If total absorbed diet calcium is substantially less than required by the cow it is possible to stimulate the secretion of parathyroid hormone before calving which can stimulate bone Ca resorption and intestinal Ca absorption mechanisms prior to calving to prevent milk fever, even in the face of metabolic alkalosis. Options for clinical treatment of milk fever should include IV treatment with calcium solutions (2 g Ca/100 kg BW) with consideration given to oral Ca gels or pastes to help prevent relapses to milk fever