This work reviews the current impact and manifestation of ketosis (hyperketonemia) in dairy cattle, emphasizing the practical use of laboratory methods, field tests, and milk data to monitoring this disease. Ketosis is a major issue in high-producing cows, easily reaching a prevalence of 20% during early postpartum when the negative energy balance is well established. Its economic losses, mainly related to decreasing milk yield, fertility, and treatment costs, have been estimated up to €250 per case of ketosis/year, which can double if associated diseases are considered. A deep relationship between subclinical or clinical ketosis and negative energy balance and related production diseases can be observed mainly in the first two months postpartum. Fourier transform infrared spectrometry methods gradually take place in laboratory routine to evaluates body ketones (e.g., beta-hydroxybutyrate) and probably will accurately substitute cowside blood and milk tests at a farm in avenir. Fat to protein ratio and urea in milk are largely evaluated each month in dairy farms indicating animals at risk of hyperketonemia. At preventive levels, other than periodical evaluation of body condition score and controlling modifiable or identifying non-modifiable risk factors, the ruminatory activity assessment during the peripartum seems to be a valuable tool at farms. We conclude that a technological advance progressively takes place to mitigate the effects of these metabolic diseases, which challenge the high-yielding cows.
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