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Dairy cows at risk of ketosis

Problems with transition cows usually manifest themselves in the month immediately after calving: around 75% of all adult cow health problems happen in the period around calving1, with around 50% of cows having some health issues at this time2. However, multiple factors can contribute, and many of the important precipitating factors start prior to calving, ie. in the dry cows.


To understand ketosis risk levels on your farm, and identify 'pinch points' that may occur in your system, use the Healthy Start Checklist. Watch Owen Atkinson from Dairy Veterinary Consultancy Ltd explain how to use the Healthy Start Checklist:

Request a call back to discuss arranging a Healthy Start Checklist on your farm; alternative contact information can be found here.

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Why do Body Condition Scoring?

Body Condition Scoring is an important management tool to help achieve a balance between economic feeding, milk production and good welfare. Cows with the correct condition score have a lower chance of developing ketosis, displaced abomasums and fatty liver around calving4.


What is Body Condition Scoring?

Body Condition Scoring provides a 'hands on' objective measure of the amount of fat cover on the cow. Since fat is an energy reserve, condition scoring helps to provide an indication of the cow's energy status. Most scoring systems use a 1-5 point scale, with increments of 0.25.


When to Body Condition Score?

Body Condition Scoring should be carried out regularly throughout the cow's production cycle, and especially at

  • Dry off
  • 3-4 weeks pre-calving
  • Calving
  • 60 days post-calving

  • Watch Owen Atkinson from Dairy Veterinary Consultancy Ltd explain how to Body Condition Score:


    All cows will drop their dry matter intake a few days before calving, but it has been shown that the cows that show the largest drop in intake, and are slowest to recover, are the cows most likely to get sick after calving3.

    Rumen Fill Scoring gives an estimate of the daily dry matter intake for the individual cow, which gives an indication that the cow is able to access sufficient feed.

    Watch Owen Atkinson from Dairy Veterinary Consultancy Ltd explain how to Rumen Fill Score:


    While some cows are more obviously at risk, in every herd there are 'outliers' which may show less obvious signs of being at risk of subclinical ketosis:

    Ketosis identifying outliers

    Some high risk cows to consider initially could be SOFT cows:

    Sick - any animals who have been lame or sick in their dry period

    Old - with lactation 3 and above5,6

    Fat animals with Body Condition Score ≥3.57,8

    Twin bearing9

    Also discuss with your vet and nutritionist about ongoing monitoring (via blood testing or inference from milk records) and prevention of ketosis in your herd alongside targeting those high risk animals.



    One option for reducing the risk of ketosis in these high risk cows is to administer a KexxtoneTM bolus 3-4 weeks pre-calving. KexxtoneTM is a prescription-only medicine available from your veterinary surgeon which contains monensin. Monensin is released over a period of around 90 days and works by favouring the proprionate-producing bugs in the rumen. Proprionate is used by the cow to produce glucose, which is the main energy source required for various processes including milk production. More proprionate = more glucose = decreased risk of ketosis.

    Contact your Elanco Account Manager or veterinary surgeon for more information on KexxtoneTM.

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    References: 1. Major Advances in Disease Prevention in Dairy Cattle, S J LeBlanc, K D Lissemore, D F Kelton, T F Duffield, K E Leslie. American Dairy Science Association 2006. 2. LeBlanc, S., 2010. Monitoring metabolic health of dairy cattle in the transition period. Journal of Reproduction and Development 56 (Suppl), S29–S35. 3. Huzzey, J. M., et al. (2007). Prepartum behavior and dry matter intake identify dairy cows at risk for metritis. J. Dairy Sci. 90(7): 3220-3233 4. Roche et al. 2009. Invited review: Body condition score and its association with dairy cow productivity, health, and welfare. J. Dairy Sci. 92:5769-5801. 5. Heringstad, Chang, Gianola, Klemetsdal 2005. Genetic analysis of clinical mastitis, milk fever, ketosis and retained placenta in three lactations of Norwegian Red cows. J. Dairy Sci. 88:3273-3281. 6. Rajala-Schultz, Grahn, McCulloch 1999. Effect of milk fever, ketosis and lameness on milk yield of dairy cows. J. Dairy Sci. 82:288-294. 7. Gillund, Reksen, Grahn, Karlberg 2001. Body condition related to ketosis and reproductive performance in Norwegian dairy cows. J. Dairy Sci. 84:1390-1396. 8. Duffield 2000. Subclinical ketosis in lactating dairy cattle. Vet. Clin. North Am. Food Anim. Pract. 16:231-253 9. Fricke 2001. Review: Twinning in Dairy Cattle. Prof. Anim. Sci. 17:61-67.
    Kexxtone™ is a veterinary medicine authorized to reduce the incidence of ketosis in periparturient dairy cows and heifers which are expected to develop ketosis. Kexxtone™ is not authorized for the treatment of any other transition disorder. Ensure correct disposal to prevent access to used or recovered boluses to other species including dogs, horses and guinea fowl. Kexxtone contains Monensin. Legal category POM-V in UK. Further information is available from the Summary of Product Characteristics. Advice should be sought from the medicine prescriber prior to use. Kexxtone, Elanco and the diagonal bar are trademarks of Elanco or its affiliates. Use medicines responsibly (http://www.noah.co.uk/responsible). PM-UK-21-0425