Metabolic diseases are significant diseases that affect the welfare, health, and production of small ruminant flocks raised for dairy and meat purposes. In breeding females, they mainly occur from six to eight weeks before and after parturition, respectively. Pregnancy toxemia and lactational ketosis are manifestations of hyperketonemia, primarily due to energetic deficit. Hypocalcemia and hypomagnesemia are related to the metabolic unavailability of calcium and magnesium, respectively. This review aimed to identify and discuss the current and most relevant aspects related to individual and herd health management of these interrelated metabolic diseases with impact on the sheep and goats’ farm sustainability. These diseases are primarily due to nutritional deficits, but homeostatic and homeorhetic disruptions are responsible for clinical signs and forms. Currently, their clinical diagnosis and monitoring are mainly assessed by biochemistry of body fluids and feed bromatological evaluation. Epidemiological studies and measuring risk factors also contribute to their prevention. Nevertheless, research on specific biomarkers and composite indices related to these diseases, in the context of herd health management and precision medicine, are new pathways driven to suitable and efficient animal production.