What is Ketosis?

Ketosis is an elevated level of ketones in the blood associated with a negative energy balance that occurs in most cows during the early stages of their lactation (2-6 weeks into lactation, most cows get ketosis around week 3 after freshening) and occasionally mid-late lactation cows.

What to look for with ketosis:

Signs of ketosis include a decreased intake of dry matter, loss of body condition, decreased milk production, the cow acting nervous, and breath that smells sickly sweet like acetone.

Why is ketosis bad?

Ketosis can kill a cow by essentially poisoning her body if not treated. Less dramatic problems include long-term decreased production, unhealthy quality of milk, inability to maintain and store vital nutrients to her body for long term health, and can cause reproductive issues. Ketosis can create fatty liver syndrome which causes a number of problems such as decreased fertility, decreased liver function, and sometimes death.

Testing for ketosis:

To know if your cow has ketosis, you can buy Ketostix strips. Collect a small sample of urine into a sterile cup and dip a strip into the urine. Read package directions to determine if your cow tests positive for ketosis. A blood test can also be done and is more accurate, but the strips provide a quick easy test. If a cow tests positive, ask your vet about getting a milk test done, as a positive test in the milk would indicate enough problem to warrant treatment.

An elevated temperature would indicate another problem, as ketosis alone should not change body temperature.

What causes ketosis?

  1. Consumption of silage that contains butyric acid can cross the rumen wall to the liver.
  2. Production of ketones in the liver. Milk production requires a large amount of glucose. By the second day after calving, a cow’s requirement of glucose doubles. Without an adequate supply, the body takes energy reserves from stored fat and produces ketones which are used in place of the glucose. Ketones should not be present for very long in a healthy cow, as she should be able to eat enough food, if high quality, to maintain her body and provide for lactating. A cow that has high levels of ketones for a long period is considered “ketotic” and must be treated to prevent damage.
  3. Overweight cows at time of calving. Healthy body condition score of 3.25-3.75 should be maintained from time of dry off to time of calving.

How to prevent ketosis:

In fact, our research showed that cows overfed energy in the dry period had higher concentrations of both BHB and NEFA in the immediate postpartum period.

Cows overfed energy in excess of predicted requirements (larger amount of corn silage and smaller amount of chopped straw compared to the controlled energy group) by approximately 50 percent had almost three times as many episodes of hyperketonemia in the first three weeks postpartum (31 versus 13) compared with cows that were fed to meet, but not exceed, energy requirements (with about 16 percent starch in the diet).

Manage, monitor metabolic ‘Armageddon’ in transition cows – Sabine Mann, Jessica McArt and Daryl Nydam for Progressive Dairyman

  • Encourage dry matter intake. Fermentation of dry matter in the rumen helps produce the fatty acid proprionate, which is essential to healthy processing of glucose for energy requirements. Around a week before calving, most cows reduce the amount of food they are eating. Therefore, the food they DO eat needs to be very high quality. High in protein, highly palatable, and NO moldy, musty, rank food.
  • Consider adding soaked beet pulp to the cow’s grain ration. The fiber helps rumen digestability.
  • Avoid stress from transitions. A cow should be close to her full milk cow ration by one week before calving. Make time (around 3 weeks) to transition hays and grain so that the cow is not suddenly confronted with something new and unusual.
  • A normal pre-fresh cow will consume about 1.75% of body weight per day. That is around 15-20 pounds of dry matter for a mid-sized cow. An increase in grain at this time can help manage the balance needed for increased intake, but be sure to maintain a level of hay feeding for rumen health and overall digestibility.
  • Balance dry matter intake with energy needs (17-18 Mcal/day for close-up cows and 25-35 Mcal/day for postpartum cows)
  • Always have available easily accessable fresh water.
  • Provide an area where the dry cow/fresh cow can eat without having to compete for her food. Always provide feed and change the selection often to encourage palate.
  • Supplement Vitamin E at 1000-4000 IU per day in the days before calving and 800 IU postpartum.
  • Treat milk fever immediately if signs are seen. IV CMPK as necessary.

Treating ketosis:

  • Dextrose, IV, one full bottle. A temporary energy source to encourage the cow to start eating and drinking. Possibly a IV bottle of CMPK.
  • Slow acting CMPK boluses & Rumen-Start capsules or Fastrack probiotic pack.
  • Adding niacin, glycerin, calcium/sodium proprionate or propylene glycol to cow’s diet (consult your vet for instructions).

Treating for ketosis can also help prevent other issues surrounding calving time:

  • Displaced Abomasum (DA) can be prevented with proper dry cow maintainence feeding.
  • In addition, a healthy dry cow will more likely calve easily,
  • expel placenta in a timely manner,
  • avoid bacterial infection and swelling of the uterus (metritis) and other immune issues,
  • breed back on schedule,
  • have a steady increase in milk production,
  • reduce somatic cell count over the duration of the lactation,
  • reduce incidences of mastitis.


Rena’s Drench:

Keeping up with Ketosis by Elizabeth Eckelkamp and Jeffrey Bewley

Steve Maske. “How nutrition can affect prepartum and postpartum cows.” February 8, 2011. Issue 3. Progressive Dairyman, 93-95.

David L. Prentice. “Are your cows ketotic?” February 8, 2011. Issue 3. Progressive Dairyman, 87-89.

Mark J. Thomas, DVM. “New tools to help us spot ketosis.”

Mary Beth de Ondarza, Ph. D., “Ketosis and Fatty Liver.”

7 thoughts on “Ketosis

    1. I would probably not drink milk from a cow with severe ketosis (and for some, the smell/taste may be off-putting) but from a mildly ketotic cow, the milk should be ok to consume. A ketotic cow gives off ketones, which in cows is beta hydroxybutyrate (BHBA).

      In general, milk should not be consumed from any unhealthy cow. That would be a smart policy to stick to, as we’re only as healthy as the food we’re consuming, so our food should be healthy, too! Some cows may be very healthy looking and still register high in BHBA, in that case, it may be an issue of fatty liver or high production that is simply going to take time to resolve. In that case, if the milk tastes good/sweet, it should be ok to use.


  1. Heather

    My cow had a mild case of Ketosis about a week after she calves (she went off feed and dropped milk production) I changed her feed and drenched her with Apple cider vinegar and molasses for several days. I had her back on feed within a week, but her milk production is still low 😦 she is gaining weight and eating good, how long will it take her to increase her milk production and will this affect her future lactations?
    Thank you for any advice you can give!


    1. Sorry for the delay in responding, computer issues.

      Recovery from ketosis can be slow. What kind and how much grain are you feeding her? What kind of hay does she get? If you have the ability to (gradually!) put her out on spring pasture, that should increase her production nicely.


  2. FAQ: I can’t find much on maintaining/curing a mild case of ketosis. So… what do I do now? Is there something I can to that will just “snap” her out of it? Or will supporting her energy requirements help her to rectify her body’s situation on her own?

    Answer: To know how to correct ketosis, you need to know why ketosis occurs:
    Milk production requires a large amount of glucose. By the second day after calving, a cow’s requirement of glucose doubles. Without an adequate supply, the body takes energy reserves from stored fat and produces ketones which are used in place of the glucose.

    It’s ok for a cow to be in a negative energy balance for a short while – it’s bound to happen to most cows to some extent after calving. The serious concern with ketosis is if it comes on strong or if it’s lingering/long lasting. Treat a cow that is moderate or highly positive for ketones as an acute case (meaning the use of IV fluids). Treat a fresh cow – low or not positive – as borderline (meaning feed supplements and vitamins/minerals to support her system) and make sure she has unlimited access to feed (a fresh cow can sometimes not consume enough in one day to meet the demands of milk production put on her system, so feed as much as possible to keep her rumen active).

    The way to eliminate ketosis is to add a form of glucose to the diet. Hay is primarily a source of fiber and protein, so if a cow is milking more than a small amount (1-3 gallons), she is likely to need something else that provides additional energy. The most traditional method is grain, a easy source of energy for the cow. For a sick cow, the cow is given any of the following: Dextrose, CMPK, Propylene Glycol (we never give that, YUK!, but many people do).

    Secondly, you can supplement her rumen with things like beet pulp, yeast, probiotic packs, Vitamin E, B vitamins, etc. to help her digest the nutrients as much as possible. Some people like to give the following drench recipe (just be careful drenching and see if she’ll drink it on her own first) –

    If the cow has a tendency to get fat between lactations, too thin during the lactation, or other metabolic issues that can cause fatty liver, that could make her more predisposed to have ketosis after calving (which is where it’s important to try to maintain a healthy body weight for as much of her life as possible).

    Hope the above information helps


  3. Lynn

    My Jersey is 2 years old and had her first calf 2-18-15. We had to pull the calf a little. She retained the placenta and the vet came and removed it. He checked her over and pronounced her healthy. No temperature, no mastitis, clear lungs. Since she calved she has no appetite. She drinks alot but shows very little interest in hay and no interest in her feed. Before calving she would knock you down to get to her grain. Tonight I tried giving her all stock with her usual Formula M vitamins. She ate every grain. I gave her a second helping and she ate that too. Now I’m wondering if something could be wrong with her dairy feed. It’s the same kind and brand as before she calved. I milk her twice a day on a regular schedule and get about 1 1/2 gallons. I expected a lot more based on what I’ve read and talking to other people who have milk cows.

    Today I noticed an unpleasent odor around her. It wasn’t constant so I’m not sure if it was gas she was passing. I worry about her. This is my first experience with cows and milking. I’ve pulled the calf and feed him her milk. All the milk goes to him. Other than licking him when he was first born and letting him nurse she showed no interest in him. Do you have any ideas about what could be going on with her? Am I worrying needlessly? Thanks.



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