Diabetic Ketoacidosis


Diabetic ketoacidosis (DKA) and diabetic ketosis (DK) are an extreme complication of diabetes mellitus. They usually occur when there is additional disease that further changes the body's response to insulin. Common causes include urinary tract infections, Cushing's Disease and/or pancreatitis. This additional disease, in turn, causes a change in energy regulation and the body produces ketones, a metabolic compound that can be toxic if too much is present. Ketoacidosis represents an extreme metabolic derangement. When ketone bodies are burned for fuel, pH and electrolyte imbalances occur and the patient's life is at risk.

Clinical Signs
Clinical signs include vomiting, lethargy, loss of appetite, frequent urination and increased thirst. Careful monitoring of diabetic patients helps reduce the risks of DK and DKA. Unfortunately, most cases of ketoacidosis are in patients that were not previously known to be diabetic so the owner (and pet) must deal with two serious diagnoses: one acutely life-threatening and expensive and the other requiring on-going commitment and daily treatment. Prior signs of diabetes (excess thirst, appetite and weight loss) may have been ignored or unnoticed, but at this point the pet is clearly very ill. Blood glucoses are typically extremely high, and ketones can usually be detected in the urine.

Diagnostics and Treatment
Once Diagnosed with DK or DKA patients should be hospitalized. DKA is life threatening and requires intensive care. The sooner the crisis is noticed, the faster treatment can be instituted. Because electrolytes can change moment by moment, blood testing is necessary throughout the day to keep track and keep the imbalances corrected. A facility that offers 24-hour care is ideal. Testing to determine the precipitating stress is necessary as well.

Fluid therapy is imperative to treatment of this condition. The patient is invariably dehydrated from the high circulating blood sugar levels, which cause excess fluid loss in urine, as well as from vomiting and/or diarrhea, which are common in ketoacidosis.

DKA patients often have severe electrolyte abnormalities (specifically potassium and phosphorous are often dangerously low). The term ketoacidosis implies that the blood pH is overly acidic. If the situation is severe enough, sodium bicarbonate must be added to the intravenous therapy. Blood sugar must be controlled with, "regular insulin" (typically Humulin R®), given either as multiple intramuscular injections or as a continuous drip. This type of insulin is short acting and wears off quickly, which allows it to provide small adjustments. All these aspects require regular monitoring, which means lab work perhaps four times daily or more. Patients in diabetic ketoacidosis require close monitoring and intensive care. It is not until the patient is eating and nausea has been controlled that maintenance insulins can be started.
Most patients are in the hospital for no less than 3 days, some as many as a week or more. The expense can be significant. The prognosis for survival is guarded depending on how severely ill the pet is at presentation and what other illnesses are present. Diabetes is a life-long condition that must be treated with insulin injections twice a day, lifestyle modifications (weight loss, exercise, dietary changes), and close monitoring.


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