Exenatide dosing in alpacas.

In order to investigate whether exenatide could be used to stimulate glucose clearance and insulin secretion in alpacas without causing colic signs, six healthy adult alpacas were injected once a day with increasing subcutaneous doses. A follow-up intravenous glucose injection was given to induce hyperglycemia, and serial blood samples were collected to measure plasma concentrations of glucose, insulin, triglycerides, beta-hydroxybutyrate, and nonesterified fatty acids. The exenatide doses used were saline control (no drug), and 0.02, 0.05, or 0.1 mcg/kg injected subcutaneously. Alpacas had significantly lower plasma glucose concentrations and higher insulin concentrations on all treatment days compared with the control day, but the increase in insulin was significantly greater and lasted significantly longer when the alpacas received the two higher dosages. Two of the alpacas developed mild colic signs at the 0.05 mcg/kg dose and were not evaluated at the highest dose. Based on these findings, the 0.05 mcg/kg dose appears to offer the greatest stimulation of insulin secretion and glucose clearance without excessive risk or severity of complications.

Effects of exenatide on plasma glucose and insulin concentrations in alpacas.

BACKGROUND: Exenatide is a degradation-resistant glucagon-like peptide 1 agonist used in the treatment of diabetes mellitus. It enhances the insulin response to hyperglycemia. Because of a poor insulin response, adult camelids are susceptible to hyperglycemia from stress, glucose administration, or energy metabolism disorders. Insulin often is administered to decrease plasma glucose concentration, but this approach has disadvantages such as the risk of hypoglycemia. Noninsulin medications targeting the incretin hormone pathway, such as exenatide, are providing alternate treatment options. HYPOTHESIS/OBJECTIVES: Exenatide will decrease plasma glucose and increase insulin concentrations in alpacas. ANIMALS: Six healthy adult alpacas. METHODS: After food was withheld for 8 hours, alpacas were given, on subsequent days in a randomly determined order, either 0.2 microg/kg of exenatide or similar volume of isotonic saline SC. Blood samples were collected before and 15, 30, 45, 60, 75, 90, 105, and 120 minutes after treatment. A rapid dextrose (0.5 g/kg) injection was given after the time 60 samples. Plasma glucose and insulin concentrations were measured at each time point. RESULTS: Alpacas had significantly (P=<.001-.015) lower plasma glucose and higher insulin concentrations for the hyperglycemic period after receiving exenatide than after saline injections. Colic signs were observed in 5 of 6 alpacas treated with exenatide. CONCLUSIONS AND CLINICAL IMPORTANCE: Exenatide appeared to increase insulin release and decrease plasma glucose concentrations in hyperglycemic alpacas. These findings are similar to findings in humans and could support therapeutic usage of exenatide in alpacas. However, induction of colic may limit practical application.

Thrombotic endocarditis in 10 alpacas.

BACKGROUND: A description of the clinical signs and necropsy findings in 10 alpacas with thrombotic endocarditis. ANIMALS: Clinical cases admitted to 2 veterinary referral hospitals between May 1998 and December 2006. METHODS: A retrospective study was performed by searching hospital records to identify alpacas diagnosed with endocarditis. RESULTS: Common clinical findings included sternal recumbency, tachycardia, tachypnea, and abdominal distension. Heart sounds were recorded as normal in 7 of 10 alpacas. Pleural and pericardial effusion and ascites were often present. Complete blood cell counts often suggested inflammation, and liver enzyme activity was often increased. When echocardiography was performed, a soft tissue density was imaged within the right ventricle. All alpacas died or were euthanized. Necropsy revealed mural endocarditis with right ventricular or biventricular fibrinous thrombi obliterating the ventricular lumina with no valvular involvement in 6 of 10 affected animals. Bacteria were not consistently identified as a cause for the endocarditic lesions. Eight of the 10 alpacas had evidence of hepatic fluke infestation. CONCLUSIONS AND CLINICAL IMPORTANCE: Valvular and mural thrombotic endocarditis should be included in the list of differential diagnoses for hepatomegaly, abdominal distension, and other signs of right-sided congestive heart failure in alpacas. The prognosis of this disease is grave.

Comparative biochemical analyses of venous blood and peritoneal fluid from horses with colic using a portable analyser and an in-house analyser.

Fifty-six horses with colic were examined over a period of three months. The concentrations of glucose, lactate, sodium, potassium and chloride, and the pH of samples of blood and peritoneal fluid, were determined with a portable clinical analyser and with an in-house analyser and the results were compared. Compared with the in-house analyser, the portable analyser gave higher pH values for blood and peritoneal fluid with greater variability in the alkaline range, and lower pH values in the acidic range, lower concentrations of glucose in the range below 8.3 mmol/l, and lower concentrations of lactate in venous blood in the range below 5 mmol/l and in peritoneal fluid in the range below 2 mmol/l, with less variability. On average, the portable analyser underestimated the concentrations of lactate and glucose in peritoneal fluid in comparison with the in-house analyser. Its measurements of the concentrations of sodium and chloride in peritoneal fluid had a higher bias and were more variable than the measurements in venous blood, and its measurements of potassium in venous blood and peritoneal fluid had a smaller bias and less variability than the measurements made with the in-house analyser.

Naturally occurring acute coliform mastitis in Holstein cattle.

Physical examination and clinicopathologic findings from 44 adult Holstein cows with naturally occurring coliform mastitis were studied. The cattle were grouped for comparison by stage of lactation and survival. Cattle within the first 4 weeks of lactation maintained higher median mature neutrophil counts (1,200 versus 300/microL) in peripheral blood than cattle later in lactation. Nonsurviving cows had higher median creatinine concentration (2.5 versus 1.6 mg/dL) and anion gap (25 versus 20 mEq/L), and lower serum protein (7.1 versus 7.6 gm/dL) and total CO2 (19.8 versus 25 mEq/L) concentrations than surviving cows (P < .05). These findings indicate that cattle with uremia and metabolic acidosis are less likely to survive the infection. Bacteriologic blood cultures were performed on 34 of the 44 cows studied. Escherichia coli was isolated from the blood in 11 (32%) cows. Clinical presentation and clinicopathologic data were compared in bacteremic versus nonbacteremic cows to evaluate these data as predictors of bacteremia. Bacteremic cows were sick longer prior to admission (2 versus 1 days), maintained higher median counts of total nucleated cells (6.6 versus 2.4 x 10(3) cells/microL), myelocytes (0.2 versus 0 x 10(3) cells/microL), metamyelocytes (0.5 versus 0.02 x 10(3) cells/microL), band neutrophils (0.7 versus 0.1 x 10(3) cells/microL), and lymphocytes (2.1 versus 1.4 x 10(3) cells/microL) than nonbacteremic cows, and had higher plasma fibrinogen concentration (600 versus 500 mg/dL) (P < .05). There were no differences between the physical or serum biochemical measurements. Four of 11 bacteremic cows and 5 of 23 nonbacteremic cows died or were euthanized (P > .05). The high prevalence of bacteremia seen in cows with coliform mastitis has not been reported previously, and may have been due to the duration of disease, severity of signs, or culture technique. These findings suggest that systemic antibiotic therapy may be beneficial in some severe cases of coliform mastitis.

Lymphosarcoma in 10 New World Camelids.

We evaluated the medical information from 10 New World Camelids with lymphosarcoma. Additionally, tumor tissue from 5 animals was examined by electron microscopy for evidence of retroviral particles. Lymphosarcoma was the most common neoplasm of New World Camelids in our hospital. Both llamas and alpacas, from 4 months to 15 years of age, were affected. Emaciation (7 of 8) and palpable masses (9 of 10) were the most common physical examination abnormalities, and a left-shifted leukogram (7 of 7) and hypoalbuminemia (6 of 7) were the most characteristic clinicopathologic findings. Lymphosarcoma was diagnosed by lymph node aspirate (n = 2), biopsy (n = 2), peritoneal fluid analysis (n = 2), or necropsy (n = 4). The clinical course after recognition of the disease was usually short, with a median survival of 1 month (1 week to 3 months). Organs with neoplastic infiltrates commonly included lymph nodes (n = 8), liver (n = 8), kidneys (n = 6), and lungs (n = 5). No retroviral particles were detected ultrastructurally.

Hepatic lipidosis in anorectic, lactating holstein cattle: a retrospective study of serum biochemical abnormalities.

The association between hepatic lipidosis (HL) and disease in 59 anorectic, ketotic, lactating Holstein heifers and cows was investigated. Severe HL, as determined by histologic evaluation of liver tissue, was present in 46 animals; only half of these animals required intensive treatment for ketosis, and only half had serum biochemical evidence of liver disease, as determined by the presence of a last value of 2-fold or greater than the upper limit of the reference ranges for at least 2 of the 4 serum tests: gamma-glutamyl transferase, aspartate aminotransferase, and sorbitol dehydrogenase activities and bile acid concentrations. Most cattle with biochemical evidence of liver disease and severe HL had been lactating for 14 or more days. Cows that required intensive treatment inconsistently had serum biochemical evidence of liver disease. Although cattle with severe HL had significantly higher serum bilirubin concentrations and aspartate aminotransferase and sorbitol dehydrogenase activities than cattle with less severe lipidosis, the specificity of abnormally high serum sorbitol dehydrogenase activity or bilirubin concentration for severe lipidosis was only 8%. Abnormally high serum aspartate aminotransferase activity was 83% sensitive and 62% specific for severe lipidosis. Serum glucose and total carbon dioxide concentrations were significantly lower in cattle with severe lipidosis than in those with mild or moderate lipidosis, and low serum glucose or total carbon dioxide concentrations were rare in cattle without severe lipidosis. From these data, we conclude that the use of a single biochemical or histopathologic criterion to define severity of disease or degree of liver compromise in anorectic, ketotic cows results in the misidentification of many animals.

Treatment of neonatal calf diarrhea with an oral electrolyte solution supplemented with psyllium mucilloid.

Dairy calves under 14 days of age with naturally occurring, uncomplicated diarrhea were treated for 3 days with a hypertonic oral electrolyte solution with (n = 15) or without (n = 12) psyllium. Clinical response and clinical pathology data were compared between the 2 groups. Glucose absorption was evaluated on days 1 and 3 by measurement of plasma glucose and lactate and serum insulin concentrations for 4 hours after formula administration. On day 1, glucose, lactate, and insulin concentrations were lower in psyllium-fed calves than in control calves, with significant differences noted in glucose and lactate concentrations at several time points (P < 0.05). Plasma lactate concentrations were higher at several times in both treatment groups on day 3 than on day 1 (P < 0.05). Fecal consistency was markedly different in psyllium-fed calves as compared with control calves within 24 hours of psyllium supplementation. Fecal percent dry matter content was lower in psyllium-fed calves than in control calves at least once a day during supplementation and on day 3 compared with day 0 in the psyllium-fed calves (P < 0.05). There were no significant differences in clinical performance scores, hydration status, arterial blood gas, serum anion gap, electrolyte, or total CO2 concentrations. Addition of psyllium to an oral electrolyte solution resulted in immediate alterations in glucose absorption without impairing rehydration in diarrheic calves, but differences were transient and did not affect clinical outcome.

Effects of exogenous insulin on glucose tolerance in alpacas.

OBJECTIVE: To evaluate the effects of exogenous insulin on clearance of exogenous glucose in alpacas. ANIMALS: 7 adult castrated male alpacas. PROCEDURE: Prior to each of 2 trials, food was withheld for 8 hours. Glucose (0.5 g/kg of body weight) was then administered by rapid IV infusion. During 1 of the trials, regular insulin (0.2 U/kg, IV) was also administered 15 minutes later. Blood was collected immediately before (0 minutes) and 15, 20, 25, 30, 45, 60, 90, 120, 180, and 240 minutes after glucose administration. Plasma concentrations of glucose and lactate were determined, and glucose fractional turnover rate and plasma half-life were calculated. RESULTS: Insulin treatment caused a significant increase in fractional turnover rate of glucose and plasma lactate concentration. Plasma glucose concentrations were less in insulin-treated alpacas from 30 minutes after glucose administration (15 minutes after insulin administration) until the conclusion of each trial, compared with nontreated alpacas. In addition, plasma glucose concentration in insulin-treated alpacas returned to baseline values 1 hour sooner than in the nontreated group. CONCLUSIONS AND CLINICAL RELEVANCE: Glucose uptake in alpacas improves after insulin treatment, suggesting that administration of exogenous insulin will increase the therapeutic and decrease the pathologic effects of exogenous glucose administered to hypoglycemic alpacas. However, alpacas and other New World camelids should be monitored carefully during treatment with glucose or insulin, because these species appear to be partially insulin resistant.

Pathogenesis of Streptococcus zooepidemicus infection after intratracheal inoculation in llamas.

OBJECTIVES: To test whether generalized Streptococcus zooepidemicus infection could be induced by intratracheal inoculation in llamas and to characterize this infection. ANIMALS: 6 test and 3 control llamas. PROCEDURE: Test llamas received 1 of 3 dosages of S. zooepidemicus by intratracheal injection, whereas control llamas received sterile culture medium. Physical examination variables and results of clinicopathologic analyses of blood, peritoneal fluid, and tracheal wash fluid were compared in test llamas between, before, and during the development of bacteremia and with control llamas. Bacteriologic culture was performed on all collected body fluids and tissue specimens that were collected at necropsy. Tissue specimens that were collected at necropsy were examined histologically. RESULTS: Infection induced fever, anorexia, and signs of depression. Five of 6 infected llamas developed specific signs of inflammation in the thorax or abdomen, bacteremia, neutrophilic leukocytosis with toxic changes and high band neutrophil cell counts, hyperfibrinogenemia, and high peritoneal fluid WBC counts and protein concentrations. On development of bacteremia, llamas had significant decreases in serum iron (from 118+/-25 to 6+/-4 microg/ml) and increases in serum glucose (from 131+/-5 to 253+/-48 mg/dl) concentrations. CONCLUSIONS AND CLINICAL RELEVANCE: Streptococcus zooepidemicus spreads rapidly to other body compartments after intratracheal inoculation in llamas. Fever, anorexia, and signs of depression are the most consistent clinical signs, although other signs are possible. Clinicopathologic analysis of body fluids yields evidence of inflammation. Infection by S. zooepidemicus can be proven by bacteriologic culture of body fluids before death or of tissue specimens after death.

Glucose tolerance testing in llamas and alpacas.

OBJECTIVE: To determine blood glucose clearance in 2 species of New World camelids after IV challenge and to examine mechanisms of this clearance. ANIMALS: 5 adult female llamas and 5 adult gelded alpacas. PROCEDURE: After food was withheld for 12 hours, camelids received 0.5 g of glucose/kg of body weight by rapid IV infusion. Serum concentrations of glucose, nonesterified fatty acids, cortisol, and insulin, and plasma concentrations of lactate were determined before and 0, 1, 2, 3, 4, 5, 15, 30, 60, 90, 120, 180, and 240 minutes after infusion. Ratios of insulin to glucose and insulin to cortisol were calculated for each time point. RESULTS: Postinfusion glucose concentrations were significantly higher in llamas than alpacas for the first 15 minutes and remained significantly higher than baseline values in both species for 180 minutes. Lactate and cortisol concentrations did not change significantly; nonesterified fatty acid concentrations decreased in both species 30 minutes after infusion. Baseline insulin concentrations were < 6 microU/ml in both species and increased only to 10.1 +/- 0.7 microU/ml in llamas. Insulin concentrations did not change significantly in alpacas. CONCLUSIONS AND CLINICAL RELEVANCE: Llamas and alpacas clear glucose more slowly than other domestic species after challenge, mainly because of a weak insulin response and slow cellular uptake. This response may impair the assimilation of exogenous glucose as well as make llamas and alpacas prone to diabetes-like disorders when an abundance of endogenous or exogenous glucogenic agents are present.

Metabolic changes and induction of hepatic lipidosis during feed restriction in llamas.

OBJECTIVES: To determine whether feed restriction induces hepatic lipidosis (HL) in llamas and to evaluate the metabolic changes that develop during feed restriction. ANIMALS: 8 healthy adult female llamas. PROCEDURE: Llamas were fed grass hay at a rate of 0.25% of their body weight per day for 13 to 28 days. Llamas were monitored by use of clinical observation, serum biochemical analyses, and ultrasound-guided liver biopsies. RESULTS: All 8 llamas lost weight and mobilized fat. Five llamas developed HL, including 4 that were nursing crias. During the period of feed restriction, mean serum concentration of bile acids and activities of aspartate aminotransferase (AST), sorbitol dehydrogenase (SDH), and gamma-glutamyl transferase (GGT) were significantly higher in llamas that developed HL, compared with llamas that did not. Mean insulin-to-cortisol concentration ratios were lower in llamas with HL before and up to 7 days of feed restriction, compared with those that did not develop HL. CONCLUSIONS AND CLINICAL RELEVANCE: HL in llamas may be induced by severe feed restriction, particularly in the face of increased energy demand. Llamas with weight loss attributable to inadequate dietary intake may develop biochemical evidence of hepatopathy and HL. Increases in serum concentration of bile acids and activities of GGT, AST, and SDH may indicate the development of HL in llamas and identify affected animals for aggressive therapeutic intervention.

Hyperglycemia, hypernatremia, and hyperosmolarity in 6 neonatal llamas and alpacas.

Neonatal camelids can develop hyperglycemia, hypernatremia, and hyperosmolarity in response to a combination of stress and inadequate water intake. Clinical signs of this syndrome include a fine head tremor, ataxia, and a base-wide stance of the hind limbs, but biochemical analyses are necessary to confirm the diagnosis. Camelids appear to be susceptible to this syndrome because of a poor insulin response to hyperglycemia; hypernatremia results from free water loss associated with glucose diuresis. Water loss associated with glucose diuresis may necessitate a higher rate of fluid administration in camelids with this syndrome than is typically used for treatment of hypernatremia in calves.

Gravel obstruction in the abomasum or duodenum of two cows.

Two Holstein cows from dry lot dairies were evaluated because of clinical signs of depression, anorexia, and decreased milk production. Bilateral abdominal distention and decreased fecal output were found on physical examination. Results of serum biochemical analyses indicated that the cows had severe hypochloremic, hypokalemic metabolic alkalosis. On the basis of physical examination and laboratory findings, an obstruction of the abomasum or cranial portion of the small intestine was suspected in these cows and abdominal exploratory surgery was performed. A mass of gravel was found in the pyloric antrum of the abomasum of 1 cow and the descending duodenum of the other cow. The duodenal obstruction was removed by enterotomy, and the pyloric mass was manually reduced during surgery. The cows were treated with antibiotics and isotonic saline solution (NaCl) supplemented with potassium chloride and recovered quickly after surgery.

Diagnosis and treatment of torsion of the spiral colon in an alpaca.

A 14-year-old 61.7-kg (136-lb) alpaca was examined for colic of 24 hours' duration. An exploratory celiotomy was performed because of lack of response to medical treatment and ultrasonography revealed an abnormally large amount of free fluid in the peritoneal cavity. Exploration of the abdomen revealed a 20-cm diameter mass, consisting of most of the ascending colon. The spiral colon was thick and edemetous, and it was decided to resect the spiral colon. Following a few complications, the alpaca was discharged 17 days after surgery. Colic in camelids is considered a severe problem because clinical signs are subtle and often not recognized until the condition is untreatable. Camelids are reported to be stoic animals, and may have few signs of pain despite severe abdominal disease. Alpacas with signs of abdominal pain should undergo early and complete physical, laboratory, and diagnostic imaging evaluations. Rapid identification of the need for surgery is vital for a successful outcome.

Congenital joint laxity and disproportionate dwarfism in a herd of beef cattle.

Three calves from a herd of beef cattle were examined because of disproportionate dwarfism and excessive extension of metacarpophalangeal and metatarsophalangeal joints. Abnormalities had been noticed at birth, 1 to 6 days earlier. A thorough herd investigation revealed that 16 calves born to 70 multiparous cows were affected during the calving season. The condition did not adversely affect calf survival. Affected calves had limbs that were disproportionally short, compared with their trunk size, and wide epiphyses of the femurs and humeri. Radiographic evaluation revealed incomplete maturation of carpal and tarsal bones and incomplete maturation and abnormal flaring of epiphyses of the short humeri and femurs. Histologic findings were consistent with chondrodystrophy. This disorder had not been seen in the herd in previous years and was traced to feeding of dry, spoiled silage to the dams during midgestation. Covering the silage prevented problems in the subsequent year.

Tooth root abscesses in New World camelids: 23 cases (1972-1994).

OBJECTIVE: To determine typical clinical and radiographic findings in a group of New World camelids with tooth root abscesses and to determine outcome after medical and surgical treatment. DESIGN: Retrospective case series. ANIMALS: 23 llamas and alpacas with radiographic and clinical evidence of tooth root abscesses. PROCEDURE: Disease history, signalment, physical and radiographic examination findings, bacteriologic culture results, treatment, and short-term and long-term outcome were retrieved from the medical records. RESULTS: Local swelling was the most common clinical abnormality in camelids with tooth root abscesses. Mandibular molars were affected most commonly, and bacteriologic culture of samples from lesions often revealed facultative anaerobic bacteria. Antibiotic treatment for at least 30 days, surgical extraction of the affected tooth, and a root canal procedure were used successfully to treat tooth root abscesses. CLINICAL IMPLICATIONS: Both surgical and medical treatment of tooth root abscesses may lead to successful resolution of clinical signs in New World camelids.

Surgical and nonsurgical correction of uterine torsion in New World camelids: 20 cases (1990-1996).

OBJECTIVE: To report clinical findings for New World comelids with uterine torsion and to compare results of 3 methods of correction. DESIGN: Retrospective case series. ANIMALS: 11 llamas and 3 alpacas with 20 uterine torsions. PROCEDURE: Information concerning history, clinical signs, management, and postpartum complications was retrieved from medical records. Information concerning subsequent reproductive performance was obtained by telephone interview of owners. RESULTS: Uterine torsion was corrected by celiotomy (n = 7); transvaginal manipulation (5), or rolling the dam (8). Direction of 19 of 20 torsions was clockwise when viewed from the rear. Retention of fetal membranes was reported for 5 camelids that underwent celiotomy, but was not reported in camelids after nonsurgical correction. The uterus prolapsed in 1 llama that underwent celiotomy and in another that underwent the rolling technique. Although 2 camelids that underwent celiotomy subsequently failed to conceive, all camelids treated by nonsurgical techniques conceived. CLINICAL IMPLICATIONS: Uterine torsion in camelids may be diagnosed by methods similar to those used in cattle. Surgical and nonsurgical methods can be used to correct torsion, and postpartum complications are rare when torsion is corrected by a nonsurgical method.

Idiopathic eosinophilic enteritis in four cattle.

Four cattle had chronic diarrhea and had lost weight but were not anorectic or dehydrated. A diagnosis of eosinophillic enteritis was made on the basis of a combination of clinical and histopathologic findings and exclusion of other diseases. Eosinophilia and hypoalbuminemia were not detected in CBC analyses. Gross and histologic examination of the small intestine revealed edema, diffuse eosinophilic inflammation (> 20 eosinophils/HPF [400 x]), and regional lymphadenopathy. A causative agent was not identified in any of the cattle. Treatment consisting of a 1-month course of systemically administered corticosteroids was attempted in 2 cattle and was apparently successful in both. Diagnostic criteria for eosinophilic enteritis have not been established for cattle and, therefore, the diagnosis was subjective. This disease resembled paratuberculosis (Johne's disease) in clinical appearance but was distinguished on the basis of a lack of a contagious etiologic agent and differences in histologic appearance.

Hepatic lipidosis in llamas and alpacas: 31 cases (1991-1997).

OBJECTIVE: To identify factors associated with hepatic lipidosis (HL) in llamas and alpacas. DESIGN: Retrospective case series. ANIMALS: 30 llamas and 1 alpaca. PROCEDURES: Medical records were searched to identify llamas or alpacas in which a histologic diagnosis of HL was made. Information was retrieved on signalment, history, clinical and laboratory findings, and results of necropsy or examination of biopsy specimens. Data were analyzed using descriptive statistics and chi 2 analyses. RESULTS: Females were affected more often than males; however, the sex distribution was not different from that of the camelid population in the diagnostic laboratory's database. Fifty-four percent of the females were pregnant, and 46% were lactating. Most affected camelids were 6 to 10 years old. Anorexia and recent weight loss were common (51.6% of camelids). An infective agent was found in only one ilama, and toxins and mineral deficiencies were not identified. The most common abnormalities on serum biochemical analysis were a high concentration of bile acids, high activities of gamma-glutamyltransferase (GGT) and aspartate aminotransferase (AST), and hypoproteinemia. Concentrations of nonesterified fatty acids (NEFA) and beta-hydroxybutyrate (beta-HB) were high in those camelids in which these compounds were assayed. Twenty-nine camelids did not survive. CLINICAL IMPLICATIONS: Sick camelids should be considered at risk for developing HL, especially those with anorexia or the metabolic demands of pregnancy and lactation. Other stresses also appear to contribute. High concentrations of NEFA, beta-HB, and bile acids; high activities of GGT and AST; and hypoproteinemia may indicate that HL has developed.