It is a metabolic disorder that can occur in animals with diabetes mellitus (DM), with DKA being the most common.
It occurs when the body lacks insulin or is resistant to insulin, making it unable to take glucose into cells, resulting in high blood sugar (hyperglycemia) and when the body is unable to use glucose as an energy source.
Fat cells (adipocytes) are broken down into free fatty acids (FFAs) which are released into the bloodstream before being sent to the liver for conversion into triglycerides and ketones.
bodies; consisting of acetone, acetoacetic acid and ß-hydroxybutyric acid) which, if there is a large amount of ketones in the bloodstream, will result in ketoacidosis.
High blood glucose levels above the renal threshold cause the animal to urinate more due to osmotic diuresis, and when combined with vomiting or diarrhea, the animal with DKA becomes severely dehydrated, resulting in a decreased glomerular filtration rate (GFR), which further increases the retention of both glucose and ketones in the body.
It may also cause kidney failure. At the same time, having more ketones in the bloodstream that exceed the renal threshold will cause more ketones to be excreted in the urine. These negatively charged ketones will attract other positively charged electrolytes, such as sodium and potassium, to be excreted in the urine, resulting in an imbalance of these electrolytes.
There are four main principles of treatment for diabetic ketoacidosis (DKA):
1. Correct dehydration and restore intravascular volume.
2. Normalize blood glucose level.
It is started after a period of fluid therapy to correct dehydration, with insulin inhibiting the ketogenesis process.
3. Correct electrolyte and acid-base abnormalities.
4. Identify and remove any precipitating factors. Diseases or abnormalities commonly found in animals with DKA include insufficient insulin, pancreatitis, bacterial infection, urinary tract infection, pneumonia, or renal failure.
Edward C et al. 2015. Diabetic ketoacidosis. Canine and feline endocrinology 4th edition. , p315-347.
Ettinger S., Feldman, E., Cote, E., 2017. Diabetic ketoacidosis. Textbook of Veterinary Internal Medicine 8th Edition, p1574-1583.
Dr.Sasipat Kittisarathamma (Dr.Mook)
Internal Medicine Center, Ultrasound Center
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