Canis ISSN: 2398-2942

Diabetic ketoacidosis

Synonym(s): DKA

Contributor(s): David Bruyette, Audrey K Cook

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.
  • Causes:
    • Undiagnosed insulin-dependent diabetes mellitus Diabetes mellitus.
    • Inappropriately low insulin dosages in treated dogs.
    • Impaired insulin action and/or resistance caused by concurrent illness or drugs (around 2/3 of dogs with DKA have one or more concurrent problems).
      Follow the diagnostic tree for Canine Diabetic Ketoacidosis Canine Diabetic Ketoacidosis.

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

  • 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.
  • Di Tommaso M, Aste G, Rocconi F et al (2009) Evaluation of a portable meter to measure ketonemia and comparison with ketouria for the doagnosis of canine diabetic ketoacidosis. JVIM 23, 466-471 PubMed.
  • Fall T, Hamlin H H, Hedhammar A et al (2007) Diabetes mellitus in a population of 180,000 insured dogs: incidence, survival and breed distribution. JVIM 21, 1209-1216 PubMed.
  • Hume D Z, Drobatz K J & Hess R S (2006) Outcome of dogs with diabetic ketoacidosis: 127 dogs (1993-2003). J Vet Intern Med 20, 547-555 PubMed.
  • Macintire D K (1993) Treatment of diabetic ketoacidosis in dogs by continuous low-dose intravenous infusion of insulin. JAVMA 202, 1266-1271 PubMed.

Other sources of information

  • Boysen S R (2008) Fluid and electrolyte therapy in endocrine disorders: Diabetes mellitus and hypoadrenocorticism. Vet Clin North Am Small Anim Pract 38, 699-717 PubMed.


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