Diabetic Ketoacidosis Flashcards
describe the signalment of diabetic ketosis
Usually middle-aged to older animals.
often newly diagnosed diabeteics
describe the pathophysiology of diabetic ketoacidosis
Reduced insulin → Reduced glucose uptake into cells → metabolic deficit
Glucagon → Lipolysis → Fatty Acids → Acetyl CoA → Ketones
Ketones are acidic and cause a metabolic acidosis
List the clinical signs of diabetic keotacidosis
Since diagnosis – PUPD hasn’t resolved, weight loss has continued. Progressive lethargy, anorexia and vomiting.
Abdominal pain
hepatomegaly
BCS loss
mental dullness
Describe how to diagnose diabeteic ketoacidosis
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
Describe fluid therapy plan for diabetic ketoacidosis
Is key
Hartmanns
Restore volume status and hydration rapidly- 6-12 hrs
Need to monitor electrolytes closely
what are the signs of severe hypokalaemia
profound muscle weakness and respiratory arrest when extreme
what are the signs of severe hypophosphataemia
weakness, myocardial depression, arrythmias and haemolysis or seizures in extreme cases
When should you treat hypocalcaemia in diabetic ketoacidotic patients
Only correct if clinical signs noted e.g. muscle twitching/tremors
Describe how to treat hyperglycaemia in diabetic ketoacidotic patients
Fluid therapy
neutral insulin administration or insulin CRI
List 3 common concurrent diseases with DKA in dogs
Hyperadrenocorticism
Pancreatitis
Urinary tract infections – antibiotics
List 5 common concurrent diseases with DKA in cats
Hepatic lipidosis
Chronic renal failure
Pancreatitis
Bacterial/viral infections
Neoplasia
what is the prognosis of DKA
Survival to discharge – 70% (Good but not perfect)
<10% dogs relapse
Up to 40% cats relapse
what is Hyperglycaemic Hyperosmolar Syndrome
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
Describe how to diagnose Hyperglycaemic Hyperosmolar Syndrome
BG > 33.3 mmol/L
Absence of urinary ketones
Serum osmolality > 350 mOsm/kg
why can fluid therapy kill patients suffering from Hyperglycaemic Hyperosmolar Syndrome
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
how long should we replace fluid in with Hyperglycaemic Hyperosmolar Syndrome
24-48 hrs
but monitor glucose and sodium very closely
what is the prognosis of Hyperglycaemic Hyperosmolar Syndrome
in short term guarded (~60%) but long term survival is probably poor (one feline study reported 12% > 2 months)
Describe how to treat hypokalaemia in DKA patients
potassium supplementation - CRI or spiked fluids
what do we need to monitor for when giving potassium supplementation
bradyarrythmias
Decsribe how we treat hypophosphataemia
CRI of potassium phosphate
Describe how to fix hyponatraemia in DKA
should correct naturally as glucose levels drop
after we control the DKA, what do we need to do
restore normoglycaemic levels- insulin CRI
what do we need to do if the animal won’t eat after 24-48 hours of DKA treatment
place a feeding tube
why do DKAs not have a high prognosis
we usually miss the window for intese treatment
why do HHS patients look very neurological
the organs are not adequatley perfused
What is the best way to monitor blood glucose of DKA or HHS patients
central venous catheter or freestyle libre
why is a central venous catheter helpful for DKA/HHS patients
they have 3 ports with 3 lumens - 1 can be giving fluid and the other can be taking blood samples
