Diabetic ketoacidosis

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Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Sex predisposition, Breed predisposition, Pathogenesis, Etiology, Predisposing factors, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Monitoring, Subsequent management, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Carmel Mooney MVB MPhil DECVIM PhD MRCVS
Dr David Bruyette DVM DipACVIM
Synonyms DKA

Introduction

  • A very serious metabolic emergency characterized by metabolic alterations.
  • Diabetic ketoacidosis (DKA) is seen less commonly in cats than other species.
  • Cause :
    • Undiagnosed insulin-dependent diabetes mellitus  Diabetes mellitus  .
    • Inappropriately low insulin dosages  Insulin  in treated animals.
    • Impaired insulin action and/or resistance caused by concurrent illness or drugs.
  • Signs : weakness, vomiting, tachypnea, collapse in addition to those of uncomplicated diabetes mellitus  Diabetes mellitus  .
  • Diagnosis : urinalysis, biochemistry.
  • Treatment : fluid therapy, insulin  Insulin  .
  • Prognosis : mortality high (even with full intensive care facilities).

Diagnosis

Clinical signs

  • Abnormal body weight (thin being more common than obese).
  • Depression.
  • Tachypnea.
  • Abdominal pain.
  • Hypothermia.
  • Same as uncomplicated diabetes mellitus  Diabetes mellitus  .
  • Smell of ketones on breath.
  • Slow deep breathing (Kussmaul respiration).
  • Profound dehydration.
  • Slow capillary refill time.
  • Coma.

Diagnosis

Differential diagnosis

  • Hyperosmolar non-ketotic diabetes mellitus .
  • Ketonuria without acidosis.

Sequelae

Prognosis

  • Guarded until stabilized.
  • Up to 30 % mortality despite intensive treatment.

Expected response to treatment

  • Improvement in demeanor and return of appetite.
  • Blood glucose <10 mmol/l.
  • Reduction in urine glucose and ketones and resolution within 12 hours-4 days.

Reasons for treatment failure

  • Acute renal failure.
  • Failure to address hypokalemia and hypophosphatemia.
  • Fluid therapy inadequate.
  • Poor absorption of soluble insulin (or insufficient dose).
  • Development of severe necrotizing pancreatitis.
  • Concurrent disease causing insulin resistance, eg hyperthyroidism  Hyperthyroidism  , acromegaly  Acromegaly  , hyperadrenocorticism  Hyperadrenocorticism  .
  • Life-threatening infection due to immunosuppression and non-sterile procedures.
  • Recurrence of DKA due to persistent concurrent disease.

Sources

Publications

Refereed papers

  • Elliott D A, Feldman E C, Koblik P Det al(2000)Prevalence of pituitary tumours among diabetic cats with insulin resistance.JAVMA216, 1765-1768.
  • Norris C R, Nelson R W & Christopher M M (1999)Serum total and ionized magnesium concentrations and urinary fractional excretion of magnesium in cats with diabetes mellitus and diabetic ketoacidosis.JAVMA215, 1455-1459.
  • Bruskiewicz K A, Nelson R W, Feldman E C & Griffey S M (1997)Diabetic ketosis and ketoacidosis in cats - 42 cases (1980-1995).JAVMA211(2), 188-192.
  • Rand J S, Bobbermein L M, Hendrikz J K & Copland M (1997)Over representation of Burmese cats with diabetes mellitus.Aust Vet J75, 402-405.
  • Adams L G, Hardy R M, Weiss D J & Bartges J W (1993)Hypophosphataemia and haemolytic anaemia associated with diabetes mellitus and hepatic lipidosis in cats.JVIM7, 266-271.

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