{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:15:46Z","timestamp":1789924546625,"version":"4.0.1"},"reference-count":31,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Bulgarian Ministry of Education and Science (MES) in the frames of the Bulgarian National Recovery and Resilience Plan, Component \u201cInnovative Bulgaria,\u201d","award":["BG-RRP-2.004-0006-C02"],"award-info":[{"award-number":["BG-RRP-2.004-0006-C02"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Veterinary Sciences"],"abstract":"<jats:p>Ketosis is one of the most common metabolic disorders in high-yielding dairy cows in early lactation. It has a negative impact on milk yield, reproduction, and general health of the animals. The present review aims to systematize and critically analyze current scientific data on the monitoring, diagnosis, prevention, and treatment of subclinical and clinical ketosis, with the aim of developing an applicable protocol for good veterinary medical practices (GMP). Based on the comparative analysis method of data from the literature and clinical practice, \u03b2-hydroxybutyrate (BHBA) in blood is confirmed as the gold standard for diagnosis with specificity and sensitivity above 90%. Indicators such as fat\/protein (F\/P) &gt; 1.4 and NEFA &gt; 0.4 mmol\/L, as well as reduced citrate content in milk, have been evaluated as useful screening tools, although with lower diagnostic value. Despite the advantages of some indirect methods (such as F\/P), critical analysis shows that they are strongly influenced by physiological status, lactation stage, and diet and cannot replace direct blood tests. Preventive approaches emphasize the importance of stable nutrition in the pre- and post-calving period, restriction of ketogenic feeds, and use of oral glucose precursors. Literature analysis shows that propylene glycol is effective, but with prolonged use it can reduce appetite. Combined antiketotic products have also been introduced, providing not only energy support but also liver protection. Particular attention has been paid to monensin (applied in the commercial product \u201cKexxtone\u201d)\u2014a polyether antibiotic with sustained release, which reduces the incidence of ketosis by over 50% and increases milk yield in the first weeks after calving. However, its high cost, antibiotic nature, and need for veterinary supervision limit its universal use. The treatment protocol is differentiated according to the clinical type: glucose I. V. and propylene glycol in type I ketosis and avoidance of glucocorticoids in suspected type II (hepatic steatosis). In the critical analysis It is noted that improper use of glucocorticoids can lead to a worsening of the condition. A structured protocol for DVMP (Dairy Veterinary Medical Practice) is proposed, which includes targeted metabolic monitoring (NEFA, BHBA, F\/P); proven preventive regimens (Kexxtone, propylene glycol, balanced rations), and staged prevention and treatment according to the form of ketosis. The adaptation of good practices to the scale of the farm and the level of knowledge and skills of the staff for their correct application remains a challenge. Providing training, a standardized control log, and access to field diagnostic tools is key to the success of any protocol.<\/jats:p>","DOI":"10.3390\/vetsci12101019","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T14:53:19Z","timestamp":1761058399000},"page":"1019","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Critical Analysis of Protocols for Good Veterinary Practices in Monitoring, Prevention and Treatment of Ketosis in Dairy Cows"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7562-6835","authenticated-orcid":false,"given":"Elena","family":"Stancheva","sequence":"first","affiliation":[{"name":"Department of Ecology and Animal Hygiene, Trakia University, 6000 Stara Zagora, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toncho","family":"Penev","sequence":"additional","affiliation":[{"name":"Department of Ecology and Animal Hygiene, Trakia University, 6000 Stara Zagora, Bulgaria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"571","DOI":"10.3168\/jds.2008-1507","article-title":"Impact of hyperketonemia in early lactation dairy cows on health and production","volume":"92","author":"Duffield","year":"2009","journal-title":"J. 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