Diabetic Ketoacidosis

Question 1

describe the signalment of diabetic ketosis

Answer 1

Usually middle-aged to older animals.
often newly diagnosed diabeteics

Question 1

describe the pathophysiology of diabetic ketoacidosis

Answer 1

Reduced insulin → Reduced glucose uptake into cells → metabolic deficit
Glucagon → Lipolysis → Fatty Acids → Acetyl CoA → Ketones
Ketones are acidic and cause a metabolic acidosis

Question 2

List the clinical signs of diabetic keotacidosis

Answer 2

Since diagnosis – PUPD hasn’t resolved, weight loss has continued. Progressive lethargy, anorexia and vomiting.
Abdominal pain
hepatomegaly
BCS loss
mental dullness

Question 3

Describe how to diagnose diabeteic ketoacidosis

Answer 3

Usually straight-forward – history and clinical signs are a strong clue.
Diabetes–> hyperglycaemia and glucosuria
Ketones–> Blood or urine ketones
Metabolic acidosis –> blood gas machine

Question 4

Describe fluid therapy plan for diabetic ketoacidosis

Answer 4

Is key
Hartmanns
Restore volume status and hydration rapidly- 6-12 hrs
Need to monitor electrolytes closely

Question 5

what are the signs of severe hypokalaemia

Answer 5

profound muscle weakness and respiratory arrest when extreme

Question 6

what are the signs of severe hypophosphataemia

Answer 6

weakness, myocardial depression, arrythmias and haemolysis or seizures in extreme cases

Question 7

When should you treat hypocalcaemia in diabetic ketoacidotic patients

Answer 7

Only correct if clinical signs noted e.g. muscle twitching/tremors

Question 8

Describe how to treat hyperglycaemia in diabetic ketoacidotic patients

Answer 8

Fluid therapy
neutral insulin administration or insulin CRI

Question 9

List 3 common concurrent diseases with DKA in dogs

Answer 9

Hyperadrenocorticism
Pancreatitis
Urinary tract infections – antibiotics

Question 10

List 5 common concurrent diseases with DKA in cats

Answer 10

Hepatic lipidosis
Chronic renal failure
Pancreatitis
Bacterial/viral infections
Neoplasia

Question 11

what is the prognosis of DKA

Answer 11

Survival to discharge – 70% (Good but not perfect)
<10% dogs relapse
Up to 40% cats relapse

Question 12

what is Hyperglycaemic Hyperosmolar Syndrome

Answer 12

Rare complication of diabetes mellitus
Pathogenesis is similar to DKA, but a small amount of insulin and hepatic glucagon resistance reduce lipolysis so ketones are not elevated.
Hyperglycaemia without ketosis
They loose loads of fluids

Question 13

Describe how to diagnose Hyperglycaemic Hyperosmolar Syndrome

Answer 13

BG > 33.3 mmol/L
Absence of urinary ketones
Serum osmolality > 350 mOsm/kg

Question 14

why can fluid therapy kill patients suffering from Hyperglycaemic Hyperosmolar Syndrome

Answer 14

however rapid correction of hyperglycaemia (and hypernatraemia) lead to an osmotic gradient across the blood brain barrier – rapid cerebral oedema is possible → seizure, coma, death

Question 15

how long should we replace fluid in with Hyperglycaemic Hyperosmolar Syndrome

Answer 15

24-48 hrs
but monitor glucose and sodium very closely

Question 16

what is the prognosis of Hyperglycaemic Hyperosmolar Syndrome

Answer 16

in short term guarded (~60%) but long term survival is probably poor (one feline study reported 12% > 2 months)

Question 17

Describe how to treat hypokalaemia in DKA patients

Answer 17

potassium supplementation - CRI or spiked fluids

Question 18

what do we need to monitor for when giving potassium supplementation

Answer 18

bradyarrythmias

Question 19

Decsribe how we treat hypophosphataemia

Answer 19

CRI of potassium phosphate

Question 20

Describe how to fix hyponatraemia in DKA

Answer 20

should correct naturally as glucose levels drop

Question 21

after we control the DKA, what do we need to do

Answer 21

restore normoglycaemic levels- insulin CRI

Question 22

what do we need to do if the animal won’t eat after 24-48 hours of DKA treatment

Answer 22

place a feeding tube

Question 23

why do DKAs not have a high prognosis

Answer 23

we usually miss the window for intese treatment

Question 24

why do HHS patients look very neurological

Answer 24

the organs are not adequatley perfused

Question 25

What is the best way to monitor blood glucose of DKA or HHS patients

Answer 25

central venous catheter or freestyle libre

Question 26

why is a central venous catheter helpful for DKA/HHS patients

Answer 26

they have 3 ports with 3 lumens - 1 can be giving fluid and the other can be taking blood samples