Diabetic Ketoacidosis (DKA) in Cats
What is DKA?DKA is a metabolic disorder that occurs when the body doesnt produce enough insulin, or the tissues dont respond to the insulin.Insulin is responsible for transporting sugar into cells for use as energy. Without insulin, the cells cant 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 FindingsIncreased drinking and urinationIncreased appetiteVomiting and/or diarrheaWeaknessAnorexia and/or weight lossDehydrationFruity odor to the breath (from the ketones)Enlarged liverRapid breathing
Diagnosis of DKAClinical Signs and Physical ExamBloodworkHyperglycemia (high glucose in the blood)Ketones in the bloodMetabolic acidosis (low body pH)Electrolyte abnormalitiesUrinalysisGlycosuria (glucose in urine)Ketones in the urineThe majority of patients with DKA also have a concurrent illness such as pancreatitis or a urinary tract infection
Treatment of DKAImmediate hospitalizationFluid therapy, often with additional electrolytes addedA few hours after starting fluid therapy, insulin is given to help slowly lower the blood glucose concentrationBroad-spectrum antibiotics to treat concurrent infection, or anti-nausea medications may also be necessaryAfter stabilization, patient will be started on subcutaneous insulin that will be given long-term to control Diabetes MellitusLong-term change to high fiber diet
Prognosis for DKADepends upon the progression of the disorder.
Fair to guarded, with concurrent illness leading to guarded prognosis
DKA Case Example: Peanut7-year old neutered male domestic shorthair catPresented with a two-day history of lethargy, anorexia, weight loss, and increased drinking and urination. Peanuts 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
PeanutPhysical Exam Findings:DehydratedMild decrease in muscle massTense abdomenPoor haircoatRecommended hospitalization, abdominal radiographs, bloodwork, and blood glucose monitoring.
Peanut DiagnosticsBloodwork: Hyperglycemia (high blood glucose), acidemia (low blood pH), low potassium, sodium, and chloride (electrolytes)Urine ketones: high Abdominal radiographs: no significant findings
Peanut TreatmentHospitalizationFluids with supplemental potassiumAnti-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 resolvedElectrolytes and blood glucose concentrations stabilizedPeanut began eating wellStarted on subcutaneous insulin that will continue to be administered by Peanuts owner at homePeanuts owners were instructed to feed him twice a day, and give insulin after he finishes each meal
ConclusionPatients that survive an episode of Diabetic Ketoacidosis will need long-term care for their Diabetes MellitusDKA is a serious metabolic disorder. Please bring your pet to the veterinarian immediately if you notice any of the listed symptoms