Tatone Elise H, Duffield Todd F, Capel Michael B, DeVries Trevor J, LeBlanc Stephen J, Gordon Jessica L
Department of Population Medicine, University of Guelph, Guelph, ON, Canada, N1G 2W1.
Department of Population Medicine, University of Guelph, Guelph, ON, Canada, N1G 2W1.
J Dairy Sci. 2016 Nov;99(11):8991-9000. doi: 10.3168/jds.2016-11358. Epub 2016 Sep 13.
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.
口服丙二醇治疗高酮血症已被证明有效，但治愈率仍处于中等水平。长期以来，地塞米松一直被建议用于治疗高酮血症，尽管其疗效证据相互矛盾。这项随机对照试验的目的是评估在口服丙二醇治疗高酮血症[血液β-羟基丁酸（BHB）≥1.2mmol/L]的基础上，单次肌肉注射20mg地塞米松的效果。纽约州4个奶牛场中所有产后3至16天的奶牛每周使用手持式酮仪检测一次高酮血症。所有入组动物每天口服312g（300mL）丙二醇，持续4天，并接受单次地塞米松注射或等量的无菌生理盐水注射。总共509只动物入组，安慰剂组和地塞米松组分别有254只和255只。地塞米松治疗降低了治疗后第二周高酮血症的几率；然而，仅在那些血液BHB浓度在1.2至1.5mmol/L之间接受治疗的动物中，治疗后第一周高酮血症的几率有所降低。对于入组时血液BHB>3.2mmol/L的8%的奶牛，接受地塞米松治疗增加了下一周高酮血症的几率。我们未发现治疗组在产后疾病几率或产奶量方面存在差异。对于初始BHB为1.2至1.5mmol/L的奶牛，地塞米松治疗倾向于降低首次输精时怀孕的几率。基于地塞米松的微小且有条件的益处以及产奶量或疾病发生率无差异，我们不建议使用地塞米松治疗高酮血症。
