Primary Ketosis in the High-Producing Dairy Cow: Clinical and Subclinical Disorders, Treatment, Prevention, and Outlook

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Abstract
Bovine ketosis typically occurs in early lactation. Clinical signs include diminished appetite, decreased milk production, loss of weight, hypoglycemia, and hyperketonemia. Susceptibility to ketosis is probably due to the combination of appetite limitation and a high degree of precedence given to the demand of the mammary gland for nutrients, in particular glucose. The precipitating cause is likely to be development of a marked imbalance between glucose supply and glucose requirement. This imbalance then leads to decreased carbohydrate status, decreased insulin secretion, increased fat mobilization, and increased hepatic ketogenesis. Hepatic ketogenesis may be augmented by the diminished carbohydrate status. The role of hormones other than insulin in the etiology of ketosis, although probably important, has not yet been elucidated satisfactorily. Treatment of ketosis involves increasing glucose supply relative to glucose demand. Incidence of clinical ketosis can be minimized by correct nutrition and management as outlined in recommended guidelines. Besides decreasing milk field, clinical ketosis may affect productivity adversely in other ways, for example, by impairing fertility. Subclinical ketosis is important because it may remain undetected and yet have effects on productivity which parallel those elicited by clinical ketosis. Future research should be directed toward understanding mechanisms conferring priority on milk production and regulating appetite.