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Diabetic ketoacidosis

ffelis

Synonym(s): DKA


Introduction

  • Diabetic ketoacidosis (DKA) is a life-threatening metabolic crisis, characterized by hyperglycemia, metabolic acidosis and dehydration.
  • Patients may decompensate quickly and prompt intervention is needed.
  • Cause:
    • Undiagnosed insulin-dependent diabetes mellitus Diabetes mellitus.
    • Inappropriately low insulin dosages Insulinin treated animals.
    • Impaired insulin action and/or resistance caused by concurrent illness or drugs.

Pathogenesis

Etiology

  • Relative or absolute insulin deficiency. Excessive lipolysis   →   production of ketone bodies in liver.
  • Excessive ketosis results in metabolic acidosis Acid base imbalance.

Predisposing factors

General

Pathophysiology

  • See pathophysiology of DKA Ketoacidosis pathophysiology for more detail.
  • Lipolysis: non-esterified fatty acids released from adipose tissue   →   converted to ketone bodies by the liver    →   ketosis and acidosis.
  • Impaired utilization of ketone bodies by peripheral tissues.
  • Excess of diabetogenic hormones, fasting and dehydration   →   increased gluconeogenesis and ketogenesis.
  • Increased production and decreased utilization of ketone bodies   →   accumulation of ketones in the blood   →   development of metabolic acidosis.

Timecourse

  • Diabetic ketoacidosis: develops within a few days of absolute insulin deficiency.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Claus M A, Silverstein D C, Shofer F S et al (2010) Comparison of regular insulin doses in critically ill diabetic cats: 29 cases (1999-2007). J Vet Emer Crit Care 20 (5), 509-517 PubMed.
  • Sieber-Ruckstuhl N S, Kley S, Tschuor F et al (2008) Remission of diabetes mellitus in cats with diabetic ketoacidosis. JVIM 22 (6), 1326-1332 PubMed.
  • Zeugswetter F & Pagitz M (2008) Ketone measurements using dipstick methodology in cats with diabetes mellitus. JSAP 50 (1), 4-8 PubMed.
  • 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. JAVMA 215 (10), 1455-1459 PubMed.
  • Bruskiewicz K A, Nelson R W, Feldman E C et al (1997) Diabetic ketosis and ketoacidosis in cats - 42 cases (1980-1995). JAVMA 211 (2), 188-192 PubMed.

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