How To Treat Milk Fever In Cows

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Photo by Adobe Stock/Daviles
Lactating cows are susceptible to "milk fever."

Keeping A Family Cow (Chelsea Green Publishing, 2013), by Joann Grohman, guides potential and current small farmers on how to care for and benefit from raising dairy cows. The following excerpt from chapter fifteen (Treating Milk Fever) details the medical condition known as ‘milk fever’ that is sometimes found in lactating cows and how cattle owners can combat this condition.

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Calcium tetany and parturient paresis are more descriptive names for milk fever, a hormonal disorder that may occur in high-producing cows just before or soon after calving or (rarely) at other times. There is no fever. It is a form of paralysis brought on by elevated calcium demands at the onset of lactation. Its principal victims are high-producing cows and goats, although it is not unknown in sows, dogs, and cats. Among cattle, it is more common in Jerseys than other breeds, because Jerseys give more milk in proportion to their size.

Steady calcium levels are essential to muscle function; calcium blood levels must be maintained as precisely as those of oxygen or glucose. A drop quickly becomes critical, and so a complex system of hormonal controls exists in all animals. Where the sudden calcium demands of lactation onset are exceptionally high, as in the higher-producing cow, the system may prove inadequate. The resulting paralysis is called milk fever. No diet can be counted on to meet the calcium demand. The hormonal control system is designed to pick up calcium from bone reserves. But during the cow’s dry period, when calcium demands are low, the system “goes to sleep.”

The milk fever prevention diet is designed to keep the cow’s system slightly starved for calcium so that the needs of the unborn calf cannot be met by the cow’s diet alone and thus bone mobilization remains active. Vitamin D should also be given. Milk fever usually occurs only after a normal calving. The stress of difficult calving seems to activate the adrenal and other glands so that the vital hormone levels are in place when needed.


The very first symptom is an unsteady gait. You may notice it during the day. Soon the cow lies down, and if you feel her ears they will be cold and usually droopy. After calving I check my cow’s ears hourly and have been known to sleep in the barn. If the cow is on her feet, early symptoms include paddling with the hind feet and swaying as if she is about to fall over. Once down, she will twist her head and neck to the side as if there were a kink in her neck. Her nose becomes dry. Another warning signal is if your cow, which was bright and active caring for her newborn calf, becomes listless and inattentive. This could be a symptom of any malaise, but at this particular moment in your cow’s life, suspect milk fever.

If not treated, the symptoms increase in severity until the cow goes down, she begins to go cold (you can feel the ears, legs, and other extremities becoming cold first), her head remains pulled around, and her pulse slows. She no longer recognizes you. All rumen activity ceases. After several hours, she will be unable to hold her head up and will fall over flat, gasping for air. If nothing is done, she will die, usually of strangulation by fluids in the windpipe or rumen pressure on her heart. It isn’t normal for a cow to lie out flat, and the body fluids and pressures go wrong in this position. The only time you see it other than in acute illness is for brief periods in the field on a warm, sunny day, and then only by an immature animal. If you ever see your cow lying flat on her side, run to her calling for help as you go. Pick up her head and do what you can to tip her up onto her brisket.


Milk fever rarely strikes a first calver. But any dairy cow should be monitored every few hours from the time she starts calving onward, through the day after calving. If you see the described symptoms, act. Milk fever does not go away by itself. The longer you wait, the more severe the treatment must be and the greater the chance of losing your cow. Call the veterinarian. I find that not all veterinarians react in the same way to milk fever. If yours has a large animal practice, meaning that he specializes in cattle and horses, he will think nothing of injecting the necessary calcium gluconate (or calcium magnesium gluconate) solution into your cow’s vein. If he is also the type to show up promptly, I would summon him and let him undertake the treatment. Some large animal vets have a pretty laissez faire attitude, because they see so many cows and don’t realize how much your cow means to you. They may arrive late and play down the need for treatment. The small animal man may suggest you drive to his dispensary and pick up a calcium tablet, or if he comes he may suffuse the injection under the skin rather than into the vein. He is certainly unaccustomed to cows and may be afraid of them.

Either way, you are well advised to be prepared to provide treatment yourself. Giving the calcium solution under the skin is not difficult, and if given early it is usually effective. There is no hazard in it for the cow, and it is good insurance. If the treatment is much delayed, though, she may rally after the treatment and get up but then go down again. Treated again, she may repeat the recovery only to go down once more. This has been termed “the downer cow syndrome.” The cow doesn’t appear to have anything wrong with her, but she does not get up, or if she does she does not stay up, no matter how many times you give her calcium. She won’t eat much of anything and she just gets thinner and thinner, a lingering death. I have had more experience with milk fever than anybody would ever want, and despite what anyone says, I am a firm believer in injecting calcium directly into the vein if the case is at all advanced. There are varying opinions as to how long it takes for calcium injected under the skin to take effect, ranging from twenty minutes to four hours. The latter appears to be more correct, and this is four precious hours lost when things are going from bad to worse before the turnaround begins. The dangers of injecting calcium in the vein or artery are infection and the possibility of shock to the heart if cold fluid is infused in the blood rapidly. I have had good luck with the procedure and no casualties caused by it.


If you want to be prepared to treat milk fever yourself, you will need some simple equipment available at farm supply stores. The equipment consists of a flutter valve, which is a one-quarter-inch rubber tube with a rubber cap on one end to fit the top of the bottle of calcium solution. The other end of the valve slips over a standard hypodermic needle. A refinement is to have a section of glass or plastic pipe in the middle to enable you to see the fluid pass through the tube, but it isn’t necessary. For subcutaneous injection you will need a needle with a bore or lumen that is about one-sixteenth of an inch. Special needles made for cows have a wide collar around the top to aid your grip in forcing the point through the skin, which, after all, is cowhide. If the special needle isn’t available, any large-bore needle will do. Needles that are one and a half to two inches long are best. A needle with a smaller lumen is used for injecting into the vein; the large needle would allow the fluid to pass into the bloodstream too rapidly. The lumen of the smaller needle should be half the diameter of the large-bore needle.

Finally, you’ll need a supply of the life-restorative fluid. It is sold under various names, but the common variety will have a solution of calcium borogluconate at 20 to 40 percent, with magnesium, phosphorus, and dextrose added. There is also a straight calcium borogluconate available. The mix, sometimes called MPD (magnesium-phosphorus-dextrose), is useful because it covers any possible magnesium or phosphorus deficiency and adds a pick-me-up in the form of the dextrose. Calcium-magnesium solutions and equipment for injection can be purchased in agricultural supply stores in some states. They can also be obtained from a veterinarian or online from an agricultural supply house.

The calcium solution is not expensive. For one cow, keep two or more 500-ml bottles on hand. Once you have seen this equipment in use, you will derive considerable peace of mind in having it ready to use if required. A short story in a national women’s magazine told of a family that moved to the country and bought a cow. The story had a tragic ending: the cow died in calving, obviously due to milk fever, although neither the author nor the family appeared to recognize this. You need not be caught in such a tragedy.

Subcutaneous Injection

If you’ve decided that your cow needs a calcium injection, proceed without delay. First, sterilize your equipment (the flutter valve and needles) by immersing them in boiling water for a few moments.

Take a clean bucket, fill it partway with hot water, and set the bottle of calcium solution in it. This will warm the fluid to somewhere near body temperature, and it provides a place to put all the bits and pieces. Otherwise, you are almost sure to lose the needle once you have completed the injection, providing yourself with the classic opportunity to look for a needle in a haystack.

If your cow is able to move, put her in a box stall if you have one. Confining her will cause her to stand relatively still while you treat her. Otherwise, once poked with a needle, she may give you a merry chase, forgetting her condition for a while. If your cow is in an advanced case of staggering and swaying, do your best to get her into a stall with good bedding (she will need sand underneath any bedding on a concrete floor in order to get up). At least get her under cover if at all possible. Don’t leave her locked in a stanchion, since she may hurt herself if she goes down. Remove all buckets, feeders, and anything she might fall on. If she has calved, remove the calf. (I had a calf squashed flat when her mother went over on her with milk fever.) A sick cow might stay down if you push her over, which would be useful for your first attempt at an injection. If she doesn’t, tie her head closely to something firm while giving the injection, and get someone to help you by holding the equipment with one hand and the cow’s tail to steady her with the other.

The subcutaneous injection can be made in the skin of the shoulder. You will be sticking in the large-bore needle by itself, no tube attached. Go back a spread hand’s distance from the front of the shoulder and the same distance down from the backbone. Push the needle in at a sharp angle to go under the skin, not into the muscle. Pick up the skin with your hand to feel the thickness of the skin and fat layer. You can hold the skin with one hand and push the needle in with the other. Push hard. See that the needle end is free under the skin by moving it slightly. That accomplished, the needle should remain there while you take off the top of the calcium bottle and replace it with the rubber cap of the flutter valve.

Hold the bottle upside down in the air, and as soon as the fluid emerges from the far end of the tube, slide the tube end onto the top of the needle. The fluid should start bubbling in the bottle and flowing through the needle. Plan to inject half of the bottle at this site. Massage the skin downward and away from the needle to disperse the fluid under the skin. This is optional but speeds the effectiveness of the injection and prevents the development of a lump under the skin. If you cannot spread the fluid very well, it probably means it has pocketed in the tissues, and it will be best to stop now and inject the remaining contents of the bottle on the other side of the shoulder. This at least will keep the size of the lump small, and usually it will disperse and be absorbed.

When the bottle is empty or you are finished with that injection site, pull out the needle, rub the area, and put everything in the bucket to be washed. If not washed thoroughly, the tube and needle will be clogged by the sticky dextrose.

Leave your cow in a comfortable state. Prop her up with hay or straw bales so she cannot roll over flat. If possible, arrange them around her like building blocks so she hasn’t space to roll over (unlike a horse, a cow cannot roll over and may die if she does). Untie the cow, or else during clumsy attempts to arise she may stumble and fall with her neck outstretched, causing her to strangle. Do your best to keep her from collapsing in a corner. A cow rises by lurching forward; if she gets herself wedged in a corner, it will take six strong men to shift her back into the middle of the room before she can even try to get up. Someone should watch her closely until the calcium takes effect.

Intravenous Injection

If your cow is in a more desperate state and you decide to inject the calcium directly into her bloodstream, here is the procedure. An inexperienced person will require a helper. You also need a wristwatch. The bottle of calcium solution needs to be at or close to blood heat — which is very similar to that of humans — by setting it in a bucket of warm water. You use the same equipment as for the subcutaneous injection, except that you will need the smaller-bore needle. Another useful item is a piece of small-diameter rope several feet long.

Your cow will already be down if you have decided this procedure is necessary. Prop her up with hay bales if at all possible. Try to get her right up on her brisket. This is not at all essential to the injection, but it is to her survival, since a cow left lying on her side will bloat (blow up like a balloon) and cut off her own air and circulation. Put every effort into sitting your cow up, for example by prying her up with a 2×4, but if she is too far gone to make it possible, get on with the injection without delay.

Have your helper hold the cow’s head up and around to one side. The effect is to stretch out straight and tight the lower side of the neck, where the blood vessels are located. You can work on either side of the neck, since the injection is effective in either the jugular vein or the artery. Work on the outside curve of the neck, since that position pulls the vessel tight. In practice, you work on what you can get at, since cows tend to move themselves into a corner in their efforts to get up after going down with milk fever. You probably can see the skid marks in the bedding where her feet have been working to get up.

With the lower side of the neck stretched tight, feel for the throb of the vein. It runs next to the windpipe, which is a stiffer tube. The vein will have the feel of quarter-inch tubing running along the lower neck, an inch or so from the fold of the neck. If you cannot feel it, have your assistant hold the head higher and turned more sharply. Your assistant will become very tired. If you have a snap nose ring, you can tie the cow’s head in place, but I always feel so sorry for the cow that I want to hold her head in my arms. If you continue to be unable to feel the vein, use the small-diameter rope mentioned above. Put it around the cow’s neck a short way behind the head and tighten it up to pinch the vein, which makes it easier for you to feel the throbbing and pumping of the blood at the point where the rope crosses the blood vessel.

Swab the site with alcohol. Pushing the needle through the skin layers and then into the blood vessel is usually a two-step process. Get the needle through the skin at the proper level to intersect the vein. Then, using one hand to hold the needle end and skin folds in line, jab into the blood vessel. If you have scored a hit, blood will drip from the needle. Now remove the tourniquet. Here is where a second helper is very handy. You need to have the calcium bottle upside down in one hand, with the flutter valve attached, its tubing coming down full of fluid and dripping. You then slip the tubing end onto the needle, hold the bottle low, and let the calcium drip very slowly into the bloodstream. The trouble is that if you haven’t got this all ready and waiting at some convenient and safe place (which there seldom is), you will have to abandon your carefully placed needle to get the calcium ready and you’ll usually lose the vein in the process. Your assistant can’t let go of the cow’s head, either, lest the needle be dislodged. The only thing I have thought of, other than a three-person team, is to hang the calcium bottle from a beam, at what one hopes turns out to be a convenient height, and to put a clothespin on the dangling tube, so that it’s ready to be transferred to the needle.

Before connecting the tube to the needle, have it running freely so that you do not inject air into the vein. You can judge the speed of flow by the bubbling of air in the bottle. Take fifteen to twenty minutes to administer the entire bottle. Administering the solution slowly is important. If the calcium enters the bloodstream too fast, the cow could die of shock. If there is a disturbance of the needle, you can verify that it remains in the vein by removing the tube for a moment and seeing that blood flows out of the needle.

When the injection is completed, just pull out the needle. Usually there will be no significant bleeding. Because of the outward flow of the blood, the infection danger is minimal if the needle was clean. See that your cow is comfortable. You might want to have a little hay and a bucket of water handy for when she comes around. Sometimes you will see brightening in ten minutes, and sometimes a cow will even get up in that time. Often she will begin to brighten but will not arise for several hours.

The first signs of brightening are swallowing, licking her nose with her tongue, and belching. She will also start to look around. If it is the middle of the night you can go back to bed for a while, but check her again soon. Then, if she is not up, and hasn’t been up (you can tell by her position and the presence of fresh dung), do your best to make her get up. A cow may decide that things didn’t go well the last time she was up and will just lie there. For her own good, she must get up. She cannot function well lying down, and her udder will get into trouble as well. But of course you can’t even begin to lift her. Shout at her sharply. Clap your hands in her ears. Slap her on the rump. Once she starts to get up, help her steady herself. A firm grip with both hands at the base of the tail will help hold her back end in line while she gets up in front. If she has been down a while, her legs will have gone to sleep. This is a terribly difficult problem with a cow that stays down any length of time. If your cow has brightened up and shows signs of recovery, she should be able to get up.

If doubts persist as to the cow’s condition, she may require further calcium treatment. I often use an injection under the skin after an injection in the bloodstream, as a slower-acting, longer-lasting backup treatment. If the cow is down, or luck is not with you in getting the needle into a vein, don’t be discouraged. Keep trying. One night when it was −25 degrees Fahrenheit and we could not get a vet, my daughter and I struggled on until dawn trying to hit a vein in our cow Faith. I was never sure whether our failure was due to our own ineptitude or the fact that the cow seemed to have virtually no pulse to show us where her blood vessels were. Faith obviously suffered each time I jabbed her. We never did get it right, but she lived. I decided later that the adrenaline response to our painful jabbing probably kept her going until an earlier subcutaneous injection could take over. I think Faith understood we were trying to help her. She changed from an aloof cow to one that was truly friendly toward us both from that day forward.

In another undeserved success on a cold winter’s night when my cow Jasmine was down, I gave up and injected the drip into milk veins on her abdomen. It worked and she lived, but both injection sites exhibited big lumps that did not resolve for many weeks.

Calcium Paste

Calcium paste is a supportive follow-up treatment given by mouth. It comes in a tube that fits into an ejecting holder exactly like a caulking gun. It may also be used as a precautionary measure before symptoms of milk fever appear. A number of formulations exist. Most claim to be “less caustic,” which tells you something about how it tastes. The paste does a pretty good job of providing calcium to a cow that is on her feet and showing appetite. To get it down her throat you will need to have a halter on your cow and her head snubbed up short. Try to have a helper. Get the tip into the side of her mouth in front of the molars and squirt it in. You can administer it several times. Follow it up with treats. I suggest warm molasses water to wash it down. The paste is capable of giving a cow a sore throat, which is a very bad thing indeed right now, when you want her to be eating as well as possible. I avoid the paste if I can.

Milk fever is indeed a serious illness, and treatment, although usually dramatically successful, is demanding. But do not worry unduly. I have never lost a cow from it when I was actually present. The only tragedy occurred once when our cow was left unattended while I was away. Learning that she was ill, my young son and I hurried home, but by the time we arrived forty-five minutes later, she had slipped and rolled into a puddle from which we were not strong enough to move her. The actual cause of death was bloat or suffocation due to her position. Had she not been left unattended, undoubtedly she would have survived.


If your cow comes around easily, no special treatment should be required afterward. As soon as she is steady on her feet, you can let her calf come back to her under supervision. Feed your cow well. Tempt her often with high-quality roughage and grain in small amounts. The idea that it is better to restrict feed to avoid recurrence of milk fever (on the theory that the more she eats, the more milk she will produce and the more calcium will be used up) may possibly be helpful in milk fever but can lead to acetonemia (ketosis), which is a more difficult metabolic disorder.

A traditional approach to avoiding milk fever recurrence is to go easy on the milking for one or two days. That is, don’t take all the milk when you milk. The theory is that by reducing the amount of milk removed, you will reduce the amount produced and thus reduce the demand for calcium. Studies have shown that this does not necessarily forestall a relapse, but it does predispose to mastitis. One of my cows permanently lost production in one quarter when I overdid this method.

An effective compromise might be to milk out enough to relieve excessive pressure and do this frequently enough to keep bacteria from gaining a foothold. Save all the colostrum you collect and freeze any not needed. If your cow seems to want it, let her drink some of the colostrum. It can be life-saving. Give her anything she will eat. A cow that does not eat will soon have ketosis, the first symptom of which is loss of appetite.

More from Keeping a Family Cow:

How to Milk a Cow

Reprinted with permission fromKeeping A Family Cow: Revised and Updated Edition by Joann Grohman and published by Chelsea Green Publishing, 2013.Buy this book from our store:Keeping A Family Cow.