Aspects of the metabolism and health of 63 cows which had been treated with different amounts of bovine somatotrophin (BST) daily in the preceding lactation and 25 control cows were studied. The aims of the study were first, to identify cows with ketotic conditions, either by measurements of blood metabolite concentrations or by clinical observations, secondly, to evaluate the risk of such conditions in cows treated with BST in the preceding lactation, and thirdly, to examine the metabolic and production consequences of the ketotic conditions in an environment in which the cows' health, body condition and nutrition were closely observed. The cows were categorised objectively by the use of cluster analysis into non-ketotic cows and ketonaemic cows, on the basis of their plasma metabolite concentrations. Twelve of the control cows and none of the cows previously treated with BST were classified as ketonaemic. Similarly, nine of the control cows but only two of the cows previously treated with BST had clinical ketosis. Some, but not all, of the decrease in the risk of clinical ketosis was attributable to the lower body condition score of the cows previously treated with BST. The clinically ketotic cows had a greater risk of other illness in the first 10 days post partum than their herdmates, but the ketonaemic cows had a significantly lower risk of other disease in the first 10 days post partum. The ketonaemic control cows were significantly heavier than the non-ketotic control cows, but they maintained a higher dry matter intake than the latter cows, probably a key factor in reducing the risk of clinical ketosis.