Canine Diabetic Ketosis-Ketoacidosis: A Retrospective Study of 23 Cases (1997-2013)

Published: Jan 31, 2018
diabetes mellitus dog ketosis ketoacidosis pancreatitis
The purpose of this retrospective study was to describe the historical and clinical findings, the clinicopathological abnormalities, the occurrence and nature of concurrent diseases, the treatment and outcome of 23 dogs with diabetic ketosisketoacidosis (DK-DKA). Inclusion criteria consisted of the presence of clinical signs suggestive of diabetes mellitus (DM) along with persistent hyperglycemia, glycosuria and ketonuria during the first 24 hours of hospitalization. In nineteen dogs (83%) DM had not been previously diagnosed. Common presenting complaints were polyuria/polydipsia (100%), partial or complete loss of appetite (87%), depression (87%), vomiting (65 %) and weight loss (30 %). The most frequent physical examination findings included dehydration (61%), depression (61%), hypotrichosis-alopecia (39%), palpable cranial abdominal organomegaly (26%), pendulous abdomen (26%), lesions compatible with superficial pyoderma (17%), thin and hypotonic abdominal skin (17%), and hypothermia (17%). The most important clinicopathological abnormalities, apart from hyperglycemia, glucosuria, and ketonuria, included anemia (48%), leukocytosis (39%), increased activities of alkaline phosphatase (100%), lipase (56%) and alanine aminotransferase (52%), hypertriglyceridemia (90%) and hypercholesterolemia (84%). Also, 12 dogs demonstrated hypokalemia on admission or during hospitalization. A concurrent disease was identified in 74% of the cases while 26% had two or more comorbidities. The latter included pancreatitis (30%), urinary tract infections (17%), superficial pyoderma (17%), urolithiasis (13%) and hyperadrenocorticism (13%). Twenty two dogs were treated with short-acting insulin (regular or lispro) and one with intermediate-acting (lente) insulin, whereas intravenous fluid therapy was instituted in 78% of them with potassium and phosphorus supplementation in 65% and 9%, respectively. Seventeen (81%) dogs survived to be discharged, three (13%) died during hospitalization, one (4%) was euthanized and on two (9%) occasions owners declined hospitalization after the first 24 hours due to financial constrains or a poor prognosis. Mean duration of hospitalization for the survivors was 5.7 ± 2.4 days, mean time to resolution of ketonuria was 4.2 ± 1.9 days and median time of rapid–acting insulin administration was 4 days (range 2-8 days).
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Behrend EN, Melian C (2013) Hyperadrenocorticism in dogs. In: (ed.: Rand J) Clinical Endocrinology of Companion Animals, Blackwell, Iowa, pp 43-64.
Boysen SR (2008) Fluid and electrolyte therapy in endocrine disorders: Diabetes mellitus and hypoadrenocorticism. Vet Clin North Am Small Anim Pract 38:699-717.
Bresciani F, Pietra M, Corradini S, Giunti M, Fracassi F (2014) Accuracy of capillary blood 3-β-hydroxybutyrate determination for the detection and treatment of canine diabetic ketoacidosis. J Vet Sci 15: 309-316.
Chastain CB, Nichols CE (1981) Intensive care of dogs and cats with diabetic ketoacidosis. J Am Vet Med Assoc 179:972-978.
Di Tomasso M, Aste G, Rocconi F, Guiglielmi C, Boari A (2009) Evaluation of a portable meter to measure ketonemia and comparison with ketonuria for the diagnosis of canine diabetic ketoacidosis. J Vet Intern Med 23:466-471.
Duarte R, Simoes DM, Franchini ML, Marquezi ML, Ikesaki JH, Kogika MM (2002) Accuracy of serum beta hydroxybutyrate measurements for the diagnosis of diabetic ketoacidosis in 116 dogs. J Vet Intern Med 16:411-417.
Efstathiou SP, Tsiakou AG, Tsioulos DI, Zacharos ID, Mitromaras AG, Mastorantonakis SE, Panagiotou TN, Mountokalakis TD (2002) A mortality prediction model in diabetic ketoacidosis. Clin Endocrinol (Oxf) 57:595-601.
Feldman EC, Nelson RW (2004) Diabetic ketoacidosis. In: (eds.: Feldman EC, Nelson RW) Canine and Feline Endocrinology and Reproduction, 3rdedn. Elsevier Saunders, St Louis Missouri, pp 580-615.
Flood RG, Chiang VW (2001) Rate and prediction of infection from children with diabetic ketoacidosis. Am J Emerg Med 19:270-273.
Forester SD, Troy GC, Dalton MN, Hufmfman JW, Holtzman G (1999) Retrospective evaluation of urinary tract infection in 42 dogs with hyperadrenocorticism or diabetes mellitus or both. J Vet Intern Med 13:557-560.
Hess RS, Kass PH, Shofer FS, Van Winkle TJ, Washabau RJ (1999) Evaluation of risk factors for fatal acute pancreatitis in dogs. J Am Vet Med Assoc 214:46-51.
Hess RS, Saunders M, Van Winkle TJ, Ward CR (2000) Concurrent disorders in dogs with diabetes mellitus: 221 cases (1993-1998). J Am Vet Med Assoc 217:1166-1173.
Hess RS (2013) Canine diabetic emergencies. In: (ed.: Rand J) Clinical Endocrinology of Companion Animals, Blackwell, Iowa, pp. 201-208.
Hoening M, Dorfman M, Koening A (2009) Use of a hand held meter for the measurement of b-hydroxybutyrate in dogs and cats. J Vet Emerg Crit Care 18:86-87.
Hume DZ, Drobatz KJ, Hess RS (2006) Outcome of dogs with diabetic ketoacidosis: 127 dogs (1993-2003). J Vet Intern Med 20:547-555.
Kerl ME (2001a) Diabetic Ketoacidosis: Pathophysiology clinical and laboratory presentation. Compend Contin Educ Pract Vet 23:220-228.
Kerl ME (2001b) Diabetic Ketoacidosis: Treatment recommendations. Compend Contin Educ Pract Vet 23:330-339.
Kitabchi AE, Nyenwe EA (2006) Hyperglycemic crisis in diabetes mellitus: diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Endocrinol Metab Clin North Am 35:725-751.
Koening A (2013) Endocrine emergencies in dogs and cats. Vet Clin North Am Small Anim Pract 43:869-897.
Macintire DK (1993) Treatment of diabetic ketoacidosis in dogs by low-dose intravenous infusion of insulin. J Am Vet Med Assoc 202:1266-1272.
McGuire NC, Schulman R, Ridgway MD, Bollero G (2002) Detection of occult urinary tract infections in dogs with diabetes mellitus. J Am Anim Hosp Assoc 38:541-544.
Nyenwe EA, KItabchi AE (2011) Evidence based management of hypeglycemic emergencies in diabetes mellitus. Diabetes Res Clin Pract 94:340-351.
O’Brien (2009) Diabetic emergencies in small animals. Vet Clin North Am Small Anim Pract 40:317-333.
Peleg AY, Weerathna T, McCarthy JS Davis TM (2007) Common infections in diabetes: pathogenesis, management and relationship to glycemic control. Diabetes Metab Res Rev 23:3-13.
Schermerhorn T, Barr SC (2006) Relationships between glucose, sodium and effective osmolality in diabetic dogs and cats. J Vet Emerg Crit Care 18:488-495.
Sears KW, Drobatz KJ, Satyaraj E, Hess R (2012) Use of lispro insulin for treatment of diabetic ketoacidosis in dogs. J Vet Emerg Crit Care 22:211-218.
Stojanovic V, Ihle S (2011) Role of beta-hydroxybutyric acid in diabetic ketoacidosis: a review. Can Vet J 52:426-430.
Xenoulis PG, Levinski MD, Suchodolski JS, Steiner JM (2011) Association of hypertriglyceridemia with insulin resistance in healthy Miniature Schnauzers. J Am Vet Med Assoc 238:1011-1016.
Xenoulis PG, Steiner JM (2010) Lipid metabolism and hyperlipidemia in dogs. Vet J 183:12-21.
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