Milk fever and alert downer cows: does hypophosphatemia affect the treatment response?

The purpose of this prospective cohort study was to identify factors that place a dairy cow with uncomplicated milk fever (MF) at significant risk of becoming an alert downer cow (ADC) and to verify if these factors could be used to predict treatment outcome. Recumbent MF cows were examined before treatment and 52 were excluded due to complications. In all, histories and pretreatment serum samples were taken and the serum of 86 cows was analyzed for electrolyte levels (calcium, phosphorus, magnesium, and potassium). In total, 36 of the 86 samples were from ADCs and 50 from animals that responded to MF treatment (MFT). A binary-two-factor logistic model determined that a MF cow with a phosphorus pretreatment level of > or = 0.9 mmol/L was 12 times more likely not to become an ADC than one with a phosphorus level < 0.9 mmol/L (CI: 6.3,23.1). Also, a binary multivariable logistic regression analysis showed that a MF cow with a pretreatment calcium level > or = 1.7 mmol/L was 14 times more likely to become an ADC than one with a serum level < 1.7 mmol/L (CI: 2.0,98). Age and the other serum electrolytes were not statistically significant risk factors at the 0.05 level. The rigorous pretreatment examination and stringent adherence to protocol reduced ADC misclassification and fostered the strong association between single factor serum phosphorus levels and ADCs. By using a cutoff level of serum phosphorus at > or = 0.9 mmol/L, a practitioner could correctly predict that 95% of the MFs would not become ADCs and, therefore, this level would be a useful pretreatment predictor.