Diabetic Ketoacidosis (DKA) in Cats

What is DKA?• DKA is a metabolic disorder that occurs when the body

doesn’t produce enough insulin, or the tissues don’t respond to the insulin.– Insulin is responsible for transporting sugar into cells for use as energy. Without

insulin, the cells can’t perform normal functions and are essentially “starved.”

• Increased production of hormones that have anti-insulin effects such as glucagon, cortisol, and epinephrine, can exacerbate the insulin deficiency or insulin resistance.

What is DKA?• The liver responds by using fatty acids as an energy

source. The fats are converted into ketones (ketoacids). This can lead to acidosis, electrolyte imbalances, and signs of systemic illness.

• DKA is a life-threatening condition that requires immediate medical attention!

Which Patients Develop DKA?• Patients with diagnosed Diabetes Mellitus

• Patients with undiagnosed Diabetes Mellitus

• Patients with poorly managed or untreated Diabetes Mellitus

Symptoms & Physical Exam Findings• Increased drinking and urination• Increased appetite• Vomiting and/or diarrhea• Weakness• Anorexia and/or weight loss• Dehydration• “Fruity odor” to the breath (from the ketones)• Enlarged liver• Rapid breathing

Diagnosis of DKA• Clinical Signs and Physical Exam• Bloodwork

– Hyperglycemia (high glucose in the blood)– Ketones in the blood– Metabolic acidosis (low body pH)– Electrolyte abnormalities

• Urinalysis– Glycosuria (glucose in urine)– Ketones in the urine

• The majority of patients with DKA also have a concurrent illness such as pancreatitis or a urinary tract infection

Treatment of DKA• Immediate hospitalization• Fluid therapy, often with additional electrolytes added• A few hours after starting fluid therapy, insulin is given to help

slowly lower the blood glucose concentration• Broad-spectrum antibiotics to treat concurrent infection, or

anti-nausea medications may also be necessary• After stabilization, patient will be started on subcutaneous

insulin that will be given long-term to control Diabetes Mellitus• Long-term change to high fiber diet

Prognosis for DKA• Depends upon the progression of the disorder.

• Fair to guarded, with concurrent illness leading to guarded prognosis

DKA Case Example: “Peanut”• 7-year old neutered male domestic

shorthair cat• Presented with a two-day history of

lethargy, anorexia, weight loss, and increased drinking and urination.

• Peanut’s referring veterinarian had seen Peanut earlier in the day, and lab work showed glucose in the blood and urine: both signs of potential Diabetes Mellitus

“Peanut”• Physical Exam Findings:– Dehydrated– Mild decrease in muscle mass– Tense abdomen– Poor haircoat

• Recommended hospitalization, abdominal radiographs, bloodwork, and blood glucose monitoring.

“Peanut” Diagnostics• Bloodwork: Hyperglycemia (high blood

glucose), acidemia (low blood pH), low potassium, sodium, and chloride (electrolytes)

• Urine ketones: high • Abdominal radiographs: no significant findings

“Peanut” Treatment• Hospitalization• Fluids with supplemental potassium• Anti-nausea medications • Insulin was started after Peanut became re-

hydrated.• Blood glucose measurements were taken every 2

hours.

• High-Fiber Diet

“Peanut” Goes Home!• Ketones in the urine resolved• Electrolytes and blood glucose concentrations stabilized• Peanut began eating well• Started on subcutaneous insulin that will continue to be

administered by Peanut’s owner at home• Peanut’s owners were instructed to feed him twice a

day, and give insulin after he finishes each meal

Conclusion• Patients that survive an episode of Diabetic

Ketoacidosis will need long-term care for their Diabetes Mellitus

• DKA is a serious metabolic disorder. Please bring your pet to the veterinarian immediately if you notice any of the listed symptoms