Ketosis was diagnosed in 10 lactating cows in private farm in Qaluabia government based on the blood level of Non-esterified fatty acid (NEFA) and Beta hydroxy butyric acid (BHBA). Another 10 healthy cows with normal NEFA and BHBA were used as control. Clinically, the affected cows had partial or complete anorexia with reduction of rumen movement. Biochemically, there was a significant (P< 0.05) increase in AST, ALT, creatinine in addition to NEFA and BHBA in ketotic group compared to control. On the other hand, there was significant decrease (P < 0.05) in triacyl glyceride, albumin, copper and zinc. The oxidative stress markers showed significant increase (P <0.05) in MDA concentration and significant decrease in SOD activity. It was concluded that ketosis is related to clinical, biochemical, oxidative stress and reduced serum Cu and Zn levels. It is recommended to add trace elements, specially serum Cu and Zn in the periparturient period.