Physical examination and clinicopathologic findings from 44 adult Holstein cows with naturally occurring coliform mastitis were studied. The cattle were grouped for comparison by stage of lactation and survival. Cattle within the first 4 weeks of lactation maintained higher median mature neutrophil counts (1,200 versus 300/microL) in peripheral blood than cattle later in lactation. Nonsurviving cows had higher median creatinine concentration (2.5 versus 1.6 mg/dL) and anion gap (25 versus 20 mEq/L), and lower serum protein (7.1 versus 7.6 gm/dL) and total CO2 (19.8 versus 25 mEq/L) concentrations than surviving cows (P < .05). These findings indicate that cattle with uremia and metabolic acidosis are less likely to survive the infection. Bacteriologic blood cultures were performed on 34 of the 44 cows studied. Escherichia coli was isolated from the blood in 11 (32%) cows. Clinical presentation and clinicopathologic data were compared in bacteremic versus nonbacteremic cows to evaluate these data as predictors of bacteremia. Bacteremic cows were sick longer prior to admission (2 versus 1 days), maintained higher median counts of total nucleated cells (6.6 versus 2.4 x 10(3) cells/microL), myelocytes (0.2 versus 0 x 10(3) cells/microL), metamyelocytes (0.5 versus 0.02 x 10(3) cells/microL), band neutrophils (0.7 versus 0.1 x 10(3) cells/microL), and lymphocytes (2.1 versus 1.4 x 10(3) cells/microL) than nonbacteremic cows, and had higher plasma fibrinogen concentration (600 versus 500 mg/dL) (P < .05). There were no differences between the physical or serum biochemical measurements. Four of 11 bacteremic cows and 5 of 23 nonbacteremic cows died or were euthanized (P > .05). The high prevalence of bacteremia seen in cows with coliform mastitis has not been reported previously, and may have been due to the duration of disease, severity of signs, or culture technique. These findings suggest that systemic antibiotic therapy may be beneficial in some severe cases of coliform mastitis.