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
- Diestrus or pregnancy may trigger diabetes mellitus and DKA in intact female dogs.
- Concurrent disorders reported in >70% of cases, and may contribute to development of DKA or overall patient morbidity:
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.