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Diabetic Ketoacidosis in cats and dogs

Over the last few days the signs have been getting worse. Your pet isn’t doing well; it is depressed, isn’t eating, and may even be vomiting. You thought it would get better, but it hasn’t and in fact your pet looks really sick. So you decide to take your pet into the veterinarian, who runs a bunch of tests. It is most likely that the animal will be whisked away to a treatment room after the veterinarian confirms a diagnosis of diabetic ketoacidosis. What is diabetic ketoacidosis (DKA)?

You didn’t even know that your pet was diabetic, so how could it have this problem? Diabetic ketoacidosis most commonly develops in animals with undiagnosed diabetes. However, animals with diabetes can develop this problem as well, if their diabetes gets out of control. The reason that your pet will be quickly taken to the treatment room is because DKA is an emergency. These animals look sick because their whole body is being affected by the problem. If the situation is not addressed quickly, DKA can cause irreversible damage. This doesn’t mean that your pet will be fixed overnight. Even uncomplicated, mild cases of DKA often stay in the hospital for two or three days.

Before we explain DKA, let’s review the meaning of diabetes. Diabetes is a situation where the body does not have enough insulin. Insulin is needed for cells to absorb glucose (which is crucial for normal cell function) from the blood stream. When cells don’t have insulin, they don’t absorb enough glucose and the cells starve. This starvation causes the liver to release more glucose into the blood stream. But without insulin, cells cannot absorb the glucose that is in the blood, and they continue to starve. This is how the vicious circle goes on.

Usually diabetes is caught at this point, and the pet is started on insulin injections. This is a simple solution that brings the problem under control. But if the diabetes isn’t caught at this point or if the insulin injections aren’t working, the next step can occur. The next step is diabetic ketoacidosis.

In addition to producing more glucose (the first step), in DKA the liver begins to produce ketones (by-products of fat metabolism). Without enough insulin, there is no control of fat metabolism. So the starved cells tell the body to break down fat (for energy) and release it into the blood stream. This fat is taken up by the liver. The liver is so overwhelmed by the amount of fat that it starts to convert fat into ketones, and releases these ketones into the blood stream.

A normal liver produces a small amount of ketones every day. But in DKA, the liver produces way too many ketones. These ketones are responsible for the signs you see in your sick pet. First of all, ketones make the blood acidic, hence the term diabetic “keto” “acidosis”. Excess ketones also cause the body to produce more urine. The combination of acidic blood and urinating too much dehydrates the animal and dehydrates the cells. Dehydrated cells don’t function well and can even die. This is why DKA is an emergency.

Very often animals develop the signs of DKA when they have another disease in addition to diabetes, such as inflammation of the pancreas, infection, or kidney disease. These diseases stress the body and cause stress hormones to be produced. These hormones also inhibit insulin production and make the insulin shortage even worse. If your pet has another stress-causing disease when it is being treated for DKA in the hospital, this disease will be treated at the same time.

We already mentioned that treatment will take at least 2-3 days. Treatment at the hospital consists of giving your pet insulin and carefully monitoring it. DKA is not an easy problem to treat. Serious cases of DKA sometimes do not have a good prognosis. In complicated situations, up to 30% of animals will die or have to be euthanized in the hospital.

As long as you spend time with your animal every day, you will notice when it isn’t feeling well. DKA is not the only disease that causes signs like depression, not eating, and vomiting. Make sure you bring your pet to the veterinarian if it ever develops these signs. The sooner diabetes or diabetic ketoacidosis is caught, the more likely you and your veterinarian will be able to get your pet back to normal!

By Ashley O’Driscoll – writer

2 Responses to this Article, So Far

  1. Avatar Tracy Veal says:

    My dog was taken to the animal emergency hospital, because he was vomiting and had diarrhea over the weekend. He has diabetes and was on insulin for quite some time. I was checking his blood sugar about three times a week by sticking his paw with a needle and he was ranging around 100 to 140. I would give him insulin twice a day around 3 to 4 units depending upon his blood sugars. I have had the dog for about four years and have known he has had diabetes for about three. This was the first time he is ever gone into a crisis, whereby I felt I needed to take him to the emergency hospital. I was never told his diagnosis and I am a nurse which I told them. I was told they would keep him overnight given fluids IV, check his glucose levels and draw the laboratory levels throughout the night, and let me know how he was doing the next morning. I had to put down a deposit of $750 before I could leave. When I call the next day to check on his condition I was told he was doing better, but he needed to stay another day to continue fluids and blood sugar check’s. I decided to take him home AMA because the bill was are ready up to $1170. I figured he had two chances either he would live or he would not. He did recover quite well.

    Six weeks later, which was this past weekend he went into crisis again. I have no idea the age of this dog. All I know is that I love him dearly. And I know I cannot afford to continue taking him to the emergency room. After getting educated upon DKA through the Internet, I have learned that key element is to keep the dog hydrated. I also have learned to give him Pepsid 10 mg 2 times a day and Peptp Bismol Tablets two times a day for the nausea and diarrhea.. This is a medication that the emergency room told me to go buy at the pharmacy, on my way home. I have been giving my dog fluids with a syringe filled with water orally as well as milk. I have puréed chicken and rice and have forced it on to his pallet and have gotten down about a tablespoon each time. Very labor intensive, but worth it. I have also gotten from work a bottle of .9% normal saline solution water and a needle and have injected with a 60 mL syringe the water into his back subcutaneously very slowly. Just like as if he were receiving an IV drip. I gave him 180 ml every day for the past three days. I’m happy to say he is making great progress and greeted me at the door this evening with a howl. His blood sugar today was 444 with keatones, so I gave him 8 units of regular insulin. I’m happy to say the nausea and diarrhea have subsided and he has eaten a small amount of food and has drank about half a cup of milk and has eaten a handful of crackers. I plan on force-feeding him the chicken and rice after I write this blog as I know he needs the food in his belly to offset his liver from excreting keatones into the blood stream.

    I know the needles in the back sound too hard to come by, if you’re not a nurse, but you can get anything off the Internet if you try. The dog does not cry when I stick him, or put the fluid in. You can buy .9% normal saline irrigating solution from any drug store. It comes in 500 mL bottles. You may have to order at the same time you order the needles, the 60 mL syringes.

    I’m only passing this advice on because this is my first time to save my dog from dying and knowing that he will go through another crisis again and again, I can be prepared until the and is here. At least I know I have done everything humanly possible to save his life and not break my banking account. My family will not allow me to do this to our finances, so I must try to do this on my own with the knowledge and the fortitude that I have and I want to pass that on to those who want to know how they can try to do the same. Good luck to all of you who feel the same.

  2. Avatar Jennifer Bryan says:

    I wish I had seen this a few days ago. I just had to make the decision to put my 13 year old girl, Lucy, down 3 days ago due to this and simply not being educated on what was going on with her and knowing that I simply didn’t have any more money to treat her. I have spent thousands on her over the years and would do it again in a heartbeat, but in this instance, I just didn’t have it and didn’t know what to do. I didn’t want her to suffer and she simply couldn’t stand anymore. Being a big girl (normally 70lb but at the time we took her to the emergency vet she was only 61lb) I couldn’t carry her on my own. I am racked with guilt at not trying to save her, even though she was older. I feel like she could have still had several good years left if only I had understood what we were facing and it not been the middle of the night when I took her in and felt pressured by finances and circumstance to make a decision. I will never make a rushed decision like that again. I wish I had known.

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