AIM: To evaluate the macromineral status of field cases of dairy cows surgically treated for left abomasal displacement (LDA), with concurrent fatty liver of different severity, and compare this for animals that died or recovered. METHODS: Sixty-eight Holstein dairy cows with LDA and 110 control cows, from 28 farms, were used in the study. Blood samples and liver biopsies were obtained during standing surgery for correction of LDA, and from control cows. The concentration of macrominerals in serum, and of total lipids (tLPD) and triglycerides (TG) in liver were determined. Liver was examined histologically, and classified for its severity of fatty liver. Cows with LDA were grouped according to severity of fatty liver. Cows in Groups 1 to 3 recovered, whereas those in Group 4 died within 4 weeks of surgery. Group 1=mild (n=4) or moderate (n=6 cows, n=4 heifers) fatty liver, Group 2 = moderate to severe fatty liver (n=13), Group 3=severe fatty liver (n=15 cows, n=5 heifers), Group 4 = severe fatty liver (n=17 cows, n=4 heifers). RESULTS: The concentration of macrominerals in serum was affected by the concurrence of fatty liver and LDA; Ca, K and Mg were significantly (p<0.05) lower in animals that died than those that survived. For cows with severe fatty liver, concentrations of tLD and TG were higher in the animals that died compared with those that recovered (p<0.01). Cows with LDA and severe fatty liver that died were earlier in lactation (median days in milk (DIM) 13 days) compared with the other cows with LDA (median DIM 21–26 days) (p<0.05); they were also significantly older (median 6 years old) than cows in the other groups (median 4 or 5 years old) (p–0.05). CONCLUSIONS AND CLINICAL RELEVANCE: Concentrations of macrominerals in serum were influenced by the concurrence of LDA and fatty liver. Animals with low concentrations of Ca, K and Mg had a guarded prognosis. The concentration of K should always be evaluated in cows with LDA and concurrent fatty liver when providing a prognosis. Most cows with severe fatty liver were detected in the first 4 weeks of lactation, but older animals and those that had more recently calved had a worse prognosis.