Ketosis is the most common metabolic disease in high-performance dairy cows during the first 6-8 weeks of lactation. Its main symptoms include an excessive amount of so-called ketone bodies in a cow's body fluids. Ketone bodies consist of β-hydroxybutyric acid (βHBA), acetoacetic acid, and acetone. βHBA is the main component with its share of the total volume of ketone bodies in the blood of about 70%. Clinical symptoms of ketosis in cows include loss of appetite, preference for forage to concentrated feed, and acetone odor in their mouth and urine. Those symptoms are accompanied by a production drop, an increase of concurrent illness (mastitis, metritis, and displaced abomasum), and poor reproductive performance. One of the ketosis characteristic effects is an increase in the level of fat in milk (>5%), while protein levels decrease (<2.9%). In the case of subclinical ketosis (SCK), the fat–protein ratio in milk is increased to above 1.4:1. The current consensus for SCK is to consider a cutoff point of βHBA to be at least 1.2 mmol/L in blood plasma. Ketosis prevention is based on keeping perinatal cows in good condition, that is, with around 3.5 points in the five-point body condition scoring, carefully balancing food doses during the first 2 months of lactation with the correct energy–protein ratio. Glucose precursor products should be administered orally, in particular to at-risk herds. Ketosis occurs in 7-14% on average of the total number of cows in a herd. In general, data on the prevalence of SCK vary considerably, depending on their source. Moreover, the problem is mostly observed in poorly-fed animals with high milk production potential. The objectives of this review are to reveal the current situation of ketosis prevalence, the possibility of diagnosis, consequences in dairy cows and to provide some recommendations for ketosis treatment and prevention.