Samples of blood and milk were taken from clinically ketotic cows at 12-hour intervals before and after treatment. The concentration of P-hydroxybutyrate was determined in plasma and milk, and the concentration of acetone was determined in milk. Measurement of milk acetone had the optimal combination of sensitivity, specificity and positive predictive value to identify ketotic cows and was subsequently used in a comparison of the fertility of ketotic and normal cows. Two samples of milk were taken approximately two weeks apart, between 12 and 60 days after calving, from 410 cows on three farms and the concentration of acetone in the milk was measured. Thirty cows with milk acetone concentrations of at least 0.4 mmol/litre were compared with paired control cows with milk acetone concentrations less than 0.3 mmol/litre. The ketotic cows had a significantly longer calving-to-conception interval and a significantly higher culling rate due to a failure to conceive (P<0.05).
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