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			<p class="Type-of-Article">&nbsp;</p>
			<p class="Type-of-Article"><span class="CharOverride-1">Case Report</span></p>
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			<p class="title- ParaOverride-1">&nbsp;</p>
			<p class="title- ParaOverride-1">Concomitant Intravenous Therapy of Ceftriaxone and Calcium in Recumbent Dairy Cow Immediate after Delivery: Ante Mortem and Post Mortem Inspection </p>
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			<p class="No-Spacing ParaOverride-1" lang="en-US">&nbsp;</p>
			<p class="No-Spacing ParaOverride-1" lang="en-US"><span class="CharOverride-2" lang="en-GB">Md. Anowar Parvez</span><span class="CharOverride-3" lang="en-GB">1</span><span class="CharOverride-2" lang="en-GB">, Md. Shafiqul Islam</span><span class="CharOverride-3" lang="en-GB">2</span><span class="CharOverride-2" lang="en-GB">, Bhajan Chandra Das</span><span class="CharOverride-3" lang="en-GB">1, 3</span><span class="CharOverride-2" lang="en-GB">, Rokeya Khatun</span><span class="CharOverride-3" lang="en-GB">4, </span><span class="CharOverride-2">Md. Abdullah al Noman</span><span class="CharOverride-3">5</span></p>
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			<p class="Affiliations ParaOverride-1"><span class="CharOverride-4">1 </span>Department of Medicine and Surgery, <span class="CharOverride-4">2</span> Department of Pathology and Parasitology, <span class="CharOverride-4">3</span> Shahedul Alam Quadery Teaching Veterinary Hospital, Faculty of Veterinary Medicine, Chittagong Veterinary and Animal Sciences University, Khulshi, Chittagong-4225; <span class="CharOverride-4">4</span>Additional Veterinary Surgeon (AVS), ECTAD-FAO (HPAI), Department of Livestock Services, Farmgate, Dhake-1215, Bangladesh; <span class="CharOverride-4">5</span>Faculty of Veterinary Medicine, Chittagong Veterinary and Animal Sciences University.</p>
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			<p class="Abstract ParaOverride-1">&nbsp;</p>
			<p class="Abstract ParaOverride-1"><span class="CharOverride-5">Abstract</span> | A high yielding variety (HYV) Holstein Friesian cow was died after five days of delivery reported at Teaching Veterinary Hospital (TVH) in Chittagong Veterinary and Animal Sciences University (CVASU) with unknown reasons. It was diagnosed by taking Ante mortem and Post mortem examination history. The reported cow was died by repeated and continuous intravenous use of calcium and ceftriaxone. So this report leads us about the safe practices about the simultaneously administration of intravenous calcium and ceftriaxone in recumbent dairy cow just after parturition to treat metabolic conditions like milk fever or parturient paresis. It is recommended not to use the ceftriaxone in combination with intravenous calcium therapy in post parturient dairy animals.</p>
		  <p class="Abstract ParaOverride-1">&nbsp;</p>
			<p class="Abstract ParaOverride-1"><span class="CharOverride-5">Keywords </span>| Calcium, Ceftriaxone, Cow, Ante mortem, Postmortem, Inspection</p>
		  <p class="Abstract ParaOverride-1">&nbsp;</p>
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			<p class="Editor----Citation"><span class="CharOverride-6">Editor</span> | Muhammad Abubakar, National Veterinary Laboratories, Islamabad, Pakistan.</p>
			<p class="Editor----Citation"><span class="CharOverride-5">Received</span> | October 23, 2014; <span class="CharOverride-5">Revised</span> | November 04, 2014; <span class="CharOverride-5">Accepted</span> | November 06, 2014; <span class="CharOverride-5">Published</span> | November 11, 2014&#9;&#9;</p>
			<p class="Editor----Citation"><span class="CharOverride-5">*Correspondence</span> | Md. Anowar Parvez, Chittagong Veterinary &amp; Animal Sciences University, Khulshi, Bangladesh; <span class="CharOverride-5">Email: </span>aparvez0445@gmail.com</p>
			<p class="Editor----Citation"><span class="CharOverride-5">Citation</span> | Parvez MA, Islam MS, Das BC, Khatun R (2015). Concomitant intravenous therapy of ceftriaxone and calcium in recumbent dairy cow immediate after delivery: ante mortem and post mortem inspection. Res. J. Vet. Pract. 3(1): 15-18.</p>
			<p class="Editor----Citation"><span class="CharOverride-6">DOI</span> | <a href="http://dx.doi.org/10.14737/journal.rjvp/2015/3.1.15.18 "><span class="Hyperlink">http://dx.doi.org/10.14737/journal.rjvp/2015/3.1.15.18</span></a></p>
			<p class="Editor----Citation"><span class="Editor---Citation CharOverride-5">ISSN</span> |2308-2798</p>
			<p class="Editor----Citation"><span class="CharOverride-6">Copyright </span>© 2015 Parvez et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p>
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			<p class="Caps-on-First-Para ParaOverride-1"><span class="_idGenDropcap-1">O</span>wner of the dairy farm was reported that a high yielding variety of Holstein Friesian (HF) dairy cow was died at 4am on 29th January, 2014 to the Director of Shahedul Alam Quadery Teaching Veterinary Hospital (SAQTVH) in Chittagong Veterinary and Animal Sciences University (CVASU). Then an investigated team was going to his farm for the diagnosis and confirmation of the exact causes of death. For that purpose a complete physical examination, clinical history and treatment protocol taken from the owner by repeated and cross questioning. The HF dairy cow had 6 years of old with 350 kg body weight and 30 litters of milk production per day. But during the period of third caving HF cow showed complete loss of appetite, no sign of excitement, body temperature rises above the normal ranges about 37.3°C, no sign of fracture or pain in leg but animal going to lateral recumbency and died on the 5th days after delivery during the course of treatment. Treatments comprises of (1) Calcium Preparation (Decam-900 ml intravenously daily for 4 days), (2) Antibiotic (Ceftron vet- 4gm intravenously daily for 2nd to 4th days), (3) Dexamethasone (Dexavet-10 ml intramuscularly daily for 2nd to 4th days), (4) Dextrose saline (DNS 10%- 6 litters intravenously daily for 4th days), (5) Thiamin preparation (Nervin-10 ml intramuscularly daily for<span class="Title CharOverride-8" lang="en-US"> </span>4 days), (6) Non-steroidal anti-inflammatory drugs (Ketorolac-50mg intramuscularly twice daily for 2nd to 4th days). <a href="#Figure-1-"><span class="Hyperlink">Figure 1</span></a> showed the high yielding dairy cow that was died due to use of calcium and ceftriaxone.</p>
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            <div class="pt" > <a href="http://nexusacademicpublishers.com/uploads/figures/20150119141243.png" target="new"><img class="img_display" src="http://nexusacademicpublishers.com/uploads/figures/20150119141243.png" width="80" height="80"></a>
            
            <p class="Figure--and-Table-Heading ParaOverride-1"><span class="CharOverride-5"><a id="Figure-1-"></a>Figure 1:</span><a href="http://nexusacademicpublishers.com/uploads/figures/20150119141243.png">  Died cow due to use of calcium and ceftriaxone</a></p>
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			<div class="pt" > <a href="http://nexusacademicpublishers.com/uploads/figures/20150119144743.jpg" target="new"><img class="img_display" src="http://nexusacademicpublishers.com/uploads/figures/20150119144743.jpg" width="80" height="80"></a>
            
            <p class="Figure--and-Table-Heading"><span class="CharOverride-5"><a id="Figure-2-"></a>Figure 2:</span><a href="http://nexusacademicpublishers.com/uploads/figures/20150119144743.jpg"> Conjunctiva become pale pink in color</a></p>
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			<div class="pt" > <a href="http://nexusacademicpublishers.com/uploads/figures/20150119145744.png" target="new"><img class="img_display" src="http://nexusacademicpublishers.com/uploads/figures/20150119145744.png" width="80" height="80"></a>
            
           <p class="Figure--and-Table-Heading"><span class="CharOverride-5"><a id="Figure3"></a>Figure 3:</span><a href="http://nexusacademicpublishers.com/uploads/figures/20150119145744.png"> Cyanosis of udder</a></p>
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			<div class="pt" > <a href="http://nexusacademicpublishers.com/uploads/figures/20150119142247.png" target="new"><img class="img_display" src="http://nexusacademicpublishers.com/uploads/figures/20150119142247.png" width="80" height="80"></a>
            
           <p class="Figure--and-Table-Heading"><span class="CharOverride-5"><a id="Figure-4"></a>Figure 4:</span><a href="http://nexusacademicpublishers.com/uploads/figures/20150119142247.png"> Bloody discharge comes out from rectum</a></p>
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			<div class="pt" > <a href="http://nexusacademicpublishers.com/uploads/figures/20150119143948.png" target="new"><img class="img_display" src="http://nexusacademicpublishers.com/uploads/figures/20150119143948.png" width="80" height="80"></a>
            
           <p class="Figure--and-Table-Heading"><span class="CharOverride-5"><a id="Figure-5-"></a>Figure 5:</span><a href="http://nexusacademicpublishers.com/uploads/figures/20150119143948.png"> Collapsed lung with congestion</a></p>
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			<div class="pt" > <a href="http://nexusacademicpublishers.com/uploads/figures/20150119141350.png" target="new"><img class="img_display" src="http://nexusacademicpublishers.com/uploads/figures/20150119141350.png" width="80" height="80"></a>
            
           <p class="Figure--and-Table-Heading"><span class="CharOverride-5"><a id="Figure-6"></a>Figure 6:</span><a href="http://nexusacademicpublishers.com/uploads/figures/20150119141350.png"> Trachea contain frothy gas</a></p>
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			<div class="pt" > <a href="http://nexusacademicpublishers.com/uploads/figures/20150119142451.png" target="new"><img class="img_display" src="http://nexusacademicpublishers.com/uploads/figures/20150119142451.png" width="80" height="80"></a>
            
           <p class="Figure--and-Table-Heading"><span class="CharOverride-5"><a id="Figure-7-"></a>F</span><span class="CharOverride-5">igure 7:</span><a href="http://nexusacademicpublishers.com/uploads/figures/20150119142451.png"> Hemorrhagic and congested peritoneum</a></p>
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			<div class="pt" > <a href="http://nexusacademicpublishers.com/uploads/figures/20150119140853.png" target="new"><img class="img_display" src="http://nexusacademicpublishers.com/uploads/figures/20150119140853.png" width="80" height="80"></a>
            
           <p class="Figure--and-Table-Heading"><span class="CharOverride-5"><a id="Figure-8"></a>F</span><span class="CharOverride-5">igure 8: </span><a href="http://nexusacademicpublishers.com/uploads/figures/20150119140853.png">Gall bladder filled with bile</a></p>
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			<div class="pt" > <a href="http://nexusacademicpublishers.com/uploads/figures/20150119144254.png" target="new"><img class="img_display" src="http://nexusacademicpublishers.com/uploads/figures/20150119144254.png" width="80" height="80"></a>
            
          <p class="Figure--and-Table-Heading"><span class="CharOverride-5"><a id="Figure9-"></a>Figure 9: </span><a href="http://nexusacademicpublishers.com/uploads/figures/20150119144254.png">Hyperemic kidney</a></p>
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			<div class="pt" > <a href="http://nexusacademicpublishers.com/uploads/figures/20150119143156.png" target="new"><img class="img_display" src="http://nexusacademicpublishers.com/uploads/figures/20150119143156.png" width="80" height="80"></a>
            
         <p class="Figure--and-Table-Heading ParaOverride-1"><span class="CharOverride-5"><a id="Figure-10-"></a>Figur</span><span class="CharOverride-5">e 10: </span><a href="http://nexusacademicpublishers.com/uploads/figures/20150119143156.png"> Pinpointed hemorrhage throughout pericardium of heart</a></p>
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			<p class="Body-Text">Antemortem examination revealed that conjunctiva pale pink in colour (<a href="#Figure-2-"><span class="Hyperlink">Figure 2</span></a>), cyanosis of udder (<a href="#Figure3"><span class="Hyperlink">Figure 3</span></a>) and bloody discharge comes out through the rectum but clear transparent mucous comes from vagina after parturition commonly known as lochia (<a href="#Figure-4"><span class="Hyperlink">Figure 4</span></a>), Post mortem examination also revealed that lung become collapsed, congested and black in colour (<a href="#Figure-5-"><span class="Hyperlink">Figure 5</span></a>), trachea filled with frothy gas (<a href="#Figure-6"><span class="Hyperlink">Figure 6</span></a>), ecchymosis and congestion throughout the peritoneum (<a href="#Figure-7-"><span class="Hyperlink">Figure 7</span></a>), gall bladder filled with bile (<a href="#Figure-8"><span class="Hyperlink">Figure 8</span></a>), kidneys are hyperaemic and congested embedded with white crystal throughout the whole structure (<a href="#Figure9-"><span class="Hyperlink">Figure 9</span></a>) and pin pointed haemorrhage found on the entire pericardium of heart (<a href="#Figure-10-"><span class="Hyperlink">Figure 10</span></a>).</p>
		  <p class="Body-Text">&nbsp;</p>
            <p class="Normal ParaOverride-1" lang="en-US"><span class="CharOverride-12" lang="en-GB">The United States of Food and Drug Administration (FDA) safety measures in relation to ceftriaxone and intravenous calcium products must not be co given to any kind of patients in order to helps to prevents precipitations in addition to damage organ (</span><a href="#Steadman-E--Raisch-DW--Bennett-CL--Esterly-JS--Becker-T--Postelnick-M--McKoy-JM--Trifilio-S--Yarnold"><span class="Hyperlink CharOverride-13" lang="en-GB">Steadman et al., 2010</span></a><span class="CharOverride-12" lang="en-GB">). </span></p>
          <p class="Normal ParaOverride-1" lang="en-US">&nbsp;</p>
            <p class="Normal ParaOverride-2" lang="en-US"><span class="CharOverride-12" lang="en-GB">The calcium salt of ceftriaxone is recognize to have low solubility (</span><a href="#Shiffman-ML--Keith-FB--Moore-EW--1990-"><span class="Hyperlink CharOverride-13" lang="en-GB">Shiffman et al., 1990</span></a><span class="CharOverride-12" lang="en-GB">)&#160;and also the formation of a 1:1 calcium: ceftriaxone salt within the</span> <span class="CharOverride-12" lang="en-GB">gallbladder and kidneys certainly make earlier identified undesirable effects (</span><a href="#Shiffman-ML--Keith-FB--Moore-EW--1990-"><span class="Hyperlink CharOverride-13" lang="en-GB">Shiffman et al., 1990</span></a><span class="CharOverride-12" lang="en-GB">; </span><a href="#Park-HZ--Lee-SP--Schy-AL--1991"><span class="Hyperlink CharOverride-13" lang="en-GB">Park et al., 1991</span></a><span class="CharOverride-12" lang="en-GB">)&#160;In some instances, ceftriaxone-calcium crystalline material was seen in the vascular beds of lungs and other tissues at autopsy (</span><a href="#Bradley-JS--Wassel-RT--Lee-L--Nambiar-S--2009-."><span class="Hyperlink CharOverride-13" lang="en-GB">Bradley et al., 2009</span></a><span class="CharOverride-12" lang="en-GB">). Ceftriaxone must be avoided or even significantly minimized in neonates (especially those treated concomitantly with intravenous calcium solutions and those with hyperbilirubinemia), and also restricted in the geriatric population treated concomitantly with intravenous calcium (</span><a href="#Monte-SV--Prescott-WA--Johnson-KK--Kuhman-L--Paladino-JA--2008-"><span class="Hyperlink CharOverride-13" lang="en-GB">Monte et al., 2008</span></a><span class="CharOverride-12" lang="en-GB">). Use of calcium and ceftriaxone may causes of pancreatitis, possibly of biliary obstruction. Most patients presented with risk factors for biliary stasis and biliary sludge may be role of ceftriaxone-related biliary pre-cipitation cannot be ruled out. In the research, it was shown that a 53-year old man who has been treated with intravenous ceftriaxone 2 grams every 12 hours for seven days resulting total, direct, and indirect bilirubin levels, increased significantly, and the patient became jaundiced. A right upper quadrant ultrasound showed that biliary sludge and cholelithiasis without sonographic evidence of cholecystitis. Ceftriaxone was thought to be the responsible agent (</span><a href="#Bickford-CL--Spencer-AP--2005-."><span class="Hyperlink CharOverride-13" lang="en-GB">Bickford and Spencer, 2005</span></a><span class="CharOverride-12" lang="en-GB">).The intravenous  use of ceftriaxone along with calcium-containing solutions in the new-born and young infant may possibly cause of death, among of the 9 reported cases 7were deaths (</span><a href="#Bradley-JS--Wassel-RT--Lee-L--Nambiar-S--2009-."><span class="Hyperlink CharOverride-13" lang="en-GB">Bradley et al., 2009</span></a><span class="CharOverride-12" lang="en-GB">). There is a connection to simultaneous use of high-dose intravenous calcium and ceftriaxone leads to severe cardio-respiratory events or death. (</span><a href="#Bruce-RD--Danny-JZ--Reza-S--Kevin-BL--2010-"><span class="Hyperlink CharOverride-13" lang="en-GB">Bruce et al., 2010</span></a><span class="CharOverride-12" lang="en-GB">).</span><span class="CharOverride-12" lang="en-GB"> </span></p>
          <p class="Normal ParaOverride-2" lang="en-US">&nbsp;</p>
			<p class="Normal--Web- ParaOverride-3" lang="en-US"><span class="CharOverride-15" lang="en-GB">The study conclude that veterinarian need to be aware of the fact that concurrent use of intravenous ceftriaxone and calcium containing solutions in dairy cows may result in a life-threatening drug reaction. </span></p>
		  <p class="Normal--Web- ParaOverride-3" lang="en-US">&nbsp;</p>
			<p class="Heading-1--Introduction----">REFERENCES</p>
		  <p class="Heading-1--Introduction----">&nbsp;</p>
			
			  <li class="References ParaOverride-5" lang="en-US"><a id="Bruce-RD--Danny-JZ--Reza-S--Kevin-BL--2010-"></a>Bruce RD, Danny JZ, Reza S, Kevin BL (2010). Concomitant Ceftriaxone and High-concentration Intravenous Calcium Therapy in Adult Critical Care Patients: A Matched Cohort Study. Ann. Pharmacother. 44(7): 1158-1163. <a href="http://dx.doi.org/10.1345/aph.1M745"><span class="Hyperlink">http://dx.doi.org/10.1345/aph.1M745</span></a></li>
				<li class="References ParaOverride-5" lang="en-US"><a id="Bickford-CL--Spencer-AP--2005-."></a>Bickford CL,&#160;Spencer AP (2005). Biliary sludge and hyperbilirubinemia associated with ceftriaxone in an adult: case report and review of the literature. Pharmacotherapy. 25(10): 1389-1395. <a href="http://dx.doi.org/10.1592/phco.2005.25.10.1389"><span class="Hyperlink">http://dx.doi.org/10.1592/phco.2005.25.10.1389</span></a></li>
				<li class="References ParaOverride-5" lang="en-US"><span lang="en-GB"><a id="Bradley-JS--Wassel-RT--Lee-L--Nambiar-S--2009-."></a>Bradley JS, Wassel RT, Lee L, Nambiar S (2009). Intravenous ceftriaxone and calcium in the neonate: assessing the risk for cardiopulmonary adverse events. Peds. 123(4): 609-613. </span><a href="http://dx.doi.org/10.1542/peds.2008-3080"><span class="Hyperlink" lang="en-GB">http://dx.doi.org/10.1542/peds.2008-3080</span></a></li>
			
				<li class="References ParaOverride-5" lang="en-US"><a id="Shiffman-ML--Keith-FB--Moore-EW--1990-"></a>Shiffman ML, Keith FB, Moore EW (1990). Pathogenesis of ceftriaxone-associated biliary sludge.  In vitro studies of calcium-ceftriaxone binding and solubility. J. Gastro. 99(6): 1772–1778. </li>
				<li class="References ParaOverride-5" lang="en-US"><a id="Steadman-E--Raisch-DW--Bennett-CL--Esterly-JS--Becker-T--Postelnick-M--McKoy-JM--Trifilio-S--Yarnold"></a>Steadman E, Raisch DW, Bennett CL, Esterly JS, Becker T, Postelnick M, McKoy JM, Trifilio S, Yarnold PR, Scheetz MH (2010). Evaluation of a potential clinical interaction between ceftriaxone and calcium. Antimic. Agents Chemo. 54(4): 1534-1540. <a href="http://dx.doi.org/10.1128/AAC.01111-09"><span class="Hyperlink">http://dx.doi.org/10.1128/AAC.01111-09</span></a></li>
		  <li class="References ParaOverride-5" lang="en-US"><a id="Park-HZ--Lee-SP--Schy-AL--1991"></a>Park HZ, Lee SP, Schy AL (1991). Ceftriaxone-associated gallbladder sludge: identification of calcium-ceftriaxone salt as a major component of gallbladder precipitate. J. Gastro. 99(6):1665–70. </li>
			
				<li class="References ParaOverride-5" lang="en-US"><a id="Monte-SV--Prescott-WA--Johnson-KK--Kuhman-L--Paladino-JA--2008-"></a>Monte SV, Prescott WA, Johnson KK, Kuhman L, Paladino JA (2008). Safety of ceftriaxone sodium at extremes of age. Expert Opin. Drug Saf. 7(5): 515-523. <a href="http://dx.doi.org/10.1517/14740338.7.5.515"><span class="Hyperlink">http://dx.doi.org/10.1517/14740338.7.5.515</span></a></li>
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