Hyperketonemia, or elevated ketone bodies, is common in dairy cows during the transition period due to negative energy balance. Testing blood beta-hydroxybutyrate (BHB) levels can identify individual cows (>1.2 mmol/L) or herds (>15% prevalence) with hyperketonemia. For individual cows, propylene glycol and vitamin B12 are recommended treatments, while herds may warrant monitoring prevalence monthly and treating all cows if over 40%. Regular testing helps identify hyperketonemic cows and herds to improve health and productivity.
3. Negative Energy Balance (NEB)
• Dairy cows enter a state of NEB during the
transition period
• Increased energy demand in early lactation
4. Energy (NEL) Requirements
2 days before versus 2 days after calving
1,600-lb Cow 1,250-lb Heifer
Function Pre Post Pre Post
Maintenance 11.2 10.1 9.3 8.5
Pregnancy 3.3 --- 2.8 ---
Growth --- --- 1.9 1.7
Milk production --- 18.7 --- 14.9
Total (Mcal) 14.5 28.8 14.0 25.1
Calculated from NRC (2001). Assumes milk production of 55 lb/d for cow and 44 lb/d for
heifer, each containing 4% fat.
Courtesy of J. K. Drackley
7. Ketosis
▪ Ketosis is the elevation of ketone bodies:
▪ Acetone
▪ Acetoacetate
▪ β-hydroxybutyrate (BHB)
▪ Clinical manifestation:
▪ Decrease in appetite
▪ Weight loss
▪ Decrease in milk production
Subclinical disease
>80% of cases
9. Types of Hyperketonemia
▪ Type I andType II: human-based distinction
▪ Inability to adapt to early lactation NEB
▪ Early in lactation, 3-21 DIM
▪ Excessive NEB just before or after calving
▪ Energy intake limited
▪ 3 to 6 weeks in milk
▪ Lack of energy substrates for level of milk production
10. Periparturient Blood BHB Concentration
0.0
0.2
0.4
0.6
0.8
1.0
1.2
-21 -18 -15 -12 -9 -6 -3 0 3 6 9 12 15 18 21
BHB,mmoL/L
Day relative to calving
Adapted from McCarthy et al., 2015, JDS
11. How much is “normal”?
▪ Incidence:
▪ Follow a group of animal through time
▪ Number of new cases/number of animals tested
▪ 25% - 85%, average ~ 45%
▪ Prevalence:
▪ Snapshot in time
▪ Number of new and existing cases/number of
animals tested
▪ 0% - 70%, average ~ 20%
Incidence ~2-2.2 x prevalence
12. Additional Info on Blood BHBTesting
▪ Time of sampling
▪ Not important in ad libTMR fed herds
▪ Otherwise highest ~ 4 to 5 hours after feeding
▪ Location of sampling
▪ Tail vessels = jugular vein
▪ Milk vein ~ 0.3 mmol/L lower
13. Blood BHB Cut-Points
▪ ≥ 1.2 to 1.4 mmol/L
▪ Based on health and production outcomes
▪ ≥ 3.0 mmol/L = more severe hyperketonemia
▪ Remember:
▪ If you your cut-point, sensitivity and specificity
▪ You correctly identify more ketotic cows but treat
more non-ketotic cows
14. Applications of HyperketonemiaTesting
▪ Identifying individual hyperketonemic cows
▪ Cow-side test for treatment decisions
▪ How intensive should we be?
▪ Identifying herds with hyperketonemia problems
▪ Herd-level testing for management decisions
15. Individual Consequences of HYK
▪ Higher risk for adverse health events
▪ Metritis
▪ Displaced abomasum
▪ Mastitis
▪ Culling
▪ Decrease milk yield in early lactation
▪ Poorer reproduction
16. When do we test?
0
5
10
15
20
25
30
35
3 4 5 6 7 8 9 10 11 12 13 14 15 16
BloodBHB≥1.2mmol/L(%)
Days in Milk
Prevalence
Adapted from McArt et al., 2012, JDS
18. HYKTreatment (BHB ≥1.2 mmol/L)
▪ Propylene glycol
▪ Vitamin B12
▪ Glucocorticoids - ?
Gordon et al., 2013, VCNA
19. Propylene Glycol
▪ Two modes of action:
▪ Increased supply of propionate = glucogenic
▪ Reduced insulin sensitivity = decreased glucose
demand by peripheral tissues
▪ Oral drenching preferred over mixing in feed
▪ No benefit with additional glycerol
20. Propylene Glycol
▪ Speeds resolution of ketosis
▪ Prevents progression to severe
ketosis
▪ Increases early lactation milk yield
▪ Reduces risk of DA and culling
▪ 300 mL, orally once a day for 5 days
~$1/dose
21. Administration of Propylene Glycol
▪ The stuff tastes horrible …
Dosing gun
Homemade pump
20 oz. soda bottle & speculum
22. Vitamin B12
▪ Synthesized in rumen
▪ Methylmalonyl-CoA mutase
▪ Coverts propionate to succinyl-CoA
▪ Vitamin B12 dependent
▪ Some supporting evidence
▪ 1 dose 25 mL Catosal (0.05 mg B12
and 100 mg butaphosphan/mL)
Propionate
Vitamin B12
24. HYKTreatment (BHB ≥3.0 mmol/L)
▪ Dextrose
▪ ½ - 1 bottle IV
▪ No randomized, controlled trials ever done on
efficacy of dextrose!
▪ Propylene glycol
▪ Vitamin B12
▪ Corticosteroids - ?
▪ Resent study shows 20mg dexamethasone may be
detrimental to cows with BHB >2.0 mmol/L
Gordon et al., 2013, VCNA
25. ▪ BHB ≥1.2 mmol/L
▪ Excellent
▪ BHB ≥3.0 mmol/L
▪ Fair to good
▪ Monitor for subsequent
diseases
▪ Severe fatty liver
▪ Poor – intensive therapy and
$$$
Prognosis of
Hyperketonemia
26. Applications of HyperketonemiaTesting
▪ Identifying individual hyperketonemic cows
▪ Cow-side test for treatment decisions
▪ How intensive should we be?
▪ Identifying herds with hyperketonemia problems
▪ Herd-level testing for management decisions
27. Incidence vs. PrevalenceTesting
▪ Incidence = new cases
▪ Difficult to measure
▪ Prevalence = new and existing cases
▪ Easier to measure
▪ First take a prevalence sample
▪ Sample at least 20 cows between 3 to 14 DIM
▪ A larger sample size will result in a more precise
estimate
28. Sample Size
▪ The more cows you test, the more precise the
prevalence estimate.
▪ 35 animals between 3-14 DIM:
▪ Bleed 14 cows, 3 ketotic
▪ 75% confident the prevalence is between 11-31%
▪ Bleed 25 cows, 5 ketotic
▪ 75% confident the prevalence is between 15-25%
▪ Bleed 33 cows, 7 ketotic
▪ 95% confident the prevalence is between 15-25%
29. TestAccuracy
▪ Ketone tests with poor sensitivity falsely
decrease prevalence estimate.
▪ Use cow-side blood BHB meters!
30. Which cows to sample?
▪ All cows in DIM range are eligible
▪ Most really sick cows will not be hyperketonemic
▪ Random sample
▪ Systematic sample – every kth animal
31. ≤ 15%
(e.g. ≤ 3/20, + cows)
Estimate Herd Level Prevalence:
Sample ~20 cows that are 3 to 14 DIM
Positive cows have BHB ≥ 1.2 mmol/L
> 15% to 40%
(e.g. 4 to 8/20, + cows)
≥ 40%
(e.g. ≥ 9/20, + cows)
≤ 15%
Monitor herd level
prevalence monthly.
Sample ~20 cows once
monthly. More frequently
when there are changes,
e.g. diet formulation.
Monitor
≥ 40%
Give 300 mL of propylene
glycol once daily for 5
days starting at 3 DIM to
all cows.
Recheck prevalence in
one month.
Treat all cows
Monitoring and Action Recommendations
Ospina et al.,
2013, VCNA
>15% to 40%
Monitor incidence of SCK.
Sample cows 3 to 9 DIM
twice a week, e.g.,
Tuesday and Friday.
Test and treat