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:
  • Pancreatitis (in 40% cases) Pancreatitis: acute Pancreatitis: chronic.
  • Urinary tract infection ( in 20% cases) Cystitis.
  • Hyperadrenocorticism (in 15% cases) Hyperadrenocorticism.
  • Renal failure Kidney: acute kidney injury (AKI) Kidney: chronic kidney disease (CKD).
  • Infection.
  • Neoplasia.
  • Inadequate insulin Insulin therapy.

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

Treatment

Outcomes