Vet Lisa Whitfield sets out a way of checking to see what caused your down cow, and therefore how she should be treated.

Down cows are one of those frustrating aspects of spring that every farmer deals with. As a vet by trade, it wasn’t until I worked as a dairy farm assistant that I realised how much extra time a down cow adds to what are already very long workdays. It was quite a shock to be out in the springer paddock by yourself, in the dark at 6am, with two metabolic bags, a head torch and a half-conscious cow for company, and with the list of delayed jobs starting to stack up. I also realised it must be daunting for people who haven’t dealt with down cows before, to feel confident in what they are doing when they are tasked with treating these cows.
Milk fever (hypocalcemia/low blood calcium) is just one of many causes of down cows. They are the most basic presentation you will see and are the fastest to respond to treatment. Other common causes of a down cow include hypomagnesaemia (low blood magnesium), hypophosphatemia (low blood phosphate), infections such as toxic mastitis, dislocated hip, and pregnancy toxemia (pre-calving).
Taking a minute to do a brief assessment of a down cow will give you clues to decide on the cause, and confidence that you aren’t missing something important that might change the standard milk fever treatment plan or require immediate help from a vet.


NOSE: Is the nose wet or dry? With hypocalcemia, the muscles which control the sweat glands in the nose are unable to contract, which results in a dry nose.
EYES: Are they sunken? A straightforward milk fever case should not have sunken eyes. NECK: Is there an S-bend in her neck? Again, alteration of muscle contractility in milk fever characteristically results in an S-bend in the neck, which is seen when the cow is sitting upright.
ALERTNESS: Is she sleepy, normal alertness or aggressively alert? Milk fever typically causes a cow to be sluggish and sleepy. If she is fully alert, or aggressively alert, there is probably something else going on.
ABDOMEN: Is she bloating? Again, reduced contractility of muscles means a milk fever cow is unable to belch up gas, and can become dangerously bloated. If a cow is flat out on her side and bloating, it is a priority to get her sitting upright and it may be necessary to use a needle or a stomach tube to relieve pressure in her rumen.
TEMPERATURE: Does she have a fever? Routine milk fever does not cause a fever so if the temperature is over 39.4 degrees Celsius, there is probably something else going on.
CALVING STATUS: Is she calving, or has she calved? If she is still in the springer mob? Check if she is calving – if she went down with milk fever before she was able to get the calf out, it is a priority to consider how you will get the calf out, especially if the cervix hasn’t dilated fully. Call your vet for advice.
FAECES: Is the dung dry? Milk fever will typically result in the faeces being very dry, almost like horse manure. This is because the prolonged passage through the end passage of the gut means more moisture than normal is absorbed from the faeces before it is passed.
UDDER: Is there any sign of clinical mastitis? – Are any quarters hard, cold or purple? While the udder can be difficult to access in a down cow, it is worth the effort of checking it.
A straightforward milk fever cow typically presents with a dry nose, eyes not sunken, S-bend in neck, either already calved, or in the process of calving, temperature normal to low, sleepy/low consciousness, dry faeces, maybe bloating.

Essential things to have in your down cow kit – at least two metabolic bags containing calcium (one plain calcium bag and one mixed calcium and magnesium bag), oral calcium + energy bottle, anti-inflammatories, rectal gloves and lube, thermometer, halter, calving ropes and handles.
Having blood tubes on hand can also be useful – if you are having problems with metabolic down cows, a red-top or green-top blood tube can be tested to see what the cause is. You can collect blood directly from the milk fever needle when it goes into the jugular vein, before attaching the bag of metabolic fluids.
If you are experiencing a lot of metabolic down cows, it is a good idea to involve your vet and nutritionist to see if there are any dietary adjustments which can be made to help the cows cope with the transition back to milking.