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Milk in addition to oral rehydration solution in calves with diarrhoea

Clinical Scenario

You are called out to a dairy farm with 25 pre-weaned calves on site. The farmer has stated they aren't thriving and have started scouring. He is particularly concerned that they will stop gaining weight, or even lose weight, until they recover. He asks for your opinion on whether or not feeding milk as well as electrolyte solutions will help with this, as he has been given conflicting advice from previous vets and other farmers.

3-Part Question (PICO)

In [dairy calves with scour] does [feeding milk and rehydration fluids as compared to rehydration fluids alone] lead to [improved weight gain]?

Search Strategy and Summary of Evidence

Search Strategy

MEDLINE(R) In-Process & Other Non-Indexed Citations and MEDLINE(R) 1946 to Present using the OVID interface

calf.mp. OR calves.mp. OR young bovine.mp. OR young bovines.mp. OR young stock.mp. OR youngstock.mp. OR young cattle.mp. OR bos.mp. OR exp Cattle/

AND

scour.mp. OR scours.mp. OR scouring.mp. OR diarrhoea.mp. OR diarrhea.mp. OR exp Diarrhea/

AND

oral rehydration.mp. OR oral replacement.mp. OR oral therapy.mp. OR electrolyte.mp. OR electrolytes.mp. OR fluid therapy.mp. OR fluid therapies.mp. OR fluid replacement.mp. OR fluids.mp. OR ORT.mp. OR ORS.mp. OR exp Fluid Therapy/ OR exp Electrolytes/ OR exp Rehydration Solutions/

CAB Abstracts 1910 to Present using the OVID interface

calf.mp. OR calves.mp. OR young bovine.mp. OR young bovines.mp. OR young stock.mp. OR youngstock.mp. OR young cattle.mp. OR bos.mp. OR exp cattle/

AND

scour.mp. OR scours.mp. OR scouring.mp. OR diarrhoea.mp. OR diarrhea.mp. OR exp diarrhoea/

AND

oral rehydration.mp. OR oral replacement.mp. OR oral therapy.mp. OR electrolyte.mp. OR electrolytes.mp. OR fluid therapy.mp. OR fluid therapies.mp. OR fluid replacement.mp. OR fluids.mp. OR ORT.mp. OR ORS.mp. OR exp fluid therapy/ OR exp oral rehydration solutions/ OR oral rehydration therapy/ OR exp electrolytes/

Search Outcome

MEDLINE

  • 377 papers found in MEDLINE search
  • 374 papers excluded as they don't meet the PICO question
  • 1 papers excluded as they are in a foreign language
  • 0 papers excluded as they are review articles/in vitro research/conference proceedings
  • 2 total relevant papers from MEDLINE

CAB Abstracts

  • 766 papers found in CAB search
  • 761 papers excluded as they don't meet the PICO question
  • 1 papers excluded as they are in a foreign language
  • 2 papers excluded as they are review articles/in vitro research/conference proceedings
  • 2 total relevant papers from CAB

Total relevant papers

2 relevant papers from both MEDLINE and CAB Abstracts

Summary of Evidence

Garthwaite et al. (1994) North America

Title:

Whole milk and oral rehydration solution for calves with diarrhoea of spontaneous origin

Patient group:

42 calves with diarrhoea assigned to one of 3 treatment groups: oral rehydration solution alone; oral rehydration solution plus partial ration of milk; oral rehydration solution plus full ration of milk.

Study Type:

Controlled clinical trial

Outcomes:
  • Faecal score 
  • Body weight
  • Rectal temperature
  • Faecal microbiology
  • Packed cell volume
  • Blood calcium, chloride, potassium, sodium, phosphorus and glucose
  • Strong ion difference
Key Results:
  • All calves had recovered by 7 days post treatment regardless of treatment group
  • No calves died
  • No significant difference between groups in terms of body weight
  • Calves given either oral rehydration solution alone or with a partial milk ration initally lost weight, while calves given oral rehydration solution with a full ration of milk continued to gain weight
  • No significant difference between groups for glucose, electrolytes, strong ion difference, rectal temperature or faecal score
  • Not all calves drank their milk, noticeably calves receiving the full milk ration in addition to oral rehydration solution
Study Weaknesses:
  • Small sample size (n=42) and therefore small numbers in each treatment group
  • No sample size calculation so likely to be under-powered
  • Method of random allocation of calves into each treatment group (if any) was unclear
  • Intervention administration was non-blinded
  • It was unclear whether or not the outcomes were blindly assessed
  • Basic data only provided for whole group, no basic data given for each group
  • Exact p values were not always given with vague terms such as 'tendency' often used 
Attachment:
No attachments.

Heath et al. (1989) Canada

Title:

The effects of feeding milk to diarrheic calves supplemented with oral electrolytes

Patient group:

19 Holstein bull calves aged 5-8 days assigned to one of 3 treatment groups: oral rehydration solution alone; oral rehydration solution plus partial ration of milk; oral rehydration solution plus full ration of milk. Each of these 3 groups was further divided into two subgroups, with one subgroup receiving an oral rehydration solution containing bicarbonate and the other subgroup receiving an oral rehydration solution not containing bicarbonate.

Study Type:

Randomised controlled trial

Outcomes:
  • Body weight
  • Faecal consistency
  • Faecal volume
  • Blood gas values
  • Hydration status
  • Depression scores 
  • Necropsy findings, including organ weights
  • Tissue histology analysis
Key Results:
  • Feeding diarrhoeic calves with an oral replacement solution supplemented with a full milk ration allowed uninterrupted weight gains of 1% body weight per day (statistically significant)
  • Diarrhoeic calves fed milk and an oral replacement solution containing bicarbonate gained less weight than those fed milk and an oral replacement solution which did not contain bicarbonate
  • Milk feeding was associated with the following findings on postmortem examination: increased absolute liver weights; increased omental, perineal and coronary fat stores; thymic atrophy; a thicker duodenal serosa; a lower mitotic index for the duodenal mucosa
Study Weaknesses:
  • Very small sample size (n=19)
  • No sample size calculation so likely to be under-powered
  • Diarrhoea was experimentally induced rather than naturally occuring
  • Intervention administration was non-blinded
  • It was unclear whether or not the outcomes were assessed blinded
Attachment:
No attachments.

Comments

Both studies identified were likely to be under-powered, making it difficult to reach solid conclusions from the results. Heath et al. (1989) experimentally induced diarrhoea in their sample of calves, so it is unclear whether the results can be generalised to cases of naturally occuring scour. Garthwaite et al. (1994) demonstrated that calves fed a full milk ration continued to gain weight while those receiving no milk or partial milk ration initially lost weight. A significant difference in body weight changes between these groups could not be demonstrated, which may be due to the small sample size used in this study. However, the differences seen are likely to be of biological significance, so feeding milk in addition to oral rehydration solution may be justified. The evidence is currently weak, so a randomised controlled trial involving a larger sample of calves is needed to answer this question with greater certainty. Calves receiving full milk rations may require force feeding due to the higher volume of fluid being consumed.

Bottom line

Feeding milk in addition to an oral rehydration solution may help scouring calves to maintain or even gain weight when compared with feeding oral rehydration solution alone. 

Disclaimer

The BETs on this website are a summary of the evidence found on a topic and are not clinical guidelines. It is the responsibility of the individual veterinary surgeon to ensure appropriate decisions are made based on the specific circumstances of patients under their care, taking into account other factors such as local licensing regulations. Read small print

References

Garthwaite BD, Drackley JK, McCoy GC, Jaster EH (1994) Whole milk and oral rehydration solution

for calves with diarrhea of spontaneous origin. Journal of Dairy Science 77: 835-43.

 

Heath SE, Naylor JM, Guedo BL, Petrie L, Rousseaux CG, Radostits OM (1989) The effects of feeding 

milk to diarrheic calves supplemented with oral electrolytes. Canadian Journal of Veterinary

Research 53: 477-85.

 

 

 

About this BET

First author:
Natalie Robinson
Second author:
Rachel Dean
Institution:

Centre for Evidence-based Veterinary Medicine

Search last performed:
2016-12-14 16:55:49
Original publication date:
2014-08-15 16:55:49
Last updated:
2016-12-14 16:55:49
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