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What Causes Ketoacidosis In Dogs

Diabetes Complications In Dogs And Cats: Diabetes Ketoacidosis (dka)

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 >>

Clinical Signs Of Diabetes Mellitus In Dogs And Cats

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 >>

Diabetic Ketoacidosis In Dogs

Diabetic Ketoacidosis In Dogs

Diabetic ketoacidosis (DKA) is an emergency. DKA develops due to: Long standing undiagnosed canine diabetes Insufficient insulin dose in treated diabetic dogs Reduced insulin action - caused by obesity, concurrent illness or drugs. This is the cause of more than two-thirds of cases of DKA. What causes diabetic ketoacidosis? Due to a lack of insulin, glucose cannot be used by the body cells as an energy source. Instead fat is broken down to provide energy. When fat is used as an energy source, acids known as ketones are produced. Ketones circulating in the blood cause signs of DKA - anorexia, nausea and lethargy. Diagnosis The diagnosis of DKA is based on detecting ketones in the urine and sometimes in the blood along with signs of illness. See Urine Monitoring for more information. Treatment DKA is an emergency and treatment must be started as soon as possible. Your veterinary surgeon will administer intravenous fluids and insulin and correct any underlying disorders to stabilise your dog. Once your dog is stabilised it will be started on long term insulin therapy again. Continue reading >>

Diabetes With Ketone Bodies In Dogs

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 >>

Diabetic Ketoacidosis (dka) In Dogs

Diabetic Ketoacidosis (dka) In Dogs

Overview Diabetic Ketoacidosis (DKA) in Dogs Diabetic ketoacidosis (DKA), the most severe form of Diabetes Mellitus in dogs, results in severe changes in blood chemicals including imbalances in small, simple chemicals known as electrolytes. Diabetes mellitus (DM) is a chronic condition in which a deficiency of the hormone insulin impairs the body’s ability to metabolize sugar. It is one of the most common endocrine (hormonal) diseases of dogs. For more information on the basics of diabetes, go to Diabetes mellitus in dogs DKA is a life-threatening condition caused by diabetes mellitus resulting from insulin deficiency that leads to excess production of ketoacids by the liver. Subsequent changes in the blood result that includes metabolic acidosis, electrolyte abnormalities producing severe signs of systemic illness. DKA condition can occur in pets with new diabetes or in current diabetics that decompensate. Secondary diseases and/or infections can cause diabetics to decompensate and develop DKA. What to Watch For with Diabetic Ketoacidosis (DKA) Signs associated with DKA depend on the individual pet and the length of time they have been ill. Signs may consist of the classic signs of diabetes including: Increased thirst Increased frequency of urination Weight loss despite a good appetite Sudden blindness Additional signs of DKA include: Lethargy Vomiting Weakness Dehydration Some pets will have a strong smell of acetone from their breath Diagnosis of Diabetic Ketoacidosis (DKA) in Dogs Diagnostic tests for DKA in dogs may include: Complete medical history and thorough physical examination. Serum biochemical profile to determine the blood glucose concentration and to exclude other potential causes of the same symptoms such as pancreatitis. Elevated blood glucose is the Continue reading >>

Emergency Situations With Diabetic Dogs

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

Diabetic Ketoacidosis

Also known as: DKA Severe diabetic ketoacidosis is a medical emergency and requires prompt treatment to correct dehydration, electrolyte disturbances and acidosis. It is a complication of insulin dependent Diabetes Mellitus. DKA is the result of marked insulin deficiency, and ketonaemia and ketoacidosis occur approximately 15 days after insulin concentrations are suppressed to fasting levels. Marked insulin suppression occurs on average 4 days after fasting glucose levels reach 30mmol/L. Many cats with DKA have other intercurrent conditions which may precipitate the condition including: infection, pancreatitis or renal insufficiency. Pathophysiology Insulin deficiency leads to increased breakdown of fat that releases fatty acids into the circulation. Free fatty acids are oxidised in the liver to ketones that are used by many tissues as an energy source instead of glucose. This occurs when intracellular levels of glucose are insufficient for energy metabolism as a result of severe insulin deficiency. In the liver, instead of being converted to triglycerides, free fatty acids are oxidised to acetoacetate, which is converted to hydroxybutyrate or acetone. Ketones are acids that cause central nervous system depression and act in the chemoreceptor trigger zone to cause nausea, vomiting and anorexia. They also accelerate osmotic water loss in the urine. Dehydration results from inadequate fluid intake in the face of accelerated water loss due to glucosuria and ketonuria. Dehydration and subsequent reduced tissue perfusion compounds the acidosis through lactic acid production. There is whole body loss of electrolytes including sodium, potassium, magnesium and phosphate and there is also intracellular redistribution of electrolytes following insulin therapy which may compound p Continue reading >>

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 >>

What Are The Treatments For Ketoacidosis In Dogs?

What Are The Treatments For Ketoacidosis In Dogs?

If your dog has diabetes mellitus, a common ailment in the canine realm, then diabetic ketoacidosis is a hazardous possibility. Ketoacidosis is a metabolic disorder that's related to extreme hyperglycemia. When diabetic dogs develop ketoacidosis, ketones, a type of acid, accumulate in their blood. Veterinary care is vital for dogs with this condition. Diabetic Ketoacidosis Background When insufficient amounts of insulin bring upon the liver's inordinate manufacturing of ketoacids, ketoacidosis arises. Numerous factors can cause diabetic ketoacidosis in canines. The primary cause of the condition is reliance on insulin, although ketoacidosis is also linked to things such as urinary tract infections and skin infections. Dogs frequently experience diabetic ketoacidosis when their diabetes mellitus hasn't yet been identified or managed. Key Diabetic Ketoacidosis Symptoms If you notice any unusual symptoms in your diabetic pet, get him to the veterinarian for treatment immediately. Diabetic ketoacidosis is an urgent condition. Common symptoms of the ailment are throwing up, nausea, appetite loss, dandruff, fatigue, feebleness, dehydration, fast breathing, depression, decreased body temperature, frequent urination, inordinate thirst, weight loss and unusual-smelling breath: If your dog's breath has an odor that's reminiscent of nail polish remover, diabetic ketoacidosis could be the culprit. Since diabetic ketoacidosis is a medical emergency in dogs, immediate care is of the essence, no matter the time of day or night. If you notice these symptoms in your pet overnight, take him to a 24-hour veterinary hospital. Female dogs are particularly susceptible to the condition, as are elderly dogs. Treatment Options Some dogs with diabetic ketoacidosis need hospitalization, others do Continue reading >>

Treatment Of Diabetic Ketoacidosis In Dogs By Continuous Low-dose Intravenous Infusion Of Insulin.

Treatment Of Diabetic Ketoacidosis In Dogs By Continuous Low-dose Intravenous Infusion Of Insulin.

Abstract In a prospective clinical trial, low-dose, continuous, IV infusion of insulin (dosage, 2.2 U/kg of body weight, q 24 h) was used to treat 21 dogs with diabetic ketoacidosis. Mean (+/- SD) blood glucose concentration at the onset of treatment was 550 +/- 150 mg/dl and after 6 hours, was 350 +/- 106 mg/dl, with a mean decline of 34 +/- 16 mg/dl/h. By 12 hours, mean blood glucose was 246 +/- 85 mg/dl, with a mean decline of 28 +/- 14 mg/dl/h during the second 6 hours of treatment. Mean duration of treatment required to reach a blood glucose concentration < or = 250 mg/dl was 10 +/- 4 hours, with a range of 4 to 24 hours. Ketonuria was observed for 26 +/- 14 hours (range, 6 to 72 hours). Hypoglycemia developed in 3 of 21 dogs during treatment, but responded to IV administration of a glucose solution and to a reduction in rate of insulin delivery. Potassium supplementation was required in 15 of 21 dogs. Mean bicarbonate concentration was 11.6 +/- 3.4 mEq/L before treatment and was 18.2 +/- 0.7 mEq/L after 24 hours. Fifteen of 21 dogs (71%) survived to be discharged. Mean duration of treatment with the insulin infusion was 50 +/- 30 hours (range, 7 to 124 hours). In this series of dogs, continuous, low-dose, IV infusion of insulin provided a gradual and consistent reduction in blood glucose concentration while ketoacidosis, electrolyte balance, and dehydration were corrected.(ABSTRACT TRUNCATED AT 250 WORDS). 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 >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is most common among patients with type 1 diabetes mellitus and develops when insulin levels are insufficient to meet the body’s basic metabolic requirements. DKA is the first manifestation of type 1 DM in a minority of patients. Insulin deficiency can be absolute (eg, during lapses in the administration of exogenous insulin) or relative (eg, when usual insulin doses do not meet metabolic needs during physiologic stress). Common physiologic stresses that can trigger DKA include Some drugs implicated in causing DKA include DKA is less common in type 2 diabetes mellitus, but it may occur in situations of unusual physiologic stress. Ketosis-prone type 2 diabetes is a variant of type 2 diabetes, which is sometimes seen in obese individuals, often of African (including African-American or Afro-Caribbean) origin. People with ketosis-prone diabetes (also referred to as Flatbush diabetes) can have significant impairment of beta cell function with hyperglycemia, and are therefore more likely to develop DKA in the setting of significant hyperglycemia. SGLT-2 inhibitors have been implicated in causing DKA in both type 1 and type 2 DM. Continue reading >>

Diabetic Ketoacidosis

Diabetic Ketoacidosis

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 >>

Diabetic Ketoacidosis In Dogs

Diabetic Ketoacidosis In Dogs

Diabetic ketoacidosis is a condition that typically occurs in dogs with severe, untreated diabetes. Diabetes is a chronic metabolic condition that occurs when your dog's body fails to produce adequate amounts of the hormone insulin, responsible for regulating blood sugar levels. Diabetic ketoacidosis is a life threatening condition that can occur in dogs that have recently developed diabetes, and it may also occur in dogs who have been living with diabetes for some time. Symptoms of Diabetic Ketoacidosis in Dogs Many of the symptoms of diabetic ketoacidosis are the same as the symptoms of diabetes. Increased thirst, increased urination, sudden vision loss or blindness, and weight loss with no reduction in appetite can point to diabetic ketoacidosis. Your dog may also suffer from weakness, vomiting, dehydration and lethargy. A sure sign that your dog is suffering from diabetic ketoacidosis is a powerful aroma of acetone on the breath (acetone smells like nail polish remover). Diagnosing Diabetic Ketoacidosis in Dogs The vet will need your dog's complete medical history and a thorough physical exam to diagnose diabetic ketoacidosis. The vet will test the dog's blood and urine to check his blood sugar and insulin levels. Your vet may perform other tests to determine if the dog is suffering from a secondary infection. Ultrasounds, X-rays and endocrinology tests can may be necessary to determine if your dog is suffering from major organ disease, tumors or hyperadrenocorticism, conditions that can complicate your dog's diabetes and make its treatment more difficult. Treating Diabetic Ketoacidosis in Dogs Treatment for canine diabetic ketoacidosis depends on the severity of the condition. In mild cases, IV therapy and insulin injections can correct the problem. In more severe Continue reading >>

Diabetes In Dogs: Symptoms, Causes, & Treatment

Diabetes In Dogs: Symptoms, Causes, & Treatment

Diabetes is a chronic disease that can affect dogs and cats and other animals (including apes, pigs, and horses) as well as humans. Although diabetes can’t be cured, it can be managed very successfully. Diabetes mellitus, or “sugar diabetes,” is the type of diabetes seen most often in dogs. It is a metabolism disorder. Metabolism refers to how the body converts food to energy. To understand what diabetes is, it helps to understand some of this process. The conversion of food nutrients into energy to power the body’s cells involves an ongoing interplay of two things: • Glucose: essential fuel for the body’s cells. When food is digested, the body breaks down some of the nutrients into glucose, a type of sugar that is a vital source of energy for certain body cells and organs. The glucose is absorbed from the intestines into the blood, which then transports the glucose throughout the body. • Insulin: in charge of fuel delivery. Meanwhile, an important organ next to the stomach called the pancreas releases the hormone insulin into the body. Insulin acts as a “gatekeeper” that tells cells to grab glucose and other nutrients out of the bloodstream and use them as fuel. What is diabetes? With diabetes, the glucose-insulin connection isn’t working as it should. Diabetes occurs in dogs in two forms: • Insulin-deficiency diabetes—This is when the dog’s body isn’t producing enough insulin. This happens when the pancreas is damaged or otherwise not functioning properly. Dogs with this type of diabetes need daily shots to replace the missing insulin. This is the most common type of diabetes in dogs. • Insulin-resistance diabetes—This is when the pancreas is producing some insulin, but the dog’s body isn’t utilizing the insulin as it should. The ce Continue reading >>

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