This disease is most common in cows in good condition ten days to six weeks after calving. However, it can occur at other times and also as a secondary complication of other diseases, particularly long-standing ones, such as Johnes disease. It is caused by the breakdown of body fat for energy, in other words, less energy coming in (eaten) than is required by the cow (for maintenance, milk production or feeding calf in uterus). The early signs may be just a decrease in milk production but later the cow may stop eating, display strange behaviour (lip smacking) and she may be excitable and staggery. A sweet acetone smell may be noticed in the breath, milk and urine. Diagnostic tablets and test strips are available, which show a colour change indicating ketones present in milk or urine. The treatment is 40% dextrose in the vein and Ketol or similar product orally. Dont give dextrose under the skin as it can form abscesses but you can give a bottle of calcium borogluconate under the skin. It is a good idea to do so if the cow is down and/or you are uncertain of the diagnosis. In the latter case it is also advisable to seek veterinary advice.