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Ketonuria Dog

Diabetes With Ketone Bodies In Dogs

Diabetes With Ketone Bodies In Dogs

Diabetes Mellitus with Ketoacidosis in Dogs Diabetes is a medical condition in which the body cannot absorb sufficient glucose, thus causing a rise the blood sugar levels. The term “ketoacidosis,” meanwhile, refers to a condition in which levels of acid abnormally increased in the blood due to presence of “ketone bodies”. In diabetes with ketoacidosis, ketoacidosis immediately follows diabetes. It should be considered a dire emergency, one in which immediate treatment is required to save the life of the animal. This condition typically affects older dogs as well as females. In addition, miniature poodles and dachshunds are predisposed to diabetes with ketoacidosis. Symptoms and Types Weakness Lethargy Depression Lack of appetite (anorexia) Muscle wasting Rough hair coat Dehydration Dandruff Sweet breath odor Causes Although the ketoacidosis is ultimately brought on by the dog's insulin dependency due to diabetes mellitus, underlying factors include stress, surgery, and infections of the skin, respiratory, and urinary tract systems. Concurrent diseases such as heart failure, kidney failure, asthma, cancer may also lead to this type of condition. Diagnosis You will need to give a thorough history of your dog’s health, including the onset and nature of the symptoms, to your veterinarian. He or she will then perform a complete physical examination, as well as a biochemistry profile and complete blood count (CBC). The most consistent finding in patients with diabetes is higher than normal levels of glucose in the blood. If infection is present, white blood cell count will also high. Other findings may include: high liver enzymes, high blood cholesterol levels, accumulation in the blood of nitrogenous waste products (urea) that are usually excreted in the urine (azo Continue reading >>

Merck And The Merck Veterinary Manual

Merck And The Merck Veterinary Manual

By Trevor J. Whitbread, BSc, BVSc, MRCVS, DECVP, Pathologist, Abbey Veterinary Services Urinalysis is an important laboratory test that can be readily performed in veterinary practice and is considered part of a minimum database. It is useful to document various types of urinary tract diseases and may provide information about other systemic diseases, such as liver failure and hemolysis. Urine may be collected by cystocentesis, urethral catheterization, or voiding. Urine should be evaluated within 30 min, but if this is not possible, it may be refrigerated for up to 24 hr or submitted to an outside diagnostic laboratory; however, this may result in crystal precipitation. Refrigeration does not alter urine pH or specific gravity. If cytologic evaluation is required and a delay in preparing the slides is anticipated, then a preservative should be added. A few drops of 10% formalin (exact concentration not necessary) is better than boric acid. However, the usual Romanowsky stains are unsuitable with formalin; if submitting to an outside laboratory, it should be communicated that formalin has been added. Urine Chemistries Urine must be at room temperature for accurate measurement of urine specific gravity and for chemical analysis. These tests are usually done before centrifugation; however, if urine is discolored or turbid, it may be beneficial to perform these tests on supernatant (see Urine Sediment). The urine specific gravity (SG) is determined using a refractometer designed for veterinary samples, which includes a scale calibrated specifically for cat urine. SG for species other than cats should be determined using the scale for dogs. In healthy animals, SG is highly variable, depending on fluid and electrolyte balance of the body. It is normally at least 1.015. Inter Continue reading >>

Ketonuria

Ketonuria

Ketonuria is a medical condition in which ketone bodies are present in the urine. It is seen in conditions in which the body produces excess ketones as an indication that it is using an alternative source of energy. It is seen during starvation or more commonly in type I diabetes mellitus. Production of ketone bodies is a normal response to a shortage of glucose, meant to provide an alternate source of fuel from fatty acids. Pathophysiology[edit] Ketones are metabolic end-products of fatty acid metabolism. In healthy individuals, ketones are formed in the liver and are completely metabolized so that only negligible amounts appear in the urine. However, when carbohydrates are unavailable or unable to be used as an energy source, fat becomes the predominant body fuel instead of carbohydrates and excessive amounts of ketones are formed as a metabolic byproduct. Higher levels of ketones in the urine indicate that the body is using fat as the major source of energy. Ketone bodies that commonly appear in the urine when fats are burned for energy are acetoacetate and beta-hydroxybutyric acid. Acetone is also produced and is expired by the lungs.[1] Normally, the urine should not contain a noticeable concentration of ketones to give a positive reading. As with tests for glucose, acetoacetate can be tested by a dipstick or by a lab. The results are reported as small, moderate, or large amounts of acetoacetate. A small amount of acetoacetate is a value under 20 mg/dl; a moderate amount is a value of 30–40 mg/dl, and a finding of 80 mg/dl or greater is reported as a large amount. One 2010 study admits that though ketonuria's relation to general metabolic health is ill-understood, there is a positive relationship between the presence of ketonuria after fasting and positive metabo Continue reading >>

Leading Science And Care For Animals

Leading Science And Care For Animals

be aware! Recent increased presentation of acquired Fanconi-like syndrome cases related to dried chicken and duck meat ingestion in the UK. A recent cluster of canine cases with PU/PD, glucosuria +/- ketonuria and without hyperglycaemia have been reported by number of referral practices and general practioners in the UK. This combination of findings is suggestive of a proximal tubular disorder and may also be associated with marked electrolyte and acid-base abnormalities. Where a dietary history has been available, the majority of these patients have been fed dried ‘jerky’ type dog treats (chicken and duck), of which many have been identified as originating from China. Acquired proximal tubular disease has previously been reported in Australia and the USA, as well as small numbers of cases in the UK and Europe in association with the ingestion of dried jerky treats. As yet, specific toxins have not been identified within these treats as a cause. Based upon previously published information, many pets presenting with these signs are responsive to discontinuation of treats alone when identified early in disease. However some patients with more significant acid-base and electrolyte disorders will require supportive medical therapy. A small percentage of cases are reported to die or are euthanased. Assessment of dietary history is key to identifying potential cases and where a compatible presentation is identified, should be considered in addition to testing for other causes of acquired proximal tubular disease. Based upon information available from other countries, some dogs may also present with PU/PD and hypophosphataemia alone, without glucosuria. We would urge veterinary surgeons throughout the UK to be aware of this potential presentation. References: Thompson et a Continue reading >>

Insulin Therapy For Diabetes Mellitus In Dogs And Cats (proceedings)

Insulin Therapy For Diabetes Mellitus In Dogs And Cats (proceedings)

1234Next Pathophysiology of DM Diabetes mellitus (DM) is a common endocrine disease in dogs and cats characterized by an absolute or relative deficiency of insulin. This results in a decreased ability of cells to take up and utilize not only glucose, but also amino acids, fatty acids, and electrolytes. In addition the lack of insulin results in increased gluconeogenesis, glycogenolysis, lipolysis, ketogenesis, and protein catabolism. Factors that have been identified as predisposing factors in cats include obesity, advancing age and being male. In dogs, older females are at higher risk of developing DM. Poodles, Dachshunds, Miniature Pinschers, Beagles, Golden Retrievers, and Miniature Schnauzers are considered to be at higher risk than the general canine population. Keeshonden appear to have a genetic predisposition to the disease. Two types of DM are recognized in man, and these classifications can be applied to the disease in dogs and cats. Type I DM (insulin dependent diabetes mellitus) is due to an absolute deficiency of insulin. This form of diabetes is characterized by minimal secretory response to β-cell secretagogues such as glucagon, and is the most common form of diabetes recognized in the dog. Type II DM (non insulin dependent diabetes) is characterized by abnormal insulin secretion and peripheral insulin resistance, and results in a stable reregulation of the blood glucose concentration at a higher concentration. This type of DM is rare in the dog but is common in the diabetic cat. The two types of diabetes are classically distinguished by characteristic responses to challenge by insulin secretagogues such as glucose, glucagon, or arginine. In type I DM, there is a decreased or negligible secretion of insulin compared to normal animals, whereas in Type II Continue reading >>

Canine Urinalysis

Canine Urinalysis

Urinalysis is a critical tool for diagnosing kidney failure, diabetes, urinary tract tumors or infections, and many other diseases. Urinalysis is a screening test that may be helpful in diagnosing many diseases, but it is an especially important test to perform whenever any urinary tract disease or abnormality is expected. Abnormal appearing urine (cloudy or red colored), difficulty in urinating, abnormal frequency of urination, or abnormal flow are all indications for ordering a urinalysis. The test is noninvasive, relatively easy to interpret, and nearly every veterinary clinic has the reagents and instruments necessary to perform it. A Test of Kidney Function Urine is the end product of a process of filtration that removes waste products and metabolic end products from the blood serum. In addition, the kidneys help maintain fluid balance in the body by concentrating (or diluting) the kidneys’ filtrate. The functional unit of the kidney is the nephron, which is comprised of the glomerulus (with its attendant vascular bed that serves as a filtration unit) and the tubule, which modifies the filtrate. From the kidney the filtrate passes through the ureters into the storage organ, the bladder, where it remains until voided via the urethra and external genitalia. Analysis of the sediment of the urine reflects the health of all these structures and the cells that line them. A complete urinalysis will test the function of the nephrons; provide some indications of the current metabolic status of the animal; and demonstrate the relative fluid status of the body. In addition, the urinalysis evaluates substances in the urine that might indicate ongoing disease. Urine Analysis Fresh samples give the best results; samples should be analyzed within two hours, or up to six hours a Continue reading >>

Clinical Methods: The History, Physical, And Laboratory Examinations. 3rd Edition.

Clinical Methods: The History, Physical, And Laboratory Examinations. 3rd Edition.

Go to: Ketone bodies (acetoacetic acid, beta-hydroxybutyric acid, and acetone) are insignificant in the blood and urine of normal individuals in the postprandial or overnight-fasted state. However, these ketoacids become important sources of metabolic energy in circumstances in which the availability of glucose is restricted, as during prolonged fasting, or when the ability to use glucose is greatly diminished, as in decompensated diabetes mellitus. During prolonged starvation the arterial concentrations of these metabolically active strong organic acids increase approximately 70-fold to 10 to 12 mM and to significantly higher levels of 30 to 40 mM in diabetic ketoacidosis. The mechanisms responsible for the development of ketonemia are: (1) increased production by the liver; (2) decreased peripheral utilization in muscle; and (3) reduced volume of distribution. Since ketone bodies are not bound to plasma proteins, they are freely filterable solutes in the renal glomerulus and appear quantifiably in the tubular urine. At the very low plasma concentrations of ketone bodies that are encountered normally after an overnight fast, urinary excretion rates are negligible. When plasma levels increase beyond 0.1 to 0.2 mM, however, excretion increases and measurable amounts of ketone bodies appear in the urine. Go to: Two semiquantitative tests are available for the rapid determination of primarily acetoacetate in urine and blood, although they have never been considered totally satisfactory for blood. The ferric chloride test is performed by adding 5 to 10 drops of freshly voided urine to a few drops of a 10% solution of ferric chloride. At first, a precipitate of ferric phosphate forms but with additional drops of urine the precipitate disappears and a burgundy red color appea Continue reading >>

Understanding And Treating Diabetic Ketoacidosis

Understanding And Treating Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a serious metabolic disorder that can occur in animals with diabetes mellitus (DM).1,2 Veterinary technicians play an integral role in managing and treating patients with this life-threatening condition. In addition to recognizing the clinical signs of this disorder and evaluating the patient's response to therapy, technicians should understand how this disorder occurs. DM is caused by a relative or absolute lack of insulin production by the pancreatic b-cells or by inactivity or loss of insulin receptors, which are usually found on membranes of skeletal muscle, fat, and liver cells.1,3 In dogs and cats, DM is classified as either insulin-dependent (the body is unable to produce sufficient insulin) or non-insulin-dependent (the body produces insulin, but the tissues in the body are resistant to the insulin).4 Most dogs and cats that develop DKA have an insulin deficiency. Insulin has many functions, including the enhancement of glucose uptake by the cells for energy.1 Without insulin, the cells cannot access glucose, thereby causing them to undergo starvation.2 The unused glucose remains in the circulation, resulting in hyperglycemia. To provide cells with an alternative energy source, the body breaks down adipocytes, releasing free fatty acids (FFAs) into the bloodstream. The liver subsequently converts FFAs to triglycerides and ketone bodies. These ketone bodies (i.e., acetone, acetoacetic acid, b-hydroxybutyric acid) can be used as energy by the tissues when there is a lack of glucose or nutritional intake.1,2 The breakdown of fat, combined with the body's inability to use glucose, causes many pets with diabetes to present with weight loss, despite having a ravenous appetite. If diabetes is undiagnosed or uncontrolled, a series of metab Continue reading >>

Ketoacidosis

Ketoacidosis

Ketones in the urine or blood, as detected by urine testing stix or a blood ketone testing meter, [1] may indicate the beginning of diabetic ketoacidosis (DKA), a dangerous and often quickly fatal condition caused by low insulin levels [2] combined with certain other systemic stresses. DKA can be fixed if caught quickly. Because of the hyperglycemia Cushing's disease creates, it's possible (but not frequent) to find ketones in the urine. [3] The three ketone bodies are acetone, acetoacetic acid, and beta-hydroxybutyric acid, with the predominating ketone body formed being beta-hydroxybutyrate acid. [4] Though they are referred to as "bodies" this is a misnomer as they are dissolved substances. [5][6] Ketones are produced by the liver as part of fat metabolism and are normally not found in sufficient quantity to be able to be measured in urine or blood (non-diabetics or well-controlled diabetics). [7] Since the body is set up to normally burn glucose as its fuel, when glucose isn't available as an energy source, (untreated/poorly treated diabetes and some other unrelated medical conditions), it begins to burn fat for energy instead. The result of the body turning to burning fat instead of glucose means more ketone production which is able to be measured when testing either urine or blood for them. [4][6] Diabetics of all species therefore need to be checked for ketones with urine testing stix, available at any pharmacy, whenever insulin level may be too low, and any of the following signs or triggers are present: Note that the triggers and signs are somewhat interchangeable because ketoacidosis is, once begun, a set of vicious circles which will make itself worse. So dehydration, hyperglycemia, fasting, and presence of ketones are not only signs, they're also sometimes t Continue reading >>

2010 Aaha Diabetes Management Guidelines For Dogs And Cats

2010 Aaha Diabetes Management Guidelines For Dogs And Cats

Renee Rucinsky, DVM, ABVP (Feline) (Chair) | Audrey Cook, BVM&:S, MRCVS, Diplomate ACVIM-SAIM, Diplomate ECVIM-CA | Steve Haley, DVM | Richard Nelson, DVM, Diplomate ACVIM | Debra L. Zoran, DVM, PhD, Diplomate ACVIM | Melanie Poundstone, DVM, ABVP - Download PDF - Introduction Diabetes mellitus (DM) is a treatable condition that requires a committed effort by veterinarian and client. This document provides current recommendations for the treatment of diabetes in dogs and cats. Treatment of DM is a combination of art and science, due in part to the many factors that affect the diabetic state and the animal's response. Each animal needs individualized, frequent reassessment, and treatment may be modified based on response. In both dogs and cats, DM is caused by loss or dysfunction of pancreatic beta cells. In the dog, beta cell loss tends to be rapid and progressive, and it is usually due to immune-mediated destruction, vacuolar degeneration, or pancreatitis.1 Intact females may be transiently diabetic due to the insulin-resistant effects of the diestrus phase. In the cat, loss or dysfunction of beta cells is the result of insulin resistance, islet amyloidosis, or chronic lymphoplasmacytic pancreatitis.2 Risk factors for both dogs and cats include insulin resistance caused by obesity, other diseases (e.g., acromegaly in cats, hyperadrenocorticism in dogs), or medications (e.g., steroids, progestins). Genetics is a suspected risk factor, and certain breeds of dogs (Australian terriers, beagles, Samoyeds, keeshonden3) and cats (Burmese4) are more susceptible. Regardless of the underlying etiology, diabetic dogs and cats are hyperglycemic and glycosuric, which leads to the classic clinical signs of polyuria, polydipsia (PU/PD), polyphagia, and weight loss. Increased fat mobi Continue reading >>

Chemical Constituents

Chemical Constituents

Chemical constituents that are a part of a urinalysis include: pH, protein (Dipstick, SSA, Bence-Jones), protein-to-creatinine ratio, glucose, ketones, bilirubin and heme. pH Knowledge of the urine pH is important in interpreting urine sediment findings. Erythrocytes, leukocytes, and casts tend to disintegrate in alkaline urine (pH > 8.0). In addition, precipitation of urine crystals in supersaturated urine is highly dependent on urine pH (e.g. struvite will precipitate in alkaline not acidic urine). The reportable range of pH by the CLINITEK Advantus Urine Chemistry Analyzer used at Cornell University is from 5.0 to >9.0, in 0.5 unit increments. The table below illustrates the reportable pH results from the CLINITEK Advantus Urine Chemistry Analyzer used at Cornell University. pH 5.0 7.5 5.5 8.0 6.0 8.5 6.5 ≥ 9.0 7.0 Factors affecting the pH of urine Diet: Diet has a marked effect on urine pH. Grazing animals (herbivores) generally have alkaline urine except for young animals on a milk diet, where urine pH is more likely to be acidic. In contrast, carnivorous animals (dogs and cats) tend to have more acidic urine than adult herbivores, except straight after eating (called the post-prandial alkaline tide, due to increased secretion of HCl into the stomach). Renal hydrogen (H+) excretion and bicarbonate (HCO3–) resorption Pathologic abnormalities of systemic acid/base balance. Pathologic abnormalities of tubular function: Failure to excrete an acid load (e.g. H+ excretion in distal tubules) or failure to absorb bicarbonate in the proximal tubules. Age of urine specimen: Over time, loss of CO2 to the air occurs, raising the urine pH. Presence of contaminant or pathogenic bacteria: Some bacteria can alter the pH of urine. Urease-positive bacteria such as Streptococcus, Continue reading >>

What Causes High Ketones In A Canine?

What Causes High Ketones In A Canine?

A dog with a high level of ketones in his urine suffers from a condition known as ketonuria, usually resulting from a buildup of these substances in the dog's blood. A ketone is a type of acid, which, if allowed to accumulate in the blood, can lead to ketoacidosis, a potentially fatal condition. The main health conditions that can cause high ketone levels in a canine are starvation and diabetes. A dog's body breaks down the food that he eats into sugars, also called glucose, that the cells of the body use for energy. The dog's pancreas then produces the hormone insulin to regulate the amount of glucose that the body will absorb. If the insulin to regulate the glucose is insufficient, typically due to chronic diabetes mellitus, the body breaks down alternate sources of fuel for its cells; a dog's body that is starved of nutrition will do the same. One of these sources is the fat stored in the dog's body. When the body breaks down this fat, it produces as a by-product toxic acids known as a ketones. These ketones then build up in the dog's blood and also his urine, leading to ketoacidosis. Always consult an experienced veterinarian regarding the health and treatment of your pet. A dog suffering from high ketone levels in his blood and urine exhibits symptoms of weight loss, vomiting, increased thirst, decreased appetite, increased urination, lethargy, low body temperature and yellowing of the skin and gums, according to PetMD. The dog's breath may also have a sweet, fruity smell due to the presence of acetone caused by ketoacidosis, says VetInfo. To properly diagnose high ketone levels and ketoacidosis in your dog, a veterinarian will take blood tests and a urinalysis, which will also check your dog's blood glucose levels. Depending on the dog's physical condition, hospit Continue reading >>

68..............................................................................................................................................................................navc Clinician’s Brief / April 2011 / Diagnostic Tree

68..............................................................................................................................................................................navc Clinician’s Brief / April 2011 / Diagnostic Tree

1. IV Isotonic Crystalloid Therapy • Shock fluid therapy is warranted if cardiovascular instability is present: Full shock dose of fluids is 90 mL/kg; start with ¼ to 1/3 dose and reassess until stable • Correct dehydration, provide maintenance needs, and replace ongoing losses over 6 to 24 hours: - % dehydration × body weight (kg) × 1000 plus - 20 mL/kg/day (insensible losses) plus - 20 to 40 mL/kg/day (maintenance sensible losses) plus - Account for vomiting, diarrhea, & polyuria (ongoing sensible losses) Alice Huang, VMD, & J. Catharine Scott-Moncrieff, Vet MB, MS, MA, Diplomate ACVIM & ECVIM Purdue University Canine Diabetic Ketoacidosis D i a gno s t i c Tre e / ENDOCRINOLOGY Peer Reviewed Physical Examination • Polyuria • Weight loss • Polydipsia • Vomiting • Polyphagia • Lethargy Patient may have only 1 or more of these signs. Laboratory Results • Blood glucose (BG): Hyperglycemia (> 200 mg/dL) • Blood gas (venous or arterial): Metabolic acidosis • Urine dipstick: Glucosuria; ketonuria or ketonemia Serum ketones can be measured if urine is unavailable. Diabetic Ketoacidosis Treatment 2. Electrolyte Supplementation (see Table 1, page 70) • Monitor serum potassium Q 4–6 H until within reference interval and stable; then Q 12–24 H • Monitor serum phosphorus Q 4–6 H until > 1.5; then Q 6–24 H • When supplementing potassium and phosphorus concurrently, take into account the amount of potassium contained in the potassium phosphate • Consider magnesium supplementation in instances of refractory hypokalemia 3. Regular Insulin • Continuous rate infusion (CRI) protocol:1 - Add 2.2 U/kg of regular insulin to 250 mL of 0.9% saline - Allow 50 Continue reading >>

Ketonuria

Ketonuria

Ketonuria in dogs is defined as the presence of ketones (acetone, acetoacetate, and beta-hydroxybutyrate) in the urine. In many dogs, glycosuria is also present and cystitis is a common sequela. This condition is mostly observed in dogs with diabetes mellitus and ketoacidosis. Continue reading >>

Urinalysis: Testing A Urine Sample

Urinalysis: Testing A Urine Sample

There are many valuable pieces of information that your veterinarian can obtain from analyzing a urine sample. As with any other procedure, it is important to remember that we need to look at the whole picture, not just one value, before we attempt to draw any conclusions from the testing. Test results always need to be interpreted in light of the history, physical exam, possible blood work, and further testing such as x-rays, ultrasound, etc. Obtaining a urine sample There are several different ways to obtain a urine sample from a pet. The most common way to catch a sample in a larger pet, such as a dog, is to use a clean, dry container, such as an aluminum pie pan, plastic dish, etc. A litter box can be washed, rinsed well to eliminate all traces of detergent or disinfectant, and allowed to dry. Then use special litter available from your veterinarian, or clean styrofoam packing peanuts instead of regular litter. After the pet has urinated, the styrofoam is removed and the sample is poured into a clean container. To minimize changes in the urine, always collect the urine sample in a clean, dry container, and take it to your veterinarian's office immediately. If there will be a wait, refrigerate the sample. If the temperature is warm, consider placing the urine in a cooler during transportation. DO NOT FREEZE A URINE SAMPLE. If a sterile sample is needed, your veterinarian may recommend that you bring your animal to the veterinary clinic for a procedure called "cystocentesis," in which a small needle is placed directly into the bladder through the body wall. This procedure does not take very long, and should provide a sample that has not been contaminated by debris or bacteria from outside the bladder. Your veterinarian may also use a urinary catheter to obtain a urine Continue reading >>

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