Milk fever in cows: everything you need to know, including most recent research

By Jolan Lemmens. This blog is updated on 14/05/2025 to include the latest research on this topic.

What is milk fever in cows?

Symptoms of milk fever in cows

What causes milk fever in cattle?

Treatment for milk fever

How to prevent milk fever in cows?

Economic consequences

Recent studies

Our boluses

What is milk fever in cows?

Milk fever is a complex metabolic disease in cows, that usually occurs around calving and most commonly in high-productive cows from three years and older. It is one of the most common mineral-related metabolic diseases affecting dairy cows and is also known as calcium deficiency, hypocalcemia, and parturient paresis. In this article, we will tell you everything you need to know about milk fever: what are the signs of milk fever in cows, how to prevent it, and treat it. And we will update you on the most recent scientific research on this topic.

"Cows with clinical hypocalcemia spend more time lying down."

Symptoms of milk fever in cows

A cow with milk fever usually shows very general symptoms of illness which appear when the blood calcium levels are low: she has a lack of appetite, lower body temperature, looks groggy, and has difficulties producing manure and urine (also known as subclinical milk fever). If not treated the cow will be unable to stand and will lay down in a typical position (known as clinical milk fever): on her chest with her head on her side. In other cases, the cow will lay on her side, or sit down the way a dog does. Furthermore, hypocalcemia is associated with diabetic-like conditions like increased blood glucose and the inability to release insulin at calving.

Summarized, the symptoms of milk fever in cows are:

• Reduced appetite
• Lower body temperature
• Dull apearence
• Delayed manure or urine production
• The cow lies down in a characteristic pose: chest on the ground, head turned along her flank

Stages of milk fever in cattle

Oetzel identified three stages of milk fever in which the syptoms are divided:

• Stage 1: early sign without recumbency. Subtle signs like irritability and nervousness that might go unnoticed. Some cows might also shift their weight frequently and shuffle their hind feet.
• Stage 2: stage 2 can last from 1 to 12 hours and is often characterised by the distinctive position of the neck. The cow will be down with their head often tucked into their flank to create an s-shape neck curvature. The skin and extremities (like her ears) will be cold and the heart rate will often exceed 100 beats per minute. They will exhibit depression and partial paralysis.
• Stage 3: these cows will be completely paralised, laying flat out on their side. They will often be bloated and and have a chance of falling into a coma. The fall in temperature continues and the heart rate goed up to 120 beats per minute. Without treatment these cows will die in a few hours.

What causes milk fever in cattle?

So now that we know the symptoms of milk fever it is time to look at the causes. Knowing the causes will help us in better understanding the treatment and the prevention.

When does milk fever in cows occur?

As we already mentioned, milk fever in cattle is a metabolic disease that occurs around calving. More precisely, three to four days before calving the levels of calcium and inorganic phosphorus in the blood serum drop. The drop in calcium is a consequence of the start of milk production, whereas the drop in phosphorus is a direct result of calving itself. Cows with milk fever, however, experience a greater drop in these minerals than cows without the disease. Cows with serum calcium lower than  7,5 mg/dL are considered hypocalcemic. 

• Cows in stage 1 of hypocalcemia will have serum levels between 5.5 to 7.5 mg/dL. 
• Stage 2 cows will show values between 3.5 and 6.5 mg/dL
• Stage 3 cows will happen when serum calcium levels drop below 2 mg/dL.

Plasma concentrations of total calcium before and after calving in mature Jersey cows with (MF) or without (NMF) clinical milk fever (Kimura et al., 2006).

It's not only about calcium

Research by Pichon shows that calcium deficiency isn't the only cause of milk fever. In her PhD dissertation she showed that only 12% of cows with milk fever have a calcium deficiency alone. A phosporus deficiency (or hypophosphatemia) ocurred in 15% of the cases while a combined deficency of calcium and phopshorus was the main cause of milk fever (43%). 12% of the cows suffering from milk gever had a magnesium deficiency an 18% had no shortage in calcium and phosphorus. 

This is why Resco develloped a bolus against milk fever with calcium, phosporus, magnesium and vitamin D3. Send us a message to know where we sell Calcitop.

Hormonal changes: Start of lactation

At the moment that the cow is adapting hormone-wise to lactation, there is a big difference between the supply of calcium and the demand for the fetus and colostrum/milk. In a single milking, a cow can lose about 23 g of calcium, which is 9 to 10 times more than the calcium supply. This gap must be filled by either increasing the absorption from the gut or bones or decreasing the outflow of calcium other than to milk.

It is important to note that milk fever is a production disease, meaning that as milk production increases the prevalence and severity of milk fever generally increases as well.

Hormonal changes: other findings

Other hormonal changes around calving have also shown to be an antecedent of milk fever. Increased estrogen and glucocorticoids may reduce serum calcium. Furthermore, increased estrogen is known to reduce appetite. Also, stress from calving may prompt the release of a number of hormones that reduce blood calcium.

Dry cow feed: calcium to phosphorus ration

We find another reason for the occurrence of milk fever in the dry cow feed. Dry cow feed high in calcium (over 100 to 125 g/kg) has proven to inactivate the parathyroid gland. However, around calving, the need for calcium is extremely high. In consequence, an inactive gland suffers to adequately supply calcium to the blood, leaving the cow with a calcium deficiency.

As for phosphorus, it is shown that rations high in phosphorus interfere with the metabolism of vitamin D, especially with the conversion of 25-hydroxycholecalciferol to 1,25-dihydroxycholecalciferol.

Dry cow feed: other findings

Another feed-related cause of milk fever can be a reduced intake of feed around parturition, again with older cows showing a greater reduction of intake in the last four days before calving.

Breed

Although reasons are unclear it is known that certain breeds are more susceptible to milk fever than others, in particular Channel Island, Swedish red and White, and Jersey cattle.

Age

How much the levels of calcium and inorganic phosphorus in the blood serum drop, is highly dependable on the cow itself, with older cows showing a bigger drop since they absorb less dietary calcium and may have less exchangeable bone calcium. Research by Jönsen showed that the percentage of cows with milk fever is highest in the group that had 9 calvings. Or in short: as dairy cows become older, the prevalence of milk fever increases.

Treatment for milk fever

If prevention failed, treatment is necessary. Without treatment 60 to 70% of the affected cows will die. In the 1800’s milk fever in cows was treated using hot packs, blankets, cayenne pepper, and alcohol. Needless to say, these treatments were rather ineffective. It was only in 1925 that the current treatment was adapted. Once a cow is laying down a veterinarian gives a calcium infusion to the animal. This keeps the cow alive until the cow is adapted to the higher demand for calcium.

Check in this video how farmer Tom Pemberton treats milk fever in one of his cows:

How long does milk fever last?

In most cases, the infusion makes for a quick recovery of the cow. However, about 25% of the cows need additional treatment. And although treatment is usually very fast, many cows tend to be recidivists and the productive life of dairy cows can be reduced by more than three years.

How to prevent milk fever in cows?

The best treatment for milk fever is prevention. A study in India on the economic losses of milk fever concluded that the potential gain if prevented, is around 10 times the economic losses. There are numerous ways to prevent the calcium level in the blood serum from getting too low:

Feed

• Low calcium: Give rations low in calcium and (relatively) higher in phosphorus during the dry period of the cow. In this way, the calcium metabolism will be activated. At calving, the parathyroid gland will be better prepared to mobilize calcium from the bones, and calcium from ration and supplements will be better absorbed. This strategy is still effective on many farms. A 2002 study by Hansen and colleagues found this strategy to be highly efficient if the calcium intake is less than 20 g per day. However, formulating rations this low in calcium proves to be difficult.
• DCAD (Dietary Cation-Anion Difference): In regions where the low calcium-strategy isn’t effective, the DCAD-strategy might be applied. By giving the dry cow anionic salts like potassium chloride at least 10 days before calving, the calcium absorption during the dry period will be lower as well. Although effective, this strategy also comes with a lot of warning: anionic salts need to be rationed daily, aren’t very tasty, need regular pH-testing, and might even increase milk fever levels when not done correctly.
• Dietary magnesium control: Dry cows should receive sufficient magnesium since numerous studies show that hypomagnesemia is highly related to milk fever.
• Feeding grain up to 1% of body weight during the dry period has shown to decrease the prevalence of milk fever.

Supplementation

• Supplementation of vitamin D 3 to 8 days before calving. This has to go together with sufficient levels of calcium and phosphorus in ration and/or supplements. Vitamin D is important for the intestinal absorption and bone mobilization of calcium, however, caution is needed as over-supplementation or supplementation 1 day before calving may increase the chances of milk fever or other toxicological effects.
• How to increase calcium in cows? Through supplementation of a rapid-action calcium supplement in the 24 hours before and after calving. Many commercial products are available in different forms: liquid, gel, paste, and bolus. They also serve as a therapy for the prevention of milk fever relapses. 

Contact us about Resco boluses

Other

• Body condition score: Energy intake of cows in mid and late lactation should be monitored as it is important to prevent the dry cow from getting too fat.
• Provide comfort and a clean box to reduce stress.
• Implement specific control programs when the prevalence of milk fever in cows at high risk increases to above 10%.
• Shortening the dry period may reduce the incidence of milk fever in cattle, but would also reduce milk production in the following lactation.

Economic consequences

An estimated 3 to 8 % of cows are affected by clinical milk fever. The production loss for cows suffering from milk fever is huge and so is, of course, the economic impact. The average cost, including medicines, veterinary services, and estimated production loss, amount up to 334 USD per case. However, it is important to note that subclinical milk fever also comes with a cost of up to 125 USD. It is even believed that the total cost because of subclinical milk fever is 4 times higher than the cost of clinical milk fever.

As mentioned before, the productive life of a cow suffering from milk fever may lower by 3.4 years. When the milk yield doesn’t recover to economically feasible amounts the cow also needs to be culled.

In addition, they also are more susceptible to secondary diseases like ketosis and mastitis. Research by Curtis showed that cows having suffered from milk fever have ketosis and mastitis 8 times more often.

Recent studies

Hendriks and colleagues (2020) studied the “associations among blood calcium (Ca) status at calving and lying behavior and activity measures during the transition period in grazing dairy cows.” Cows with clinical hypocalcemia (but without milk fever) were found to be less active on the day of calving and spend more time lying down (also on the night before calving) than subclinical hypocalcemic and normocalcemic cows. These differences however disappeared two days after calving.

A study on 30 local breed cows in Iraq (Hassan et.al., 2020) showed known signs of milk fever and confirmed the idea that older cows are more susceptible to milk fever.

Goff and colleagues (2020) studied the effect of hypocalcemia on rumination activity. They confirmed their hypothesis that milk fever reduces rumination activity, even to the point that cows given an intravenous calcium treatment almost show no activity at all.

When studying 32 Holstein X Gir dairy cows, Rodrigues and colleagues found an impact of subclinical hypocalcemia on energy levels, somatic cell count, and milk components during early lactation. More specifically, these cows had less serum insulin, a greater somatic cell count, and lower concentrations of milk fat, protein, and lactose.

Recently (2025) Burim Ametaj concluded that milk fever should be seen as a "a multi-layered problem rather than a single nutrient issue" which would help in preventing it more efficiently.

Some interesting meta-analysises were published in recent years, we recommend reading:

• Graduate Student Literature Review: What do we know about the effects of clinical and subclinical hypocalcemia on health and performance of dairy cows? (Serrenho et.al.; 2021)
• Milk fever and related postpartum diseases in dairy cattle - A review (Crivei et.al.; 2021)
• Milk fever in dairy cows: a systematic review (Ibrahim & Kirmani; 2021)

Our boluses

Resco is a manufacturer of boluses and effervescent tablets that deliver solutions for cattle, calves, sheep, and poultry. Our mission is to optimize your animals' health and productivity with a practical and economical solution. We designed three boluses to help prevent milk fever. Our boluses are easy to use and do not need a veterinarian, as such they are great home remedies for milk fever in cows.

Calcitop

Our milk fever bolus Calcitop is a cattle supplement designed to prevent milk fever in cattle. It combines calcium, phosphorus, magnesium and vitamin D.

Learn more about Calcitop bolus

Pidolatop

Our milk fever bolus Pidolatop is a cattle supplement designed to prevent milk fever in cattle. It uses calcium pidolate and magnesium pidolate to withdraw calcium from the bones more efficiently, preventing milk fever in a more natural way. 

Learn more about Pidolatop bolus

Fosfotop

Our milk fever bolus Fosfotop is a cattle supplement designed to prevent milk fever in cattle by focusing on a phosphorus deficiency.

Learn more about Fosfotop bolus

Bibliography "Milk fever in cattle: everything you need to know - 2023 update"

N. Ametaj, B. (2025). From parts to whole: a systems biology approach to decoding milk fever. Veterinary Sciences, 12(4).

Boda, J. M. (1956). Further Studies on the Influence of Dietary Calcium and Phosphorus on the Incidence of Milk Fever. Journal of Dairy Science, 39(1), 66–72. 

Cariappa, A. G. A., Chandel, B., Sankhala, G., Mani, V., Sendhil, R., Dixit, A., & Meena, B. L. (2021). Estimation of economic losses due to milk fever and efficiency gains if prevented: evidence from Haryana, India. RePEc: Research Papers in Economics.

Crivei, I., & Crivei, L. (2021). Milk fever and related postpartum diseases in dairy cattle - A review. Scientific Papers, 64(4).

Curtis, C. R., Erb, H. N., Sniffen, C. J., & Smith, R. D. (1984). Epidemiology of Parturient Paresis: Predisposing Factors with Emphasis on Dry Cow Feeding and Management. Journal of Dairy Science, 67(4), 817–825.

Goff, J. P., Hohman, A., & Timms, L. L. (2020). Effect of subclinical and clinical hypocalcemia and dietary cation-anion difference on rumination activity in periparturient dairy cows. Journal of Dairy Science, 103(3), 2591–2601.

Harris, D. J. (1981). Factors predisposing to parturient paresis. Australian Veterinary Journal, 57(8), 357–361.

Hassan, S. D., Al-Obaidi, Q. T., Al-Iraqi, O. M., & Alhamo, M. A. (2020). Clinical, hematological and some serum biochemical alterations in local cows affected with milk fever in gogjalee region, mosul, iraq. Egyptian Journal of Veterinary Sciences, 51(2), 143–151.

Heuer, C., Schukken, Y. H., & Dobbelaar, P. (1999). Postpartum body condition score and results from the first test day milk as predictors of disease, fertility, yield, and culling in commercial dairy herds. Journal of Dairy Science, 82(2), 295–304.

Hibbs, J. W. (1950). Milk Fever (Parturient Paresis) in Dairy Cows—A Review. Journal of Dairy Science, 33(10), 758–789.

Hibbs, J. W., & Conrad, H. R. (1960). Studies of Milk Fever in Dairy Cows. VI. Effect of Three Prepartal Dosage Levels of Vitamin D on Milk Fever Incidence. Journal of Dairy Science, 43(8), 1124–1129.

Hibbs, J. W., & Conrad, H. R. (1966). II. Calcium, Phosphorus, and Vitamin D. Journal of Dairy Science, 49(2), 243–246.

Horst, R. L., Goff, J. P., Reinhardt, T. A., & Buxton, D. R. (1997). Strategies for Preventing Milk Fever in Dairy Cattle. Journal of Dairy Science, 80(7), 1269–1280.

Ibrahim, N., & Kirmani, M. A. (z.d.). Milk fever in dairy cows: a systematic review. Research and Reviews: Research Journal of Biology.

Jorgensen, N. A. (1974). Combating Milk Fever,. Journal of Dairy Science, 57(8), 933–944.

Kimura, K., Reinhardt, T. A., & Goff, J. P. (2006). Parturition and Hypocalcemia Blunts Calcium Signals in Immune Cells of Dairy Cattle. Journal of Dairy Science, 89(7), 2588–2595.

Moodie, E. W., Marr, A., & Robertson, A. (1955). Serum Calcium and Magnesium and Plasma Phosphate Levels in Normal Parturient Cows. Journal of Comparative Pathology and Therapeutics, 65, 20–36.

Oetzel, G. R. (2011). An update on hypocalcemia in dairy herds. School of veterinary medicine, university of madison, wisconsin, 80–85. 

Patel, V., Kansara, J., Patel, B., Patel, P., & Patel, S. (2011). Prevention of Milk fever: Nutritional Approach. Veterinary World, 278.

Pichon, S. (2008). Analyse von festliegerursachen bei kühen – eine praxisstudie [PhD dissertation]. Universität Leipzig.

Radostits, O. M., Gay, C., & Hinchcliff, K. (2000). Veterinary Medicine: A Textbook of the Diseases of Cattle, Sheep, Pigs, Goats and Horses 9th Edition (9de editie). Saunders Ltd.

Rodrigues, R., Cooke, R. F., Ferreira, H. A. O., Florido, R. R., Camargo, V., de Godoy, H. O., Bruni, G. A., & Vasconcelos, J. L. M. (2020). Impacts of subclinical hypocalcemia on physiological, metabolic, and productive responses of Holstein × Gir dairy cows. Translational Animal Science, 4(2), 1060–1069.

Serrenho, R. C., DeVries, T. J., Duffield, T. F., & LeBlanc, S. J. (2021). Graduate Student Literature Review: What do we know about the effects of clinical and subclinical hypocalcemia on health and performance of dairy cows? Journal of Dairy Science, 104(5), 6304–6326.

Thilsing-Hansen, T., Jørgensen, R. J., & Østergaard, S. (2002). Milk fever control principles: a review. Acta Veterinaria Scandinavica, 43, 1–19. 

Valldecabres, A., Pires, J. A. A., & Silva-del-Río, N. (2019). Cow-level factors associated with subclinical hypocalcemia at calving in multiparous Jersey cows. Journal of Dairy Science, 102(9), 8367–8375.

van de Kerk, P. (1979). Renderende rundveehouderij (2de editie). Lannoo.

Venjakob, P. L., Borchardt, S., & Heuwieser, W. (2017). Hypocalcemia—Cow-level prevalence and preventive strategies in German dairy herds. Journal of Dairy Science, 100(11), 9258–9266.

Wilkens, M. R., Nelson, C. D., Hernandez, L. L., & McArt, J. A. A. (2020). Symposium review: Transition cow calcium homeostasis—Health effects of hypocalcemia and strategies for prevention. Journal of Dairy Science, 103(3), 2909–2927.