Ketosis of highly productive cows is one of the most common metabolic pathologies, the etiological basis of which is the negative energy balance of the animal's body. The consequences of this disease is a deterioration in the health and productive qualities of the animal. Therefore, it is necessary to carry out timely and comprehensive diagnostics. The aim of these studies was to analyze the level of ketone bodies in the blood of highly productive Holstein cows and their clinical condition in the first three weeks of milk production. The studies were carried out in one of the livestock farms of the Leningrad region on 35 highly productive cows (the annual milk yield is more than 10,000 liters of milk) of the Holstein breed щт 5, 10, 15 and 20 days after calving. At the same time, the clinical manifestation of ketosis and concomitant diseases, as well as changes in the dynamics of the level of ketone bodies in the blood, were taken into account using test strips for the determination of ketone bodies in the Optium Xceed glucometer. According to the results of the studies, the average level of ketone bodies in the blood of cows on the 5th day after calving was 1.59 ± 1.08 mmol / l, which corresponded to the norm. In cows, on the 10-15th day after calving, an increase in the level of ketone bodies was noted by 1.3-1.4 times and averaged 2.1 ± 1.14 and 2.25 ± 1.4 mmol / l, respectively. On the 20th day after calving, the level of ketone bodies stabilized. It was equal to 1.55 ± 1.22 mmol / l. During the clinical examination of the animals, no obvious signs of ketosis were found. Throughout the experiment, 31% of the cows have had postpartum endometritis of first degree (according to the grades adopted at the farm: I, II, and III degrees), 2.8% - second degree, and 2.8% - third degree endometritis. Mastitis was registered in 22.7% of cows, and purulent pododermatitis in 2.8%. In addition, the animals with an increased level of ketone bodies were not recorded clinical manifestations of ketosis and concomitant diseases. And the cows with high level of ketone bodies in the blood was noted the presence of clinical signs of concomitant diseases (mastitis, endometrium, etc.). We can suggested the absence of a characteristic relationship between the content of ketone bodies in the animal's body and its health. It could be necessary to continue research on a larger livestock of animals and it should be pay an attention on the farm’s management, cows’ production schedule (milking, feeding, rest) and their productivity as well.