the walls and floor or biting
at gates, will usually distinguish this disease
 Differential diagnosis
• Listeriosis :high rectal temperature and
absence of true hyperaesthesia in listeriosis
cases should be enough to distinguish this
disease.
• Bovine spongiform encephalopathy test the
Mg level
• Lightning strike
 Treatment
• Discard 100ml of fluid from a 400ml bottle of 40
per cent CBG, which also contains magnesium 0.2
per cent and phosphorus 0.5 per cent, and
replace this with 100ml of 25 per cent
magnesium sulphate solution.
• The mixture, which then contains 9g of calcium
and approximately 6g of magnesium, is infused
intravenously very slowly, taking 8–10 minutes.
• The remaining 300ml of the original 400 ml 25
per cent magnesium sulphate is injected
subcutaneously
 Prevention
• Add calcined magnesite (magnesium oxide) to
cattle concentrate that is being fed to the cows.
• Dusting the pastures with magnesium oxide has
been attempted using 50g/cow per day of
magnesium oxide,or 0.5 kg/week applied in the
early morning when the dew is on the grass.
• Magnesium acetate via a water proportioner is
effective
• Magnesium chloride crystals to the drinking
water