Seven hundred-eighty dairy cows in Kafr-Elshikh and El-Beheira provinces were tested for subclinical ketosis (SCK) using qualitative determination of β-hydroxybutyric acid (BHBA) in urine from January to December 2022. All 280 positive cows were gathered in a questionnaire. The clinical examination, serum biochemical analysis, complete blood picture, and liver ultrasound of 89 subclinical ketotic cows were all performed. Our findings showed that both ruminal motility and milk production had significantly decreased while serum levels of BHBA, non-esterified fatty acid (NEFA), TAG, GGT, AST, ALT significantly elevated, blood glucose, total protein, albumin, and calcium levels decreased. Hb, RBCs, PCV, MCV, MCH, and MCHC, whereas WBCs, neutrophils, eosinophils, basophils, monocytes, and neutrophil-lymphocyte (N/L) ratio significantly increased. These cow's ultrasonography examinations revealed the typical signs of fatty liver. The prevalence of subclinical ketosis was 35.9 %. The development of SCK in dairy cows is influenced by various risk factors such as cows at the first 60 days of lactation, body condition score (3.5-5), age greater than 6 years, high milk production, and parity greater than three times. Early detection of SCK in early postpartum dairy cows is crucial to prevent financial loss to the farmers. Routine estimation of SCK in early postpartum dairy cows can be achieved using BHBA and NEFA estimation, along with hepatic ultrasonography.