Replacement of calcium by parenteral administration is the most important initial step, which should not be delayed in severely hypocalcaemic animals.

Nowadays two different types of parenteral calcium preparations are available in the market;

The choice of drug should be rational. The thumb rule is: when the animal is showing signs of peripheral vascular failure, hypothermia and cold extremities, calcium borogluconate should be administered intravenously. In such case intramuscular administration of dicationic calcium may not be reliable as due to impaired blood supply to peripheral organs, absorption of calcium from the injection site is likely to be delayed. The results have shown that , after intramuscular injection of dicationic calcium, blood calcium levels are increased within 3 hours, which remain consistently high up to 24 hours. Thus, administration for 3 consecutive days would ensure high blood calcium during the entire high risk period.
 

The treatment strategy in milk fever should be

As a matter of fact even herdsman with little experience can diagnose milk fever, but usually the problem is intimation to veterinarian and thus the time lag in administration of calcium.It is well known that if calcium is administered early the likelihood of relapses and complication arising out of recumbancy can be minimized. Unlike intravenous, many herdsman are able to administer intramuscular injection. An intramuscular dicationic calcium therefore can be recommended as a strategic treatment before the arrival of the Veterinarian for intravenous administration. It is now emphasized that after onset of first sign of milk fever calcium should be administered within one hour, otherwise the chance that the animal may turn Downer Cow is significantly high. There is an urgent need in India to implement this strategic approach.

The second important issue is to maintain the level of calcium in blood for a longer period of time to avoid relapses. Since calcium administered intravenously is not retained for a long time, for sustained absorption and maintenance of the level, administration of calcium borogluconate subcutaneously is also practiced. But this is not without danger and in hypothermic cases the absorption may be delayed considerably. In any case, it is recommended that waiting for more than one hour for the response after subcutaneous injection is improper. In all such cases, administration of intrmuscular dicationic calcium as starting and follow up to intravenous calcium borogluconate is by far the most rational approach.

The dose of intravenous calcium in cows and buffaloes:
The dose of intravenous calcium should be calculated rationally and arbitrary dose may be risky and expensive. Various workers have found that an ARD system of dose fixation is convenient. The word A denotes "appetite", R denotes "ruminal activity" and D denotes "ability to defecate". The animal with normal ARD are slightly hypocalcaemic for which 2g calcium (110 ml of calcium borogluconate) is sufficient. Animal lacking in one or two functions of ARD are judged moderately hypocalcaemic and should be given 4 g calcium (225 ml calcium borogluconate), whereas, those having severely depressed ARD must be given 6g calcium (330ml calcium borogluconate) intravenously.
 

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