Managing Diabetes Complicated By Ketoacidosis
Go to site For Pet Owners Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus that has to be aggressively treated. Diagnosis The diagnosis is based on the presence of ketonuria with signs of systemic illness. Management guidelines Goals of treatment include the correction of fluid deficits, acid-base balance and electrolyte balance, reduction of blood glucose and ketonuria, and beginning insulin therapy and treatment of concurrent diseases. Many protocols for treatment exist but rapid-acting insulin (regular) must be administered first, as decreases in the hyperglycemia must be achieved quickly. When blood sugar levels are lowered and maintained at 200−250 mg/dL for 4−10 hours, then Vetsulin® (porcine insulin zinc suspension) can be used. Evaluation of treatment When evaluating the regulation of insulin therapy, it is important to consider several areas including the evaluation of glycemia, urine monitoring, routine rechecks and glycated protein evaluations. Evaluation of the glycemia Creating a blood glucose curve is the most accurate way to evaluate glycemia in order to adjust the dose of Vetsulin. Indications for creating a blood glucose curve are: First, to establish insulin dose, dosing interval, and insulin type when beginning regulation. Second, to evaluate regulation especially if problems occur. Third, when rebound hyperglycemia (Somogyi effect) is suspected. Contraindications for creating a blood glucose curve are: Concurrent administration of drugs affecting glycemia. Presence of a known infection or disease. Stressed animal. The procedure is as follows: The most accurate way to assess response to management is by generating a blood glucose curve. Ideally, the first sample should be taken just prior to feeding Continue reading >>
's Experience With Ketoacidosis.
Signs Treatment Zama's experience Diabetic ketoacidosis is caused by a lack of insulin or an insufficient amount of insulin. Since the lack of insulin means that glucose in not able to be used, the body searches for a new source of energy. In this condition, the diabetic breaks down body fat (lipolysis) to use as energy. During lipolysis, waste products called ketones are produced. Ketones are eliminated in the urine and through the lungs. Under normal conditions, the body can tolerate and eliminate ketones. But in diabetic ketoacidosis, fats are being broken down at such a high rate that the body can not eliminate the ketones fast enough and they build up in the blood. In high amounts, ketones are toxic to the body. They cause the acid-base balance to change and serious electrolyte and fluid imbalances result. Some of the signs of ketoacidosis include polyuria polydipsia lethargy anorexia weakness vomiting dehydration There will probably be ketones in the urine (ketonuria) The breath may have a sweet chemical smell similar to nail polish remover. However, some owners have said that even during documented ketoacidosis, their pet's breath did NOT have any unusual odor. Treatment Mildly ketoacidotic animals can be alert and well hydrated. After your pet is stabilized, your pet can return home and be treated with proper diabetes management techniques including insulin therapy, diet, and exercise. "Sick" ketoacidotic animals require intensive medical management in the vet hospital. This is a life-threatening emergency that requires complex medical management and monitoring. It may take several days for the animal to be out of danger. Treatment involves injections of regular insulin, intravenous fluids, electrolytes, and frequent monitoring of blood glucose, blood chemistry, Continue reading >>
Clinical Signs Of Diabetes Mellitus In Dogs And Cats
Clinical signs are useful in the diagnosis and monitoring of canine and feline diabetes. Other laboratory tests are also necessary for diagnosis of Diabetes mellitus and the monitoring of treated diabetic pets. There are three distinct clinical pictures in diabetes mellitus: Uncomplicated diabetes mellitus The classical signs are polyuria,polydipsia, polyphagia, cachexia and increased susceptibility to infections (e.g. urinary tract infections). In long term diabetes complications due to protein glycosylation can be seen: cataracts (mainly in dogs) and peripheral neuropathy (mainly in cats). Diabetic ketoacidosis DKA develops due to long standing undiagnosed diabetes mellitus, insufficient insulin dose in treated diabetics and impaired insulin action and/or resistance, caused by obesity, concurrent illness or drugs. This is the cause of more than two thirds of cases of DKA. Due to the lack of insulin, glucose cannot be used as an energy source. Fats are broken down to provide energy. During lipolysis, high levels of ketones are produced. Ketosis and acidosis develop and are accompanied by electrolyte imbalances. Ketosis causes anorexia, nausea and lethargy. Treatment DKA is an emergency and treatment must be started as soon as possible. The goals of treatment are to correct fluid deficits, acid-base balance and electrolyte balance, lower blood glucose and ketone concentrations and recognize and correct underlying and precipitating factors. Therapy includes intravenous fluid therapy with isotonic fluids, e.g. 0.9% saline, and intravenous administration of rapid-acting insulin. If possible the electrolyte concentrations and acid-base balance should be measured and corrected. Caninsulin is an intermediate-acting insulin and is not suitable for intravenous administration. W Continue reading >>
Do You Believe That Pets Can Find Cancer And Other Diseases By Smell?
No belief, but have been proven to do so, see these scientific publications. From dogs sniffing out explosives, drugs, even peanuts to prevent an allergic child to ingest hidden peanuts in the food, it's not so a big step to sniffing out cancers from people's breath, urine and stool samples: Page on googlegroups.com "Diagnostic Accuracy of Canine Scent Detection in Early- and Late-Stage Lung and Breast Cancers" by Michael McCulloch et al found that Among lung cancer patients and controls, overall sensitivity of canine scent detection compared to biopsy-confirmed conventional diagnosis was 0.99 (95% confidence interval [CI], 0.99, 1.00) and overall specificity 0.99 (95% CI, 0.96, 1.00). Among breast cancer patients and controls, sensitivity was 0.88 (95% CI, 0.75, 1.00) and specificity 0.98 (95% CI, 0.90, 0.99). Sensitivity and specificity were remarkably similar across all 4 stages of both diseases. Conclusion: Training was efficient and cancer identification was accurate; in a matter of weeks, ordinary household dogs with only basic behavioral “puppy training” were trained to accurately distinguish breath samples of lung and breast cancer patients from those of controls. For canine lung cancer detection by sniffing exhaled breaths also see Canine scent detection in the diagnosis of lung cancer: revisiting a puzzling phenomenon For canine bladder cancer detection by sniffing urine please see: Olfactory detection of human bladder cancer by dogs: proof of principle study For canine prostate cancer detection by sniffing urine please see: Trained dogs can sniff out prostate cancer - Harvard Prostate Knowledge referring to Olfactory System of Highly Trained Dogs Detects Prostate Cancer in Urine Samples. looking at the urine samples of 362 prostate cancer patients and 540 Continue reading >>
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4 Signs Of An Impending Diabetic Pet Emergency
Caring for a diabetic pet can be challenging, but there are certain precautions pet owners can take to prevent a diabetic emergency like hypoglycemia. Preventing a health crisis in a dog or cat with diabetes involves employing a consistent daily routine involving diet, exercise, insulin therapy, and supplementation. It also involves avoiding any and all unnecessary vaccinations. Even the most diligent pet parent can find himself facing a diabetic emergency with a dog or cat. Hypoglycemia is the most common health crisis, and is usually the result of an inadvertent overdose of insulin. Symptoms of hypoglycemia can appear suddenly and include lethargy or restlessness, anxiety or other behavioral changes, muscle weakness or twitching, seizures, coma, and death. At-home treatment for a diabetic pet with hypoglycemia is determined by whether or not the animal is alert. Signs of other potential impending diabetic emergencies include ketones in the urine; straining to urinate or bloody urine; vomiting or diarrhea; or a complete loss of appetite or reduced appetite for several days. By Dr. Becker Caring for a diabetic pet can be quite complex and time consuming. It involves regular monitoring of blood glucose levels, making necessary dietary adjustments, giving insulin injections or oral medications, and keeping a careful eye on your pet at all times. Frequent veterinary visits are the norm for dogs and cats with diabetes, as are the costs associated with checkups, tests, medical procedures, and insulin therapy. And unlike humans with the disease, our pets can’t tell us how they’re feeling or help in their own treatment and recovery. Preventing Diabetic Emergencies The key to preventing diabetic emergencies with a pet involves implementing a consistent daily routine and sti Continue reading >>
Diabetes With Ketone Bodies In Dogs
Studies show that female dogs (particularly non-spayed) are more prone to DKA, as are older canines. Diabetic ketoacidosis is best classified through the presence of ketones that exist in the liver, which are directly correlated to the lack of insulin being produced in the body. This is a very serious complication, requiring immediate veterinary intervention. Although a number of dogs can be affected mildly, the majority are very ill. Some dogs will not recover despite treatment, and concurrent disease has been documented in 70% of canines diagnosed with DKA. Diabetes with ketone bodies is also described in veterinary terms as diabetic ketoacidosis or DKA. It is a severe complication of diabetes mellitus. Excess ketone bodies result in acidosis and electrolyte abnormalities, which can lead to a crisis situation for your dog. If left in an untreated state, this condition can and will be fatal. Some dogs who are suffering from diabetic ketoacidosis may present as systemically well. Others will show severe illness. Symptoms may be seen as listed below: Change in appetite (either increase or decrease) Increased thirst Frequent urination Vomiting Abdominal pain Mental dullness Coughing Fatigue or weakness Weight loss Sometimes sweet smelling breath is evident Slow, deep respiration. There may also be other symptoms present that accompany diseases that can trigger DKA, such as hypothyroidism or Cushing’s disease. While some dogs may live fairly normal lives with this condition before it is diagnosed, most canines who become sick will do so within a week of the start of the illness. There are four influences that can bring on DKA: Fasting Insulin deficiency as a result of unknown and untreated diabetes, or insulin deficiency due to an underlying disease that in turn exacerba Continue reading >>
Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)
Unfortunately, we veterinarians are seeing an increased prevalence of diabetes mellitus in dogs and cats. This is likely due to the growing prevalence of obesity (secondary to inactive lifestyle, a high carbohydrate diet, lack of exercise, etc.). So, if you just had a dog or cat diagnosed with diabetes mellitus, what do you do? First, we encourage you to take a look at these articles for an explanation of the disease: Diabetes Mellitus (Sugar Diabetes) in Dogs Once you have a basic understanding of diabetes mellitus (or if you already had one), this article will teach you about life-threatening complications that can occur as a result of the disease; specifically, I discuss a life-threatening condition called diabetes ketoacidosis (DKA) so that you know how to help prevent it! What is DKA? When diabetes goes undiagnosed, or when it is difficult to control or regulate, the complication of DKA can occur. DKA develops because the body is so lacking in insulin that the sugar can’t get into the cells -- resulting in cell starvation. Cell starvation causes the body to start breaking down fat in an attempt to provide energy (or a fuel source) to the body. Unfortunately, these fat breakdown products, called “ketones,” are also poisonous to the body. Symptoms of DKA Clinical signs of DKA include the following: Weakness Not moving (in cats, hanging out by the water bowl) Not eating to complete anorexia Large urinary clumps in the litter box (my guideline? If it’s bigger than a tennis ball, it’s abnormal) Weight loss (most commonly over the back), despite an overweight body condition Excessively dry or oily skin coat Abnormal breath (typically a sweet “ketotic” odor) In severe cases DKA can also result in more significant signs: Abnormal breathing pattern Jaundice Ab Continue reading >>
68..............................................................................................................................................................................navc Clinicianâ€™s Brief / April 2011 / Diagnostic Tree
1. IV Isotonic Crystalloid Therapy â€¢ Shock fluid therapy is warranted if cardiovascular instability is present: Full shock dose of fluids is 90 mL/kg; start with Â¼ to 1/3 dose and reassess until stable â€¢ Correct dehydration, provide maintenance needs, and replace ongoing losses over 6 to 24 hours: - % dehydration Ã— body weight (kg) Ã— 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 â€¢ Polyuria â€¢ Weight loss â€¢ Polydipsia â€¢ Vomiting â€¢ Polyphagia â€¢ Lethargy Patient may have only 1 or more of these signs. Laboratory Results â€¢ Blood glucose (BG): Hyperglycemia (> 200 mg/dL) â€¢ Blood gas (venous or arterial): Metabolic acidosis â€¢ 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) â€¢ Monitor serum potassium Q 4â€“6 H until within reference interval and stable; then Q 12â€“24 H â€¢ Monitor serum phosphorus Q 4â€“6 H until > 1.5; then Q 6â€“24 H â€¢ When supplementing potassium and phosphorus concurrently, take into account the amount of potassium contained in the potassium phosphate â€¢ Consider magnesium supplementation in instances of refractory hypokalemia 3. Regular Insulin â€¢ 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 >>
Outcome Of Dogs With Diabetic Ketoacidosis: 127 Dogs (1993-2003).
Abstract The aim of this study was to retrospectively describe the outcome of 127 dogs with naturally occurring diabetic ketoacidosis (DKA) and to examine the association between outcome of canine DKA and clinical and clinicopathologic findings. Eighty-two (65%) dogs were diagnosed with DKA at the time of initial diagnosis of diabetes mellitus (DM). Eighty-seven dogs (69%) had one or more concurrent disorders diagnosed at the time of hospitalization. Commonly identified concurrent conditions included acute pancreatitis (52, 41%), urinary tract infection (21, 20%), and hyperadrenocorticism (19, 15%). Dogs with coexisting hyperadrenocorticism were less likely to be discharged from the hospital (P = .029). Of 121 treated dogs, 89 dogs (70%) survived to be discharged from the hospital, with a median hospitalization of 6 days. Nonsurvivors had lower ionized calcium concentration (P < .001), lower hematocrit (P = .036), lower venous pH (P = .0058), and larger base deficit (P = .0066) than did survivors. Time from admission to initiation of subcutaneous insulin therapy was correlated with lower serum potassium concentration (P = .0056), lower serum phosphorus concentration (P = .0043), abnormally high white blood cell count (P = .0060), large base deficit (P = .0015), and low venous pH (P < .001). Multivariate analysis showed that base deficit was associated with outcome (P = .021). For each unit increase in the base deficit, there was a 9%) greater likelihood of discharge from the hospital. In conclusion, the majority of dogs with DKA were not previously diagnosed with DM. Concurrent conditions and electrolyte abnormalities are common in DKA and are associated with length of hospitalization. Survival was correlated to degree of anemia, hypocalcemia, and acidosis. Continue reading >>
Emergency Situations With Diabetic Dogs
In diabetic dogs, the following emergency situations may arise: 1. Hypoglycaemia - extremely low blood sugar 2. Diabetic ketoacidosis or hyperglycaemic hyperosmolar non-ketotic syndrome HHNK syndrome) - caused by extremely high blood sugar CONTACT YOUR VETERINARIAN IMMEDIATELY for possible adjustment of the insulin dose or treatment of additional medical problems if your diabetic dog shows any of these signs: · Excessive drinking for more than 3 days · Excessive urination or inappropriate urination in the house for more than 3 days · Reduction in or loss of appetite · Weakness, seizures or severe depression · Behavioural change, muscle twitching or anxiety · Constipation, vomiting or diarrhoea · Signs of a bladder infection (passing frequent small amounts of urine, straining to urinate, blood in the urine) Swelling of the head or neck Hypoglycaemia in treated diabetic dogs One of the most important complications seen in diabetic dogs on insulin treatment is an unduly low blood glucose level, called hypoglycaemia. Situations that may lead to hypoglycaemia are: 1. Your dog receives the normal dose of insulin but has not received its normal quantity of food - it does not eat, vomits up the meal or has diarrhoea. 2. Your dog is abnormally active, leading to abnormally high energy (glucose) use. 3. Your dog accidentally receives a dose of insulin that is too high. 4. Your dog's insulin requirement has naturally fallen. Signs of low blood glucose Low blood glucose can be fatal, so it is extremely important that you recognize these signs, which are often subtle in the early stages: · restlessness · trembling or shivering · unusual movements or behaviour - some animals become very quiet and stop eating. · muscle twitching · coma What to do If any of the above signs Continue reading >>
Diabetic Ketoacidosis In Cats And Dogs
Over the last few days the signs have been getting worse. Your pet isn’t doing well; it is depressed, isn’t eating, and may even be vomiting. You thought it would get better, but it hasn’t and in fact your pet looks really sick. So you decide to take your pet into the veterinarian, who runs a bunch of tests. It is most likely that the animal will be whisked away to a treatment room after the veterinarian confirms a diagnosis of diabetic ketoacidosis. What is diabetic ketoacidosis (DKA)? You didn’t even know that your pet was diabetic, so how could it have this problem? Diabetic ketoacidosis most commonly develops in animals with undiagnosed diabetes. However, animals with diabetes can develop this problem as well, if their diabetes gets out of control. The reason that your pet will be quickly taken to the treatment room is because DKA is an emergency. These animals look sick because their whole body is being affected by the problem. If the situation is not addressed quickly, DKA can cause irreversible damage. This doesn’t mean that your pet will be fixed overnight. Even uncomplicated, mild cases of DKA often stay in the hospital for two or three days. Before we explain DKA, let’s review the meaning of diabetes. Diabetes is a situation where the body does not have enough insulin. Insulin is needed for cells to absorb glucose (which is crucial for normal cell function) from the blood stream. When cells don’t have insulin, they don’t absorb enough glucose and the cells starve. This starvation causes the liver to release more glucose into the blood stream. But without insulin, cells cannot absorb the glucose that is in the blood, and they continue to starve. This is how the vicious circle goes on. Usually diabetes is caught at this point, and the pet is star Continue reading >>
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 >>
What Does A Diabetic Person Smell Like?
Acetone breath is one of the classic symptoms of untreated diabetes. A diabetic lacking insulin will release fats into the bloodstream which are partially converted to ketones (acetoacetate and hydroxybutyrate). These substances, in turn, may be converted into acetone which may then appear in the breath or urine. Ketones are an important source of energy for the brain when carbohydrates are not available. Acetone breath may appear in people eating a very low carbohydrate diet or have not eaten for more than 2–3 days. In modern times, no diabetic person should have acetone in their breath unless they neglect to take enough insulin. If you smell it in a diabetic person arrange for proper treatment right away. Continue reading >>
My Dog Has Acute Kidney Failure And Diabetic Ketoacidosis. Should We Put Her To Sleep?
First of all, you have my heart felt sympathies for what you are going through. I know how painful this time must be for you and your family. That decision to put your furry kid to sleep is yours and only yours to make. I am in a position to only share my experience with my own GSD's AKD. My Dash was affected by Acute Kidney disease at the age of 9 months. Within 3-4 hours of fluid therapy, our vet told us upfront that it's not working as the creatinine level had spiked from 5 at the time of reaching the vet to 9. We were proactive in asking her what can we do to save Dash. She told us that prompt dialysis is the only chance he has, no assurances / guarantee, just a chance; and directed us to the only private facility in the city where he could be given dialysis. Unfortunately, Dash couldn't be given dialysis there due to some last minute technical glitch. During this time, his creatinine had shot up to 11. Then, as the last resort, we took him to the government Veterinary hospital (which each and every one of our contact was against) as it has the only other canine dialysis unit in the city. As our luck would have it, the dialysis unit there too got stuck at the last minute. The vet there assured us she would stabilise Dash till the next morning and then have him go through dialysis. Sure enough, Dash did pull through the night and we were back the next morning for dialysis. The unit was fixed, however, Dash was found to be unfit for dialysis as his electrolyte levels had dropped substantially as well as his blood clotting was taking longer than normal. It took us almost 2 weeks to get him fit for dialysis. During this period, his creatinine had stayed above 10, fluctuating now and then; in addition, Dash had not eaten a single morsel of food in all this time. He was b Continue reading >>
Diabetic ketoacidosis (DKA) is a serious complication of diabetes mellitus. Before the availability of insulin in the 1920s, DKA was a uniformly fatal disorder. Even after the discovery of insulin, DKA continued to carry a grave prognosis with a reported mortality rate in humans ranging from 10% to 30%. However, with the expanding knowledge regarding the pathophysiology of DKA and the application of new treatment techniques for the complications of DKA, the mortality rate for this disorder has decreased to less than 5% in experienced human medical centers (Kitabchi et al, 2008). We have experienced a similar decrease in the mortality rate for DKA in our hospital over the past two decades. DKA remains a challenging disorder to treat, in part because of the deleterious impact of DKA on multiple organ systems and the frequent occurrence of concurrent often serious disorders that are responsible for the high mortality rate of DKA. In humans, the incidence of DKA has not decreased, appropriate therapy remains controversial, and patients continue to succumb to this complication of diabetes mellitus. This chapter summarizes current concepts regarding the pathophysiology and management of DKA in dogs and cats. • Diabetic ketoacidosis (DKA) is a severe form of complicated diabetes mellitus that requires emergency care. • Acidosis and electrolyte abnormalities can be life threatening. • Fluid therapy and correction of electrolyte abnormalities are the two most important components of therapy. • Concurrent disease increases the risk for DKA and must be addressed as part of the diagnostic and therapeutic plan. • Bicarbonate therapy usually is not needed and its use is controversial. • About 70% of treated dogs and cats are discharged from the hospital after 5 to 6 days Continue reading >>