Bovine ketosis: A comprehensive review on pathophysiology, diagnosis, monitoring strategies, therapeutics, and prevention in dairy cattle

Ketosis remains one of the most prevalent metabolic disorders in high-producing dairy cows, particularly during the early postpartum period when negative energy balance (NEB) induces excessive mobilization of adipose reserves. This leads to elevated concentrations of ketone bodies primarily ?-hydroxybutyrate (BHBA), acetoacetate, and acetone in blood, milk, and urine. Subclinical ketosis (SCK), defined by BHBA ?1.2 mmol/L without overt clinical signs, affects a significant proportion of herds and predisposes animals to secondary conditions such as displaced abomasum, metritis, and reduced reproductive performance. Diagnosis typically relies on ketone quantification in body fluids, with BHBA as the gold standard. However, recent research indicates that inflammatory biomarkers (e.g., serum amyloid A, haptoglobin, LPS-binding protein) and metabolomic signatures may serve as early predictors of disease risk. Therapeutic interventions involve administration of glucogenic precursors like propylene glycol or glycerol, the latter also modulating rumen fermentation and hepatic gluconeogenesis. Preventive strategies include precise nutritional management, maintenance of optimal body condition scores, and minimization of periparturient stressors. Emerging data suggest that ketosis involves not only metabolic dysregulation but also systemic inflammatory responses and gut-derived endotoxemia. This review integrates current knowledge on the pathogenesis, clinical and subclinical manifestations, diagnostic advancements, economic ramifications, and evolving preventive paradigms for ketosis, with contextual relevance to Indian dairy production systems.